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Medicinal and Synthetic Cannabinoids for Pediatric Patients: A Review of Clinical Effectiveness and Guidelines

Last updated: October 11, 2019
Project Number: RC1186-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of medical cannabinoids in pediatric patients?
  2. What is the clinical effectiveness of synthetic cannabinoids in pediatric patients?
  3. What are the evidence-based guidelines regarding the use of medical or synthetic cannabinoids in pediatric patients?

Key Message

One systematic review (SR) without independent literature selection or data extraction and one fair-quality randomized controlled trial (RCT) were identified. Cannabidiol and oral cannabis extracts of various dosing strategies were identified and associated with a reduction in epilepsy frequency in pediatric patients with epilepsy, based on the SR. In the RCT recruiting pediatric patients with severe complex motor disorder, the 5% oil formulation of cannabis made with two cannabidiol-to-tetrahydrocannabinol (THC) ratios (20:1 or 6:1) was associated with a reduction in spasticity, sleep difficulties, and pain and an improvement in quality of life relative to baseline with rare occurrence of adverse events.Dronabinol was a synthetical cannabinoid identified in the SR and associated with a reduction in seizure frequency in epilepsy patients and a reduction in spasticity in patients with spasticity. No evidence-based guidelines were identified, and no summary could be provided.This report was limited by several factors: small sample sizes in the primary studies (several studies with fewer than 30 patients), lack of publication bias assessment, and the lack of comparability between primary studies due to the differences in the patients and the types and dosages of cannabinoids. The identified evidence for this report was limited to the following conditions: PTSD for mental health conditions, epilepsy and spasticity for neurodegenerative diseases, and neuropathic pain for pain disorders. The synthetic cannabinoid evaluated in the systematic review, Dronabinol, is not available in Canada. Therefore, this evidence may be of limited value in a Canadian clinical setting or for pediatric patients with other mental health conditions, neurogenerative diseases, or pain disorders.Further research in the effectiveness of medicinal or synthetical cannabinoids in Canadian contexts may help to reduce uncertainty.