Finally, someone other than me is asking about the effects of marijuana on kids,
but there are many more questions need answering
About half of Canadian doctors surveyed have child or
adolescent patients who have used cannabis
The Canadian Press 
Workers produce medical marijuana at Canopy Growth Corporation's Tweed facility in Smiths Falls, Ontario. In a survey released by the Canadian Paediatric Society on Thursday, many pediatricians expressed concern about the lack of evidence about medical marijuana's effectiveness and its potential risks. (Sean Kilpatrick/Canadian Press)
About half of pediatric doctors surveyed about cannabis say they've encountered a young patient who had used marijuana for a medical reason.
The questionnaire for the Canadian Paediatric Surveillance Program found 419 of 835 respondents had a patient who had used either authorized or unauthorized cannabis for some sort of medical relief.
The one-time study did not detail how many cases involved unauthorized use, the nature of the condition being treated or the ages of the patients.
But principal investigator Richard Belanger said he's surprised by the number of young cannabis users and says it points to the need for more information for doctors, parents and patients.
The Quebec City pediatrician, also a professor at Laval University, notes that more than a third of respondents — or 316 doctors — said they had been asked by a parent or adolescent patient to prescribe cannabis.
Only 34 doctors said they had done so, with many expressing reservations about efficacy, impacts to developing young brains, and concerns about abuse and dependence.
'Truly worrisome': Pot legalization will hurt youth unless changes made to proposed law, journal says
The survey was conducted in the spring of 2017 as part of the surveillance program's larger look at a host of hot-button issues, including Lyme disease, Zika virus and eating disorders.
'Not only an adult issue'
Belanger said researchers were surprised by how many kids and adolescents appeared to be turning to medical marijuana: "We thought it was less than that."
"We really want to make clear that cannabis is not only an adult issue, either for recreational but [also] medical purposes," Belanger said of the findings.
"Sometimes when we look at treatment we tend to forget kids, and it should not be the case."
Because kids have no voice. That's why people like Dr Belanger need to speak up twice as loud, 'cause politicians are certainly not listening to kids.
Dr. Richard Belanger, a Quebec pediatrician and principal investigator for the survey, says the use of medical marijuana for children is 'a burning issue' for doctors. (Veronique Cote/Handout photo via Canadian Press)
He suspected younger kids received authorized use for conditions including refractory seizures, cerebral palsy and chronic pain, while adolescents were more likely to be unauthorized users and to treat other conditions "such as sleep problems or anxiety."
Belanger said the higher-than-expected usage could also be because the doctors surveyed generally treat kids with chronic and severe conditions that may require alternative treatments, and because most respondents came from urban and academic centres more likely to handle severe cases.
The survey response rate was also just 31 per cent, which "may under or over represent the knowledge and/or experiences of Canadian pediatricians," said the study released Thursday.
Still, the findings raise questions about how impending legalization of recreational marijuana could impact unauthorized medical use.
"We're a bit anxious regarding that," said Belanger, pointing to "mixed perspectives" among doctors.
"From a pediatric perspective, there's seldom reason to authorize cannabis and maybe seizure is one of them, but still, there's no clear, no big evidence regarding that."
The survey found a clear majority of respondents had no knowledge or minimal knowledge on why cannabis might be prescribed for a child or youth and what products and dosages may be authorized.
"Paradoxically, they have a fairly positive view regarding cannabis use for medical purposes for certain conditions, despite the lack of solid scientific evidence regarding its safety and efficacy," said the survey, noting that could be due to difficult cases with limited therapeutic options.
Although medical marijuana has been legal since 2001, many questions remain, said Belanger: "It's a burning issue."
"There's a large space for the [Canadian Paediatric Society] or any other association or authorities to give more information on what are the clear facts regarding the possible benefits and the likely adverse events that can be related to medical use of cannabis."
Belanger noted that the data was gathered prior to the publication of a pivotal study evaluating the use of cannabidiol (CBD) to treat epilepsy among children with Dravet syndrome. The study was in the New England Journal of Medicine in the spring of 2017.
Still, he bemoaned a dearth of material to offer guidance. While more studies are underway, he said, they mostly look at CBD and its effects on seizures and severe conditions.
See below (More Potent Pot) to see why CBD is being bred out of pot.
"There are still problematic issues of studying cannabis with kids. I won't counsel anyone from entering a study exposing someone to cannabis if they don't have severe conditions.... On the contrary, in the adult field, there are many more studies regarding cannabis either for pain related to arthritis, pain related to fibromyalgia or spasticity regarding multiple sclerosis."
In the meantime, many parents and adolescents are asking for cannabis prescriptions.
"I think that everyone right now is aware that cannabis is not a simple thing," said Belanger. "When someone starts using cannabis for a long period of time at an early age, it's probably at that time that the greater impact is likely. But at the same time, if your kids have seizures several times a day, what's the worse issue? It's kind of a tricky question for parents."
There are many other questions that need to be answered, like:
What happens to a kid who gets a steady stream of 2nd hand pot smoke?
What happens to a kid who eats a handful of marijuana edibles?
What does a one-time overdose on pot do to a small child?
How are police and social services supposed to deal with chronic pot users with small children?
What little we do know:
Medical journal calls for tighter rules on legal pot to protect young
Powerful pot strains put developing brains of young people at risk, CMAJ editorial says
CBC News
A pot smoker has a joint at the annual 4/20 day, which promotes the use of marijuana, in Vancouver.
Cannabis shouldn't be used by young people, a medical journal editorial says. (David Horemans/CBC)
Marijuana legalization will harm the health of youth unless major changes to the proposed law are made to protect their developing brains, a medical journal editorial says.
Dr. Diane Kelsall, interim editor in chief of the Canadian Medical Association Journal, says Bill C-45 fails to safeguard vulnerable youth.
"There are a number of things in the legislation that are truly worrisome," Kelsall said in an interview. "If the intent is truly a public health approach and to protect our youth this legislation is not doing it."
Canadian young people ranked first for cannabis use in North America and Europe, with one-third saying they tried it at least once by age 15, the Canadian Pediatric Society says.
Before the federal election, physicians said the right legislation to legalize pot might curb teen toking by restricting access.
The editorial takes issue with several aspects of the bill, which:
- Sets the minimum age to buy recreational marijuana at 18. Kelsall calls that too young given evidence suggesting that the human brain doesn't mature until about age 25.
- Allows people to grow pot at home, which Kelsall said increases the likelihood of diversion to young people.
- Lacks national standards for retail distribution.
- Lacks limits on potency of strains despite increased risk of harmful effects with higher-strength cannabis.
The guinea pigs are the kids
"From my perspective, from my colleagues' perspective, this legislation is being pushed through," Kelsall said. "We're just very worried that we're conducting a national experiment and unfortunately the guinea pigs are kids."
On Monday, Health Minister Jane Philpott was asked by reporters if she was prepared to change the age.
"Provinces and territories will have the opportunity to address the age," Philpott said. "Our bill is not entirely through the legislative process. It is possible that it could change along the way."
Making a product legal does not mean it is advisable or recommended, Philpott said.
Marijuana as a psychosis trigger
At the Centre for Addiction and Mental Health in Toronto, psychiatrist Romina Mizrah uses PET scanners to study how cannabis use changes brain function in young people with an average age of 20.
In young people who regularly use cannabis, preliminary evidence points to a reduction in an enzyme that regulates the endocannabinoid system that buffers key chemistry within the brain, said Mizrahi.
"There is some understanding at this point from epidemiological studies that certainly marijuana is a trigger," said Mizrahi, director of the Focus on Youth Psychosis Prevention program. "Marijuana use predates the psychosis. Whether it causes the psychosis, that's a different question and that we don't know."
I suspect there needs to be a susceptibility toward psychosis present, but that susceptibility might reside in a very large segment of the population, and, it might remain dormant through a person's entire life without a trigger like marijuana.
It may be possible in the future to determine whether or not a person is susceptible to psychosis and should therefore avoid pot like the plague. But it isn't possible now, nevertheless, we rush in anyway.
Studies using MRI scanners also show physical and functional changes in the developing brains of regular users that are associated with damage, Kelsall said.
More potent pot
Mike Stroh, 35, of Toronto says he's part of a generation who grew up smoking current strains of marijuana, which have been genetically selected to produce a powerful high, with THC levels of about 20 per cent. That's up from around seven per cent in the 1960s and '70s.
And the methodology of raising the THC requires the reduction of CBD. It's CBD that may be helpful to those mentioned above with epilepsy or certain other conditions. CBD may also decrease the risk of contracting schizophrenia or other psychosis. So, of course, we remove it to make the THC more powerful. How insane are we?
If we had the research, the government could restrict the amount of THC and ensure a certain level of CBD be present. This would reduce the risk of developing psychosis. But, our extreme left government cannot wait for such research, we must have pot legalized and we must have it now.
"I was into sports," Stroh recalled. "I wanted to do stuff at school, but I wouldn't make it to the practice, I wouldn't make it to the tryouts, because I was either up all night selling drugs, trying to get them, fall asleep in a drug-induced coma, and then wake up in a mess."
Mike Stroh with his kids. Stroh is now a mental-health advocate who wants to show recovery is possible. (Mike Stroh)
Stroh also lived with depression and anxiety and said he was never able to like himself. "That's the torment that brought me to my knees." He felt robbed of being himself and the opportunity for emotional maturity, cognitive development and professional opportunities.
"Because marijuana doesn't bring you to your knees as quickly as other drugs may … there's this illusion that because you can be high and do things, it's not bad, so to speak."
Stroh is now a mental health advocate who draws on his personal and family experiences to educate.
"We need to teach kids how to take care of themselves so when they do feel anxious and do feel depressed, scared or … frustrated with life, because yes, that's a part of being a teenager, then they learn that there's so many things they can do to help themselves as opposed to use drugs."
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