Growing evidence supports the use of medical cannabis in children
Most Canadian pediatricians are reluctant to use medical cannabis for their patients, knowing that it can harm brain development and that there is not much research to guide them. However, some doctors say that they are receiving more and more requests for cannabis from parents, for an increasingly long list of pathologies.
Dr. Adam Rapoport, medical director of the pediatric palliative care team at Toronto Children's Hospital, says: "It’s mostly les parents that are causing this phenomenon, and the doctors have fallen behind. "
“It is happening and we are playing catch up. "
Lauren Kelly is a pharmacologist and scientific director of the Canadian Childhood Cannabinoid Clinical Trials, a national research consortium. His group is quickly working on developing answers to questions about cannabis for children. "Its use has far exceeded the evidence, and this is the biggest challenge."
50% of pediatricians interviewed in 2017 had at least one patient who had used cannabis for medical reasons in the previous year. But cannabis use does not follow from a prescription (called doctor's authorization). Only 4% of pediatricians reported having 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 that the demands have only grown and the reasons for these requests have become more diverse.
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 problems.
But there are very few conditions for which science is solid when it comes to cannabis use in children.
Dr. Evan Lewis, a pediatric neurologist in Toronto, reported on a handful of well-performed randomized controlled trials and a recent magazine on medical cannabis for complex disorders of pediatric convulsions. He said there is very good evidence of its use in certain conditions of seizures, such as Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis.
"Other than that, it's sort of 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.
It is a path worth following 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, research is not as good as it would be and, for many conditions, it does not exist at all.
Dosage issues Another difficulty is that the standard dosage has not been established and that experimental cannabis protocols often use purified cannabidiol (CBD), a cannabis compound with no psychoactive effect.
This type of CBD only preparation is not available for 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, 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 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 children getting high," he says, but based on the results, he adds, "it's not so much a concern," at least in this population.
And contrary to popular belief, he found that the drug appeared to help cognitive functions, rather than deteriorate them. He was cautious, however, and warned that the study was carried out on a small number of children.
Guidelines under development : Canada's rapidly changing cannabis landscape, doctors seek advice. The Canadian Pediatric Society plans to release guidance materials this summer, according to its cannabis task force co-chair, Dr. Christina Grant, 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 opposite," she says, noting that one-sixth of young people who experiment with cannabis, even for self-medication, develop problems with cannabis use.
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 it can be a panacea. It is not magic. But some areas are promising… we should invest in research, ”says Kelly.