While medical cannabis research is on the rise around the world, with some studies demonstrating that cannabis products can be useful in treating several conditions that affect children and adolescents – the most researched being rare forms of epilepsy – wider evidence of the efficacy and safety of cannabis-based medical products in this group remains unclear.
Medical cannabis, colloquially known as medical marijuana, was legalised in the UK in November 2018 following the high-profile cases of children suffering from rare forms of epilepsy for whom cannabis oils had been an effective treatment. There are currently only three medical cannabis products that are licensed for use in the UK. One of these products is Epidyolex, a CBD-based medication that has been found to reduce seizures in severe, treatment-resistant forms of epilepsy that are most common in children and adolescents.
In Switzerland, synthetic or natural cannabis derivatives with over 1% THC content are classed as an illicit substance, however, these products have been legal for medical uses since 2011. Furthermore, pure CBD-based products (such as Epidyolex) do not require exceptional authorisations for prescriptions.
A recent retrospective study aimed to assess the “clinical and epidemiological characteristics of medical cannabis treatment and caregiver-reported effects in children and adolescents in Switzerland”.
Design and Methods of the Study
For this review, researchers collected clinical data from children and adolescents (under the age of 18) who had received THC, CBD, or a combination of the two between 2008 and 2019 in Switzerland. A total of 205 were contacted about participation, 90 of which agreed to take part in the assessment.
The authors of this assessment developed and piloted a standardised questionnaire in collaboration with an advisory panel, consisting of two pharmacists and three clinicians prescribing medical cannabis.
Results of the Study
The most common reason for medical cannabis prescription in the patient sample was epilepsy (66; 73%), followed by cerebral palsy (32; 36%), encephalopathy (15; 17%), metabolic diseases (8; 9%), and autism (7; 7%). More than half of the participants were diagnosed with more than one condition.
Treatment and Interruptions
For this study, participants were separated into two groups: those that received pure CBD preparations, and those that received preparations containing THC. Over half (n=51; 57%) of patients were treated with pure CBD while 39 (43%) were prescribed a THC preparation. According to the results, “participants were more likely to receive THC therapy if one of the following symptoms or signs were present: spasticity, pain, lack of weight gain, loss of appetite, vomiting, or nausea, whereas seizures were the dominant indication for pure CBD therapy.”
Of the 90 participants, 39 reported interruptions to medical cannabis treatment, with 22 stopping treatment completely – 17 patients resumed treatment. Side effects were the reported reason for treatment interruption in 18 patients (46%). The need for a gastric tube also restricted the continuation of treatment in 17 patients (44%), and the cost of treatment caused interruptions in 9 patients (23%).
Reported side effects included tiredness, sedation, and dry mouth, with 25 patients (28%) reporting such symptoms. Side effects were observed to be similar in both the THC and CBD groups.
Effects of Medical Cannabis Treatment
Medical cannabis treatment was reported to be successful by two-thirds of caregivers (66%). Furthermore, participants who received THC-containing preparations most frequently reported reductions in pain, spasticity, seizures, and a reduction in additional medications. On the other hand, those who received pure CBD preparations most frequently reported a reduction in the frequency of seizures.
Fifty-five per cent of patients with epilepsy reported a reduction in seizures, whilst 6% experienced seizure aggravation during medical cannabis treatment. Of other studies in this area, one revealed that 84% of patients reported a reduction in seizures. Furthermore, another retrospective study based on clinical records showed that almost 90% of children with treatment-resistant epilepsy reported a reduction in seizure frequency.
The second most common indication for the use of medical cannabis in this review was spasticity. Of these participants, 49% – mainly patients with cerebral palsy – reported a reduction in spasticity.
The caregivers of patients reported that participating children and adolescents were generally “more relaxed, more satisfied, and in a better general condition than before the therapy with medical cannabis.”
The authors of this study conclude that these results may indicate potential applications of medicinal cannabis in several conditions in children and adolescents. However, the researchers stress the need for further research, using standardised THC and CBD preparations to assess the efficacy of medical cannabis in different diseases and long-term effects in children and young people, as this is still unknown.