Medical Marijuana for Children: No Indications

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Currently, there are no accepted indications for medical marijuana in children.
Currently, there are no accepted indications for medical marijuana in children.

The 2015 University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health found that 63% of responders said they approve of medical marijuana use for adults. 

But only 36% of the responders approved of medical marijuana for children, and 80% said adults should not be allowed to use medical marijuana in front of children younger than 18. 1

In 2015, the American Academy of Pediatrics (AAP) updated their position on the legalization of marijuana. Although the AAP recognizes that there may be some exceptions for compassionate use in children with debilitating diseases, the organization does not support the legalization or use of medical marijuana in children.2,3

Are There Any Indications for Medical Marijuana in Children?

“Currently, there are no accepted indications for medical marijuana in children. In other words, there are no medical conditions for which the medical community has formally identified medical marijuana as an accepted therapy,” said Matthew M. Davis, MD, professor of pediatrics at the University of Michigan Medical School in Ann Arbor, Michigan, and director of the national children's health poll.

“At this point, there is only one small study showing some support for the cannabinoid [cannabidiol] for intractable seizures in children. The results were based on self-reports. It may work in some cases, but we have only anecdotal evidence at this point,” said Seth Ammerman, MD, clinical professor of pediatrics at Stanford School of Medicine in Stanford, California, and an author of the AAP position paper.

When marijuana has been used in children, it is usually in a liquid, non-psychoactive form, such as the cannabinoid cannabidiol (CBD). 

Anecdotal evidence exists for using medical marijuana in children with seizure disorder, autism, cancer, and attention deficit disorder. But there is no evidence to say that the potential benefits outweigh the known risks marijuana poses to child health and development.3,4

“The potential short-term and long-term effects of medical marijuana on child's developing central nervous system are the main reasons for concerns expressed by physicians on this topic. In my opinion, there is too little rigorous research information about medical marijuana use in children to draw firm conclusions about long-term effects,” said Davis.

“Medical marijuana is a bit of a misnomer,” said Ammerman. “Marijuana is actually made up of a couple hundred cannabinoids. Any approved indication for use in children will probably be limited to one of these and will not include the psychoactive component THC, which we don't want for children.” 5

What Is the Current Legal Status of Medical Marijuana for Children?

“The legal status for medical marijuana for children differs by state and by whether children are mentioned specifically in state laws regarding medical marijuana. It makes sense for states to approach the question of medical marijuana use for children separately from use among adults. For example, in Michigan, to have permission to use medical marijuana an adult needs the signature of one physician, whereas a child needs the signature of two physicians,” said Davis.

“In most states where medical marijuana is legal, use in a person under age 18 will require parental permission. It is worth mentioning that all use is still considered illegal at the federal level,” said Ammerman.

Where Do We Go From Here?

We probably still need to go quite a way. 

“To get the research we need started, the AAP has recommended changing marijuana from a schedule I drug to a schedule II drug. This will allow researchers to start using the marijuana for research purposes,” said Ammerman. “Any substance classified as schedule I by the federal government cannot be the focus of research involving federal funding, but such funding is the main way in which medical research is conducted,” added Davis.

Other than dronabinol for nausea, we are a long way from any approved indications for medical marijuana in children. 

For example, seizures may be a likely indication for medical marijuana use in children. But even in adults, the evidence in support of medical marijuana is weak: A 2012 Cochrane review of all randomized and controlled studies that were published on medical marijuana for epilepsy in adults found no reliable conclusions. 4,6

“When parents choose to use medical marijuana for their children, it is often in circumstances when they believe that the child's medical situation is severe enough that even long-term risks are outweighed by short-term benefits. That is a very difficult balance and needs to be assessed for each child, rather than [based on] broad judgments about the appropriateness or inappropriateness of medical marijuana use in general for children. Parents and health care providers alike would benefit from having better research evidence to inform their decisions,” said Davis.

“We are going to need information on dose and purity of the various cannabinoids. There will be some trial and error. Right now we have no good data, so it will take time. Testimonials are not enough. We need the research,” said Ammerman.

 Medically reviewed by: Pat F. Bass III, MD, MS, MPH      

References

1.     University of Michigan Health System, Most Americans say medical marijuana shouldn't be used by kids or in front of kids – legal or not.

2.     Pediatrics, The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update.

3.     American Academy of Pediatrics, American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use.

4.     Medscape, Pot for Tots: Children and Medical Marijuana.  

5.     Children's Hospital of Michigan, Marinol.

6.     Cannabinoids for Epilepsy (Review), The Cochrane Collaboration.

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