Articles

Pediatric Use of Cannabis or CBD

By Katie Golden

Three advocacy organizations share their perspectives and expertise

Babies, children, and adolescents are not immune from chronic pain. In recent years, there has been a rise in the use of cannabis and especially cannabidiol (CBD) to treat several pediatric conditions.

The following three organizations are dedicated to education, advocacy, and access to these options for the treatment of pediatric pain and have shared their knowledge through a Question & Answer session.

  • Project CBD: A California-based nonprofit dedicated to promoting and publicizing research into the medical uses of CBD and other components of the cannabis plant. This group provides educational services for physicians, patients, industry professionals, and the general public.
  • The​ ​Realm​ ​of​ ​Caring​ ​Foundation:​ An organization that empowers​ ​individuals​ ​to​ ​enhance​ ​their quality​ ​of​ ​life​ ​by​ ​providing​ ​and​ ​expanding​ ​cannabinoid​ ​research​ ​initiatives, educational​ ​services,​ ​and​ ​advocacy​ ​programs for children and adults.
  • Mothers Advocating Medical Marijuana for Autism (MAMMA): A grassroots parent advocacy group whose primary goal is the legalization of medical marijuana as a qualifying condition for those with autism.

What is your organization’s stance on pediatric use of cannabis or CBD?

Project CBD: Cannabis is now recognized as a medicine that can save the lives of desperately ill children. It is an extraordinarily safe, non-lethal substance. Project CBD maintains that cannabis should be considered a first-line treatment for many pediatric diseases, not merely an option of last resort when all else has failed.

Realm of Caring: Being​ ​that​ ​our​ ​initial​ ​clients​ ​were​ ​all​ ​pediatrics​ ​clients,​ ​​we completely​ ​support​ ​parents​ ​in​ ​their​ ​journey​ ​to​ ​learn​ ​more​ ​about​ ​the therapeutic​ ​benefits​ ​of​ ​all​ ​forms​ ​of​ ​medical​ ​cannabis.​ ​Research​ ​shows​ ​that in​ ​addition​ ​to​ ​the​ ​many​ ​benefits​ ​of​ ​CBD,​ ​side​ ​effects​ ​are​ ​very​ ​mild​ ​in​ ​the short​ ​term.​ ​We​ ​fully​ ​support​ ​conducting​ ​research​ ​to​ ​learn​ ​about​ ​the​ ​long-term​ ​effects​ ​of​ ​CBD​ ​on​ ​pediatrics.

MAMMA: We have a campaign called #cannabis4autism, which focuses on changing state laws so that children with autism can have access to this healing plant under a doctor’s guidance.

What are the foremost pediatric medical conditions that have shown significant improvement through use of cannabis and/or CBD?

Project CBD: Most scientific research on cannabis and children has focused on using pure CBD for certain kinds of epilepsy, such as Lennox-Gastaut and Dravet syndrome. Some children with intractable epilepsy, cancer, and other life-threatening conditions have benefited significantly from whole plant CBD-rich cannabis oil extracts.

Children with ADHD may respond well to cannabis-based medicinal preparations, although reports are generally based on anecdotal information provided by adult caregivers.

A few pilot studies have shown that pure THC (the most well-known phytocannabinoid, sold as Marinol), smoked cannabis, and a one-to-one CBD:THC extract (sold as Sativex outside the U.S.) can effectively reduce symptoms of ADHD with minimal side effects. In other preclinical studies, it has been demonstrated that THC can treat Ritalin-resistant ADHD.

Realm of Caring: Two severe forms of epilepsy​, Dravet syndrome and Doose syndrome, were ​the original focus of our organization. ​Since​ ​starting​ ​a​ ​comprehensive​ ​database​ ​in

2014,​ ​we​ ​are aware of ​a​ ​high​ ​population​ ​of​ ​children​ ​using​ ​medical​ ​cannabis​ ​for Autism​ ​Spectrum​ ​Disorder,​ ​Cerebral​ ​Palsy,​ ​and​ ​cancer,​ ​as​ ​well​ ​as​ ​many other​ ​diagnosis.

MAMMA: Autism Spectrum Disorder has shown improvement with the use of cannabis.

 

What roadblocks exist in gaining access to cannabis or CBD for children?

Realm of Caring: The​ ​lack​ ​of​ ​understanding​ ​of​ ​the​ ​difference​ ​between​ ​low-THC​ ​cannabis (food-grade​ ​hemp)​ ​and​ ​high-THC​ ​cannabis​ ​has​ ​led​ ​to​ ​many​ ​restrictive laws.​ ​Federal​ ​laws​ ​don’t​ ​distinguish​ ​between​ ​the​ ​two.​ ​Realm of Caring believes that all​ ​hemp products,​ ​both​ ​high-CBD​ ​and​ ​low-CBD,​ should​ ​be​ ​removed​ ​from​ ​the​ ​DEA Controlled​ ​Substances​ ​Act.

 Project CBD: Marijuana prohibition. CBD is still a Schedule I substance illegal under federal law. The Farm Bill did not legalize hemp-derived CBD in all 50 states.

What are some drastic measures families have taken in order to obtain cannabis or CBD for their child?

Realm of Caring: We’ve​ ​had​ ​well​ ​over​ ​500​ ​families​ ​documented​ ​as​ ​moving​ ​states​ ​in​ ​2013​ ​and 2014​ ​in​ ​order​ ​to​ ​access​ ​medical​ ​cannabis.​ ​These​ ​are​ ​families​ ​that​ ​sold

belongings,​ ​left​ ​established​ ​support​ ​groups,​ ​had​ ​to​ ​remove​ ​themselves​ ​from jobs—all​ ​to​ ​access​ ​this​ ​natural​ ​plant​ ​as​ ​a​ ​life​-saving​ ​option for their child.

Are there cases where a child’s condition improved so dramatically when using cannabis or CBD that their life expectancy changed for the better? Or for the worse?

​Realm of Caring: We​ ​have​ ​received​ ​feedback​ ​on​ ​several​ ​clients​ ​who​ ​have​ ​had an​ ​exponential​ ​change​ ​in​ ​lifestyle,​ ​for​ ​the​ ​better.​ ​We​ ​have​ ​heard​ ​of​ ​several children​ ​that​ ​have​ ​come​ ​off​ ​of​ ​hospice​ ​and​ ​palliative​ ​services​ ​thanks​ ​to​ ​the addition​ ​and​ ​use​ ​of​ ​medical​ ​cannabis.​ ​ 

What are some of the dangers of cannabis or CBD use in children?

Project CBD: Weight loss is a common side effect in studies where children are given high doses of pure CBD. Although many people will think of weight loss as a beneficial effect, it is quite serious when a 50-pound child loses 10 pounds.

Significant drug interactions can occur between CBD and many pharmaceutical medications. Drug interactions can usually be managed by adjusting the dose of the other meds, but this should be done with a doctor’s guidance.

 

Realm of Caring: Child​ ​protective​ ​services​ ​poses​ ​the​ ​largest​ ​danger​ ​to​ ​children​ ​who​ ​are​ ​using cannabis​ ​products.​ ​It’s​ ​imperative​ ​that​ ​parents​ ​get​ ​a​ ​medical​ ​card​ ​from their​ ​state​ ​if​ ​a​ ​program​ ​exists,​ ​and​ ​comply​ ​with​ ​all​ ​laws​ ​in​ ​their​ ​jurisdiction.

Health-wise,​ ​the​ ​side​ ​effects​ ​of​ ​CBD​ ​are​ ​extremely​ ​mild,​ ​especially​ ​when compared​ ​with​ ​many​ ​commonly​ ​prescribed​ ​pharmaceuticals.​ ​There​ ​is research​ ​showing​ ​that​ ​THC​ ​may​ ​impair​ ​a​ ​developing​ ​brain,​ ​but​ ​results​ ​are mixed.​ ​Unfortunately,​ ​there​ ​is​ ​no​ ​research​ ​on​ ​the​ ​long-term​ ​effects​ ​of​ ​CBD on​ ​an​ ​adolescent​ ​brain,​ ​but​ ​we​ ​fully​ ​support​ ​seeing​ ​it.

Are there states where cannabis is approved for either medicinal or recreational use that have restrictions on use for those under 18 years old?

Realm of Caring: There​ ​are​ ​16​ ​states​ ​that​ ​have​ ​not​ ​legalized​ ​medical​ ​or​ ​recreational​ ​cannabis, but​ ​have​ ​made​ ​special​ ​provisions​ ​for​ ​high-CBD​ ​hemp​ ​extracts​ ​for​ ​minors. 15​ ​of​ ​those​ ​16​ ​states​ ​have​ ​approved​ ​it​ ​for​ ​seizure​ ​disorders​ ​only.​ ​

In​ ​most​ ​cases,​ ​if​ ​medical​ ​cannabis​ ​is​ ​approved​ ​for​ ​minors,​ ​it​ ​is​ ​approved​ ​for fewer qualifying​ ​conditions​ ​and​ ​fewer​ ​types​ ​of​ ​product.​ ​

  • Connecticut’s​ ​medical​ ​cannabis​ ​law​ ​allows​ ​use​ ​only​ ​for​ ​those​ ​who​ ​are​ ​18+.
  • Delaware’s​ ​law​ ​originally​ ​only​ ​allowed​ ​18+​ ​to​ ​use,​ ​and​ ​for​ ​a​ ​long​ ​list​ ​of conditions.​ ​In​ ​2015​ ​they​ ​expanded​ ​the​ ​law​ ​to​ ​allow​ ​minors​ ​with​ ​intractable epilepsy​ ​or​ ​dystonia​ ​to​ ​use​ ​non-smoked​ ​cannabis​ ​oil​ ​that​ ​is​ ​no​ ​more​ ​than 7%​ ​THC.​
  • ​Illinois​ ​was​ ​initially​ ​for​ ​18+,​ ​but​ ​was​ ​expanded​ ​to​ ​include​ ​minors for​ ​the same​ ​conditions​ ​as​ ​adults,​ ​but​ ​only​ ​in​ ​unsmoked​ ​form.
  • All​ ​recreational​ ​states​ ​have​ ​set​ ​the​ ​age​ ​limit​ ​at​ ​21,​ ​so​ ​minors​ ​are​ ​completely prohibited​ ​from​ ​using​ ​recreationally.

MAMMA: Autism is a qualifying condition in its own right in Pennsylvania, Delaware, and Georgia.

Are there any other issues, discussions or information that haven’t been discussed on the subject of cannabis or cannabidiol for the use of pediatric pain?

Project CBD: Focusing on CBD as the “medical” part of cannabis does a disservice to the large population that could benefit significantly from other compounds in the plant. Research has demonstrated that there is synergy between many components of cannabis. This “ensemble effect” created by the use of CBD and THC can augment the anti-inflammatory, anti-spasmodic, and anti-epileptic properties, while lowering the risk of adverse interactions with other drugs. These benefits should not be lost in the effort to promote access to CBD.

When talking about treating children with cannabis or CBD, it is important to consider the pharmaceutical medications they would otherwise be prescribed that have higher risks of serious side effects than CBD.

Realm of Caring: Clinical​ ​trials​ ​are​ ​prohibitively​ ​difficult​ ​for​ ​several​ ​reasons.​ Obtaining

​permission​ ​from​ ​multiple​ ​Federal​ ​agencies​ ​can​ ​take many​ ​years.​ ​The​ ​next​ ​best​ ​type​ ​of​ ​research​ ​that​ ​can​ ​be​ ​done​ ​is observational,​ ​and​ ​it​ ​is​ ​much​ ​easier​ ​to​ ​conduct.​ ​

To​ ​fill​ ​this​ ​void,​ ​Realm​ ​of Caring​ ​started​ ​an​ ​online​ ​observational​ ​research​ ​registry​ ​in​ ​partnership with​ ​Johns​ ​Hopkins​ ​University​ ​and​ ​the University of Pennsylvania. ​It​ ​is​ ​open​ ​to​ ​anyone,​ ​affected​ ​or healthy,​ ​using​ ​cannabis​ ​product​ ​or​ ​not.​ ​It​ ​is​ ​currently​ ​the​ ​largest​ ​of​ ​its​ ​kind in​ ​the​ ​country.​ ​To​ ​learn​ ​more​ ​about​ ​this​ ​effort​ ​and​ ​information​ ​on​ ​joining, visit theroc.us/participate.

MAMMA: We believe that one of the reasons children with autism exhibit self-injurious behavior is because they are in pain that they can’t find relief for, nor can they can they tell us about it. It stands to reason that cannabis would improve the symptom of self-injury by alleviating the underlying condition that is causing their pain.

In addition, our kids certainly have pain (acute and chronic) after self-injury, sometimes years of self-injury, and cannabis would be needed for that. At MAMMA we are thankful that pain is a qualifying condition in many states because it allows some autism families to get legal access to the medicine their children need.