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Cannabinoid Use in Pediatrics, Part 3: FAQs From Parents and How to Address Them
In the final segment of this 3-part series on Cannabinoid Use in Pediatrics, Dr. Jennifer Griffith discusses addressing parents’ concerns and other frequently asked questions about the use of cannabinoids for childhood conditions or illnesses.
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Learn more about Jennifer Griffith, MD, PhD
Jennifer Griffith, MD, PhD
Jennifer Griffith, MD, PhD is a Washington University pediatric neurologist at St. Louis Children's Hospital.Learn more about Jennifer Griffith, MD, PhD
Transcription:
Melanie Cole, MS (Host): Welcome back to the final segment of our three part series on cannabinoid use in pediatrics. My guest Dr. Jennifer Griffith. She’s a Washington University pediatric neurologist at St. Louis Children's Hospital, and she’s joining us to discuss addressing parent concerns and other frequently asked questions about the use for childhood conditions or illnesses. Dr. Griffith, what a great three part series that we are doing here today. Tell us some of the most common questions that you hear from parents about cannabinoid use.
Jennifer Griffith MD, PhD (Guest): So those questions have changed somewhat as the public awareness of CBD has become greater, and also as the legal standing of CBD has changed somewhat. I think really the most fundamental question I get from parents is the one you always start with, and that’s what do you think? I guess for the physicians that are listening, I think that emphasizes that parents really do value our medical opinion about these products, and they want answers as much as we do. So after many years of having the CBD talk with my patients, I have sort of a spiel for them. We can talk about a few of those things. I think really it comes down to almost information gathering with most of my families.
Host: So information gathering is really, really important, but are they concerned about long-term effects, safety.
Dr. Griffith: They are.
Host: Obviously whether or not it’s similar to marijuana and are their kids going to get high from it/
Dr. Griffith: I think that really comes down to it. So I think many people don’t understand the difference between CBD and medical marijuana. I certainly didn’t until a few years ago when I started learning about what it was. So as we discussed in the first part of the series, there are different products that are available. Everything from products that are advertised at a local shop to products that are at least somewhat regulated by the state to an FDA approved product that’s available prescription. So one thing I do is start by explaining those many different forms. I think once people understand that there is a prescription drug available, they understand that it may have real medical benefit. I think it also emphasizes to them that some of the products they may be seeing advertised may not be quite as efficacious or safe as what they think they might be since they're not in anyway regulated by the FDA.
So I think when it comes to long-term effects and safety, I think that emphasizes especially that there's a lot of unknowns about what’s in these products. In addition to not knowing a lot about CBD, we also don’t know a lot about even what's in some of the forms that aren’t regulated by the government.
Host: Is there anything else we don’t know about CBD?
Dr. Griffith: There's almost everything that we don’t know.
Host: Almost everything, right?
Dr. Griffith: As we start to use these drugs, especially once we have a drug that’s very purified CBD. So less than 0.1% THC, which is a very, very pure form of CBD. We now at least know that what we’re giving to our patients is CBD. We know how much CBD they're getting. So we can really start to study both the effects of it and the implications for drug interactions as well as side effects and long term effects. Now there's also a lot more research about the safety of it and it’s effects in both animal models and placebo trials. I think when you bring up potential things that we hope aren’t the case—Things like does it have the potential to have a teratogenic effect? Or does it have the potential to have effects on long term reproductive health? And you're speaking to parents about their children, I think those are potential unknown long term side effects that really resonate with them.
Host: What would you like to learn about it Dr. Griffith? You're so well informed and you know so much about the epidiolex and really CBD in general. What don’t you know? What would you like to learn?
Dr. Griffith: Well, I think we have some really good information that it can work for some patients with epilepsy. In particular, some really devastating forms of epilepsy. In the two forms of epilepsy for which it’s approved— Lennox-Gastaut syndrome and Gervais Syndrome—these are patients that typically have dozens if not hundreds of seizures every week if not every day. Those patients often have effects on their development and cognition. In those patients, the potential benefits of controlling their seizures are not outweighed by the potential risk to their cognition. For many of my patients though, they have good cognition and they have a lot of developmental potential. I think one of the things we want to know is that CBD epidiolex don’t have any long term cognitive side effects. They don’t have effects on the development of the brain, and especially the very young brain, and that they're safe to give long term.
Host: At what point would you recommend a pediatrician or for a patient for a consultation with a neurology specialist?
Dr. Griffith: Well, I want you to refer all of your patients to us. So any patient who has neurologic symptoms, whether it’s epilepsy or headaches or ticks, Cerebral Palsy. Of course, our group would be happy to see all of those. Again, I think one of the great things is that St. Louis Children's Hospital has really supported us having products like CBD available for our patients as long as their inline with state and federal law. So I know that since we have such a large and diverse group of pediatric neurologists, we are all going to stay on the cutting edge of available information about CBD and it’s use in our particular pediatric neurology patient population. So that as we get more information about things other than epilepsy that CBD might be helpful for, we’ll be able to see whether it would benefit our individual patients.
Host: To consult with a specialist, please call the children’s direct physician access line at 1-800-678-HELP. That’s 1-800-8678-4357. As we wrap up Dr. Griffith, what else would a referring physician need to know about CBD use in the pediatric setting? Wrap this up with your best advice. Learning what you have learned and through your research, what do you want them to know?
Dr. Griffith: I think most of this has come from just my experience of talking to families. I think many of us, we hear about something that’s supposedly natural and what parents think is a miracle cure. We have a tendency to immediately poo-poo that out of a kind of knee jerk caution. But I think it’s important to remember that patients and their parents are often sometimes just desperate for help. So what I've learned is that if we leave the door open to the possibility of any product or any drug providing hope for their child, but then couch that in sort of a cautious optimism where we say that our job is to first do no harm. We’re not willing to sacrifice our children’s potential for development and cognition and health for the sake of trying something that hasn’t been proven. I think parents really do respond to that. It’s important to remember that how they're making decisions as parents is different from how we make them as physicians. If we keep our communication open and honest, almost always my patients and I come to an understanding and continue to be able to have a therapeutic relationship regardless of what they decide to use as far as CBD.
Host: Well said. What a great series that we’ve done here for providers. We’re always looking for the latest treatment advances for any of these kinds of pediatric conditions. Thank you so much, again, Dr. Griffith for joining us. To consult with a specialist or to learn more about services offered at St. Louis Children's Hospital, please call children’s direct physician access line at 1-800-678-HELP. That wraps up episode three of our three part series on cannabinoid use in pediatrics on Radio Rounds with St. Louis Children's Hospital. Head on over to our website at stlouischildrens.org for more information and to get connected with one of our providers. If you found this series as informative as I did, please share on social media and be sure to check out all the other fascinating podcasts in our library. I'm Melanie Cole.
Melanie Cole, MS (Host): Welcome back to the final segment of our three part series on cannabinoid use in pediatrics. My guest Dr. Jennifer Griffith. She’s a Washington University pediatric neurologist at St. Louis Children's Hospital, and she’s joining us to discuss addressing parent concerns and other frequently asked questions about the use for childhood conditions or illnesses. Dr. Griffith, what a great three part series that we are doing here today. Tell us some of the most common questions that you hear from parents about cannabinoid use.
Jennifer Griffith MD, PhD (Guest): So those questions have changed somewhat as the public awareness of CBD has become greater, and also as the legal standing of CBD has changed somewhat. I think really the most fundamental question I get from parents is the one you always start with, and that’s what do you think? I guess for the physicians that are listening, I think that emphasizes that parents really do value our medical opinion about these products, and they want answers as much as we do. So after many years of having the CBD talk with my patients, I have sort of a spiel for them. We can talk about a few of those things. I think really it comes down to almost information gathering with most of my families.
Host: So information gathering is really, really important, but are they concerned about long-term effects, safety.
Dr. Griffith: They are.
Host: Obviously whether or not it’s similar to marijuana and are their kids going to get high from it/
Dr. Griffith: I think that really comes down to it. So I think many people don’t understand the difference between CBD and medical marijuana. I certainly didn’t until a few years ago when I started learning about what it was. So as we discussed in the first part of the series, there are different products that are available. Everything from products that are advertised at a local shop to products that are at least somewhat regulated by the state to an FDA approved product that’s available prescription. So one thing I do is start by explaining those many different forms. I think once people understand that there is a prescription drug available, they understand that it may have real medical benefit. I think it also emphasizes to them that some of the products they may be seeing advertised may not be quite as efficacious or safe as what they think they might be since they're not in anyway regulated by the FDA.
So I think when it comes to long-term effects and safety, I think that emphasizes especially that there's a lot of unknowns about what’s in these products. In addition to not knowing a lot about CBD, we also don’t know a lot about even what's in some of the forms that aren’t regulated by the government.
Host: Is there anything else we don’t know about CBD?
Dr. Griffith: There's almost everything that we don’t know.
Host: Almost everything, right?
Dr. Griffith: As we start to use these drugs, especially once we have a drug that’s very purified CBD. So less than 0.1% THC, which is a very, very pure form of CBD. We now at least know that what we’re giving to our patients is CBD. We know how much CBD they're getting. So we can really start to study both the effects of it and the implications for drug interactions as well as side effects and long term effects. Now there's also a lot more research about the safety of it and it’s effects in both animal models and placebo trials. I think when you bring up potential things that we hope aren’t the case—Things like does it have the potential to have a teratogenic effect? Or does it have the potential to have effects on long term reproductive health? And you're speaking to parents about their children, I think those are potential unknown long term side effects that really resonate with them.
Host: What would you like to learn about it Dr. Griffith? You're so well informed and you know so much about the epidiolex and really CBD in general. What don’t you know? What would you like to learn?
Dr. Griffith: Well, I think we have some really good information that it can work for some patients with epilepsy. In particular, some really devastating forms of epilepsy. In the two forms of epilepsy for which it’s approved— Lennox-Gastaut syndrome and Gervais Syndrome—these are patients that typically have dozens if not hundreds of seizures every week if not every day. Those patients often have effects on their development and cognition. In those patients, the potential benefits of controlling their seizures are not outweighed by the potential risk to their cognition. For many of my patients though, they have good cognition and they have a lot of developmental potential. I think one of the things we want to know is that CBD epidiolex don’t have any long term cognitive side effects. They don’t have effects on the development of the brain, and especially the very young brain, and that they're safe to give long term.
Host: At what point would you recommend a pediatrician or for a patient for a consultation with a neurology specialist?
Dr. Griffith: Well, I want you to refer all of your patients to us. So any patient who has neurologic symptoms, whether it’s epilepsy or headaches or ticks, Cerebral Palsy. Of course, our group would be happy to see all of those. Again, I think one of the great things is that St. Louis Children's Hospital has really supported us having products like CBD available for our patients as long as their inline with state and federal law. So I know that since we have such a large and diverse group of pediatric neurologists, we are all going to stay on the cutting edge of available information about CBD and it’s use in our particular pediatric neurology patient population. So that as we get more information about things other than epilepsy that CBD might be helpful for, we’ll be able to see whether it would benefit our individual patients.
Host: To consult with a specialist, please call the children’s direct physician access line at 1-800-678-HELP. That’s 1-800-8678-4357. As we wrap up Dr. Griffith, what else would a referring physician need to know about CBD use in the pediatric setting? Wrap this up with your best advice. Learning what you have learned and through your research, what do you want them to know?
Dr. Griffith: I think most of this has come from just my experience of talking to families. I think many of us, we hear about something that’s supposedly natural and what parents think is a miracle cure. We have a tendency to immediately poo-poo that out of a kind of knee jerk caution. But I think it’s important to remember that patients and their parents are often sometimes just desperate for help. So what I've learned is that if we leave the door open to the possibility of any product or any drug providing hope for their child, but then couch that in sort of a cautious optimism where we say that our job is to first do no harm. We’re not willing to sacrifice our children’s potential for development and cognition and health for the sake of trying something that hasn’t been proven. I think parents really do respond to that. It’s important to remember that how they're making decisions as parents is different from how we make them as physicians. If we keep our communication open and honest, almost always my patients and I come to an understanding and continue to be able to have a therapeutic relationship regardless of what they decide to use as far as CBD.
Host: Well said. What a great series that we’ve done here for providers. We’re always looking for the latest treatment advances for any of these kinds of pediatric conditions. Thank you so much, again, Dr. Griffith for joining us. To consult with a specialist or to learn more about services offered at St. Louis Children's Hospital, please call children’s direct physician access line at 1-800-678-HELP. That wraps up episode three of our three part series on cannabinoid use in pediatrics on Radio Rounds with St. Louis Children's Hospital. Head on over to our website at stlouischildrens.org for more information and to get connected with one of our providers. If you found this series as informative as I did, please share on social media and be sure to check out all the other fascinating podcasts in our library. I'm Melanie Cole.