Canada has been at the forefront of medical cannabis for years now, developing trends and mechanisms for a legal and accessible cannabis movement. However, medical professionals are apprehensive to prescribe cannabis for developing minds due to a lack of research.
Despite this, professionals are getting more and more requests for medical cannabis for children and a growing list of conditions. Dr Adam Rapoport, the medical director of the pediatric palliative care team at the Hospital for Sick Children in toronto says: “This is mostly driven by parents, and doctors have fallen behind.”
Lauren Kelly, pharmacologist and scientific director of the Canadian Childhood Cannabinoid Clinical Trials (a national research consortium) agrees with Dr Rapoport: “It’s happening and we’re playing catch-up.”
Her group is working to develop the answers needed on medical cannabis for children and for developing minds. “The use of it has far outpaced the evidence, and that’s the biggest challenge.”
Up to 50% of paediatricians surveyed in 2017 had at least one patient who had made use of medical cannabis for medical reasons in the past year. However, the cannabis consumption isn’t a result of prescriptions. Only 4% of paediatricians said that they had made allowances for medical cannabis for one of their patients.
The Lack of Research
Since then, paediatricians such as Dr Daniel Flanders, director of Kindcare Pediatricians in Toronto, says that requests have increased and the reasons for these requests have also diversified.
Flanders says that he is asked about medical cannabis for children frequently throughout the weeks, for conditions such as mental health issues, chronic pain, arthritis, ADHD and troubles with sleep. However, there are only a few conditions for which the data allows for childhood cannabis consumption.
When looking at a handful of well-executed trials and a recent review of various literature on medical cannabis for complex pediatric seizure disorders, Dr Evan Lewis, a Toronto based pediatric neurologist, believes that there is very good evidence supporting cannabis use for certain seizure contexts – such as Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis.
“Outside of that, it is kind of extrapolating from the evidence and using less robust evidence in the literature,” he says.
Despite this, parents and some medical professionals are willing to push the boundaries. Some believe that this is a path worth taking.
Lewis has been applying cannabis therapies to other types of seizures, and also prescribes cannabis for various conditions, including migraines, autism, ticks, sleep troubles, movement disorders and behavioural problems in children with neurological conditions.
Lewis does still believe that much of the research is not of the highest quality, which is required for medicines. And for some conditions, the research is non-existent.
What about Dosing?
One major shortfall of medical cannabis thus far is the issue of dosing. No dosing guidelines have been established for adults or children and experimental protocols often use isolated and purified cannabidiol (CBD), the cannabinoid with no psychoactive effects.
Unlike other western medicines, we are unable to accurately dose cannabis for a certain individual and their experiences.
Dr Richard Huntsman, a pediatric neurologist at the University of Saskatchewan, is a member of the team aiming to solve the problem of dosing regimens for children with complex seizure disorders. In addition to establishing target doses for oils, his study also observed THC and CBD levels in the blood and showed that these amounts remained low. The study used an oil with a 20:1 CBD to THC ratio.
“People are very worried about their kids getting high,” he stated, but judging by these results, he adds, this is “not so much of a worry,” at least in this population.
In contrast to popular belief, he noted that medical cannabis appeared to help with cognitive function, rather than impairing it. He remains cautious, however, and warns that the study was done with a small sample group.
Developing the Future
With the global cannabis landscape rapidly changing, doctors are seeking advice and research. The Canadian Pediatric Society intends on publishing guidance documents, according to Dr Christina Grant, an adolescent health specialist at McMaster Children’s Hospital.
In the meantime, she has been advising teens who visit her office that medical cannabis is not yet a suitable treatment for anxiety and depression. She says that “The effect is the opposite,”, noting that one sixth of youth who experiment with cannabis, even for self-medication, develop cannabis use disorder.
While the medical professionals await recommendations, Kelly says that her team has launched 5 new clinical trials for medical cannabis consumption in youth, with other groups following her lead.
“I certainly don’t think it can be the cure-all. It’s not magic. But there are some areas that are showing promise … we should be investing in research,” says Kelly.
It’s a similar story with cannabis these days – the potential has been recognised but we are seriously lacking in the research and data aspect. Without trustworthy evidence, medical cannabis cannot become readily available for a variety of health conditions.