Medical Marijuana for Children

The use of the drug marijuana (also known as cannabis) as a medical treatment for children is a subject that has attracted much public debate. Marijuana is a plant that has been consumed for centuries for its psychoactive and physiological properties, which include a sense of relaxation and euphoria. Medical marijuana, or medical cannabis, refers to the use of marijuana or its derivatives for the treatment of diseases or to ease symptoms. As laws have changed regarding marijuana use in the United States and other countries, the dispute over medical marijuana in the treatment of children with certain chronic and terminal illnesses has also become highly publicized.

Some parents state that medical marijuana, in various forms, has been the only treatment that has successfully helped their child. Notable illnesses in children treated with medical marijuana include leukemia, a cancer that affects white blood cells, and seizure conditions such as epilepsy. Frequent seizures are highly disabling and can lead to brain damage and even death, and marijuana-derived drugs have been approved as effective treatment. Some parents have claimed positive results in treating other conditions as well, such as autism, though experts caution that further scientific research is needed before conclusions can be drawn in such cases.

Critics on the other side of the argument claim that the safety and effectiveness of medical marijuana has never been thoroughly tested on children or adolescents. They often note that the use of marijuana may cause long-term complications during a child’s development. For example, the American Academy of Pediatrics has cited the negative effects of long-term marijuana use on users’ short-term memory, attention and concentration, motivation, reaction time, and tracking ability. There can also be legal complications in the use of medical marijuana for children. Notably, marijuana remained illegal at the federal level in the United States even as many individual states legalized the drug.

Brief History

Marijuana has been consumed for centuries for its psychoactive and physiological properties, which can include a sense of relaxation and euphoria. The drug has been shown to be beneficial in the treatment of chronic pain, migraines, nausea and vomiting, epilepsy, and several other conditions and symptoms. But while medical marijuana has been shown to alleviate numerous negative symptoms, many critics argue that there is insufficient evidence concerning its safety and efficacy.

During the twentieth century, federal law in the United States made the possession, distribution, and use of the drug illegal. Oregon became the first state in the United States to decriminalize possession of small amounts of marijuana in 1973, and California became the first state to legalize medical marijuana in 1996. Nearly 56 percent of California voters approved Proposition 215, also known as the California Compassionate Use Act; the law that allows patients and primary caregivers who have the recommendation of a California-licensed physician to possess and cultivate marijuana for the treatment of various medical conditions. Several more states passed similar laws in the following years.

The use of medical marijuana for children with chronic and terminal illnesses became a widespread topic of debate in the early 2000s. Various medical organizations have recommended the use of medical marijuana to reduce spasticity and pain in patients with multiple sclerosis, to reduce chorea in patients with Huntington's disease, to treat sleep disturbance in patients with fibromyalgia, to reduce HIV-associated neuropathic pain, and to reduce chemotherapy-induced nausea and vomiting. These organizations have also cited many possible side effects of medical marijuana, including dizziness, drowsiness, increased heart rate, anxiety, and increased risk of wheezing and phlegm.

By 2023, thirty-eight US states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands had legalized medical marijuana for patients with qualifying medical conditions, according to the National Conference of State Legislatures. Although the majority of these states allowed the drug's use for children, gaining access sometimes remained difficult for parents. Several states and cities passed or considered laws pertaining to the ability for children to consume medical marijuana treatments at school. All permitting states required a physician’s approval, with some requiring more than one doctor to approve a prescription, and many limited the number of medical-marijuana dispensaries in the state. Furthermore, marijuana remained technically illegal at the federal level in the United States; the US Drug Enforcement Agency categorized marijuana as a Schedule I drug, meaning that it was considered to have "no currently accepted medical use and a high potential for abuse."

Overview

Children treated with medical marijuana are typically given an oral capsule containing oil extracted from the marijuana plant. This extract is low in tetrahydrocannabinol (THC), which causes psychoactive effects, and rich with cannabidiol (CBD), a chemical compound that contains the highest amount of marijuana’s medicinal properties. Studies have shown that this compound can stimulate the endocannabinoid system within the brain, which helps regulate appetite, mood and motor tone, and cellular and humoral responses to neuroinflammation and pain. Other studies have shown that cannabidiol can directly inhibit tumor growth in animals, suggesting it might do the same for humans. However, experts note that there remains a lack of strong research on marijuana's actual medical impact on children. The US Food and Drug Administration (FDA) issued multiple warnings to companies that claimed their CBD products could treat or even cure cancer, for example. The FDA also warned that CBD products often did not even contain the marketed level of CBD and could contain other unlisted substances or contaminants.

The best-studied application of medical marijuana for children relates to seizure conditions, including epilepsy, tuberous sclerosis, Dravet syndrome, and Lennox-Gastaut syndrome. In 2018 the FDA approved the medication Epidiolex, whose active ingredient is CBD, for the treatment of seizures in patients two and over. Epidiolex, which contains no THC, was extensively tested in three clinical trials before its approval and found to be comparable in its side effects to other epilepsy medications. The FDA commissioner stated at that time that the organization supported further rigorous scientific research into the potential medical applications of marijuana.

Children with chronic or terminal illnesses are usually treated with opioid analgesic drugs such as morphine and oxycodone. These drugs are typically used to treat the pain caused by severe cancer and other terminal diseases. However, they can also cause overdoses and their addiction rates are significantly higher than those of marijuana. They also frequently cause negative side effects in children, such as nausea and vomiting, and can lead to opioid abuse. Many medical marijuana advocates argue that marijuana could help replace such drugs—and that if a highly addictive and sometimes harmful drug such as oxycodone can legally be used to treat children, then restrictions on medical marijuana seem arbitrary. Furthermore, advocates often point out that legalization of medical marijuana has been associated with reductions in the rate of opioid overdoses and mortality.

Those who oppose medical marijuana for children frequently cite the lack of studies concerning long-term effects and how the drug affects cognitive development. For example, in a February 2013 letter to the Massachusetts Department of Public Health, Sharon Levy, the medical director of the Adolescent Substance Abuse Program at Boston’s Children Hospital, warned of the unknown long-term effects of medical marijuana for children. She argued that it is an addictive drug that may lead to physical health consequences such as depression and anxiety, which she had observed in adolescents who use marijuana as a recreational drug.

Many health professionals believe that marijuana use in children may lead to long-term cognitive problems, including decreased intelligence quotients (IQs). One of the major reasons they believe this is because during adolescence, the frontal cortex of the brain is still developing. The adverse cognitive effects of marijuana may be more pronounced and long-lasting than in adults due to this ongoing brain maturation. Organizations that have opposed the use of medical marijuana to children include the US National Institute on Drug Abuse and the US National Association of School Nurses.

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