Is CBD Oil a Good Idea for My Child?
It seems these days that CBD (cannabidiol) oil can fix all that ails you – as CBD containing products are found everywhere from corner stores to hair salons, to farmer’s markets. Many times the vendors of these oils make wide-reaching claims to their benefit for a variety of medical conditions, but how much of this is supported by sound research? More importantly, how safe are CBD oils – especially when considering using them for your children?
Scott Perry, M.D., the Director of Neurology at Cook Children’s, has participated in multiple international studies, examining the effectiveness and safety of a nearly-pure CBD oil for treating patients with epilepsy. While the internet is full of testimonials for the effective use of CBD for other conditions, epilepsy remains one of the only disorders with strong data to support the benefit of CBD for medical treatment. He points out that lack of data does not mean CBD cannot be effective in other conditions, it simply means the research is not there yet to tell us how effective the drug may be, what doses might be needed, how it interacts with other drugs used in the condition, the safety of the drug used in specific patients, etc.
So as a scientist and physician, it’s difficult to blame him for being a little concerned at the number of medicinal CBD oil stores popping up around the area.
Dr. Perry has seen success in treating children with severe forms of epilepsy during the clinical trials he has overseen. But as far as day-to-day use such as treating anxiety or chronic pain, he says not enough research has been performed. He’s especially concerned about the use of CBD in children for common ailments and he says more and more Cook Children’s pediatricians are being asked about its use daily.
The trials Dr. Perry conducted used a form of CBD oil produced under strict guidelines to ensure the purity of the product – no different from how any FDA-approved pharmaceutical would be produced. The studies were rigorously designed to provide the data necessary to show the drug works and is safe to use. The studies are blinded and placebo-controlled which means neither the doctor nor the patient knows whether they are getting the real drug or a placebo during the study. This helps remove bias (people feeling like their seizures are better because they know they are taking the real drug). It also helps separate which side effects are due to the drug and which occur randomly in the course of life (for example fevers, rash, nausea which can occur commonly regardless).
While the studies showed CBD helped reduce seizures, the number of patients who became seizure free was small. Likewise, the drug was well tolerated, but not without side effects. In fact, the studies revealed that some patients taking CBD oil could get significant elevation of their liver enzymes which needs to be monitored. Without these studies, commenting on the safety and effectiveness of CBD for epilepsy would largely be a guessing game. The same now holds true for other conditions – recommending CBD oils for other ailments is still largely a guessing game, based on small reports or testimonials, but without the support needed to make an informed medical decision.
Dr. Perry points out that it is important to understand the CBD oil tested in these studies is but one version of CBD oil and the data cannot be applied to every other CBD oil. There are thousands of CBD oils being sold these days and all may be made in different ways, contain various amounts of CBD, have varied levels of purity, and may contain substances other than CBD where the safety and efficacy is even more unknown.
“When you walk into a CBD store, you don’t know exactly what you’re getting because it’s not regulated or monitored,” Dr. Perry said “I worry they haven’t been studied or proven effective, certainly not in most pediatric cases, for use. Many of the conditions that CBD is being used for have subjective symptoms, so assessing response is very difficult. Even when a store provides a lab analysis of the CBD oil they provide you, there is no regulation or true oversight to ensure the report is accurate. This is not to say that CBD retailers are trying to make a quick buck, it just means there are shortcomings to the products that must be taken into account.”
When people are treated with typical antiepileptic drugs, they are taking a single compound, like carbamazepine or levetiracetam for example. But when you get a CBD oil in a store, you get a substance that may have a high amount of CBD, but it also can contain varied amounts of the multiple other compounds from the plant.
“We don’t know how effective and safe those other compounds are, so we must be cautious to recommend it to treat a child,” Dr. Perry said “Currently, there are no testing standards to make sure the CBD oil you get from a company contains what the label says, thus the formulation may change some from month to month.”
While all CBD oils contain the similar CBD compound, they may be produced from different types of plant, using different growing techniques/conditions, and manufactured with different processes, creating different medications with different other compounds included.
Dr. Perry said it’s not that doctors are necessarily against using CBD oils, “we just have to be realistic about their limitations.”
Another concern is that many children for whom CBD oil might be tried are on other medications and “we don’t know enough to know how it might interact with those medicines or oils.”
“Cannabis and CBD have a long history of use for medical purposes,” Dr. Perry said. “But until recently, standardized studies gathering large amounts of data have been lacking. Now, with the change in social climate and attitude toward the potential of cannabis and CBD, we are gaining that data in the practical use of CBD in patients with seizures and epilepsy. But as far as general use in conditions such as anxiety or insomnia, I don’t believe we have enough research yet. Without more research and actual studies, we don’t know proper doses or side effects.”
For now if you are thinking about using CBD or allowing your child to use it, Dr. Perry asks parents to please talk to their pediatrician first.
Get to know M. Scott Perry, M.D.
I joined the Neurosciences Program of Cook Children's in 2009 as a pediatric epileptologist, then served as the Medical Director of the Epilepsy Monitoring Unit and Tuberous Sclerosis Complex clinic before assuming the role of Medical Director of Neurology in 2016. My clinical and research interests focus on the treatment of childhood onset epilepsy, specifically those patients with uncontrolled epilepsy or those for which the cause has not been determined. I have an intense interest in the use of surgical therapies to treat and cure epilepsy. The majority of my research has investigated the use of multimodal imaging techniques to localize seizure onset, as well as the description of patient and disease characteristics that predict favorable outcomes from surgical therapies. The pool of candidates which may benefit from surgical therapy continues to expand and I came to Cook Children's specifically because the staff of the Epilepsy Monitoring Unit and Comprehensive Epilepsy Program were dedicated to improving the care of children with epilepsy through cutting-edge techniques, research, and concern for their patients' well-being. Click to learn more.