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CBD use decreased seizure frequency to a greater extent than placebos but also was associated with higher rates of adverse events.
However, parents need to know that the research on cannabis outcomes for seizure-afflicted in- dividuals is mixed.
For example, a research team at the Univer- sity of Colorado studied seventy-five pediatric patients (ages six months to eighteen years) who were using oral cannabis extracts to control epilepsy.50 Publishing their results in Epilepsy & Behavior in 2015, the investigators reported that only one third (33 percent) of the patients responded to treatment (defined as experiencing a greater than 50 percent reduction in seizures), whereas 44 percent experienced adverse events, including increased seizures and one death. (Conventional treatment for seizures typically brings relief to two out of three patients.51) Eight of the children had adverse events ordinarily deemed “rare,” including developmental regres- sion, new movement disorders, transient weak- ness on one side of the body (hemiparesis) and epileptic seizures requiring intubation.
A 2017 clinical trial reported in The New England Journal of Medicine shared similarly mixed findings. Studying a specific form of childhood epilepsy called Dravet syndrome (which is characterized by seizures resistant to most other drugs), the researchers found that CBD use decreased seizure frequency to a greater extent than placebos but also was associated with higher rates of adverse events, including serious adverse events in ten of sixty- one patients in the CBD group (versus three of fifty-nine in the placebo group).52 Eight patients in the CBD group withdrew from the trial due to the adverse events, and another ten reduced their CBD dose. Twelve patients in the CBD group (compared to one in the placebo group) displayed an elevated biomarker indicative of liver damage.
In both studies, the authors concluded that additional data are needed to determine long- term efficacy and safety of CBD for epileptic seizures. Nonetheless, the FDA is moving forward on this front, having reviewed and approved prescription-only Epidiolex, the first CBD pharmaceutical, in June 2018.53 However, the FDA approval pertains solely to Dravet syndrome and one other rare and severe form of epilepsy.
Seizure disorders often respond well to a
diet very high in fats and low in sugar and re- fined carbohydrates, the so-called “ketogenic” diet, especially when short- and medium-chain fatty acids (the kind found in coconut oil) are included. Unfortunately, specialists in seizure disorders recommend this diet only “for children whose seizures have not responded to several different seizure medicines.”54 Since both con- ventional seizure medications and CBD treat- ments can have side effects, it makes sense to try dietary intervention first, before resorting to any drugs.
LITTLE EVIDENCE OF PAIN RELIEF
Pain is another common reason that people give for medicating with cannabis. A humorous quip often heard from drug prevention activists is that “anyone who can fake an ache qualifies
for a medical marijuana card.”
What does the science show in terms
of cannabis’ effectiveness as a medicine for chronic pain? A 2017 review published in the Annals of Internal Medicine suggested that the evidence for marijuana as a pain reliever is weak.55 The author concluded from the limited data available that cannabis may possibly help with neuropathic and cancer pain but not with other common pain conditions; commenting on the association of long-term cannabis use with adverse mental health effects, the author concluded, “it is not certain that the benefits of medical marijuana are greater than its risks.” A 2018 systematic review of medical cannabinoids in Canadian Family Physician reached a similar conclusion, reporting that adverse events are the most consistent effects of medical cannabi- noids, and that adverse events can have a greater magnitude of effect than the potential benefits for the conditions targeted.56 The authors also noted that their methodology underestimated the risk of long-term and serious adverse events, including the risk of psychosis.
A third review, published in 2018 in the journal Pain, looked at cannabis extractions used in addition to other pain medications to treat chronic noncancer pain (CNCP). The researchers found that the “number needed to treat to benefit is high, and the number needed to treat to harm is low... . It seems unlikely that cannabinoids are highly effective medicines for
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Wise Traditions
SPRING 2019