Medical Use of Cannabis and CBD in Children
Many states have now legalized medical use of marijuana products, and several, including Washington, have legalized recreational use as well. This has led to more questions about the role any of these products may have for pediatric patients. Little research exists on the use of these products in children. Despite legalization at the state level, the federal government still classifies marijuana as a Schedule I drug, meaning there is “no current accepted medical use.” Research on Schedule I drugs, is greatly limited.
Compounds and Their Effects
THC (tetrahydrocannabinol) is the active compound in marijuana plants that provides the psychoactive effects. Low levels of it can also be found in hemp.
CBD (cannabidiol) is found in marijuana or hemp. It does not have psychoactive effects, other than sedation. Its use has been touted for many different conditions, and many forms of the product are available without a prescription. CBD derived from marijuana plants is illegal at the federal level. CBD derived from hemp is legal at the federal level and in most states.
A few drugs containing THC or close derivatives are FDA approved for limited indications, such as nausea associated with chemotherapy or anorexia in AIDS patients. These must be prescribed by a physician. None are FDA approved for patients under the age of 18. Products containing THC are not legal for children in any state, so there is essentially no research on their use.
One new drug called Epidiolex has been developed that contains purified CBD. It has been found to be effective in treating seizures in two rare conditions: Lennox-Gastaut syndrome and Dravet syndrome.
Other than Epidiolex, no FDA approved or regulated forms of CBD exist. It is available without prescription, in a variety of forms such as oils, gummies and patches. The purity and the amount of CBD in these products is highly variable. Some products will contain small amounts of THC, which is not recommended for children. CBD can have adverse effects. It interferes with the metabolism of a number of prescription medications. The clinical trials of the drug Epidiolex showed that CBD can be toxic to the liver in some patients.
CBD products are being used in children by their parents for a variety of reasons but there are not good studies to support this. There is some evidence that CBD is helpful for anxiety in adults, but this has not been studied in children. One study suggested CBD could help reduce symptoms in children with more severe forms of autism, but the study did not include a control group. More research needs to be done before this can be recommended.
The American Academy of Pediatrics does not support the use of medical marijuana products outside the regulatory process of the FDA. They do support changing the DEA classification of marijuana to Schedule II, which would make it easier to do more research. They do not recommend any drug ever be administered through smoking.
Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists do not recommend the use of marijuana products in pregnancy. There is no amount of marijuana use in pregnancy known to be safe. Use in pregnancy has been associated with fetal growth restriction, preterm birth, higher risk of stillbirth and miscarriage, and a higher rate of admission to neonatal intensive care units.
The bottom line is that there is very little reliable scientific evidence available at this time to support the use of cannabis or CBD products in pediatric patients. We encourage you to discuss any questions about CBD use with your child’s provider.
CBD: What Parents Need to Know
Parents are giving it to kids to combat anxiety and other problems. But there are risks, and little research to support it.
What You’ll Learn
- Is CBD safe for kids?
- What are the risks of giving kids CBD?
- Can CBD help kids who have mental health disorders?
- Quick Read
- Full Article
- What do we know about CBD?
- Concerns about CBD
- Is CBD safe?
- CBD oil for anxiety
- CBD and autism
- Research boom
These days, you can find CBD everywhere. Some people believe that it can treat everything from chronic pain and cancer to anxiety and ADHD. But is it safe for kids?
CBD is still pretty new, so there’s very little research about its safety or how well it works, especially for children. So far, there’s only one marijuana-derived medication that has been approved by the Food and Drug Administration. It’s called Epidiolex, and it’s used to treat a rare form of epilepsy in patients who are at least two years old.
Because CBD is so new, there also aren’t a lot of rules about what can and cannot be included in CBD products. So, there’s a huge variety in the quality of products. You may even find different amounts of CBD in different packages of the same product.
Since there isn’t a lot of research about CBD, doctors say there are some risks with using CBD for kids. For example, CBD products may contain things other than CBD, and those things could be harmful. Plus, we don’t yet know if CBD works well with other medications or how much you should give your child.
Although a few studies have found that CBD oil might work for anxiety, they only looked at healthy people who were put in situations that made them anxious. There are no studies yet on people with chronic anxiety. Researchers are also exploring CBD for kids with autism spectrum disorder. The results are good so far, but more research needs to be done before we can know if it’s safe and effective.
CBD is everywhere. From corner stores and bars to medical marijuana dispensaries, it’s being offered for its reputed ability to relieve pain and make people feel better.
Though CBD — full name cannabidiol — is extracted from marijuana or hemp, it doesn’t contain THC, the chemical in marijuana that has psychoactive effects, so it doesn’t make you feel high.
Available in the form of vaping, oils, lotions, cocktails, coffee, gummies — you name it — CBD has been touted as a treatment for complaints as far-reaching as chronic pain, cancer, migraines, anxiety and ADHD. You know it’s gone mainstream when even Consumer Reports has issued guides on how to shop for CBD and tips for safe CBD use.
Not only are adults experimenting with CBD for whatever is bothering them, increasingly parents are turning to CBD to help their kids focus, sleep, calm down and more.
But popular use of CBD is blowing up with very little research into its safety or its efficacy, especially in children. The first and only marijuana-derived drug approved by the Food and Drug Administration, Epidiolex, is used to treat a rare, severe form of epilepsy in patients two years of age and older. And since cannabis is in the early stages of legalization and regulation, there is a huge variety in the quality and dosage of products — risks associated with using products that have not been vetted by the FDA.
What do we know about CBD?
For millennia, hemp plants have been used for medicinal purposes around the world. In 1851 marijuana was classified by the United States Pharmocopeia as a viable medical compound used to treat conditions like epilepsy, migraines and pain. But since marijuana and cannabis-related products were made illegal in the US in 1970, there has been a dearth of research about either marijuana or CBD. Its classification as a Schedule 1 drug made it nearly impossible to get federal funding to study cannabis.
“The biggest problem is there’s a lot that we still need to know, especially in kids,” says Paul Mitrani, MD, a clinical psychiatrist at the Child Mind Institute. “In regards to treating mental health disorders in children and adolescents, there’s a lack of evidence to support its use.”
Dr. Mitrani, who is a pediatrician and child and adolescent psychiatrist, says it’s an area worthy of investigation but recommends that parents wait until further research is done before giving a child CBD.
Concerns about CBD
While anecdotal evidence of the benefits of CBD is common, there are risks associated with using these products, especially in children. Some of the concerns:
- Products are unreliable in delivering a consistent amount of CBD. They could have less, or more, than advertised, and most do not offer independent verification of active contents. Analysis of products for sale show that many do not have the amount of CBD that they advertise. “So you can’t depend on the quality of what you’re getting,” notes Dr. Mitrani.
- How much is absorbed? Very little is known about how much CBD is actually delivered to the brain in a given product. Various delivery systems — vaping, taking it orally, eating it in baked goods, etc. — have different rates of delivery. Even the oils that the CBD is dissolved in can result in varying effects. “Effects can vary a lot based on the delivery system used and the amount people are exposed to can be inconsistent,” Dr. Mitrani says.
- Products may contain things other than CBD, and they could be harmful. Lab testing — which provides information about CBD levels, THC levels (if any), and contaminants in the product — isn’t mandatory for CBD products in every state. Without a CoA (Certificate of Analysis) it’s that much harder to verify the safety of the product. Bootleg CBD may be connected to recent lung illnesses and deaths that have been attributed to vaping. The CDC and the American Medical Association recommend avoiding vaping entirely while the cause of these illnesses is determined.
- CBD may be safe itself, but it may interact with other medications a child is taking, that are also metabolized in the liver.
- If it’s used for sleep, Dr. Mitrani worries that while it may potentially help with sleep, “your child may become tolerant to it and possibly experience worsening sleep problems if stopped.”
- Since CBD use — especially for kids — is a still so new, few people are familiar with dosing for children, so determining how much to give your child would be tricky. Clinical doses versus what you might find at a coffeehouse could vary dramatically.
- The legality of cannabis products and CBD is still murky. CBD derived from hemp is federally legal, while CBD derived from marijuana plants is subject to the legal status in each state — and remains federally illegal. Meanwhile, the FDA issued a statement making clear that products that contain CBD — even if they are derived from legal, commercial hemp — cannot claim to have therapeutic benefits or be sold as dietary supplements unless they have been approved by the FDA for that use.
Is CBD safe?
Last year the World Health Organization, acknowledging the explosion in “unsanctioned” medical uses of CBD, reviewed the evidence for its safety and effectiveness. The WHO report concluded that “CBD is generally well tolerated with a good safety profile.” Any adverse effects could be a result of interactions between CBD and a patient’s existing medications, the WHO noted.
The report found no indication of potential abuse or dependence. “To date there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.”
As for effectiveness, the WHO noted that several clinical trials had shown effectiveness for epilepsy, adding: “There is also preliminary evidence that CBD may be a useful treatment for a number of other medical conditions.”
CBD oil for anxiety
In 2015 a group of researchers led by Esther Blessing, PhD, of New York University, investigated the potential of CBD for treating anxiety. In a review of 49 studies, they found promising results and the need for more study.
The “preclinical” evidence (ie from animal studies) “conclusively demonstrates CBD’s efficacy in reducing anxiety behaviors relevant to multiple disorders,” Dr. Blessing wrote. Those include generalized anxiety disorder, PTSD, panic disorder, social anxiety disorder and OCD.
The review notes that the promising preclinical results are also supported by human experimental findings, which also suggest “minimal sedative effects, and an excellent safety profile.” But these findings are based on putting healthy subjects in anxiety-producing situations and measuring the impact of CBD on the anxiety response. Further studies are required to establish treatment with CBD would have similar effects for those who struggle with chronic anxiety, as well as what the impact of extended CBD use may be.
“Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders,” Dr. Blessing concludes, “with need for further study of chronic and therapeutic effects in relevant clinical populations.”
CBD and autism
A group of Israeli researchers have been exploring the use of CBD to reduce problem behaviors in children on the autism spectrum. A feasibility study involving 60 children found substantial improvement in behavioral outbreaks, anxiety and communication problems, as well as stress levels reported by parents.
The researchers, led by Adi Aran, MD, director of the pediatric neurology unit at Shaare Tzedek Medical Center, went on to do a double-blind, randomized, placebo-controlled trial with 150 participants with autism. In this trial, just completed but not yet analyzed, patients were treated CBD for three months.
In the US, research has been given a boost by changing guidelines and laws. In 2015 the DEA eased some of the regulatory requirements that have made CBD, as a Schedule 1 substance, difficult to study. “Because CBD contains less than 1 percent THC and has shown some potential medicinal value, there is great interest in studying it for medical applications,” the DEA said in announcing the change.
And in approving the first CBD-based drug, Epidiolex, last year the FDA expressed enthusiasm for the research boom that is sure to come, paired with stern words for the flood of marketers of products claiming unsubstantiated health benefits.
“We’ll continue to support rigorous scientific research on the potential medical uses of marijuana-derived products and work with product developers who are interested in bringing patients safe and effective, high quality products,” the FDA pledged. “But, at the same time, we are prepared to take action when we see the illegal marketing of CBD-containing products with serious, unproven medical claims.”
Children and CBD: What parents should know first
CBD could cause problems with Child Protective Services, because of what some call a loophole in our state law.
SOUTHERN COLORADO — Cannabidiol, otherwise known as CBD, is a derived from the hemp plant and is now one of the most common cannabis products used to treat a variety of medical conditions, ranging from epilepsy to autism.
As parents seek out this treatment for their children, they could run into problems with state Child Protective Services due to a perceived loophole in Colorado law.
News5 spoke with staff at the El Paso County Department of Human Services, who say calls regarding child CBD usage do not make up a large percentage of their workload. A local cannabis group for medical patients, the Canna-Patient Resource Connection says otherwise, claiming they’ve seen a spike in the number of parents coming forward asking why DHS would question their child’s CBD usage.
News5 spoke with several families and their experiences with CBD and problems with authorities who watch out for the well-being of children.
In Colorado, CBD products are legally allowed to contain .03% of THC (Tetrahydrocannabinol), which is the part of the cannabis plant that gets a person high. The Canna-Patient Resource Connection says that small amount of THC can build up over time, possibly leading to a positive result for marijuana use on a drug test. With the rapid spread of CBD products across the country, not regulated by the US Food and Drug Administration, it is difficult to know the exact amounts of THC in the products.
“By definition, you are always giving your child THC and that’s the loophole that CPS uses. It’s not necessarily that you’re giving CBD, it’s that you are technically always giving the child THC, and that’s illegal under state law unless you are in the registry,” said Bridget Seritt, the co-founder of the Canna-Patient Resource Connection.
Seritt says it is common for cases regarding CBD to be dropped by DHS quickly. She wants to remind parents it would be wise to take steps to secure a medical marijuana card for their child before using CBD products recommended by a doctor.
Marijuana is still considered a Schedule I drug under federal law and illegal for children to use without the proper documentation secured. On the other hand, CBD is derived from hemp, which is no longer considered a controlled substance because of the Farm Bill.
News5 visited Grow Life Medical Dispensary in Colorado Springs which does sell CBD products containing THC. Manager Chris Spurlock says people should expect some THC in almost every CBD product. “However, there are some out there that definitely claim to have zero levels of THC or incredibly low levels. Those you can only trust to a certain extent,” Spurlock says.
Grow Life only sells to to customers who have a medical marijuana card or caregivers of a cardholder. “I know that a lot of these doctors are incredibly careful about giving any kind of recommendation to anybody who’s under 18 at all,” Spurlock says.
Ginger Harless told us she did not realize sat first she needed a medical marijuana card for her son to use CBD products. Her family turned to CBD for treatment after multiple pharmaceutical attempts to treat her son’s autism, bipolar disorder, and ADHD failed.
“I actually asked his pediatrician at first, you know, I’ve read up on this, what do you think? And the pediatrician gave me the information to go see a medical marijuana doctor,” Harless says. Harless told News5 they started using CBD in 2018 and introduced THC into the mix in 2019. She said in October of 2019, DHS was knocking on her door. “Without that credential to have, without that recommendation, and without that card, I could serve jail time,” Harless says.
Harless says she now has a medical marijuana license for her teenage son, but is still upset about being reported to DHS. “For them to then turn me over, to add more to my plate with DHS and police officers, sometimes the days feel absolutely unmanageable,” Harless says.
State law requires ‘mandatory reporters’ to report any suspicions of child abuse or neglect. Mandatory reporters include medical professionals, social workers, firefighters, and police officers. (Click here for a full list)
At the El Paso County Department of Human Services, officials are checking to make sure the child is safe, the substance is stored properly, and there’s a sober caregiver in the house, according to April Jenkins, the Children, Youth, and Family Services Intake Manager.
“When we get a report that there is an allegation that a child may be consuming CBD, if there is no information in that report that this is prescribed or even any medical marijuana is prescribed to that child, that does raise our level of concern. We won’t just go out if we have information that it’s being used properly. So, if a referral comes in and it is clear that it’s being used properly and for the right reasons, and there’s a prescription in place, there may not be a reason for us to respond. But we are responding when there are concerns in that report that alleges that it may be misused,” Jenkins says.
Jenkins says the reporting system used by her department does not classify their calls with specific drug categories. She shared with us data showing the offices received more than 16,000 referrals, assessed a little more than a third of those contacts, and found roughly 1,800 being substantiated for child abuse and neglect.
The Wann Family
News5 spoke to other families who have been reported to CPS in the past for giving their children CBD. One of those families lives in Douglas County, and gives their epileptic son CBD for his seizures. However, they said once they told their school district about the CBD, they were reported to DHS.
Ben Wann has been getting seizures since he was three years old. His mother, Amber Wann, said when they put him on anti-epileptic drugs they noticed some side-effects. “He just had rages and fits and everything like that. And it seemed very painful, it seemed like he was in pain emotionally and we didn’t know how to help him,” said Amber Wann.
With their doctor’s approval, Amber said they started weaning Ben off of the pharmaceuticals, and he went nine months without a seizure. But then, they came back. “They were lasting four minutes long, and five minutes is typically when brain damage sets in for most children, so it seemed pretty dire that we get something for him,” said Amber.
So the family turned to CBD, and Amber said now, Ben has not had a seizure for four years. “It made me relax more,” said Ben Wann.
Amber Wann said she emailed the school to let them know about the changes to Ben’s medication. Soon after she sent the email, she said they were reported to DHS. “We went ahead and just told them that we were giving him Charlotte’s Web and that his doctor knows about it, and that we’re not doing anything wrong,” said Amber Wann.
Amber Wann said the case was dropped pretty quickly, but the family is still fighting the school district. The Wann’s want the district to allow medicinal marijuana to be stored on school campuses, and for the school nurses to be able to administer it. Currently, the Wann’s said only parents or caregivers could administer medical marijuana to a student while on campus. While Ben only takes CBD normally, the Wann’s have a nasal spray that contains THC, which is to be used in case of an emergency to help Ben come out of a seizure.
News5 reached out to the Douglas County School District, which provided this statement: “A complaint has been filed with a State regulatory agency against DCSD regarding this matter. As a result, we are unable to provide anything further at this time.” The district did also point us to their board policies and related documents, which we have attached below.
Still, Amber Wann said she does want to ensure other families are aware of the best way to protect themselves while using CBD for children. “It wouldn’t just hurt to just take the steps to get that medical card and be protected all the way around in case you were questioned,” said Amber Wann.
Amber Wann also pointed to the Rohrabacher-Farr Amendment, which defunds the Department of Justice from coming after people who use or handle medical marijuana.
The Jerger Family
A different side of this story about CBD and children comes from outside of Colorado. The Jerger family now lives in Colorado Springs, after moving from Indiana because they said the Department of Child Services there harassed them for having their young epileptic daughter use CBD.
Lelah Jerger said her daughter, Jaelah, was diagnosed with epilepsy when she was a little more than one year old. Jerger said in 2017, CBD was legal in Indiana for certain medical conditions, but not Jaelah’s specific form of epilepsy. “It was on the fence. It wasn’t legal, but it wasn’t illegal,” said Jerger.
Jerger said their family was reported by the hospital they used for Jaelah at the time. She said DCS was concerned the family was not giving Jaelah her prescribed pharmaceuticals. “She hands us this paper, and this paper says that we are to take Jaelah to the hospital to get lab work done every single week because we have to prove to CPS she’s on Keppra,” said Jerger. Jerger said the Keppra was negatively affecting her daughter.
By October, Jerger said they were told the case looking into their family had been dropped. However, Jerger said caseworkers continued to show up at their home. The Jergers said they filed a lawsuit against DCS at the start of 2018. “That began the crapshoot that was going to be our life from then on. We were investigated by CPS every 30 days,” said Jerger.
Jerger said she felt as though nothing would change in Indiana, and had seen dramatic improvements in her daughter’s seizures since using the CBD. So the family left, and moved to Colorado Springs, where she said they have not once been contacted by the El Paso County Department of Human Services. “They ruined our life in Indiana. They completely destroyed every sense of security that we had, they destroyed every sense of family, I mean everything. But I knew that if we did not get our kids out of there, we would have lost them,” said Jerger.
The Jergers said they will continue their case against DCS in Indiana for as long as it takes, because they believe their rights were violated.
News5 reached out to those with Indiana DCS, who said they cannot comment on pending legislation. The Jerger case can be found on the ACLU’s website.
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