Medical Cannabis for Children: Evidence and Recommendations

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In Canada, the medical cannabis stream allows physicians and nurse practitioners to authorize medical cannabis use for children. There is a growing, but variable-quality evidence, suggesting benefit in some paediatric conditions and safety considerations.

Different types of cannabis products available in Canada

Cannabis-based pharmaceuticals

Products have DIN and Health Canada-approved indications
Available only by prescription
Examples available in Canada include Sativex and Nabilone

Medical Cannabis

Shipped directly to patients
Requires medical document (authorization)
Wide variety of products available including CBD only and CBD-enriched oils

Recreational Cannabis

Only available to adults in Canada
Storefront or online access without documentation
Wide variety of products available including CBD only and CBD-enriched oils

Evidence on efficacy in paediatric patients

Epilepsy

Clinical trials in children with drug-resistant epilepsy using purified CBD have shown consistent efficacy.
Skin patch CBD administration has shown efficacy in reducing seizures and disease burden.

Autism

Observational studies suggest improvements in behavioral problems, anxiety, and communication, with mild adverse events.

Cancer and palliative care

An observational study of 21 Canadian children found improvement in symptoms after receiving cannabis for pain, nausea, and vomiting.

Other neurological conditions

Small open-label study shows CBD-enriched cannabis extracts improved abnormal muscle tightness and involuntary muscle contractions in children.
CBD was well tolerated and reduced severe behavioral problems.
Shown benefits for patients with Tourette’s syndrome and fragile X syndrome.

There are over 32 clinical trials on cannabinoid use for chronic noncancer pain in adults, but no studies on acute or chronic pain in children, highlighting an extreme evidence gap.

Safety considerations

Cannabis-related adverse events should be discussed with children, adolescents, and families.
Conversations should differentiate between what is known about individual product components versus indications, product types, and dosing information that have (and have not) been studied in children.
THC can cause adverse effects such as euphoria, reduced consciousness, nausea, dizziness, and fatigue.
Adverse events for purified CBD include somnolence, decreased appetite, diarrhea, fatigue, malaise and asthenia, rash, sleep disorders, infections, and transaminase elevations.
Consideration must be given to potential adverse neurodevelopmental effects based on each child's individual condition, prognosis, and risk:benefit ratios.

Family and caregiver considerations

Parents who seek medical cannabis for their children report barriers to access and a
need for unbiased information.
The lack of reputable sources may push them to seek information from social media,
cannabis storefronts, or friends.

Authorizing medical cannabis in children

Authorization of medical cannabis in children should be based on individual benefits and risks, considering previous therapies, prognosis, and symptom severity.
Smoking and edibles are not recommended due to dosing issues and respiratory hazards.
Cannabinoid oils are typically given orally, but may cause unpleasant side effects.
Only medical cannabis authorization allows legal access to CBD for children in Canada, but few clinicians are trained in this process.
Clear treatment goals, dosing schedules, timelines, and discontinuation parameters are
important.

Recommendations

Further research is needed to establish the role of medical cannabis in paediatric
conditions.
Counselling should include evidence-based, unbiased information to help parents
make informed decisions.
Therapeutic considerations should focus on the child's condition, prognosis,
potential benefits and risks, a clear treatment plan, and follow-up.
There is also a need for unbiased education for clinicians on THC, CBD, and
other cannabinoids, including potential risks and benefits.

For more information, visit www.medcannkids.ca

Produced by Jessica Steer and Zina Zaslawski in November 2023.

C4T is an academic partnership. Funding details and COI are available on our website.

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