The use of medical cannabis in pediatric palliative care: a case series

Abstract

Background Medical cannabis may be a useful tool for managing treatment-resistant epilepsy and chronic pain, which affect many patients in pediatric palliative care (PPC); however, little evidence is available in this setting. Case presentation We aimed to describe a clinical experience in a setting where high-level evidence may not be obtained. We report our clinical experience in a pediatric palliative care department in Italy. Caregivers reported changes in intensity and frequency of pain and epilepsy events. Six patients received a titrated plant extract of cannabis sativa for 1 year. Only mild and transient adverse events occurred: drowsiness, euphoria, restlessness and tachycardia; the resolution was either spontaneous or obtained by modifying the administration schedule. Treatment was never discontinued. No overdoses occurred. All patients experienced seizures during the pre-treatment observation period, and obtained a reduction in seizure frequency, although with variable extent while receiving cannabis. In addition, a benefit on pain was observed, based on the caregiver’s evaluation, and a reduction of analgesic use. Conclusion Our experience suggests that a titrated plant extract preparation of medical cannabis may be useful to control treatment-resistant pain and epilepsy in PPC patients.

Use of Medicinal Cannabis for Palliative Care Patients: A Systematic Review

“…Given the condition to which they are subjected, in which there are no more technical resources to progress with the treatment, sleep disorders, anxiety and depression are conditions that will be inserted in the context. And cannabis also acts in these aspects [1]…”

“…For some diseases, such as epilepsy and autism, it is considered one of the first-line treatments, be- ing extremely safe and effective. Based on this scenario, its use for other pathological conditions has been studied [1].…”

“…The results for the improvement of symptoms and the quality of life of palliative patients is excellent, with an improvement in adverse effects, anxiolytic, antitumor, antiemetic and analgesic with synergism with opioids, actions, increased appetite, improved sleep, and significant reduction of the drug load of these patients [2] [3] [6] [7] [8] [9]. However, cannabis administration involves numerous variables, such as composition, form, possibility of acquisition, drug interaction management [1] and socioeconomic and political issues surrounding cannabis spp. Thus, this review seeks knowledge on the subject and determination as a search for the area.…”

“…positive effect on its improvement has been demonstrated, especially of THC[2] [3][5] [6][11] [16][18]. Cannabinoids have been shown to be more effective than various antiemetics, such as prochlorperazine, metaclopramide, chlorpromazine, thiethylperazine, domperidone, and alizapride[2] [11].Not restricted to just these occurrences, CBD and THC present good results in cases of anorexia, fatigue and constipation[1] [2] [3] [5] [9] [11] [16] [18] [19],and weight gain was observed in patients who administered 3 mg of THC 1 hour after meals[2] [19]. In addition, its antitumor effect has been verified, mainly for astrocytomas and glioblastomas[2] [6] [16][18].…”

New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

“…Children and young adults with cancer reported using cannabis products for nausea and vomiting, depressed mood, sleep disturbances, pain, poor appetite, and weight loss [ 204 ]. Divisic et al described a clinical experience of six patients in a pediatric palliative care who received a titrated plant extract of cannabis sativa for 1 year [ 205 ]. All patients received cannabis therapy for treatment-resistant epilepsy and chronic pain.…”