Selective Studies on the Challenges of Cannabis Use in Children, Youth and Young Adults

Abstract

The legalization of medical and recreational cannabis in Canada poses several challenges and opportunities in children, youth, and young adults. A clear understanding of the challenges and opportunities, though, remains elusive as cannabis use in younger people is vastly understudied. An evidence base is growing for use of medical cannabis to treat refractory pediatric seizures and to aid in the management of oncology pain. With some conditions, however, there is no data to support efficacy or safety but public enthusiasm has promoted off-label use. For example, some parents have admitted to administering cannabis for refractory symptom management of their child’s attention deficit hyperactivity disorder (ADHD). Presently, there are no trials on the efficacy or safety of medical cannabis in children, youth, or young adults with ADHD. Dosing recommendations for such studies will require an understanding of the pharmacokinetics of cannabis components in children diagnosed with ADHD or other off-label conditions. Children and youth who are successfully stabilized on medical cannabis have also experienced other challenges. For example, some children who take medical cannabis require a dosage during the school day. School policies that address the risks of recreational cannabis can be prohibitive for those who require cannabis to treat a medical condition. With respect to recreational cannabis, its use in youth is concerning since cannabis can cause harm to the developing brain. Education is needed for youth, their parents, and teachers to promote risk reduction and healthy choices.

This PhD program explored both medical and recreational aspects of cannabis use in the vulnerable population of children, youth, and young adults. In the context of medical use, the first objective was to determine treatment efficacy and pharmacokinetics of cannabis in ADHD, a pediatric condition where there was a perceived benefit, but lack of evidence. We designed a proof-of-concept study, but experienced significant delays with the Covid-19 global pandemic and challenges with study recruitment. Nevertheless, we published the study protocol and a case report describing our experience and cannabinoid plasma levels in three young adults taking medical cannabis for treatment of their ADHD. The potential challenge of medical cannabis at schools was also examined. A scoping review of the scientific literature, Canadian policies and laws underscored the lack of clear guidance on medical cannabis in schools and discrepancies across jurisdictions. Qualitative studies exploring the experiences of clinicians who authorize medical cannabis for school-aged children and caregivers highlighted challenges for these individuals, and guidance for moving this area forward. To address the use of cannabis in children and youth in a recreational context, we developed an educational toolkit for middle school and high school students, parents, and teachers. This education program was approved as a curriculum resource by the Ministry of Education in Saskatchewan and can be accessed by Saskatchewan teachers. The evolving cannabis legislation in Canada requires effective education and communication, both for reducing the risks associated with recreational cannabis and decreasing the stigma for those who require it medically.