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Evidence lacking for pediatric cannabinoid use beyond epilepsy, palliative care
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Current evidence supports the benefits of medical marijuana for the treatment of chemotherapy-induced nausea and vomiting; however, marijuana use for conditions such as spasticity, neuropathic pain, post-traumatic stress disorder and Tourette syndrome is not sufficiently supported through current research, according to a review published in Pediatrics.
Shane Shucheng Wong, MD, and Timothy E. Wilens, MD, from Massachusetts General Hospital note that evidence supporting the use of medical marijuana for the treatment of epilepsy has increased.
“Part of the process of conducting pediatric research is going to be guided by adult literature. What may be helpful for adults may sometimes be helpful for children,” Wong told Infectious Diseases in Children. “The caveat would be that the brain in children and adolescents is developing quite quickly and may often times have different cannabinoid receptor densities in different areas of the brain.”
To evaluate evidence presented in current published reports regarding the use of cannabis as a medical treatment in both children and adolescents, the researchers conducted a review of 103 full texts collected from searches on PubMed, Medline and the Cumulative Index to Nursing and Allied Health Literature databases in May 2017.
Wong and Wilens included 21 articles. These articles encompassed 22 studies with 795 participants. Additionally, the researchers acknowledged five randomized controlled trials, five retrospective chart reviews, five case reports, four open-label trials, two parent surveys and one case series.
The researchers concluded that the strongest evidence supporting the use of medical marijuana was observed for the treatment of nausea and vomiting related to chemotherapy, although evidence has been rising for the treatment of epilepsy.
Although evidence was strongest for these two conditions, many of the studies did not include control groups, large sample sizes and a design conducive to collecting statistical significance from outcome measures. Cannaboid composition in the studies varied, as did dosage. Additionally, the studies included in this review did not implement a follow-up of participants to assess for adverse effects.
“A lot of the harm associated with cannabis is based on literature regarding recreational use,” Wong said. “It can be different from medical cannabis literature in terms of dosage, composition and frequency of use. It is less tightly controlled and can include more frequent, heavier use. But what that literature suggests is that for adolescents, cannabis can have negative effects on cognition, including learning, memory, attention and problem solving.”
Wong also mentioned that onset of frequent and heavy use of cannabis at an early age has been associated with depression, psychosis and addiction. He suggests that all potential risks should be considered in addition to the potential benefits of cannabis use.
“I would recommend physicians to have a thorough discussion of the risks and benefits [if a parent or patient is interested],” Wong said. “This discussion should also depend on what they are looking to treat. For example, if treatment was for seizures, I would recommend that they speak with a pediatric neurologist, especially at one of the academic medical centers involved with ongoing clinical trials of cannabidiol for seizures as they may be more aware of the risks and benefits for seizures at this time.”– by Katherine Bortz
Disclosure: The authors report no relevant financial disclosures.
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