Cannabis Treatment for the Pediatric Patient

I have been a pediatrician for 25 years and a medical cannabis specialist for the last nine years, assisting thousands of adults and children with serious medical conditions in using cannabis treatment. I have evaluated hundreds of children with severe epilepsy, autism, and cancer and have seen many obtain an incredible improvement in their quality of life with cannabis medicine.

marijuana leafIn medical school, I was taught that cannabis was a drug of abuse.  I never thought of it as medicine until I saw a friend with a serious illness have incredible benefits from it.  I started researching the scientific literature and was shocked to find that cannabis had so many medicinal properties.   Since cannabis is classified by the federal government as an illegal substance, clinical trials in humans have been largely prohibited here in the U.S.   Thanks to curious and diligent scientists, however, both here and abroad, we have an advanced understanding of how cannabis works as medicine.  The medicinal compounds in the plant called phytocannabinoids and terpenoids work by interacting with a complex system in the brain and body called the endocannabinoid system.  The endocannabinoid system is a signaling system responsible for maintaining balance of the chemical messages that are sent between
our cells.  We humans make compounds called endocannabinoids, “cannabis-like” molecules that are quite similar to the cannabinoids found in the cannabis plant, that work to maintain homeostasis — balance — of our cells.  If you have an imbalance in these compounds, disease may result. We have only known about this system since 1988, but recent research has allowed us to understand that it is critical in the manifestation of disorders that have previously not been well understood or effectively treated.

There is a growing body of evidence that children with epilepsy, autism and psychiatric disease have a dysfunction within their endocannabinoid system. When this system is not working properly, the chemical messages in the brain are not balanced, and this imbalance is expressed as seizures, abnormal behaviors, and thought processes.

Cannabis Medicine in Practice

Dr. Bonni Goldstein's book "Cannabis Revealed"

Dr. Bonni Goldstein’s book “Cannabis Revealed”

I am often asked why I recommend cannabis to children despite the popular understanding that THC, the main cannabinoid responsible for psychoactivity, the “high” if you will, is bad for the brain.  Studies have shown that a normal functioning endocannabinoid system is required for the maturation of the developing brain, and that by using THC, the brain may not develop as it should.  Adolescence is a time when the developing brain is quite vulnerable, and interference in the normal changes that lead to a healthy adult brain can dramatically alter brain maturation.   Research looking at otherwise healthy teenagers who use chronic heavy doses of THC has shown that there is some risk for increased problems with executive function, impulsivity, memory deficits, attention deficits, problems with decision-making, and lower overall and verbal IQ.  There are many other variables involved in assessing these attributes, but the bottom line is that in a child or adolescent who is medically well, cannabis should be avoided so that the endocannabinoid system can do its thing — function uninterrupted and lead to the desired end result: a healthy and mature adult brain.  

What about children that are not medically well?  Again, since we are lacking critical studies, we don’t necessarily know long-term effects.  What we do know is that the cannabis plant gives us cannabidiol, also known as CBD, a compound that is not psychoactive but has tremendous medicinal value with its anticonvulsant, antioxidant, antianxiety, antipsychotic, antiinflammatory and antitumoral properties.  Strains of cannabis are being grown with higher amounts of CBD and lower amounts of THC,  so-called CBD-rich strains.  There is still a small amount of THC in these strains, but the overall effect is dominated by the CBD.  It is important to note that there are no long term studies of CBD use in children, but those of us who are treating children with CBD are not witnessing any negative effects.  In fact, we are seeing children who previously had very poor prognoses with uncontrolled seizures, developmental delay and cognitive dysfunction now progressing developmentally instead of regressing.  Many are able to stop using toxic medications that may have not been effective.  We cannot compare the healthy teenagers that are chronic heavy users of THC-rich cannabis, behavior which may result in interference of normal development, with severely ill children using CBD-rich cannabis which may repair the dysfunctional endocannabinoid system.   My approach in treating children with cannabis is case-by-case; however, children suffering severe disease and not responding to conventional treatment and/or experiencing intolerable side effects, should have an option to use cannabis medicine, as the underlying cause may be within the endocannabinoid system.

“Cannabis Medicine in Practice” is the first installment of a five-part series on Children and Cannabis Medicine.

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