By Jane Gerster
Dr. Michael Rieder wants it made clear that cannabis is not a side-effect free, cure-all.
The London, Ont., pediatrician has had many children referred to him by doctors who know Rieder wrote the Canadian Paediatric Society’s position statement on cannabis use and aren’t sure whether to prescribe.
The conversations, Rieder says, are rather interesting.
“The families usually come in with a certain set of ideas,” he says.
“Medical cannabis is imbued with a certain mythological character … a panacea for all ills quite unlike most other drugs.”
But it is still a drug.
It just happens to be one that providers know less about, Rieder says. They don’t know when to prescribe or how much or for how long. Although there’s a list of authorized providers from Health Canada, he notes, there isn’t a product monograph outlining side effects or possible risks in the short and longer term.
A spokeswoman for Health Canada, says the government is in the process of updating five-year-old information about cannabis so that it is in a “format similar to that of a drug product monograph.”
In fact, 49 per cent weren’t even aware they can prescribe cannabis to children, according to a survey of pediatricians released Thursday by the Canadian Paediatric Surveillance Program (CPSP), and 39 per cent didn’t know they could prescribe to youth. More than three-quarters reported little to no knowledge about why cannabis might be used or what the correct dosage might be.
That’s not stopping minors from using marijuana for medical purposes. Half of the pediatricians who responded to the survey reported treating patients who were using medical marijuana in the year prior, for reasons both authorized and unauthorized. The vast majority, per the survey, saw five or less patients who used cannabis.
“We were amazed,” says Dr. Richard Bélanger, who helped conduct the survey for CPSP and who is also a pediatrician and researcher in Quebec. “It was a shock … but in the end, it really makes sense.”
Almost everywhere in Canada, Bélanger says, “pediatricians are treating complex diseases in children with sometimes fewer treatment possibilities than for adults.”
Despite half saying they treated a patient who was using cannabis for medical reasons, only 34 said they personally had prescribed authorized cannabis use in the year prior. However, only a third of Canadian pediatricians and pediatric subspecialties responded to the 2017 survey (877 out of 2,816).
This survey is just one step toward untangling the confusion around how pediatricians can and should use medical marijuana, Bélanger says. With legalization coming Oct. 17, he says, there are still many health professionals saying they don’t have enough knowledge around prescribing cannabis.
“We have to continue producing knowledge around that and to inform pediatricians and health professionals working with kids,” he says.
In particular, Bélanger wants to build a better picture of how cannabis is being used to treat minors in more rural areas. Most of the survey respondents were from major centres or university towns.
“We’re not exactly sure that it is a clear representation of what is taking place, let’s say, in northern Manitoba,” Bélanger says.
Regardless of where cannabis is being prescribed, Rieder says it’s important to make sure it’s being done so by a professional — especially as legalization prompts more people to inquire about medical marijuana.
While there have been some studies pointing to its usefulness in treating children with epilepsy, he’s concerned around some children as young as five or six using cannabis to manage attention deficit hyperactivity disorder (ADHD).
Rieder says most inquiries he fields for cannabis are about calming children with ADHD.
“It’s a terrible idea,” he says.
“They may be a little bit more mellow and they may act up less in class but we know that cannabinoids have significant effects on some developing brains.”
As research continues and pediatricians arm themselves with the latest information ahead of legalization, Rieder says its important for parents to remember that cannabis is just like any other drug with “potentially good effects and potentially bad effects.”
“Like any drug, there are certain questions you should always ask,” he says. “What is the expected benefit? What’s the expected risk? How is it going to be followed up?”