Growing evidence supports the use of medical cannabis in children
Most Canadian pediatricians are hesitant to use medical cannabis for their patients, knowing that it can interfere with brain development and that there isn't much research to guide them. However, some doctors say they are receiving more and more requests for cannabis from parents, for an increasingly long list of conditions.
Dr Adam Rapoport, medical director of the pediatric palliative care team at Toronto Hospital for Sick Children, declares: “It is above all les parents which are at the origin of this phenomenon, and the doctors have fallen behind ”.
“It's happening and we're playing catching up.”
Lauren Kelly is a pharmacologist and scientific director of the Canadian Childhood Cannabinoid Clinical Trials, a national research consortium. His group is working quickly to develop answers to questions about cannabis for children. “Its use is well beyond the evidence, and that is the biggest challenge”.
50% of pediatricians surveyed in 2017 had at least one patient who had used cannabis for medical reasons in the previous year. But cannabis use does not come from a prescription (called doctor's authorization). Only 4% of pediatricians said they had authorized cannabis for medical purposes for one of their patients.
Research is still lacking for many pathologies. Since then, pediatricians like Dr Daniel Flanders, director of Kindercare Pediatrics in Toronto, say the demands have only grown and the reasons for those demands have diversified.
Dr Flanders is asked about medical cannabis at least two to three times a week for issues such as chronic pain, mental health issues, arthritis, ADHD, and sleep issues.
But there are very few conditions that science is sound like when it comes to cannabis use in children.
Dr Evan Lewis, a pediatric neurologist in Toronto, reported on a handful of well-executed randomized controlled trials and a recent magazine on medical cannabis for complex pediatric seizure disorders. He said there is very good evidence for its use in certain seizure conditions, such as Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis.
“Other than that, it's kind of like extrapolating from the evidence and using less solid evidence in the literature,” he says.
That doesn't stop some parents and doctors from pushing the envelope.
This is a path worth pursuing in some cases. Lewis now uses cannabis for other types of seizures, and also allows cannabis in some cases for a variety of conditions such as migraines, concussions, sleep disorders, autism, tics, movement disorders and behavioral problems in children with neurological disorders. It is also used in Canada to relieve symptoms in palliative care, chronic pain disorders, spasticity, incurable malignancies and ADHD.
But, according to Lewis, the research is not as good as he would like it to be, and for many conditions it doesn't exist at all.
Dosage issues : Another difficulty is that the standard dosage has not been established and that experimental protocols on cannabis often use purified cannabidiol (CBD), a compound in cannabis without a psychoactive effect.
This type of CBD-only preparation is not available to patients in Canada. Doctors should therefore choose products that contain both CBD and the compound delta-9-tetrahydrocannabinol (THC), which is psychoactive and gives users a high.
Dr. Richard Huntsman, a pediatric neurologist at the University of Saskatchewan, is part of a team trying to solve the problem of dosage regimens for children with complex seizure disorders. In addition to establishing a target dose using oils, his study also measured the levels of CBD and THC in the blood and showed that these levels remained low. The study used an oil that contained 20 times more CBD than THC.
“Parents are very worried about their kids getting high,” he says, but based on these results, he adds, “it's not that much of a concern,” at least in this population.
And contrary to popular belief, he found that the drug appeared to help cognitive function, instead of deteriorating it. He is however cautious, and warns that the study was carried out on a small number of children.
Guidelines under development : With the rapidly changing cannabis landscape in Canada, doctors are seeking advice. The Canadian Pediatric Society plans to release guidance documents this summer, according to its Cannabis Working Group co-chair, Dr. Christina Grant, an adolescent health specialist at McMaster Children's Hospital.
In the meantime, she says that every day she advises teens in her Hamilton office that cannabis is not a good option. treatment for anxiety and depression.
“The effect is the opposite,” she says, noting that a sixth of young people who experiment with cannabis, even for self-medication, develop cannabis use disorders.
As doctors await recommendations, Kelly says her research consortium has launched five new clinical trials of medical cannabis in children, and other Canadian research groups are quickly trying to catch up.
“I certainly don't think this can be a panacea. It is not magic. But there are some promising areas… we should invest in research, ”says Kelly.