Medical Marijuana For Kids? Really?

Here’s the provocative lede of an NBC News report earlier this week:

Zaki Jackson was 6 months old when doctors diagnosed him with a form of epilepsy so severe that it sparked as many as 250 seizures a day.

For years his mom, Heather Jackson, feared for his life. “He would stop breathing,” she told NBC chief medical editor Dr. Nancy Snyderman. “All the air leaves his lungs and he does not take another breath until that seizure is over.”

After 10 years and 17 medications, Zaki wasn’t getting any better. Then, finally, his doctor wrote a prescription for a medication that calmed the electrical storms in Zaki’s brain. The surprise was that it wasn’t for a standard anti-seizure medication — it was a prescription for marijuana.

(“Caveman Chuck” Coker/flickr)

(“Caveman Chuck” Coker/flickr)

Wow, I thought, I’ve never heard of any doctors prescribing medical marijuana for kids. I called around, and none of the pediatricians I contacted knew of any specific cases.

It’s clearly not the norm, though it’s permitted under state regulations approved by the Mass. Department of Health. According to an earlier post here:

…youth under 18 will have access to the use of medical marijuana, but will need two physicians to certify that the risks and benefits have been assessed and the benefits will outweigh the risks, one being a board-certified pediatrician.

But when the state was finalizing the rules earlier this year, the Massachusetts Medical Society raised concerns about use by children in a May 8 statement:

We are concerned that the Department has changed the regulations related to children, by allowing the override of the “life-limiting” provision and by changing the definition of “life-limiting illness” from six months to two years. In the absence of well-designed scientific research data, we are concerned about extending the time from six months to two years. The scientific evidence is clear that marijuana use by children is dangerous, as studies have found toxic effects on the still-developing brains of young people.

Here, Dr. Sharon Levy, of Boston Children’s Hospital and Harvard Medical School, offers her perspective to NBC:

“I worry that we just don’t know enough about it,” said Dr. Levy. “I think they’re putting their child at risk of long-term consequences of marijuana use that we don’t fully understand.”

She adds:

“A couple of generations ago physicians were recommending tobacco as a good method of relaxation or to relieve stress,” Levy said. “It seems unbelievable now.”

I asked Levy for more of her thoughts on the issue and she sent along this email:

I believe that cannabinoids (the active molecules in marijuana) have significant therapeutic potential, and I fully support research in this important area, as do many of my colleagues. However, to my knowledge, there is no rational reason that marijuana should be treated as a medication without the regulatory steps that every other medication goes through. This is very important because without long term, serious studies, we can make mistakes – the history of medicine is filled with examples.

What we know about marijuana exposure to developing brains comes from epidemiologic studies of adolescents who use marijuana illicitly. (There have not been any studies of “medical marijuana” in children.) The studies that have been done have found associations between marijuana use during adolescents and a number of bad outcomes, including significantly increased rates of thought disorders (schizophrenia), depression and anxiety. A large, longitudinal study also found cognitive decline (drops in IQ) for those who used marijuana heavily during adolescence. We cannot do randomized trials of marijuana use, and so all of these studies look at associations, which is not necessarily the same as causation. However, other research, including MRI studies which have found changes in the brains of heavy marijuana users similar to changes seen in patients with schizophrenia, etc. also support the hypothesis that marijuana use may play a role in causation. What we do know should be enough to give us pause before we rush to push marijuana out as a medication, especially to children.

The media keeps trotting out anecdotal cases of severely debilitated children who seem better when treated with medical marijuana. These children may well be better off getting cannabinoid therapy than without it, and “compassionate use” – for which guidelines and approval processes already exist – may be reasonable in these cases. What I believe is at issue is the policy – not an individual child’s treatment or family’s decisions. We need more research to better understand cannabinoids, their potential therapeutic benefits, dosing, side effects and possible long term harms. If some children need to be treated “compassionately” in the meantime fine, but that does not equate with states allowing use of “medical marijuana.”

Parents, do you know any children who have been prescribed medical marijuana for pain or other symptoms? What do you think about marijuana use as a treatment for children and adolescents?

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