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.