CBD use in youth has become a hot topic in recent years. There has been a noticeable shift in the societal perception of certain substances being of medicinal value rather than being viewed as substances of nefarious nature. The current conversations around things like cannabis and even some other psychedelic substances are quite a bit different than the conversations fueled by the war on drugs in previous eras.
To start, let’s look at the difference between CBD and THC. Both are cannabinoids that are found in marijuana. While there are similar benefits in what both CBD and THC may help treat, the most important distinction between the two is that THC can cause a person to experience a high. CBD on the other hand will not.
FDA approved CBD Treatment
The only FDA-approved CBD use for pediatric patients is for specific forms of epilepsy (*Epidiolex described in more detail in the Q and A below). Many stores sell CBD products over the counter. However, there are no safety and quality requirements for non-prescription CBD. There are currently many CBD products available on the market and it is important to understand where each product is coming from and whether or not they have undergone any sort of purity testing. While many professionals, in both the cannabis industry and the medical field, will attest to the fact that CBD and cannabis use does look promising for numerous health conditions and medical purposes, there is a distinction between what is “thought” or “expected” to be true and what has actually been proven by scientific data and evidence.
Jacquie Cohen Roth, MS, Founder and CEO of Cannabiz MD, says that when it comes to youth, “Pediatrics are not tiny humans, they are not miniature versions of ourselves, their bodies work very differently. There is not a great deal of scientific evidence yet to prove safe and effective use of CBD in youth.” She does go on to say that for youth suffering from seizure disorders, there have been some medical advancements and discoveries made resulting in approved treatments.
Misinformation About CBD Use in Youth
When looking at safe and effective use of CBD Roth says there is a lot of misinformation out there about cannabis in general. “These plants cannot kill you.” She says. “There is no fear of overdose.” This does not mean that there are no contraindications or adverse effects, it simply means that the risk of severe effects is minimal which is part of the drug’s appeal in looking at how it can be used to effectively treat children and adults suffering with chronic health conditions.
Safe Treatment of CBD Products
Roth says that for parents and families who keep cannabis or CBD products in the home, they should keep the products safely locked and stored out of the reach of children much in the same way that any other pharmaceutical would be stored. She questions the ethics and safety of the numerous products on the market that are designed to look like cookies, candy, or other appealing food products.
“We are a medical industry.” She says, “Kids should know that these are not treats, they are substances for medical use.” In children who ingest too much of a CBD or cannabis product, Roth says they may need to seek medical intervention to address hyperemesis, or uncontrollable vomiting. “Treatment for that would be things like fluids at the ER.” She says. “In some cases it can also slow breathing, so it is safe but it is not risk free.” In terms of cannabis use among youth, Roth said that there are some studies that showed a decline in juvenile use after it became legalized in Colorado.
As far as looking for reputable brands in CBD products Roth says that we simply don’t know where some of these products on the market are coming from. One brand she does feel comfortable recommending is Charlotte’s Web, but she says that parents wanting to incorporate CBD in a child’s treatment plan should seek the insight of their pediatrician. She also says that parents should not be afraid of talking with their own providers about their personal use of CBD or cannabis use.
Do Pediatricians Endorse CBD Use in Youth?
When speaking with area pediatricians about CBD use in youth, there is a pretty similar consensus in the idea that while there is some promising anecdotal evidence, more scientific studies are needed to truly understand the safety and efficacy for pediatric use. Dr Faith Hackett of SP Docs says “The data is just not there yet. I am curious to see what actual data will show.”
Another well known pediatrician in the Annapolis area spoke on the condition of anonymity stating their belief that there are some very real benefits to using CBD in treating pediatric patients. They stated that through their integrative approach to pediatric treatment they do use CBD quite frequently and “Find it VERY helpful.” They expressed gratitude that this topic of conversation is starting to see more light.
Q & A
For a deeper look at CBD use in the youth population, we sought insight from Chad Johnson, PhD, Co-Director of the Masters in Cannabis Science and Therapeutics Program at the University of Maryland, Baltimore School of Pharmacy and the Masters in Medical Cannabis Science and Therapeutics program. Our Q and A can be seen below.
1) What is the difference between CBD and THC
Despite having very similar chemical structures, they can elicit different effects. While both cannabinoids have the ability to cross the blood-brain barrier (and hence could be considered “psychoactive”), THC is responsible for creating the “high” or sense of euphoria due to its ability to bind to and activate the CB1 (cannabinoid type 1 receptor) in the brain. On the other hand, CBD is not psychoactive in the same manner as THC. It binds very weakly to CB1 receptors and does not produce the same euphoric effect. In fact, it is thought to counteract some of the unwanted psychoactive effects of THC.
2) Are there risks for addiction or dependency
Currently, the DEA classifies potential drugs of abuse into five scheduling categories. THC is currently a Schedule 1 drug because it has the potential for abuse and has no federally approved medical use. When referring to abuse liability, it is important to discuss four terms: tolerance, dependence, reinforcement, relapse—not the word addiction. Drugs of abuse hijack the internal reward system by eventually increasing extracellular levels of dopamine.
This “hijacking” of the reward system is what we call reinforcement and is an acute effect—meaning it can happen after one dose. Upon chronic administration of the drug, your body adapts to having the drug in your system, which can occur through various cellular mechanisms in the body. If you were to stop taking the drug suddenly, you would experience withdrawal symptoms. For example, if you drink a lot of coffee each day, your body will adapt to the elevated caffeine levels. But when you go a day or two without caffeine, you might get terrible headaches. This is an example of withdrawal from caffeine because you have become dependent on it.
If you are dependent on a drug and stop taking it, you experience withdrawal symptoms. Therefore, you begin seeking the drug to eliminate the withdrawal signs, not necessarily for its rewarding effects. So, both dependence and reinforcement lead to drug-seeking behavior but for different reasons. Tolerance is simply needing more of a drug to elicit the same effect, which can happen with many medications, not just with cannabis.
Research has shown that THC is reinforcing due to its ability to bind and activate CB1 receptors in the brain. Additionally, we’re aware that it is taken because of its ability to elicit the “high” feeling associated with cannabis use. THC has also been shown to cause dependence since chronic administration of THC over time followed by stopping leads to withdrawal symptoms. However, the withdrawal signs are not as severe as opioids. In contrast, CBD does not appear to activate the CB1 receptors in the brain, and therefore, there is no current evidence that suggests CBD causes reinforcement, dependence, or tolerance.
3) Are there laws and regulations surrounding the use of CBD?
Federally, CBD and THC are still illegal substances and are only approved for medication and recreational use in certain states. Therefore, should a patient or parent/guardian want to begin using or administering CBD/THC (or whole plant) as a potential alternative therapy, it is imperative that they first investigate their state guidelines. A great way to do this would be to contact your state Medical Cannabis Commission.
4) Are there guidelines on pediatric use?
What we can say for certain right now comes from the clinical trial results from Epidiolex. When administered to pediatric patients aged 2 years or older with Lennox-Gastaut syndrome or Dravet syndrome in a dosage range of 5-20 mg/kg/day, it reduced the frequency of seizures by 36-41% when compared to placebo. CBD has not been adequately studied (e.g., randomized clinical trials) for treatment of other conditions for which it has claimed to have a positive therapeutic effect.
There are several clinical trials currently underway attempting to close this gap in knowledge—so we will have answers in the future! Please talk to your child’s pediatrician if you think your child may benefit from CBD use.
5) Can a child on CBD be denied access to it in schools.
This has been a popular topic of debate in many states, and several legal proceedings have occurred over the right of children to have their CBD (or medical cannabis) administered by a nurse at school. Some states have passed legislation allowing CBD to be administered to children in school, however, I would encourage any parent considering this option to speak to the school’s administrators and review your state’s current laws and regulations. In some cases, it may be best to obtain legal advice if necessary.
6) What should parents know?
Do your research before trying an alternative treatment regimen. The cannabis field still lacks regulation (although it is improving), so it is important to vet the sources from which you obtain information and advice. Also, recognize that the cannabis field is quickly evolving, but there is little research on the long-term safety of CBD administration to children (or adults). Contacting your state’s cannabis commission or your healthcare provider would be a good start collecting information.
Purchase your products from a licensed dispensary that carries reputable brands/products, should you decide that administration of CBD would be a good fit for you or your child. Be aware that your CBD product may contain small amounts of THC since THC is still present in the hemp plant.
7) What are the differences between available pharmaceuticals on the market and CBD? How should parents decide which approach to take?
There are only a few approved pharmaceuticals on the market that contain CBD and THC. Epidiolex (mentioned above), Nabiximols (Sativex, approved in Europe, not FDA approved), Dronabinol (or Marinol, contains THC), and Cesamet (contains Nabilone, a THC derivative) are the only approved medications to date. Should a parent want to give CBD to their child, the only pharmaceutical option would be Epidiolex. However, since it only has FDA approval to treat seizures associated with Lennox-Gastaut syndrome, obtaining it may be a challenge.
Therefore, parents may have to purchase CBD products from a dispensary, which could cause some concern. For example, CBD products (that are not pharmaceuticals) may not undergo the same rigorous standardization and regulation that pharmaceutical products undergo to ensure quality, purity, etc.
8) Are there any common myths or misconceptions you would like to dispel?
CBD has not been shown to be a drug of abuse and is tolerated at various doses with minimal side effects. But there is still much research to be done in order to fully understand the therapeutic potential (along with dosing regimens) of CBD.
9) What would you say to those who view CBD and cannabis as illicit and dangerous drugs?
According to current research, it is not. I would encourage those who make this claim to consider reading the WHO’s report in 2017 on CBD. The cannabis industry does need more regulation and oversight to ensure quality products are being produced for patients.
By Jillian Amodio