Understanding the impact of medical cannabis on children; cannabis-based products for pediatric epilepsy; and more
Research regarding the impact of medical cannabis on children and a study about cannabis use during the female reproductive cycle (1350 words, 7 minutes)
Researchers have been investigating how medical cannabis may impact children and young people for decades. In the last few years, more research has been emerging regarding medical cannabis use in this cohort.
This edition of CJMC Fortnightly examines the impact of medical cannabis on children by reporting a meta-analysis of the literature on the risks and benefits of cannabis use among young people. This edition also explores recent research that reviews the effectiveness and benefits of using cannabis-based products to treat pediatric epilepsy. On a similar note, this issue also summarizes a report analyzing whether cannabis affects brain development in young people diagnosed with ADHD. Finally, today’s edition also examines a cross-sectional study of women in U.S. states where recreational cannabis has been legalized to determine factors associated with cannabis use during the female reproductive cycle.
If you are new to our e-newsletter, welcome to our community. We are delighted to have you join us. Every two weeks, CJMC Fortnightly provides readers with an update on new findings about medical cannabis. Delivering your cannabis news this week is Cristela Tello Ruiz of the Canadian Journal of Medical Cannabis (CJMC), a publication for physicians produced in Toronto, Canada. Here is this week’s medical cannabis news:
Understanding the impact of medical cannabis on children, a meta-analysis
A team of researchers from the Hebrew University of Jerusalem (HU) in Israel has completed the first-ever meta-analysis of the literature on pediatric patients treated with medical cannabis to try to understand the impact that medical cannabis has on children. The meta-review was led by Ilan Matok, Ph.D., at HU’s School of Pharmacy and the David R. Bloom Center for Pharmacy, along with Ph.D. candidate Nir Treves.
Study framework
The researchers reviewed seven clinical studies involving approximately 500 patients under the age of 18 years.
Despite the limited number of participants, the team was able to identify both positive and negative effects of medical cannabis use on the mental and physical health of these children.
Findings
The team determined that CBD (cannabidiol) effectively decreases the number of severe seizures in children.
CBD can also suppress children’s appetites.
Several constituents of the cannabis plant can cause fatigue, apathy, dizziness, and lethargy.
Medical cannabis is particularly successful at treating severe epilepsy and the side effects of chemotherapy.
Bottom line
Despite some positive results, the side effects of these treatments in children are still to be fully determined. Dr. Matok said in a press release that because cannabis is not widely recognized as an accepted or regulated drug, there have not been enough studies to know whether it is appropriate for children or not. He also emphasized that it is necessary to remember that children are not small adults, and cannabis affects them differently. Finally, he concluded that doctors must pay close attention to those differences to prescribe the right products and treatments.
Insights from the world of medical cannabis research
“THC does not really act on the pain receptors. What it does is that it changes the pain signals by telling the body that it does not hurt as much. It changes your perception of the pain. If you can change how a patient perceives the pain, you basically change the pain threshold and that will be able to reduce opioid use in patients because [the pain is] not as bothersome as it used to be before they took the THC.”
-- Dr. Guy Chamberland, CEO and Chief Regulatory Officer at Tetra BioPharma Inc., speaking at the virtual Real World Medicannabis Symposium in December, 2020
Cannabis-based products for pediatric epilepsy: A systematic review
As reported in a study in the journal Seizure, European Journal of Epilepsy, researchers from the University of Ottawa conducted a systematic review of previous trials and studies regarding the use of cannabis-based products for epilepsy. Their main objective was to provide an up-to-date summary of the benefits and harms of cannabis-based products for epilepsy in children.
Study framework
The researchers reviewed 35 studies published up to May 2019.
They included randomized controlled trials (RCTs) and non-randomized studies (NRS).
Outcomes were seizure freedom, seizure frequency, quality of life, sleep, status epilepticus, death, gastrointestinal adverse events, and ER visits.
Findings
There was no statistically significant difference between CBD and placebo for seizure freedom, quality of life, or sleep disruption in the RCTs.
Data from both RCTs and NRS suggest that CBD can reduce seizure frequency and increase treatment response.
CBD increased the risk of gastrointestinal adverse events.
Death and status epilepticus were infrequently reported.
Bottom line
Evidence supports earlier findings that CBD can reduce the frequency of seizures among children with epilepsy, especially those with treatment and drug-resistant epilepsy. However, studies are still limited, and it is too early to determine whether cannabis-based products are effective and safe for children diagnosed with epilepsy.
Does cannabis affect brain development in young people with ADHD?
In a review study published in the Harvard Review of Psychiatry, a group of physicians led by Dr. Philip B. Cawkwell of Stanford University School performed a systematic review of research on the combined effects of cannabis use and ADHD in adolescence.
Study framework
Systematic review following PRISMA guidelines using PubMed, Embase, PsycINFO, and Cochrane CENTRAL to find trials conducted until January 1, 2020.
The researchers included articles that examined the impact of cannabis use on youth with ADHD.
Findings:
Eleven studies compared outcomes for individuals with ADHD who used cannabis or CBD against those with ADHD who did not.
Seven of these studies used neuroimaging techniques, including fMRI, structural MRI, and SPECT.
Differential regions of activation were identified, including the right hippocampus and cerebellar vermis and bilateral temporal lobes.
Morphological differences were identified in the right precentral and postcentral gyri, left nucleus accumbens, right superior frontal and postcentral gyri.
No study identified any additive or ADHD and cannabis use interaction on neuropsychological tasks of executive function.
Two studies found adverse differential impacts of early-onset cannabis use in this population.
Bottom line
The study concludes that the existing limited evidence does not support the initial hypothesis that cannabis use harms brain development in youth with ADHD. According to the researchers, larger and longer-term studies are needed to better understand the impact of cannabis use in youth with ADHD.
Insights from the world of medical cannabis research
“There are a number of cannabis products currently marketed toward facilitating recovery from exercise, however there is no evidence that cannabis use directly improves exercise recovery.”
--Dr. Tyler Churchward-Venne, Assistant Professor at McGill University, speaking at the Real World Medicannabis Symposium in December, 2020
Factors associated with cannabis use during the reproductive cycle
A study conducted by the University of California, Davis (UC Davis) and published in the Maternal and Child Health Journal aimed to contribute to the limited literature on factors associated with cannabis use during the preconception, prenatal and postpartum periods. This retrospective cross-sectional study also included U.S. state legalization status, concurrent use of tobacco and e-cigarettes and adequacy of prenatal care.
The study authors hypothesize that the legalization of cannabis and other substances always has an impact on the way these substances are used. According to the researchers, there is significant concern among physicians about how the passage of cannabis laws may affect pregnant women since exposure to certain substances can cause harm to both the woman and fetus.
Study framework
Researchers conducted a cross-sectional analysis using combined survey data from 36,391 women from the 2016-2018 Pregnancy Risk Assessment Monitoring System (PRAMS).
Logistic regression was used to estimate the impact of state legalization, adequacy of prenatal care, and other substance use on cannabis use during the preconception, prenatal, and postpartum periods.
Findings:
In both preconception and prenatal models, living in a state where cannabis was legal for recreational use compared to a non-legal state was associated with higher odds of cannabis use.
There was no prenatal use increase in regions with only legal, medical use.
Tobacco use, including e-cigarettes, and moderate prenatal alcohol use were also significantly associated with cannabis use.
Bottom line:
The study concluded that recreational cannabis legalization is indeed associated with the use of cannabis before, during and after pregnancy. However, medical cannabis legalization did not have a significant impact on cannabis use. Innovative clinical and policy efforts need to update prenatal substance use prevention programs, educational campaigns and provider education as cannabis legalization evolves.
The next edition of CJMC Fortnightly will be distributed on Wednesday, July 14. Sign up for a free subscription by clicking the link below.
If you are a healthcare provider and you found this newsletter valuable, you may wish to request a subscription to the Canadian Journal of Medical Cannabis, our quarterly Medical Cannabis research publication, at www.cjmc.ca