Medical Marijuana Won’t Help Most Kids

When people like the headline writer of this HealthDay news article talk about “medical marijuana,” they usually mean everything. The plant’s dried flowers which people smoke. Concentrates that can contain up to 90 percent THC, whose extraordinarily high levels are almost certainly what is sending toddlers and children who accidentally consume them and adults who consume them on purpose to emergency rooms with many needing to be hospitalized. “Edibles” – cookies, candies, and soft drinks infused with marijuana that are now in the food chain. And hundreds more, all sold as “medicines.”

 
The HealthDay author does a good job of covering a new study in Pediatrics, the journal of the American Association of Pediatrics. But notice the study’s title: “Medical Cannabinoids – not Medical Marijuana – in Children and Adolescents: A Systematic Review.”
 
What’s the difference?  
 
The marijuana plant contains about 500 different chemicals. Most have not been studied. Some 100 of those are called cannabinoids, so-called because they are unique to the cannabis plant. Most of these have not been studied either, but that is changing. Some cannabinoids show scientific promise and may become medicines. Two already are.
 
By medicines, we mean they have gone through rigorous preclinical (test tubes and animals) and clinical (humans) research. They have proven to FDA that they are both safe and effective, can be manufactured with a consistent dose, and most importantly are pure. They contain no contaminants unlike most of the products in legal states. A further FDA safeguard is that sometimes approved medicines cause dangerous side effects in the larger population after approval. FDA has a notification system that requires doctors to report any that occur so the medicine can be pulled from the market, if necessary.
 
The most studied cannabinoids are delta-9 THC and cannabidiol (CBD). The former makes people high. The latter doesn’t. The two medicines that FDA has approved are nabilone (trade name Cesamet®) and dronabinol (trade names Marinol® and Syndros®). Cesamet® and Marinol® are pills. Syndros® is an oral liquid. They are used to reduce chemotherapy-related nausea and AIDS wasting in patients who do not respond to standard medications.
 
Two more cannabinoids, nabiximols (trade name Sativex®, approved in other countries but not yet in the US yet) and CBD (trade name Epidiolex® which has completed clinical trials and is applying for FDA approval) are in the pipeline.
 
About half our medicines originated in plants. But when drug makers create a new medicine from them, they use pure chemicals to make a molecule-for-molecule carbon copy of the plant’s component. Nabilone and dronabinol are made that way. Patients know when they take these medicines that they will not contain any contaminants and FDA has approved them.
 
Not so the “medical” marijuana products being produced and sold in states that have legalized the drug for medical use. In fact, the American Epilepsy Society calls such CBD products “artisanal CBD” to differentiate them all from Epidiolex®, which may be available as early as next year to treat children and adolescents suffering intractable seizures.
 
Not one of the marijuana products states allow to be sold as medicines has been approved by FDA.
 
This new study searched several databases for scientific articles about pharmaceutical-grade cannabinoids that are being studied to treat a variety of illnesses in children and adolescents. They found 2,743 citations that might meet their search criteria and reviewed the full texts of 103. From these, they found 21 articles about 22 studies with a total sample of 795 participants: 

  • Five were randomized controlled trials, the gold standard of knowledge development.
  • Five were retrospective chart reviews.
  • Five were case reports.
  • Four were open-label trials.
  • Two were parent surveys.
  • One was a case series. 

The medicines used in these studies were nabilone, dronabinol, Epidiolex®, a formulation of delta-8 THC, and other pharmaceutical-grade preparations, not Charlotte’s Web, Haleigh’s Hope, Cannatol, or any of the hundreds of other artisanal CBD products states allow to be shipped – and Amazon sells – to all 50 states in violation of federal law.
 
The researchers found that in children and adolescents:

  • “Evidence for benefit was strongest for chemotherapy-induced nausea and vomiting (four RCTs), with increasing evidence of benefit for epilepsy [1 RTC using Epidiolex® rather than artisanal products]. At this time, there is insufficient evidence to support use for spasticity, neuropathic pain, posttraumatic stress disorder, and Tourette syndrome.
  • “The methodological quality of studies varied, with the majority of studies lacking control groups, limited by small sample size, and not designed to test for the statistical significance of outcome measures. Studies were heterogeneous [varied] in the cannabinoid composition and dosage and lacked long-term follow-up to identify potential adverse effects.
  • “Additional research is needed to evaluate the potential role of medical cannabinoids in children and adolescents, especially given increasing accessibility from state legalization and potential psychiatric and neurocognitive adverse effects identified from studies of recreational cannabis use.” 

Read HealthDay account of this study here.
Read American Association of Pediatrics study abstract here.
Read what Colorado Children’s Hospital tells families who want artisanal CBD for their children here.

Source: Email from National Families In Action http://www.nationalfamilies.org October 2017

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