In the past ten years or so there has been a lot of interest to see if medicinal cannabis can help children with emotional and behavioural problems - the ones associated with conditions such as autism, ADHD (attention-deficit hyperactivity disorder) and Tourette syndrome.
Authors
- Daryl Efron
Associate Professor, Department of Paediatrics, The University of Melbourne
- Kaitlyn Taylor
Clinical Trial Coordinator, Murdoch Children's Research Institute
Australia's drug regulator confirms doctors are prescribing medicinal cannabis for such conditions.
If discussions on social media are anything to go by, some parents want their children to try it when other strategies have not worked. Some teenagers are curious to see if it's right for them.
But there's not yet a lot of high-quality evidence to support medicinal cannabis for these emotional and behavioural problems. There are also potential safety concerns.
Why medicinal cannabis?
Many children with conditions such as ADHD, autism and Tourette's have major emotional and behavioural problems, including anxiety, agitation and aggression. Alongside psychological therapy, and family and other supports, these children often take medications such as stimulants, antidepressants and anti-psychotics.
These medications can be very helpful, especially for ADHD . But these medications are not effective for all children with these conditions. They also have a high rate of side effects.
So some doctors and parents hope medicinal cannabis can help manage these emotional and behavioural problems and possibly allow some children to stop taking their other medications.
According to data from the Therapeutic Goods Administration (or TGA), autism, anxiety and ADHD are among the most common conditions for which medicinal cannabis is prescribed for children and teenagers in Australia.
However, our survey found over half of the medicinal cannabis used for children with emotional or behavioural problems was purchased without a medical prescription, and one-quarter had not told their child's doctor about it.
Some parents hear about the potential for medicinal cannabis to help their children from online support groups. Others read about it on websites of medicinal cannabis clinics or manufacturers, or via media reports .
Does it work?
There have not been many high-quality studies of using medicinal cannabis in children with behavioural and emotional difficulties. Most have not used a placebo (such as oil without any cannabis) to compare.
The best designed study so far found mixed results in 150 people aged 5-21 years with autism. Some of its findings suggest medicinal cannabis may help with disruptive behaviour, other findings suggest it is no better than placebo.
A number of well-designed clinical trials of medicinal cannabis are being conducted internationally in children and adolescents with conditions including autism and ADHD .
Our large Australian study in children with intellectual disabilities and autism has just been completed. We expect results will be published this year.
So, to date, the published evidence does not support its use for behavioural and emotional difficulties in children and adolescents.
Medicinal cannabis prescriptions have skyrocketed in Australia, mostly for legal but unapproved products we don't even know work or are safe. In this series , experts tease out what's fuelling the rise of medicinal cannabis, the fallout, and what needs to happen next.
Are there side effects?
Like all other medicines, medicinal cannabis has potential side effects. These differ depending on the main active ingredient.
There are hundreds of chemicals in the cannabis plant. But the two main ones are tetrahydrocannabinol (THC) and cannabidiol (CBD).
THC is a powerful compound that causes the "high" in recreational cannabis use. Because it can potentially cause serious side-effects (such as paranoia and psychosis), it's not generally recommended for children.
But CBD seems to cause fewer side effects . These include a stomach upset, decreased appetite, irritability or feeling sleepy. So some doctors might prescribe a trial of CBD, despite the lack of strong evidence to show it works.
However, CBD needs to be used carefully if a child is also taking certain other medications, such as some sedatives and anti-seizure medicines. That's because it can interact and cause other medicines to build up, increasing the risk of side effects.
There have also been no studies of the long-term effects of medicinal cannabis on children.
Is it right for my child?
Most medicinal cannabis products prescribed in Australia for any condition are "unapproved". This means the TGA has not assessed them for safety, quality or effectiveness.
However, if you'd like to find out more, talk to your child's doctor. They will consider your child's medical history, existing medications, discuss the options, and explain the pros and cons.
If it's right for your child, they will likely prescribe a product containing almost entirely CBD, as an oil taken orally. Pastilles (tablets that dissolve in the mouth) are also available, as well as cannabis gels that are rubbed on the skin.
However, medicinal cannabis for behavioural and emotional problems is not subsidised by the government, so is expensive. The price varies according to factors including the dose used, the individual product and the supplier.
Some caution
Until robust evidence comes in, we don't yet know if medicinal cannabis works to manage children's emotional and behavioural problems. There are also some potential safety concerns.
So your child's doctor is best placed to give personalised advice.
Daryl Efron is a Consultant Paediatrician at The Royal Children's Hospital and Senior Research Fellow at the Murdoch Children's Research Institute. His medicinal cannabis research has been predominantly funded by a Medical Research Future Fund (MRFF) grant, but has also been supported by small project grants and study drug provided in-kind from Cann Group and Cannatrek, study drug provided in-kind from Tilray, and in-kind study drug manufacturing support from Epsilon Healthcare. These companies have had no role in the design, conduct or reporting of research results. Daryl Efron does not work for, consult, own shares in or otherwise receive funding from any company or organisation that would benefit from this article.
Kaitlyn Taylor is employed through Daryl Efron's MRFF grant outlined above.
