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For 10 years, Zaki’s family triedto combat his syndrome with17 different pharmaceuticalmedications, a specialized diet, and alternative forms of therapy, such as acupuncture. The various medica- tions caused weight gain, incoheren- cy, extreme cramping, and sleepless- ness; they never stopped the seizures. Today, Zaki is among more than 180 Colorado children currently being treated with a special strain of med- ical cannabis known as “Charlotte’s Web,” named for 7-year old Charlotte Figi, whose successful treatment was featured in a 2012 CNN documentary called “Weed.” In the year since Zaki began treatment, he has been seizure- free (Schwartz, 2014).

Should Children Have Access to Medical Marijuana?

Medical marijuana for adults has gained acceptance across the United States. A recent survey of a random- ized sample of over 1,000 registered voters revealed that 85% of Americans think adults should be allowed to use marijuana for medical purposes if a physician prescribes it (Fox News Poll, 2013). Today, 20 states and the District of Columbia (see Figure 1) have legalized medical marijuana (ProCon.org, 2014).

What about children? Should they, too, have legal access to medical

marijuana? Certainly, Zaki’s life-alter- ing story would make one think so. Anecdotal evidence indicates the effectiveness of medical marijuana in the treatment of various disorders or diseases. For instance, a liquid, non – psychoactive form of marijuana was found to reduce seizures for children with Dravet’s syndrome, a rare form of childhood epilepsy (Melville, 2013). Reports have suggested possi- ble benefits of using marijuana in the treatment of children with autism (Gillette, 2013), cancer (Szalavitz, 2012), attention-deficit hyperactivity disorder (Centonze et al., 2009), as well as other conditions.

Unfortunately, there is limited high-quality evidence about the effi- cacy of medical marijuana. For exam- ple, a 2012 Cochrane review of all published randomized-controlled tri- als involving the treatment with mar- ijuana or one of marijuana’s con- stituents in people with epilepsy stat- ed that no reliable conclusions could be made at present regarding the effi- cacy of cannabinoids as a treatment for epilepsy (Gloss & Vickrey, 2012). All of the reports were of low quality.

Importantly, there are virtually no data about the safety of using mar- ijuana or cannabinoids with children (Melville, 2013). While some experts caution that the effects of the drug on child development are unknown, others point out that the same is true for other medications used to fight pain and nausea that are currently given to children with cancer, as well as for powerful antipsychotic drugs that are used in long-term treatment of childhood mental illness (Szalavitz, 2012). Morphine, oxycodone (Oxy – contin®), and other opioid drugs that are sometimes used to treat the severe pain that accompanies life-threaten- ing cancer and other diseases can cause overdoses.

Addiction rates are often lower

with marijuana than those with opi- oid drugs, and the severe physical withdrawal symptoms associated with opioids are not seen with mari- juana. Opioids can cause nausea and vomiting, while marijuana reduces the risk of these symptoms that fre- quently occur as side effects of radia- tion or chemotherapy (Szalavitz, 2012).

Clark (2003) considers the failure to give an effective therapy to serious- ly ill patients, whether adults or chil- dren, as a violation of the core princi- ples of both medicine and ethics:

Medically, to deny physicians the right to prescribe to their patients a therapy that relieves pain and suffering violates the physician- patient relationship. Ethically, failure to offer an available thera- py that has proven to be effective violates the basic ethical princi- ple of nonmaleficence, which prohibits the infliction of harm, injury, or death and is related to the maxim primum non nocere (“above all, or first, do no harm”), which is widely used to describe the duties of a physician. Therefore, in the patient’s best interest, patients and parents/sur- rogates have the right to request medical marijuana under certain circumstances, and physicians have the duty to disclose medical marijuana as an option and pre- scribe it when appropriate. The right to an effective medical ther- apy, whose benefits clearly out- weigh the burdens, must be avail- able to all patients, including children. (p. ET 1)

Acknowledging that children may benefit from medical marijuana, individuals and groups are advocating for legalization of its use with chil- dren. Moms for Medical Marijuana –

Pot for Tots: Children and Medical Marijuana

Judy A. Rollins, PhD, RN

From the Editor

Since he was just a few months old, 10- year-old Zaki Jackson has suffered from a rare form of epilepsy that, at its worst, causes him to have thousands of seizures a day. The seizures, which his mother describes as a “full body electro- cution,” render him unable to talk or walk, and sometimes cause him to stop breathing (Schwartz, 2014).

60 PEDIATRIC NURSING/March-April 2014/Vol. 40/No. 2

an alliance of mothers, community leaders, and concerned parties – are advancing the equal treatment of medical marijuana patients and providers (Moms for Medical Mari – juana, n.d.). Medical organizations, such as the American Academy of Pediatrics (AAP), while opposing the legalization of marijuana, supports rigorous scientific research regarding the use of cannabinoids for the relief of symptoms not currently ameliorat- ed by existing legal drug formulation (Jacobs et al., 2004).

Unintended Exposure To Medical Marijuana

While the controversy regarding medical marijuana for children con- tinues, other concerns regarding adults using medical marijuana can have implications for children living in or visiting their homes. Wang (2013) describes a new appearance of unintentional marijuana ingestions by young children after decriminaliz- ing medical marijuana in Colorado. In October 2009, when the Justice Department instructed federal prose- cutors not to seek arrest for medical marijuana users and suppliers, the issuance of the number of medical marijuana cards increased to 60,000, up from 2,000 in 2001. Medical mari- juana was now present in a greater number of homes, including homes with young children.

Wang (2013) conducted a retro- spective cohort study at a tertiary care, free-standing children’s hospital. The study included patients younger than 12 years evaluated for suspected unintentional marijuana ingestion from January 1, 2005, through December 31, 2011. Findings revealed that between January 1, 2005, and September 30, 2009, no patients younger than 12 years sought care at the emergency department for mari- juana ingestion. However, between October 1, 2009, and December 31, 2011, 14 patients younger than 12 years had confirmed marijuana inges- tion by urine toxicology screen. Ages ranged from eight months to 12 years, and 64% were males. Most patients had central nervous system effects, such as lethargy or somno- lence; the most serious symptom was respiratory insufficiency. Of the med- ical marijuana exposures, seven were from food products. Wang (2013) believes that this increase in marijua- na exposure in young children in

Colorado is most likely due to the decriminalization of medical marijua- na in 2009.

Improved palatability of medical marijuana may also be related to the increase in pediatric exposures. Medi – cal marijuana is sold in many prod- ucts besides plant and cigarette form, including edibles such as candies, baked good, and soft drinks, which likely increases attractiveness to young children. In fact, in Wang’s (2013) study, most exposures were due to ingestion of medical marijuana in a food product. Regulations are needed on storing medical marijuana products in child-resistant containers, including labels with warnings or pre- cautions, and providing counseling on safe storage practices.

Implications for Pediatric Nursing

With an overwhelming majority of Americans in favor of legalizing medical marijuana, I envision more states joining the roster. As in the past, parent advocacy will be respon- sible for many significant changes. Parents looking for hope for their children are already moving to states that have legalized medical marijuana for children to enable their children to receive treatments unavailable to them at home. Some parents will not want to or may be unable to leave their homes to take such drastic action, and will unite to advocate for decriminalizing medical marijuana for children in their states.

To provide sound guidance to par- ents, we need to stay informed about current research findings regarding medical marijuana and our own indi- vidual state’s policies. We also have a role in reducing unintentional inges-

tion of medical marijuana by advocat- ing for regulations on and providing information about safe storage of med- ical marijuana products. Nurses can ask specifically about medical marijua- na in the home. Families may be reluc- tant to report its use to health care providers because of a perceived stig- ma. The third person technique may be helpful: “Many families have mem- bers who are now using medical mari- juana because they are not able to ade- quately control their symptoms with traditional medications. I wonder if that is the case in your family.”

The train has left the station. The children we care for must not be left behind.

References Centonze, D., Bari, M., Di Michele, B., Rossi,

S., Gasperi, V., Pasini, A., … Maccarrone, M. (2009). Altered anan- damide degradation in attention- deficit/hyperactivity disorder. Neurology, 72(17), 1526-1527.

Clark, P. (2003). Medical marijuana: Should minors have the same rights as adults? Medical Science Monitor, 9(6), ET 1-9.

Fox News Poll. (2013). Fox News Poll: 85 per- cent of voters favor medical marijuana. Retrieved from http://www.foxnews. com/politics/interactive/2013/05/01/fox- news-poll-85-percent-voters-favor-med- ical-marijuana

Gillette, H. (2013). Parents use liquid medical marijuana to calm autistic boy’s rage. Saludify. Retrieved from http://voxxi. com/2013/02/25/medical-marijuana- autistic-child

Gloss, D., & Vickrey, B. (2012). Cannabinoids for epilepsy. Cochrane Database of Systematic Reviews, 6, CD009270. doi: 10.1002/14651858.CD009270.pub2

Jacobs, E., Joffe, A., Knight, J., Kulig, J., Rogers, P., & Williams, J. (2004). Legali – zation of marijuana: Potential impact on youth. Pediatrics, 113(6) 1825-1826.

Melville, N. (2013). Seizure disorders enter medical marijuana debate. Medscape. Retrieved from http://www.medscape. com/viewarticle/809434_print

Moms for Medical Marijuana. (n.d.). Face – book. Retrieved from https://www. facebook.com/pages/Moms- for – Medical-Marijuana/103263843067026

ProCon.org. (2014). Medical marijuana. Retrieved from http://medicalmarijua- na.procon.org/view.resource.php?resou rceID=000881

Schwartz, C. (2014). Meet the children who rely on marijuana to survive. Huffington Post. Retrieved from http://www.huffing- tonpost.com/2014/01/31/cannabis-for- children_n_4697135.html

Szakavitz, M. (2012). Is medical marijuana safe for children? TIME. Retrieved from http://healthland.time.com/2012/11/28/i s-medical-marijuana-safe-for-children

Wang, G. (2013). Pediatric marijuana expo- sures in a medical marijuana state. JAMA Pediatrics, 167(7), 630-633.

Pot for Tots: Children and Medical Marijuana

Figure 1. Legal Medical Marijuana States,

Including the District of Columbia

Alaska Arizona

California Colorado

Connecticut District of Columbia

Delaware Hawaii Illinois Maine

Massachusetts

Michigan Montana Nevada

New Hampshire New Jersey New Mexico

Oregon Rhode Island

Vermont Washington

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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