Medical Tetrahydrocannabinol May Be Beneficial For Seizures and Chemotherapy Side Effects Interview with:

Dr. Wong

Dr. Wong

Shane Shucheng Wong, MD
Massachusetts General Hospital
Boston, Massachusetts What is the background for this study?

Response: Medical cannabis is now legal in 29 states and the District of Columbia, and in those areas with active programs, children and adolescents can legally access medical cannabis with certification from their doctor and consent from a parent. This means that doctors and families need to understand what we know and what we don’t yet know about medical cannabis in order to make the best decision for the health of the individual child. Two synthetic cannabinoids – compounds that act on specific receptors in the brain – have been approved for medical use in the U.S., both of which mimic a form of THC (tetrahydrocannabinol), the compound responsible for the “high” of recreational cannabis use. Dronabinol (Marinol) is approved to treat chemotherapy-induced nausea and vomiting in both children and adults, while the pediatric use of nabilone (Cesamet) carries a caution. A third cannabinoid, cannabidiol, is currently in phase 3 trials for treatment of seizures. What are the main findings?

Response: The main findings showed that medical cannabis, specifically tetrahydrocannabinol, may be beneficial for seizures and chemotherapy-induced nausea vomiting. The trials for chemotherapy side effects – 4 of which were randomized controlled trials – found that medical cannabis was significantly better than anti-nausea drugs standard at the time of study for reducing nausea and vomiting. Similarly the epilepsy studies, including a single randomized trial, found that medical cannabis, specifically cannabidiol, reduced the frequency of seizures in participants, some with treatment-resistant seizures.

Limitations of these studies include lack of a control group for many, small sample size, differences in the medications used and lack of long-term follow-up.  Two studies investigating the use of cannabis for spasticity and three case report on use for neuropathic pain, post-traumatic stress disorder or Tourette syndrome all lacked controls or blinding, conferring a high risk of biased findings. What should clinicians and patients take away from your report?

Response: At this time, we do not have good evidence that cannabis can be useful in children and adolescents for any conditions other than seizures or chemotherapy-induced nausea and vomiting. What recommendations do you have for future research as a result of this study?

Response: Additional research is needed to better understand the benefits, risks and long-term effects of cannabis-based drugs in this population. Studies need to specifically differentiate between the effects of tetrahydrocannabinol and cannabidiol, which are active compounds in cannabis that have different effects. Is there anything else you would like to add?

Response: Decisions regarding medical cannabis use need to weigh the likely benefits against the known risks, which – based on the results of studies in recreational cannabis users – are probably even greater for children and adolescents. Their still-developing brains may make them even more vulnerable than adults to cannabis’s negative effects on learning, memory, attention and problem solving.

If a family is interested in medical cannabis, I recommend they have a thorough discussion of the risks and benefits with a physician who has specialized knowledge and experience in the area. For chemotherapy side effects, that could be a pediatric oncologist or palliative care specialist; for seizures, that could be a pediatric neurologist, especially at an academic medical center involved in the ongoing clinical trials of medical cannabis for seizure disorders. Thank you for your contribution to the community.

Citation: Medical Cannabinoids in Children and Adolescents: A Systematic Review

Shane Shucheng Wong, Timothy E. Wilens

October 23, 2017
Pediatrics doi: 10.1542/peds.2017-1818

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 

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Last Updated on November 7, 2017 by Marie Benz MD FAAD