CBD Use in Children—Miracle, Myth, or Mystery? | Pediatrics | JAMA Pediatrics | JAMA Network
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April 26, 2021

CBD Use in Children—Miracle, Myth, or Mystery?

Author Affiliations
  • 1Department of Pediatrics, University of Florida College of Medicine, Gainesville
  • 2Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
JAMA Pediatr. 2021;175(6):652. doi:10.1001/jamapediatrics.2021.0367

Cannabis plants have 2 varieties: marijuana and hemp.

Both contain tetrahydrocannabinol (THC) and cannabidiol (CBD). The levels of THC in marijuana are significant, while hemp contains mostly CBD. THC is the ingredient that can cause a “high” and can lead to addiction and psychosis. Since hemp was legalized in 2018, CBD products have flourished. They claim to cure problems such as acne, cancer, and mental health issues. Many celebrate cases like Charlotte, the little girl whose seizures responded well to a specifically formulated concentrate of CBD known as Charlotte’s Web. However, there is limited scientific evidence to back these claims, and CBD may carry risks too. Cannabis in general has a lot of health effects, regulating blood pressure, sugar, mood, pain, hunger, and stress responses. These effects have not been well studied in children. Adolescents are using CBD/THC products frequently as they see these products trending on social media or advertised on storefronts. Teens are even trying new kinds of products like Delta-8, thinking that they are safe.

Adults use CBD to treat chronic pain, nausea, vomiting, mood disorders, and opiate addiction. In children, the only US Food and Drug Administration–approved CBD product is Epidiolex (Greenwich Biosciences). It can be used only in clinical trials for 2 rare forms of childhood seizure disorders that do not respond to medications. Also, new studies in children with autism spectrum disorder show promising improvement in hyperactivity, anxiety, sleep problems, and self-injurious behaviors. CBD is also being studied for depression and spasticity. However, CBD has important adverse effects. CBD is known to cause sleepiness, fatigue, and diarrhea, and there are reports that it can cause seizures in toddlers. It can harm the liver and can interact with other medications. There has been an increase in CBD poisoning cases after eating edibles or overdosing with an adult product. CBD poisoning should be suspected if a child has unexplained vomiting, fever, or drowsiness. Most importantly, the long-term effects of CBD on the developing brain are unknown.

One reason for these conflicting reports of CBD helping or hurting is that CBD products seen online or in stores are not regulated by the Food and Drug Administration or any other national organization. Because of this, CBD products are frequently mislabeled, and many products can contain very high doses of THC and other contaminants such as pesticides or heavy metals. Until more research is done, CBD should only be used to treat children in special cases who have not responded to treatment for specific seizures or, possibly, autism spectrum disorder. Stories of miracle cures for children are encouraging, but just because it is a plant product or is easily available does not make it safe to use in children. Ask your primary care physician to discuss CBD use if you are curious or you think your child might benefit from it. Your physician should be willing to discuss without judgment, keeping your child’s best interest in mind. They also may be able to direct you to clinical trials that are carefully guided by experts.

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Article Information

Published Online: April 26, 2021. doi:10.1001/jamapediatrics.2021.0367

Conflict of Interest Disclosures: None reported.

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    1 Comment for this article
    A few comments
    Jordan Tishler, MD | Harvard Medical School
    This is a great synopsis. As a practicing cannabis specialist, the paucity of data on CBD is very concerning to me, and I do not recommend using CBD except in those rare disorders for which Epidiolex is approved. You state that "Adults use CBD to treat chronic pain, nausea, vomiting, mood disorders, and opiate addiction," which should be differentiated from we, physicians, treat adults for... In fact, I would not recommend, based on data, the use of CBD for any of those things in adults.

    However, you also state, "THC is the ingredient that can
    cause a “high” and can lead to addiction and psychosis," which is a gross misstatement of fact. While it is true that THC does cause intoxication as a side effect (in a medical context) and can lead to dependence and possibly psychosis, the statement ignores the fact that we have over 60 years of real data on the use of THC or THC-dominant cannabis for treatment of pain, nausea and vomiting, spasticity, anxiety and depression, and insomnia. Further, we have more long-term safety data on cannabis than on any other substance.

    Since all medications can create side effects and risks, it is concerning THC is being dismissed here as solely responsible for the risks and side effects without regard to its benefits. Undoubtedly more, FDA-level research on cannabis needs to be done, but that is inarguable for nearly all subjects, and current federal law makes such studies impractical if not completely impossible.

    The time is well overdue to view cannabis and cannabinoids as the medicines that they are, will all their risks and benefits, and to regulate their use for medical purposes like any other medication.