​Medicinal Cannabis for children:  ​(All CBD International tretaments are Free for children in Hospice & Palliative care.)

Using cannabis products for a medical purpose in children under the age of 18 years is increasing. There are many medical cannabis products available that can include cannabidiol (CBD) or delta-9-tetrahydrocannabinol (THC), or both cannabinoids. Despite many therapeutic claims, there are few rigorous studies to inform the dosing, safety, and efficacy of medical cannabis used in paediatric clinical practice. This statement reviews the current evidence and provides recommendations for using medical cannabis in children. Longer term (2-year) reports support the sustained tolerability and efficacy of cannabidiol therapy for patients with Lennox-Gastaut and Dravet syndromes. CBD-enriched cannabis extracts containing small amounts of THC have been evaluated in a small number of paediatric patients, and further research is needed to inform clinical practice guidelines. Given the widespread use of medical cannabis in Canada, paediatricians should be prepared to engage in open, ongoing discussions with families about its potential benefits and risks, and develop individualized plans that monitor efficacy, reduce harms, and mitigate drug−drug interactions.

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Cannabis contains a complex mixture of hundreds of bioactive compounds. Of the more than 140 cannabinoids it contains, the two most abundant and well-studied are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), although other cannabinoids may have therapeutic potential. THC and a few other minor cannabinoids produce euphoric effects associated with cannabis use, while CBD elicits broad antioxidant, anti-inflammatory, and neuroprotective effects. The endocannabinoid system includes CB1 and CB2 receptors. Both are G-protein-coupled receptors, which means they work as cellular surface trans-membrane proteins that convert extracellular signals, such as from drugs, hormones, and neurotransmitters, into intracellular responses. 

CB1 receptors are found primarily in the central and peripheral nervous system, though recently they have also been found outside the nervous system, while CB2 receptors are found throughout the human immune system. THC exerts its primary effects as a partial agonist of CB1 receptors, while CBD is a negative allosteric modulator of CB1 and acts via several other receptors, such as serotonergic and vanilloid receptors. Literature has suggested that minor cannabinoids and terpenoids may have synergistic effects, possibly through competition for drug metabolic enzymes or direct receptor activation. The pharmacodynamics of cannabinoids are affected by their formulation, the route of administration, and gastric contents. The mechanisms of action for CBD are still under investigation.

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​Cancer and Palliative care ​(All CBD International tretaments are Free for children in palliative care.)

Cancer and palliative care 92% of Canadian paediatric oncologists and palliative care physicians had provided care to at least one child who had used cannabis for medical purposes, with or without an authorization from a health care provider. Despite limited research on cannabis use in children with cancer, reported reasons for using cannabis products in this population vary widely, from managing cancer and cancer treatment-related symptoms to aiming for a cancer cure. There is significant interest among families regarding the reputed antitumor properties of cannabis, based in part on in vitro and in vivo work. ​Prognosis remains a key consideration for physicians who authorize medical cannabis for children. One observational report of 21 Canadian children (aged 3 months to 19 years) who were followed by a paediatric palliative care team found they all experienced symptoms improvement after receiving cannabis for pain or nausea and vomiting

 The effects of medical cannabis on seizures was mixed, some adverse events were reported in 33% of children, which  included somnolence, insomnia, and vomiting. One study of six children who received palliative care with cannabis oils reported reduced pain and seizure frequency, with mild and transient side effects. Cannabis oil has successfully managed spasticity in children with neurological complexities and receiving palliative care. This evidence has informed international pharmacovigilance work on the safety and efficacy of medical cannabis for children receiving palliative care.

Safety considerations

Cannabis-related adverse events should be discussed with children and adolescents, as appropriate for age and stage, and with family whenever possible. Such conversations should differentiate clearly between what is known about individual product components (THC, CBD, terpenes, other cannabinoids) versus indications, product types, and dosing information that have (and have not) been studied in children and youth. Little is known about the short or long term safety of Oral THC in medical cannabis formulations, due to a paucity of early phase studies and poorly characterized exposures. THC levels can vary based on interactions with other drugs, cannabinoids, and terpenes (e.g., limonene). Due to the lipophilic nature of THC, blood levels do not correlate well with clinical effects, intoxication, or central nervous system effects. Research suggests that THC may alter white and grey matter distribution in the developing brain, and may impair memory.  The potential for adverse neurodevelopmental effects must be considered in the context of each child’s overall condition and prognosis and the risk to benefit ratios of alternative therapies. The suggestion is to circumvent the gastro intenstinal tract by administering suppository based treatments for cancer and palliative prognosis.