Medical Cannabinoids in Children Poorly Tolerated

Written by Hannah Harp

Spoon Feed
Children treated with pharmaceutical-grade cannabinoids for various health conditions were more likely to withdraw from studies and experience serious adverse events.

Synopsis
This systematic review and meta-analysis evaluated the adverse event profile of cannabinoids used in 23 randomized controlled trials (RCTs) involving 3,612 pediatric participants. Key findings included increased risks of overall adverse events (risk ratio, RR 1.09, 95%CI 1.02-1.16), serious adverse events (RR 1.81, 95%CI 1.21-2.71), and withdrawals due to adverse events (RR 3.07, 95%CI 1.73-5.43). Commonly reported adverse effects included somnolence, diarrhea, and elevated liver enzymes. Limitations included heterogeneity in study design and short study durations, precluding long-term safety conclusions. The study highlights the need for careful risk-benefit assessment and long-term safety research when prescribing cannabinoids to children and adolescents. (AI-generated)

Despite heterogeneity, side effects abound
Cannabinoid products are currently approved for children only for drug-resistant epilepsy and chemotherapy-associated nausea and vomiting. Such approved treatments already have plenty of potential adverse effects, and this review included other treatment indications (intellectual disability, autism, cannabis use disorder), which makes it difficult to analyze adverse effects in a pooled sample. In fact, the main weakness of this review is the heterogeneity of the included studies—with a wide range of indications, formulations, and dosages of CBD/THC. Some studies were published as early as 1977 and used THC-containing or THC-derived substances. Standardized dosing in the form of nabilone started in the mid 80s. For pre-nabilone studies, potency of those extracts was not standardized. I’d like to see adverse events grouped by dosage and to compare pharmaceutical-grade, regulated products (cannabidiol, nabilone, and dronabinol) with THC or THC-like products. As indications for these medications expand, learning more about their effects on neuropsychological development in children and adolescents becomes even more important. We need more data on the long-term effects as well.

How will this change my practice
As a PCP, I’ll likely never be prescribing cannabinoids, but occasionally parents ask my opinion about using CBD oil for such-and-such. With more non-pharmaceutical CBD products, we should be able to counsel parents about them, emphasizing the known adverse effects and the uncertainty about what we don’t yet know.

Source
Cannabinoids Used for Medical Purposes in Children and Adolescents: A Systematic Review and Meta-Analysis. JAMA Pediatr. 2024 Nov 1;178(11):1124-1135. doi: 10.1001/jamapediatrics.2024.3045. PMID: 39283619; PMCID: PMC11406456.