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Kelly LE, Rieder MJ, Finkelstein Y. Medical cannabis for children: Evidence and recommendations. Paediatr Child Health 2024; 29:104-121. [PMID: 38586483 PMCID: PMC10996577 DOI: 10.1093/pch/pxad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/20/2023] [Indexed: 04/09/2024] Open
Abstract
Interest in using cannabis products for a medical purpose in children under the age of 18 years is increasing. There are many medical cannabis products available that can include cannabidiol (CBD) or delta-9-tetrahydrocannabinol (THC), or both. Despite many therapeutic claims, there are few rigorous studies to inform the dosing, safety, and efficacy of medical cannabis in paediatric clinical practice. This statement reviews the current evidence and provides recommendations for using medical cannabis in children. Longer-term (2-year) reports support the sustained tolerability and efficacy of cannabidiol therapy for patients with Lennox-Gastaut and Dravet syndromes. CBD-enriched cannabis extracts containing small amounts of THC have been evaluated in a small number of paediatric patients, and further research is needed to inform clinical practice guidelines. Given the widespread use of medical cannabis in Canada, paediatricians should be prepared to engage in open, ongoing discussions with families about its potential benefits and risks, and develop individualized plans that monitor efficacy, reduce harms, and mitigate drug-drug interactions.
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Affiliation(s)
- Lauren E Kelly
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
| | - Michael J Rieder
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
| | - Yaron Finkelstein
- Canadian Paediatric Society, Drug Therapy Committee, Ottawa, Ontario, Canada
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2
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Kelly LE, Rieder MJ, Finkelstein Y. Les données probantes et les recommandations sur le cannabis à des fins médicales chez les enfants. Paediatr Child Health 2024; 29:104-121. [PMID: 38586491 PMCID: PMC10996578 DOI: 10.1093/pch/pxad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/20/2023] [Indexed: 04/09/2024] Open
Abstract
L'intérêt envers l'utilisation des produits du cannabis à des fins médicales chez les enfants de moins de 18 ans augmente. De nombreux produits du cannabis à des fins médicales contiennent du cannabidiol, du delta-9-tétrahydrocannabinol ou ces deux produits. Malgré les nombreuses prétentions thérapeutiques, peu d'études rigoureuses guident la posologie, l'innocuité et l'efficacité du cannabis à des fins médicales en pédiatrie clinique. Le présent document de principes passe en revue les données probantes à jour et expose les recommandations sur l'utilisation du cannabis à des fins médicales chez les enfants. Les rapports à plus long terme (deux ans) souscrivent à la tolérabilité et à l'efficacité soutenues d'un traitement au cannabidiol chez les patients ayant le syndrome de Lennox-Gastaut ou le syndrome de Dravet. Les extraits de cannabis enrichis de cannabidiol qui renferment de petites quantités de delta-9-tétrahydrocannabinol ont été évalués auprès d'un petit nombre de patients d'âge pédiatrique, et d'autres recherches devront être réalisées pour éclairer les guides de pratique clinique. Étant donné l'utilisation répandue du cannabis à des fins médicales au Canada, les pédiatres devraient être prêts à participer à des échanges ouverts et continus avec les familles au sujet de ses avantages potentiels et de ses risques, ainsi qu'à préparer des plans individuels en vue d'en surveiller l'efficacité, de réduire les méfaits et de limiter les interactions médicamenteuses.
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Affiliation(s)
- Lauren E Kelly
- Société canadienne de pédiatrie, comité de la pharmacologie, Ottawa (Ontario)Canada
| | - Michael J Rieder
- Société canadienne de pédiatrie, comité de la pharmacologie, Ottawa (Ontario)Canada
| | - Yaron Finkelstein
- Société canadienne de pédiatrie, comité de la pharmacologie, Ottawa (Ontario)Canada
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3
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Hasan Z, Kuyvenhoven C, Chowdhury M, Amoudi L, Zeraatkar D, Busse JW, Sadik M, Vanstone M. Patient perspectives of recovery from myalgic encephalomyelitis/chronic fatigue syndrome: An interpretive description study. J Eval Clin Pract 2024; 30:234-242. [PMID: 37927138 DOI: 10.1111/jep.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
AIMS AND OBJECTIVES Myalgic encephalomyelitis (ME), also called chronic fatigue syndrome (CFS), is characterised by persistent fatigue, postexertional malaise, and cognitive dysfunction. It is a complex, long-term, and debilitating illness without widely effective treatments. This study describes the treatment choices and experiences of ME/CFS patients who have experienced variable levels of recovery. METHOD Interpretive description study consisting of semi-structured qualitative interviews with 33 people who met the US Centers for Disease Control (2015) diagnostic criteria for ME/CFS and report recovery or symptom improvement. RESULTS Twenty-six participants endorsed partial recovery, and seven reported full recovery from ME/CFS. Participants reported expending significant time and energy to identify, implement, and adapt therapeutic interventions, often without the guidance of a medical practitioner. They formulated individualised treatment plans reflecting their understanding of their illness and personal resources. Most fully recovered participants attributed their success to mind-body approaches. CONCLUSION Patients with ME/CFS describe independently constructing and managing treatment plans, due to a lack of health system support. Stigmatised and dismissive responses from clinicians precipitated disengagement from the medical system and prompted use of other forms of treatment.
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Affiliation(s)
- Zara Hasan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Mehreen Chowdhury
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lana Amoudi
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Anesthesiology, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Anesthesiology, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marina Sadik
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Huntsman RJ, Elliott J, Lewis E, Moore-Hepburn C, Alcorn J, Mansell H, Appendino JP, Bélanger RE, Corley S, Crooks B, Denny AM, Finkelstein Y, Finley A, Fung R, Gilpin A, Litalien C, Jacobs J, Oberlander TF, Palm A, Palm J, Polewicz M, Quinn D, Rassekh SR, Repetski A, Rieder MJ, Robson-McKay A, Seifert B, Shackelford A, Siden H, Szafron M, ‘t Jong G, Vaillancourt R, Kelly LE. Removing barriers to accessing medical cannabis for paediatric patients. Paediatr Child Health 2024; 29:12-16. [PMID: 38332979 PMCID: PMC10848115 DOI: 10.1093/pch/pxac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/05/2022] [Indexed: 02/10/2024] Open
Abstract
Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
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Affiliation(s)
- Richard J Huntsman
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jesse Elliott
- Independent Researcher, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Evan Lewis
- Neurology Center of Toronto and Division of Pediatric Neurology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juan P Appendino
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Richard E Bélanger
- Départment de Pédiatrie, Faculté de medicine, Université de Laval, Québec, Québec, Canada
| | - Scott Corley
- Cannabinoid Research Initiative of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bruce Crooks
- Division of Paediatric Hematology/Oncology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - AnneMarie M Denny
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Allen Finley
- Departments of Anesthesia and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Fung
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Andrea Gilpin
- The Rosalind and Morris Goodman Family Pediatrics Formulation Centre of the CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Catherine Litalien
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, and The Rosalind and Morris Goodman Family Pediatric Formulation Centre of the CHU Sainte Justine, Montréal, Québec, Canada
| | - Julia Jacobs
- Division of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Timothy F Oberlander
- Department of Pediatrics and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Jacob Palm
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Monika Polewicz
- Division of Pediatric Research, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Declan Quinn
- Division of Pediatric Psychiatry, Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Repetski
- Parent Advocate, Canadian Collaborative for Childhood Cannabinoid Therapeutics, Winnipeg, Manitoba, Canada
| | - Michael J Rieder
- Division of Pediatric Pharmacology, Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Amy Robson-McKay
- Division of Pediatric Psychiatry, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Blair Seifert
- Department of Pediatric Pharmacy, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | | | - Hal Siden
- Division of Palliative Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Geert ‘t Jong
- Departments of Pediatrics and Pharmacology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Régis Vaillancourt
- Department of Pediatric Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- George and Fay Yee Centre for Health Care Innovation and Children’s Hospital Research Institute of Manitoba, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Schwaller K, Krauss Z, Chen AM, Cole JW. Parental Perceptions and Usage of Unlicensed Cannabidiol Products in Children With Anxiety and Neurodevelopmental Disorders. J Pediatr Pharmacol Ther 2023; 28:323-328. [PMID: 37795288 PMCID: PMC10547042 DOI: 10.5863/1551-6776-28.4.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Data evaluating the use of unlicensed cannabidiol (CBD) products for the treatment of -symptoms associated with anxiety and neurodevelopmental disorders in children are limited despite increasing -product availability. The objectives of this study are to quantify the usage of unlicensed CBD products among pediatric patients diagnosed with anxiety and neurodevelopmental disorders and compare the -perceptions of CBD between parents who administer a CBD product to a child and parents who do not. METHODS A survey containing 31 items was designed after pretesting with pediatric health care professionals. The refined survey was distributed using Qualtrics Panels to a representative sample of US parents of a child 7 to 18 years of age diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and/or generalized anxiety disorder (GAD). Responses were analyzed with descriptive -statistics and compared using a χ2 or Mann-Whitney U test. RESULTS Of the 518 completed surveys, 162 parents (31.3%) reported the administration of an unlicensed CBD product to a child with ADHD, ASD, and/or GAD. The highest prevalence of use was found in the West geographic region and among children diagnosed with GAD or with 2 or more diagnoses (i.e., ADHD, ASD, GAD). Parents who administered CBD products had more positive views of product safety and higher -perceived community support for usage. CONCLUSIONS Nearly one-third of parents have administered an unlicensed CBD product to a child with ADHD, ASD, and GAD. Health care providers should assess pediatric patients for CBD use and be prepared to engage parents in conversations regarding the safety of these products.
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Affiliation(s)
- Kathryn Schwaller
- Department of Pharmacy Practice, Cedarville University School of Pharmacy, Cedarville, OH
| | - Zachary Krauss
- Department of Pharmacy Practice, Cedarville University School of Pharmacy, Cedarville, OH
| | - Aleda M.H. Chen
- Department of Pharmacy Practice, Cedarville University School of Pharmacy, Cedarville, OH
| | - Justin W. Cole
- Department of Pharmacy Practice, Cedarville University School of Pharmacy, Cedarville, OH
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Mansell H, Zaslawski Z, Mbabaali S, King PM, Kelly LE, Lougheed T, Anderson J, Huntsman RJ, Alcorn J. Medical cannabis in schools: The experiences of caregivers. Paediatr Child Health 2023; 28:102-106. [PMID: 37151922 PMCID: PMC10156934 DOI: 10.1093/pch/pxac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 05/09/2023] Open
Abstract
Objectives Implementing medical cannabis (MC) into a child's daily routine can be challenging and there is a lack of guidance for its therapeutic use in schools in Canada. Our objective was to learn about the experiences of caregivers of school-aged children who require MC. Methods Qualitative description was used and caregivers were interviewed about MC in schools and in general. The transcripts were entered into Dedoose software for qualitative analysis and content analysis was performed. Sentences and statements were ascribed line by line into meaning units and labelled with codes, and organized according to categories and subcategories. Results Twelve caregivers of school-aged children who take MC participated. The most common reasons for treatment were drug-resistant epilepsy (DRE), autism, or other developmental disorders. Approximately half of the participants' children (n = 6) took MC during the school day and most (5/6) perceived their experiences to be positive or neutral but reported a lack of knowledge about MC. While data saturation was not reached regarding MC in schools, rich dialogues were garnered about MC in general and three categories were identified: challenges (subcategories stigma, finding an authorizer, cost, dosing, and supply); parents as advocates (subcategories required knowledge, attitudes, skills, and sources of information); and caregiver relief for positive outcomes. Conclusions Caregivers demonstrate remarkable tenacity despite the many challenges associated with MC use. Education and practice change are needed to ensure that children using MC can benefit from or continue to experience its positive outcomes within the school environment and beyond.
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Affiliation(s)
- Holly Mansell
- Correspondence: Holly Mansell, College of Pharmacy and Nutrition, University of Saskatchewan, Office E3208, Health Sciences Building, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada. Telephone (306) 966-1512, e-mail
| | - Zina Zaslawski
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sophia Mbabaali
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia M King
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lauren E Kelly
- Departments of Pharmacology and Therapeutics and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Taylor Lougheed
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Section of Emergency Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Jennifer Anderson
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard J Huntsman
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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7
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Li J, Areal CC, Toffa DH, Citherlet D, Deacon C, Jutras-Aswad D, Keezer MR, Nguyen DK. Use of non-medical cannabis in epilepsy: A scoping review. Front Neurol 2023; 14:1132106. [PMID: 36949852 PMCID: PMC10025318 DOI: 10.3389/fneur.2023.1132106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
Objective The use of medical cannabis among people with epilepsy (PWE) has been garnering increasing interest. In this scoping review, we aimed to summarize the literature on recreational/non-medical cannabis (NMC) use in PWE, focusing on the experience, habits, and beliefs of PWE regarding NMC. Methods Four databases (OVID Medline, OVID Embase, Ovid APA PsycInfo, and Web of Science) were searched for studies describing NMC use in PWE. NMC was defined as cannabis products procured from sources other than by prescription. Studies that consisted in original research and that detailed the experience, habits, and/or beliefs of PWE regarding NMC use were included in the analysis. Data pertaining to study identification, demographics, NMC use, and epilepsy characteristics were extracted. Descriptive statistical analyses and reflexive thematic analyses were performed to map these data. Results In total, 3,228 records were screened, and 66 were included for analysis: 45 had mainly adult samples, whereas 21 had mainly pediatric samples. Most studies were published after 2010, originated from the USA, and were cross-sectional. The median number of PWE using cannabis in these studies was 24.5 (1-37,945). No studies showcased elderly PWE, and most had predominantly Caucasian samples. The lifetime prevalence of NMC use in PWE was variable, ranging between 0.69 and 76.8%. Factors frequently associated with NMC use in PWE were male sex, younger adult age, and lower education status. Children with epilepsy took NMC primarily for seizure control, using high CBD/THC ratios, and only orally. Adults with epilepsy took NMC for various reasons including recreationally, using variable CBD/THC ratios, and predominantly through smoking. The majority of PWE across all studies perceived that NMC aided in seizure control. Other aspects pertaining to NMC use in PWE were rarely reported and often conflicting. Conclusion The literature on NMC use in PWE is sparse and heterogeneous, with many salient knowledge gaps. Further research is necessary to better understanding the experience, habits, and beliefs of PWE pertaining to NMC.
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Affiliation(s)
- Jimmy Li
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- *Correspondence: Jimmy Li
| | - Cassandra C. Areal
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Dènahin Hinnoutondji Toffa
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
| | - Daphné Citherlet
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Charles Deacon
- Neurology Division, Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Didier Jutras-Aswad
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, QC, Canada
| | - Mark Robert Keezer
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- School of Public Health, Université de Montréal, Montreal, QC, Canada
- Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- Neurosciences Axis, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
- Neurology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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8
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Awal M, Kelly LE, Anderson J, Brace T, Brown C, Buettner T, King PM, Klemmer J, Lougheed T, O'Shea K, Mansell H. Medical Cannabis in Canadian Schools: A Scoping Review of Existing Policies. Cannabis Cannabinoid Res 2022; 7:758-768. [PMID: 36251467 DOI: 10.1089/can.2021.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective: An increasing number of children and youth in Canada are taking medical cannabis for complex medical conditions. While they deserve safe and consistent access to pharmacotherapy throughout the day, administrative policies on cannabis use in schools are inconsistent. A scoping review identified policies and publications associated with medical cannabis in Canadian schools. Methods: Five databases (Scopus, PubMed, CINAHL, EMBASE, and Web of Science) were searched to identify scientific literature. Legislation in each province and territory and Ministry of Education webpages were reviewed for pertinent laws and policies regarding cannabis use in schools. Results: The scientific search resulted in 1289 articles. The five included articles pertain to implications for school nurses in the United States, which are not relevant to the Canadian context. A search of Ministry of Education websites identified only one policy with information regarding medical cannabis in schools (from Ontario). Federal legislation (the Cannabis Act) does not specifically address medical cannabis in schools, and there is a lack of consistency in terminology and clarity within provincial and territorial laws. All provinces and territories prohibit smoking and vaping of cannabis on school property and some provinces prohibit any method of cannabis consumption. Conclusions: In Canada, there is a lack of guidance for medical cannabis administration, storage, and disposal in schools, with some policies explicitly prohibiting this type of treatment. This shifts the burden to families to individually create plans school by school. A federally harmonized approach to supporting children who take cannabis for medical purposes ought to be explored.
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Affiliation(s)
- Manya Awal
- Department of Biological Sciences, University of California San Diego, La Jolla, California, USA
| | - Lauren E Kelly
- Department of Pharmacology and Therapeutics and University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jennifer Anderson
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Tracy Brace
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, Canada
| | - Clare Brown
- South Shore Regional Centre of Education, Bridgewater, Canada
| | - Tye Buettner
- Saskatchewan Health Authority, Saskatoon, Canada
| | - Patricia M King
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Jennafer Klemmer
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Taylor Lougheed
- Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Section of Emergency Medicine, Northern Ontario School of Medicine, Sudbury, Canada
| | - Kerry O'Shea
- Legal Counsel Clinical Trials, University of Saskatchewan, Saskatoon, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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9
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Mansell H, Zaslawski Z, Kelly LE, Lougheed T, Brace T, Alcorn J. Medical cannabis in schools: A qualitative study on the experiences of clinicians. Paediatr Child Health 2022; 28:113-118. [PMID: 37151920 PMCID: PMC10156924 DOI: 10.1093/pch/pxac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Guidance is lacking for medical cannabis use in Canadian schools in both legislation and approach; the impact of ambiguous policy on patient care is unknown. A qualitative study was undertaken to explore the experiences of clinicians who care for school-aged children who take medical cannabis.
Methods
Semi-structured interviews were recorded and transcribed verbatim. Qualitative content analysis performed using the Dedoose qualitative software ascribed meaning units and codes, which were further consolidated into categories and subcategories.
Results
Thirteen physicians were interviewed virtually, representing seven provinces in Canada. The physicians provided care for between five and hundreds of school-aged children who took medical cannabis. The most common indications were refractory seizure disorders and autism. The interviews provided rich descriptions on perceptions of medical cannabis in schools, and in general. Five overarching categories were identified across both domains including variability, challenges (subcategories: lack of knowledge, stigma, lack of policy, and pragmatic challenges), potential solutions (subcategories: treat it like other medications, communication, education, and family support), positive experiences and improvements over time.
Conclusion
In Canada, cannabis-based medicine use in schools still faces important challenges. Effective education, communication, family support and policy refinements that allow cannabis to be treated like other prescription medications are recommended to improve the status quo. These findings will guide the C4T Medical Cannabis in Schools Working Group’s future priorities and initiatives.
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Affiliation(s)
- Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Zina Zaslawski
- Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba , Canada
| | - Lauren E Kelly
- Departments of Pharmacology and Therapeutics and Community Health Sciences, University of Manitoba , Winnipeg, Manitoba , Canada
- Children’s Hospital Research Institute of Manitoba , Winnipeg, Manitoba , Canada
| | - Taylor Lougheed
- Department of Family Medicine, University of Ottawa , Ottawa, Ontario , Canada
- Section of Emergency Medicine, Northern Ontario School of Medicine , Sudbury, Ontario , Canada
| | - Tracy Brace
- BC Mental Health and Substance Use Services, Provincial Health Services Authority , Vancouver, British Columbia , Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
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Gunning M, Rotenberg A, Anderson J, Balneaves LG, Brace T, Crooks B, Hall W, Kelly LE, Rassekh SR, Rieder M, Virani A, Ware MA, Zaslawski Z, Siden H, Illes J. Neither the “Devil’s Lettuce” nor a “Miracle Cure:” The Use of Medical Cannabis in the Care of Children and Youth. NEUROETHICS-NETH 2022. [DOI: 10.1007/s12152-022-09478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fletcher S, Pawliuk C, Ip A, Huh L, Rassekh SR, Oberlander TF, Siden H. Medicinal cannabis in children and adolescents with autism spectrum disorder: A scoping review. Child Care Health Dev 2022; 48:33-44. [PMID: 34403168 DOI: 10.1111/cch.12909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental condition estimated to affect 1 in 66 children in Canada and 1 in 270 individuals worldwide. As effective therapies for the management of ASD core and associated symptoms are limited, parents are increasingly turning to clinicians for advice regarding the use of medicinal cannabis to manage behavioural disturbances. OBJECTIVE The objective of this scoping review was to identify and map symptoms, outcomes and adverse events related to medicinal cannabis treatment for ASD-related behaviours. METHODS Ovid MEDLINE, Embase, CINAHL, PsycInfo, Web of Science Core Collection, Google Scholar and grey literature sources were searched up to 5 January 2020 for studies. Included studies met the following criteria: (1) investigate the use of medicinal cannabis, (2) at least 50% participants had ASD, (3) at least 50% of the study population was 0-18 years old and (4) any study design (published or unpublished). RESULTS We identified eight completed and five ongoing studies meeting the inclusion criteria. All studies reported substantial behaviour and symptom improvement on medicinal cannabis, with 61% to 93% of subjects showing benefit. In the three studies reporting on concomitant psychotropic medication usage and with cannabis use, up to 80% of participants observed a reduction in concurrent medication use. Adverse events related to cannabis use were reported in up to 27% of participants related, and two participants had psychotic events. CONCLUSIONS Early reports regarding medicinal cannabis in paediatric ASD symptom management are presented as positive; the evidence, however, is limited to very few retrospective cohort and observational studies. Evidence of safety and efficacy from prospective clinical trials is needed.
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Affiliation(s)
- Sarah Fletcher
- MD Undergraduate Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Pawliuk
- Department of Paediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Angie Ip
- Department of Paediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda Huh
- Department of Paediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - S Rod Rassekh
- Department of Paediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim F Oberlander
- Department of Paediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harold Siden
- Department of Paediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia, Canada.,Canuck Place Children's Hospice, Vancouver, British Columbia, Canada
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Gunning M, Rotenberg AD, Kelly LE, Crooks B, Oberoi S, Rapoport AL, Rassekh SR, Illes J. Clinician views on and ethics priorities for authorizing medical cannabis in the care of children and youth in Canada: a qualitative study. CMAJ Open 2022; 10:E196-E202. [PMID: 35292477 PMCID: PMC8929429 DOI: 10.9778/cmajo.20210239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of cannabis for medical purposes by pediatric patients is expanding across Canada; however, supporting evidence, federal regulations and treatment guidelines are lacking. To understand factors affecting treatment decisions in this landscape, we sought to delineate clinician perspectives, ethics priorities and values for cannabis authorization. METHODS We sampled participants purposefully through Canadian Childhood Cannabinoid Clinical Trials listservs, which include the majority of pediatric oncologists and palliative care physicians practising in Canada, among many other pediatric physicians and clinicians. Inclusion criteria were being a practising clinician in Canada, involvement in the care of children and willingness to be interviewed regardless of stance on medical cannabis. In November and December 2020, we conducted semistructured interviews focusing on principles, values and priorities, including medical, professional, regulatory, evidentiary and social considerations, for authorizing medical cannabis to children. Interviews were recorded, transcribed and analyzed by means of deductive and inductive thematic methods. RESULTS We conducted 18 interviews with a diverse group of clinicians representing a range of specialties within pediatric care, including neurology, palliative care, oncology, family medicine and pharmacology. The interviews yielded 4 themes and 12 subthemes related to a priori (medical, professional, regulatory, evidentiary and social themes) and emergent themes. The 4 themes of access, relationships and relational autonomy (autonomy within relationships), medically appropriate use and research priorities were grounded in principles of harm reduction. Participants described problematic authorization procedures that negatively affect patient use. Principles associated with relational autonomy were highlighted as a feature of open clinical communication. Benefits of appropriate medical uses weighed positively over risks, even in the context of potential effects on neurodevelopment. Participants expressed that more research is essential to align medical cannabis with biomedical standards. INTERPRETATION Clinicians reported pursuing ethical use of medical cannabis for pediatric patients and prioritizing their safety under principles of harm reduction. There is a need for evidence about neurodevelopmental risks, support for research, treatment guidelines and greater knowledge about stakeholder perspectives to alleviate burdens related to use of medical cannabis for pediatric patients in Canada.
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Affiliation(s)
- Margot Gunning
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Ari D Rotenberg
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Lauren E Kelly
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Bruce Crooks
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Sapna Oberoi
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Adam L Rapoport
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - S Rod Rassekh
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Judy Illes
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
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Coverage of medical cannabis by Canadian news media: Ethics, access, and policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103361. [PMID: 34252784 DOI: 10.1016/j.drugpo.2021.103361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The use of recreational cannabis by adults was legalized in Canada in 2018 (The Cannabis Act, 17 October 2018). This change in drug policy indirectly opened the doors to broader uses, including those for health-related conditions. As a first step towards understanding ethical, legal, and social shifts on this landscape, we examined messaging surrounding medical cannabis and health in Canadian news media before and after legalization. METHODS We retrieved news articles about medical cannabis and health from Canadian sources (2010-2020). Deductive and inductive content analytic approaches were applied to code eligible articles for both a priori ethical, legal, social, and issues, and emergent themes. Wilcoxon-Mann-Whitney U tests were used to test for thematic changes pre- and post-legalization. RESULTS Two hundred and sixteen (216) articles met inclusion criteria. Analysis yielded three themes and eight subthemes, comprising 4931 coded references. The a priori theme of Ethical, Legal and Social Issues (access, benefits/risks of medical cannabis, public engagement, and conflicts of interest) dominated news media coverage across the decade (coded in 99% of articles). The emergent theme of Medical Applications (therapeutic use of cannabis, consumption considerations, comparisons to other drug and treatment options) was coded in 86% of articles; Resource Issues (research and education) in 50%. We found little discourse on ethics issues specific to exceptional populations. Coverage on aspects of access declined significantly post-legalization. CONCLUSION Capturing the push of Canadian news coverage of medical cannabis is a powerful means of understanding how public opinions on the subject are shaped and then, by extension, inform public policy for well-being and healthcare. Continued examination of these issues, public consultation, engagement with diverse populations such as people with disabilities and neurologic and mental health conditions, and integration of diverse cultural views into the policy discourse are critical steps for future research and action.
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