Medical cannabinoids effective for chemo-induced nausea, vomiting in kids

Last Updated: 2017-10-25

By Anne Harding

NEW YORK (Reuters Health) - Medical cannabinoids can be beneficial for chemotherapy-induced nausea and vomiting (CINV) in children, and there is growing evidence they may help pediatric epilepsy patients as well, according to a new systematic review.

But there is not enough data to support cannabinoids for pediatric spasticity, neuropathic pain, post-traumatic stress disorder (PTSD) or Tourette syndrome, Dr. Shane Wong and Dr. Timothy Willens of Massachusetts General Hospital in Boston conclude in their report, online October 23 in Pediatrics.

Medical marijuana is now legal in 29 U.S. states and the District of Colombia, leading to a "widening gap between its accessibility and the limited evidence base for cannabinoids as medical treatment of pediatric populations," the authors note. All of these states allow the use of medical marijuana in minors with a guardian's consent and physician certification, they add.

To look at the evidence base for medical cannabinoids in children, the authors reviewed 22 studies including 795 patients. Cannabinoids tested included plant-derived cannabidiol (CBD) and tetrahydrocannabinol (THC), as well as nabilone and dronabinol, synthetic forms of THC approved by the U.S. Food and Drug Administration for treating CINV.

Eleven of the studies were of seizures, six were in CINV, two in spasticity, and one each in tics, PTSD and neuropathic pain.

Evidence was strongest for CINV, with randomized controlled clinical trials of both nabilone and THC showing benefits.

One randomized controlled trial found that CBD reduced seizure frequency in children with Dravet syndrome, while an open-label trial found benefit in patients with treatment-resistant epilepsy. The remaining studies of CBD in children with seizures were smaller but also found benefits.

The evidence is not sufficient to support the use of cannabinoids in pediatric spasticity, neuropathic pain, PTSD or Tourette syndrome, the authors conclude.

While some information can be drawn from studies of medical cannabinoids in adults, "we have to understand that the child's brain is much different from an adult, so they are much more vulnerable to the negative effects of cannabis," Dr. Wong noted in a telephone interview with Reuters Health.

Associations between recreational cannabis use and negative psychiatric outcomes in young people are particularly strong in those who started using the drug at a younger age, at higher frequencies and higher dosages, he added.

If a parent does approach a physician to discuss medical cannabis, Dr. Wong said, they should be prepared to thoroughly discuss the risks and benefits for their child.

Dr. Scott Hadland, an adolescent medicine and addiction specialist at Boston University School of Medicine, told Reuters Health, "Although the authors found a small amount of high-quality data for use of cannabis for chemotherapy-induced nausea and vomiting and some early indications that cannabis may also be effective for epilepsy, overall I think this study really demonstrates the gaps we have in our current knowledge."

He added: "The problem right now is that our research and our policies are not keeping pace with what the general public is asking for."

The American Academy of Pediatrics has called for rescheduling cannabis to make it easier to study, and Dr. Hadland said he supports this recommendation, but is concerned that legalizing medical use of cannabis may give teens the wrong impression.

"I worry that legalizing marijuana and highlighting with preliminary data the small ways in which marijuana may be effective for a limited number of conditions may actually send the message to adolescents that marijuana is safe," he said. But marijuana has been linked to mental health problems in teens, the researcher pointed out, and many young people who start using cannabis more heavily have difficulty quitting or cutting back.

SOURCE: http://bit.ly/2ixi1c1

Pediatrics 2017.