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25.09.19

Children and Medical Cannabis

by Mary Biles
1913 Words
Faced with conditions like severe epilepsy and autism, some parents have decided to give their children medical cannabis. Here’s what we know.

A parent’s love for their child will move mountains, especially if that child is seriously ill and conventional medicine is failing them. In many cases, this has included breaking the law to access a medicine that has been prohibited in most countries in the world. That medicine is cannabis, and for children with life-limiting illnesses like epilepsy, it has had seemingly miraculous effects. But is cannabis really safe for kids to take? Here’s a look at the evidence.

Childhood Epilepsy Changes the Global Landscape

For almost 60 years, cannabis has been classified as a Schedule 1 drug, meaning it has no therapeutic benefit and is liable for abuse. This classification has stifled research, holding back regulatory change in countries across the world. However, with several high profile cases of children with drug-resistant epilepsy who thanks to cannabis have experienced a dramatic reduction in seizures, governments have been forced to rethink their positions.

Such was the story of Charlotte Figi, who by the age of five was having approximately 300 seizures a week due to a rare type of epilepsy called Dravet Syndrome. When doctors ran out of solutions, her parents decided to try medical cannabis, choosing a high-CBD strain. Much to their amazement, Charlotte’s seizures all but stopped, a cannabis strain was named in her honour (Charlotte’s Web), and she became the unofficial star of the medical cannabis CNN documentary, ‘Weed’.

In Ireland, Dravet sufferer Ava Barry, became the poster girl of her country’s campaign to legalize medical cannabis when CBD oil reduced her seizures by 80%.

Ava’s parents also saw a noticeable improvement in Ava’s overall well-being and cognitive ability, a story shared by many other children taking CBD for epilepsy. 

“She was standing up straighter,” mum Vera says. “She was making more eye contact and the next thing, in a family joke, Ava was giggling just like the other kids. She had never laughed like that before.”

Believing that Ava’s seizures would further improve if a small amount of THC were added to her CBD oil, something that was illegal in her native Ireland, the whole family moved to Holland for her treatment.

At the same time, the story of the Northern Irish boy, 12-year-old Billy Caldwell was unravelling. Billy, also with severe intractable epilepsy, had been prescribed a combination of CBD and THC under a pediatric neurologist in Canada. On entering the UK, Billy’s medicine was confiscated. After a concerted media campaign and public uproar, cannabis was reclassified by the government to a schedule 2 drug, heralding the momentous legalisation of medical cannabis in the UK.

These high profile stories also gave extra impetus to research being carried out using CBD to treat drug resistant, rare types of pediatric epilepsy, culminating in the recent approval of the purified CBD drug Epidiolex, developed by GW Pharmaceuticals. 

These positive results mirror the findings of a retrospective study charting the experiences of five Israeli pediatric epilepsy clinics treating children with CBD-enriched medical cannabis oil for their seizures. Overall, CBD caused a reduction in seizure frequency in 89% of cases, as well as “improvement in behavior and alertness, language, communication, motor skills and sleep.”

Cannabis for Children: Other Conditions

Autism

Parents’ strength and determination to find alternatives for their child’s health when conventional medicine has run out of answers hasn’t stopped with epilepsy. The use of medical cannabis in cases of children with Autism Spectrum Disorder (ASD) has gained public interest in recent years, much in part to some high profile parent activists. 

In the United States, Mieko Hester-Perez started giving her severely autistic son Joey medical cannabis at the age of nine to help with his appetite after he was “withering away.” Not only did the high THC strain he was given help him gain weight, but it also transformed his behaviour. 

“When you’re a parent of a child with autism, you have very simple goals and one of my goals was just to see my son smile,” says Mieko. “Joey started interacting with other people. He doesn’t speak, but he now has a joking personality, something we hadn’t seen before.” 

Israeli mother Abigail Dar’s experience with her severely autistic and non-verbal son Yuval echoes Mieko’s. Despite being prescribed antipsychotic drugs, Yuval was violent not only to his family members but also to himself. When he began taking medical cannabis, this all changed. 

“It was like magic,” says Abigail. My son became a calm person, more concentrated, having a smile on his face. And over a year, he didn’t show any self-injurious behavior or any outbursts, which for me and for him is a miracle. It was life-changing.”

In fact, Israel is at the forefront of research into the use of medical cannabis in childhood autism, with two studies coming out last year. The first, from Raphael Mechoulam’s lab using a CBD rich oil, found 85% of subjects with significant to moderate improvement in their ASD symptoms. Just a few months later, Dr Adi Aran published his findings after studying 60 children with ASD who were given CBD rich cannabis. Considerable improvement in behavior problems was noted in 61% of subjects, as well as a 39% improvement in anxiety and 47% in communication difficulties. 

It should be noted, however, that in pediatric ASD, researchers are often reliant on the observations of parents as many children are non-verbal.

Childhood Cancer

Perhaps the ultimate nightmare for any parent is for a child to be diagnosed with cancer. Not only are childhood cancers usually more aggressive, but parents face the heartbreaking experience of watching their child endure the side effects of anticancer drugs like chemo. Interestingly, one of the first studies examining the therapeutic use of cannabis in children was as a potential anti-emetic drug for chemo-induced nausea and vomiting. 

Carried out in 1994 by Israeli cannabinoid research pioneer, Raphael Mechoulam, a pill containing 18mg of THC was administered to the children two hours before chemotherapy. Not only was vomiting completely prevented, but the side effects were negligible. However, the fact that THC has intoxicating effects in humans means that administering it to children is a taboo most doctors aren’t prepared to question and there have been no further follow up studies. 

In fact, the use of THC in childhood conditions remains a controversial topic for pediatricians, despite their willingness to prescribe other prescription medication such as opioids that come with serious side effects.

The use of cannabinoids like THC and its non-intoxicating cousin, CBD, as anticancer drugs has been an exciting area of research for the last 20 years. Despite advancements in the lab, few clinical trials have taken place, and none in children.

But again, for the love of their child, a number of parents around the world have given their children cannabis oil when little other hope remained. 

In Colorado, three-year-old Landon Riddle’s mother Wendy gave her son cannabis oil containing both THC and CBD when he was diagnosed with lymphocytic leukemia. She told CNN,  “I think that the chemo in combination with the cannabis did put him into remission and now the cannabis will keep him there.” 

His doctor, agreed that cannabis may have played a role in his exceptional response to treatment saying: “when you look at children who go through that same course of treatment and compare Landon to them, it seems like he’s doing better than what would be expected.” 

But as a rule, most oncologists or pediatric specialists are not receptive to treating children with cannabis, stating a lack of evidence and sufficient knowledge about the plant’s safety profile.

Cerebral Palsy

Cannabis is associated with improving symptoms of spasticity in multiple sclerosis in adults. As a result, researchers are keen to see whether the effects are replicated in other conditions where patients experience spasticity, such as cerebral palsy in children. 

An Israeli pilot study on cerebral palsy patients between 1-17 years old, in which different ratios of THC and CBD were administered, found “significant improvement in spasticity and dystonia, sleep difficulties, pain severity,” and with very few side effects.

The mother of a two-year-old child participating in the trial told Haaretz: “The difference was felt quickly and was reflected in his calm, compared to his previous restlessness. There was also a significant improvement in sleep, which led to an improvement in our sleep. His motor function also improved, but we don’t know if this was due to the treatment or the fact that he was getting older.”

Brain Damage in Newborn Babies

If we thought the taboo concerning medical cannabis for children was enough, imagine the implications of giving cannabinoids to newborn babies. But that is just what an ongoing clinical study is doing in cases of hypoxic ischemic encephalopathy (brain damage caused by lack of oxygen). 

In combination with the current therapy, hypothermia — reducing the baby’s body temperature to 33-34°C within six hours after birth, scientists hope giving pure CBD intravenously to babies starved of oxygen will replicate the extremely positive preclinical results. In studies on newborn piglets, they found the combination of CBD with hypothermia reduced brain damage by almost 100%.  

Is Cannabis Safe in Kids?

The most comprehensive information about the safety of medical cannabis in children comes from the research into epidiolex as an anti-seizure treatment for children in rare cases of epilepsy. 

It is thanks to this research by GW Pharma that we know CBD has a good safety profile in children. Any reported side effects have been relatively minor and include sleepiness, diarrhoea, and lack of appetite.

However, one area of concern relates to how CBD, the main compound in epidiolex, may interact with some anti-epilepsy medication. Researchers found that administering CBD alongside clobazam, a common epilepsy drug given to children, blocked clobazam from being broken down in the body by cytochrome P450 enzymes. This led to higher levels of clobazam in blood plasma, potentially changing its therapeutic window and worsening side effects.

It should also be remembered that epidiolex is administered in doses of between 5-20mg per kilo of bodyweight, far greater than the amounts of the whole plant cannabis oil prescribed to children in medical cannabis clinics. It is posited that only high doses of CBD interfere with the metabolism of some prescription drugs, but more research needs to be carried out.

Medical Cannabis Dosage in Children

Medical cannabis is a personalised medicine. However, extra challenges are faced in cases where children cannot fully express how cannabis-based medicine makes them feel.

Approved cannabis-based drugs such as epidiolex come with a dosing regime based on the findings of clinical trials. Otherwise, doctors prescribing to pediatric cases follow the same up-titration method as adults, starting sub-therapeutically and gradually building up.

California based MD and Medical Director of Canna-Centers Wellness & Education, Bonni Goldstein, shares her dosing protocols for a variety of pediatric conditions in this helpful presentation. That said, if you are considering giving medical cannabis to your child, you should consult directly with a medical cannabis doctor as every child’s case is different.  

When it comes to prescribing cannabis to children, education within the medical profession lags behind patient/parent knowledge. But as more research comes out about the efficacy and safety profile of cannabinoids in childhood illnesses, doctors around the world may eventually feel more comfortable about prescribing cannabis-based medicines alongside, or in some cases, instead of other prescription medication.