The Prevalence of Nonprescription Cannabinoid-Based Medicines in British Children's Hospices: Results of a National Survey

Abstract

Background: Almost 50,000 children and young people are affected by life-limiting conditions in the United Kingdom, around a third of which use children's hospices. Anecdotal evidence suggests that cannabinoid-based medicines (CBMs), specifically cannabis oil (CO), are being used by families with increasing frequency to manage distressing symptoms. The use of most nonprescription CBMs in the United Kingdom remains illegal. Objective: The objective of the study was to identify the prevalence of CO use by families who use children's hospices in the United Kingdom, and the approaches taken by those services to manage it. Design: An electronic survey was sent to each of the 54 children's hospices in the United Kingdom between May and July 2018, comprising 10 questions. Results: Forty children's hospices from across the four countries of the United Kingdom responded to the survey, representing 74% of British children's hospices. About 87.5% of hospices knew of children who use CO therapeutically. Sixty-nine percent of those hospices have received requests to administer CO during an episode of care. Approaches by organizations around CO management varied across the sectors, including arrangements for storage, administration, and recording of its use. Hospices highlighted how the lack of available guidance made decision making more challenging. Only a third of responding organizations routinely questioned families about the use of cannabis when prescribing medicines. Conclusion: CO is used extensively by children who use children's hospices. Despite recognizing the use of CO, many hospices are unable to support it. There is a need for clear guidelines on how hospices should approach the care needs of children, allowing hospices to meet the needs of children who use CO, and families in a safe, consistent, and relevant way, safeguarding all children, families, and professionals within the organization.

Crossing the Line: Care of a Pediatric Patient with Intractable Seizures and Severe Neuropathic Pain in Absence of Access to Medical Marijuana

“…Provider response to parents reporting MM use in Schedule I settings notably varies from direct inquiry, feigned ignorance, or informed ignoring. 1 Ideally, providers would compassionately and competently inquire about pharmaceutical and nonpharmaceutical interventions (to include MM use) as part of comprehensive palliative care symptom assessments. 26 Our pediatric palliative care team opted for honesty, transparency, and proactive preparation in supporting this child and family through a transition into our care setting where MM is not legally administered and yet where the shared goal was to ensure excellent symptom management.…”

“…In a recent review of nonprescription cannabinoid-based medicine use in Canadian hospices, a setting where marijuana remains a Schedule I drug, 35 (88%) pediatric hospice organizations knew of families that use cannabinoid-based medicine to manage the symptoms of their child. 1 For those geographies where medical marijuana (MM) is permitted, medical providers are asked with increasing frequency for access options. In a cross-sectional survey of 288 pediatric oncologists in Illinois, Massachusetts, and Washington (states with legalized MM), more than one-third of the responding pediatric oncologists received MM requests in the month before survey completion with 92% of these providers willing to help pediatric cancer patients access MM.…”