Is medical use of cannabis a therapeutic option for children? Flashcards
What are the major psychoactive compounds found in cannabis?
- Delta-9-tetrahydrocannabinal (delta-9-THC)
- Cannabidiol (CBD) lacks psychoactive effects but foes have behavioural and other CNS effects
Historically what medical indication has cannabis been used for?
Refractory epilepsy
When was marijuana approved for medical use in Canada?
2011
Describe the process by which patients obtain medical marijuana in Canada
- See a ohysician who prescribed it
- Visit a licensed producer who is able to dispense 150g, enough for one month
- Therapeutic use of cannabis oils also permitted
What is the evidence supporting a therapeutic role for cannabis in children with epilepsy?
- Animal models show delta-9-THC and CBD have anticonvulsant effects in animal models with epilepsy
- Pro-convulsant activity has been demonstrated in animal models
- Individual case reports published but no RCTs
- Cochrane review of 47 adult patients showed short term tolerance with no reduction in seizure frequency
What indications have stronger evidence for the use of cannabis?
- Spasticity in adults with MS treated with oral cannabinoids
- Central pain or painful spasms in adults with MS
Do cannabinoids work for movement disorders?
- Ineffective for controlling tremor in MS, chorea in Huntington’s disease, levo-dopa associated dyskinesia in Parkinson’s disease or tics in adults with Tourette’s syndrome
What is the role of cannabis in management of pediatric pain or nausea?
- No studies demonstrate efficacy and safety of marijuana to manage pain or nausea in pediatric patients
What are the side effects of marijuana?
- Red eyes, dry mouth, delayed motor skills and tachycardia
- Nausea, weakness, mood changes, anxiety
- 2x increased risk of cognitive impairment
- Cannabinoid use in adult MS pts associated with increased suicide risk
- Controversy about potential risk of mental health effects: in a recent study up to 25% cases of new onset psychosis were associated with cannabis
- Dependence: risk 9-50%, higher risk when use begins in adolescence and is daily
What impacts the effect of cannabis on cognitive impairment?
- Age dependent
- In kids with ADHD, see impaired executive function, impaired cognitive function when marijuana was started before the age of 16
What withdrawal symptoms are seen with stopping cannabis?
- HA
- Sleep disruption
- Irritability
- Anxiety
Why is smoking an unacceptable drug delivery system for kids?
- Combustion produces tars and other by products associated with known carcinogenesis
- Drug delivery with smoking makes it hard to predict how much kids are actually getting
- Considerable variability in THC content from one batch to the next
Does legalization o fmarijuana increase its use?
- In states where marijuana is legal, no increased use in teens and kids
- In states where it is only allowed for medical indications, there is incresaed use, lower risk perception and an increase in fatalities related to marijuana use while driving
What does the CPS recommend for the use of cannabis for children with refractory epilepsy?
- Efficacy should be carefully evaluated over the long term using appropriately supported and well designed research into developmental effects, including neuroimaigng
Who can be treated with medical marijuana?
- While research ongoing, cannabis for medical purposes should be evaluated on a case by case basis; treatment plans need to carefully consider the dose, efficacy ansd safety monitoring, and shoul donly be done by clinicians with clinical expertise and ability to monitor for toxicity and efficacy
