How would a parent know if medicinal cannabis is the right way to go if their child is suffering from epilepsy?
I will start out by saying the use of medical cannabis in children is very controversial. There are no published studies on the use of medical cannabis/cannabinoids in the pediatric population. Thus, there is no efficacy, safety, or tolerability data available.

The American Academy of Pediatrics (AAP) recently reaffirmed its opposition of the use of medical cannabis in the range of 0-21 year olds, citing negative health and brain development effects in this age group. Furthermore, AAP opposes medical cannabis use outside of the FDA regulatory process. However, AAP also recognizes medical cannabis/cannabinoids may be an option for children with severely debilitating conditions for whom current therapies are insufficient. Finally, AAP “strongly supports” research and development of pharmaceutical cannabinoids, reclassifying medical cannabis as a Schedule II drug in order to facilitate research, and decriminalization of marijuana use.

So, going back to the question, parents should start to seek alternative therapies once traditional interventions have failed and/or have caused significant side effects. But all decisions should be made under the advice and supervision of a physician.

What’s the first step for parents to begin navigating the medicinal cannabis road?
Parents need to consult their pediatrician and do some research. Several large epilepsy centers will be participating in a study to test the efficacy of GW Pharmaceuticals’ Epidiolex, which is a liquid form of CBD,

How does medicinal cannabis work for patients who are suffering from epilepsy?
The exact mechanism of action is unknown but several hypotheses include:

  • Modulation of neurotransmission
  • Decrease neuro-inflammation
  • Modulation of oxidative stress
  • Multifactorial in modulation of number of endogenous systems in order to attenuate and or possibly prevent hyper-excitability of neurons, which may be influenced through ion channel control, endocannabinoid system, and inflammatory processes
  • Of note, CBD has very minimal binding at the Cannabinoid Receptor 1 (CB1), which is a binding site for THC

How are the CBD oils administered?
Oral administration is probably the simplest route. Administration of the medication has been via slow titration to desired effect. Again, there is no efficacy, safety or tolerability data to help guide caregivers and physicians. The majority administer the oral medication anywhere from one to four times per day.

How do you determine who should be using cannabis oil?
Most parents have chosen medical cannabis for their child whom is refractory to the standard treatment with Antiepileptic Drugs (AED), or the side effects from these medications have become intolerable to the child. Intractable epilepsy can lead to frequent seizures, neurodevelopmental delays, impaired quality of life, severe side effects from AEDs, and possibly death. Treatment with medical cannabis is usually the last option parents turn to for reprieve from the medically resistant seizures.

How can parents determine if the medicine they are getting is legitimate and safe?
This is such an important point and very difficult to verify. A recent study from Colorado revealed a significant variation in the concentration of THC, presence of contaminants, and inconsistencies in the reported CBD/THC ratios. Colorado will now require independent testing.

Nevada already has statutes in place for independent laboratory testing to confirm what the cultivation and production facilities place on their labels. Therefore, once the dispensaries open, the patients can be confident that what they purchase will contain the percentages written on the label.

What should parents ask a physician/caregiver to make sure he/she qualified to treat their child with medicinal cannabis?
Experience is important; however, this quality might be difficult to find because there will not be many experts in this burgeoning field.

The FDA has given GW Pharmaceuticals orphan drug status for Epidiolex which is described as an oral liquid formulation of a highly purified extract of CBD. How far are we from seeing Epidiolex becoming an over-the-counter drug?
Manufacturers are afforded 20 years of patent protection from the date of filing. GW Pharmaceuticals is going through the FDA process. Thus, once they get FDA approval for Epidiolex, it will be a covered medication through the insurance companies. This is much different than obtaining a similar high-CBD oil from a dispensary, which will be cash based.

And if Epidiolex is as effective as the studies show, will it become the go-to drug that physicians will prescribe over traditional epilepsy medicines now in use?
The jury is still out on this. Epidiolex will have to go through the Phase III and Phase IV clinical trials in order to assess efficacy, safety, therapeutic effect, and long-term effects.

The most well-known medicinal cannabis treatment for epilepsy is Charlotte’s Web made by the Stanley Brothers in Colorado, which was made famous by the 2013 CNN documentary “Weed.” If a Nevadan has a medicinal marijuana card, can they get legal access to Charlotte’s Web?
The cultivation of medical cannabis has become very scientific. The different genetics produced are becoming very specialized. There will most likely be many different strains that will contain very high CBD/THC ratio, which will potentially have anti-epileptic properties.

Editor’s note: CWNevada is the Stanley Brothers’ Nevada partner and has exclusive rights to Charlotte’s Web here in the state.

Are there any cons to giving a child medicinal cannabis?
There are several potential negative effects of cannabis that one needs to be aware of. These effects have been observed in adolescents and include:

  • Impaired short-term memory;
  • Decreased concentration, decreased attention span, difficulty problem solving;
  • Adolescent brain, specifically the pre-frontal cortex, which controls judgment and decision-making, are not fully developed until early to mid-20s. Thus, substance use may affect the developing brain.

One thing to keep in mind is that these children are being administered medical cannabis because they have intractable epilepsy which leads to frequent seizures, neurodevelopmental delays, impaired quality of life, severe side effects from antiepileptic drugs, and possibly death.

Has the success of CBD oil started to change the way the medical community views the treatment of epilepsy?
In general physicians are very conservative. Any change in how medicine is practiced is thoroughly scrutinized. Physicians look for studies to confirm the outcomes. Most physicians and most medical societies favor changing the classification of medical cannabis from a Schedule I drug to a Schedule II in order to facilitate research. Going back to your question, there is no doubt in my mind that physicians are looking at the potential positive effects of medical cannabis after the investigative reporting of Dr. Sanjay Gupta, CNN’s Chief Medical Correspondent.