Thursday, January 10, 2019

Cannabis and Pediatrics



Cannabis and Pediatrics


With pediatric patients, infants and children, the conditions for which medical cannabis is prescribed are epilepsy, cancer, and autism spectrum disorders that do not respond well to conventional treatments. Any consideration of cannabis as a medicine for infants or children must be approached with special caution and informed, professional medical oversight, because cannabis constituents interact with the receptors that regulate physical development and a variety of functions throughout the body.

There are very few effective pharmaceuticals for childhood cancers and parents are increasingly investigating the use of alternative treatments, including cannabis.

Raphael Mechoulam is the Israeli medical chemist who first elucidated the structure of THC in the early 1960, also known as the Father of Cannabinoids, has conducted a small trial in the 1990s – under the supervision of pediatric oncologists at an Israel hospital – on eight children, age 3-10, undergoing chemotherapy for blood cancers. Mechoulam was moved by the suffering of these children and the horrible nausea and vomiting they endured after chemo treatments. He and the oncologists designed a protocol to test dalta-8-THC as an antiemetic. Delta-8 is the most stable isomer of THC and, unlike delta-9-THC, does not readily oxidize into cannabinol. For the next two years these 8 children received high doses of cannabinoid four times a day. One child (4 yrs) showed signs of euphoria and irritability during the trial, another (3.5 yrs) showed irritability, but only for the first two doses. All of the children stopped vomiting for the duration of the trial.


Cannabinoids and the Endocrine System

The Endocannabinoid System regulates diverse functions such as memory, digestion, motor function, immune response and inflammation, appetite, pain, blood pressure, bone growth, and the protection of neural tissues, among others. The Endocannabinoid System take up cannabinoids and distributes them to receptors throughout your body.  The two primary subtypes of cannabinoid receptors in the endocannabinoid system are CB1 and CB2. These receptors are distributed throughout the central nervous system, immune system, and within many other tissues including the brain, gastrointestinal system, reproductive and urinary tract, spleen, endocrine system, heart, and circulatory system.

Cannabinoids can be found naturally in your body (endocannabinoids). Some people are deficient in natural cannabinoids. Recent research has shown that a possible "Endocannabinoid Deficiency" may be the reason for many diseases and other conditions. Plant cannabinoids found in Cannabis are called Phytocannabinoids, such as THC, CBD, CBG, CBC, CBN, and more. The two most popular and most researched cannabinoids are THC (known to cause some psychoactivity) and CBD (non-psychoactive). CBD (cannabidiol) can help ease distress, while THC is more effective for pain relief, for reducing the number of opioids needed to treat, and increasing the quality of sleep. Medicines with CBD and THC can lessen the psychoactivity feeling from THC.

It can be a disturbing experience for a cannabis-naive person to use a cannabis product with a high level of THC. Paranoia and anxiety are some side-effects that occur with high THC products. Products with combined ratio of THC and CBD are recommended. Cannabis products can interfere with specific prescription medications. A trusted physician can advise whether there are potential interactions between cannabis and current medications.


Cannabis and Pediatric Research

In 2013, researchers at Stanford University presented a preliminary survey of the use of CBD cannabis with pediatric epilepsy patients in California. Increasingly, researchers and physicians are seriously examining the potential of cannabis-based medicines in pediatric patients.

(Stanford Survey supervised by Dr. Brenda Porter, was presented at the “Curing the Epilepsies” meeting of the National Institute of Neurological Disorders and Stroke, April 17-17, 2013)

Dr. Elizabeth Anne Thiele, professor of neurology at Harvard Medical School and director of the Pediatric Epilepsy Service at Massachusetts General Hospital, gave testimony at the Massachusetts Department of Public Health hearings on medical marijuana, in which she stated that: “Based on a review of the literature and firsthand experience treating pediatric epilepsy patients, it is my opinion that medical marijuana – and the non-psychoactive ingredient, cannabidiol (CBD) – may have substantial medical benefit for pediatric epilepsy patients, as well as significantly fewer adverse effects than many of the other anti-epileptic therapies available today.”

(Massachusetts Department of Public Health: Public Hearings on Proposed Regulations at 105 CMR 725.000 (April 18, 2013) Testimony of Elizabeth Anne Thiele, MD, PhD, Director, Pediatric Epilepsy Program, Massachusetts General Hospital)

It is important to understand that when using cannabis with severely ill children, the herb is not always effective in delivering symptomatic relief. Cannabis does not always help every child and may not work well. There are not enough trials or research done on cannabis and children who have life-limiting illnesses, due to todays laws. Hopefully, by changing some laws and pediatric patients working with physicians closely monitoring, this may one day change so that we can find the right cannabinoids and the right medication for pediatric patients to experience some relief.


In late 2013, the FDA approved an Investigational New Drug study to be conducted at New York University and University of California – San Francisco, using CBD on intractable pediatric epilepsies. The CBD is furnished by GW Pharmaceuticals in the form of an extract called Epidiolex. This is a very small-scale study enrolling 25 patients at each facility. If the preliminary results are encouraging, the study may be expanded to other research programs around the United States. Epidiolex completed several Phase 3 trials in late 2016. The preliminary results are encouraging, but only a miracle for the patients and parents responding well to the treatment.

News reports from Colorado reported that many families whose children have these epilepsies are moving to Colorado to take advantage of laws legalizing cannabis in the state. A cannabis dispensary in Colorado is cultivating high-CBD cannabis and extracting oil from it for the use of these families.

This information was taken from the amazing book on cannabinology – Cannabis Pharmacy: The Practical Guide to Medical Marijuana, by Michael Backes, Andrew Weil MD, Jack D. McCue MD

You can find the book (on this and other cannabis information) here.


Cannabis compound CBD, may be of help for children who are unresponsive to other medications for epilepsy. In these treatment-resistant epilepsies, families often seek alternative treatments. This survey explored the use of cannabidiol-enriched cannabis in children with treatment-resistant epilepsy.

“Nineteen responses met the following inclusion criteria for the study: a diagnosis of epilepsy and current use of cannabidiol-enriched cannabis. Thirteen children had Dravet syndrome, four had Doose syndrome, and one each had Lennox–Gastaut syndrome and idiopathic epilepsy. The average number of antiepileptic drugs (AEDs) tried before using cannabidiol-enriched cannabis was 12. Sixteen (84%) of the 19 parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25–60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue.”

It's important to note that safety and tolerability data for CBD use among children are not available. Objective measurements of a standardized preparation of pure cannabidiol are needed to determine whether it is safe, well tolerated, and efficacious at controlling seizures in this pediatric population with difficult-to-treat seizures.


Another good site for more information on Cannabis use in Pediatric Epilepsy can be found here. This site offers a library of cannabis research studies for pediatric epilepsy.



The Children’s Hospital of Colorado does not mind helping families with children who want to experience healing with cannabis.

“If a family chooses to explore the use of medical marijuana, we want to continue to provide care to their children. Most of these families have children with very complex medical needs, and Children's Colorado wants to continue to see them to help monitor them and the side effects they experience.”

The Children’s Hospital of Colorado does not prescribe or recommend the use of medical marijuana in pediatric patients outside of clinical trials, however if the parents want to seek these treatments, the Children’s Hospital wants to help and closely monitor.


In O’Shaughnessy’s article by Bonni Goldstein, MD Cannabis in the Treatment of Pediatric Epilepsy

“After starting on CBD oil, the children are observed for one or two weeks. Patients whose seizures are less frequent —for example only three seizures a month— may be observed for a longer period without increasing the dose. Most of the patients I see have daily seizures, which enables parents to tell quite quickly if there is any benefit from the oil.  Parents are asked to keep a diary or calendar of seizures and improvements and to check in every one to two weeks If the child is doing well, after a week or two the dose is titrated up by increments of 0.5 milligrams per pound per day.  It appears from the data collected in Colorado that the therapeutic range is 2 – 6 mg per pound per day for many of the children that respond well to CBD treatment.”

Goldstein goes on to explain specifically how CBD in cannabis medicines work best with children with epilepsy “CBD’s Anticonvulsant Mechanism of Action CBD does not act directly on the CB1 receptor. It works by multiple actions —what has been termed “polypharmacology,” exerting various effects within different parts of the brain that might defuse seizures.  I explain it in comparison to the AEDs that parents are all familiar with. CBD blocks NMDA receptors, which are involved in excitation. Felbamate acts similarly. CBD binds to GABA receptors, enhancing the inhibition of excitation —as do Felbamate, Depakote, Tegratol, Onfi, and Phenobarbital. CBD stabilizes ion channels —as do Banzel, Lamictal, Dilantin, Keppra, and Trileptal. CBD modulates calcium release in neurons, blocking the uptake of endocannabinoids in order to normalize endocannabinoid tone. CBD counters inflammatory reactions that appear to increase neuronal excitability and impair cell survival. This is why the National Football League is reviewing a proposal that CBD be provided to players suffering head injuries. CBD is neuroprotective; it reduces oxidative stress and glutamate toxicity.”


Flowering Hope Foundation is an amazing Cannabis Medicine, advocacy, and patient’s rights group that helps many pediatric patients. Floweringhope.co is a good place to find help if you need to talk to someone about what you can do for your child.

“Our goal is to facilitate safe access to life changing medication to those that suffer from multiple ailments, including but not limited to, Cancer, Crohns, Epilepsy, and MS. We create opportunities for patients to receive a better quality of life, making it possible for parents and caregivers to have some piece of mind that their loved ones get the best chance at a successful future. We also strive to spread healthcare education to communities far and wide.”

HaleighsHope.com is also a good site to find Organic Botanical Oil Blend.
MAMMA USA, Mothers Advocating Medical Marijuana for Autism - is a great resource for parents needing help to better understand Cannabis medicine, their child's autism and getting access to affordable medicine.
It is important to understand that there is very little research done for Cannabis use and pediatric patients. It is known that medical marijuana has a severe impact on developing brains. It is recommended that children stay away from cannabis to help support the development of their brain until the age of 25 yrs. However, not all children, or their parents, have this option to consider when it comes to a severe condition or disease, parents and patients will have to educate themselves about how cannabis works on the developing brain and weigh the pros and the cons of self-medicating with cannabis.

It is imperative to find a trusted family doctor who knows cannabinoids, the endocrine system, these pros and cons, and can help monitor the child’s condition with alternative therapy.

 More Resources for Parents
https://www.marijuanadoctors.com/blog/category/marijuana-for-children/
http://medicine.lunagardens.co/2018/01/cannabis-and-autism.html







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