A recent study published in the Journal of the American College of Emergency Physicians (JACEP) Open evaluated the recent use of marijuana and its by-products, its effects and clinical manifestations, perceptions, pharmaceuticals, epidemiological studies, and the ramifications of long term in pediatrics. populations.
Study: Marijuana use in children: an update focused on pediatric use of tetrahydrocannabinol and cannabidiol. Image credit: Yarygin / Shutterstock
Fund
Cannabis is among the most popular recreational drugs in the United States, and a growing number of children and adolescents use it in some way. The legalization of cannabis has led to an increase in drug use among children and adolescents, due to widespread knowledge of the negligible risk anticipated with its use.
However, cannabis use during childhood carries risks of acute intoxication due to overdose and permanent neuropsychiatric changes. In addition, the dangers associated with severe intestinal absorption are not uncommon with cannabis use during childhood.
Pharmacology of cannabis
Cannabinoids are ingredients that cause the euphoric and sedative effects of cannabis, as they bind to certain brain receptors. Cannabidiol (CBD) and delta-9 tetrahydrocannabinol (THC) are the two widely researched and known cannabinoids; However, more than 100 types of cannabinoids are currently known.
CBD is a widely used cannabinoid derivative and does not interact with THC receptors or have any psychoactive effects. CBD is known for its analgesic, anti-nausea, anxiolytic, anti-inflammatory, anti-epileptic and anti-ischemic effects.
THC affects the hypothalamus, cerebellum and hippocampus to cause psychotropic effects and sensations. Serum THC levels increase in a matter of minutes after consumption, reaching a maximum in 1-4 hours and then declining rapidly.
There are different forms of cannabis; Marijuana refers to dried and crushed leaves / flowers; the concentrated oil is known as “hashish oil,” while the resin part is known as hashish. In addition, electronic steam and other cannabis products have increased access to and effectiveness of the drug.
Legalization of marijuana has substantially increased availability and access, especially among the younger generation. A 2019 national study on drug use and health described that the proportion of individuals over the age of 12 who consumed marijuana increased from 25.8 million in 2002 to 48.2 million in 2019, with an average of the number of teenagers who began to consume marijuana the previous year. about 3,700 teens a day.
Cannabidiol
As of June 30, 2021, poison control institutes had already treated 2,158 cases of cannabidiol. Utah documented 52 incidents of CBD oil poisoning during 2017 and 2018, with symptoms including hallucinations, nausea / vomiting, seizures, and loss of consciousness.
Although there have been cases of unwanted adulteration of these products with THC, the clinical aspect of acute CBD poisoning is usually benign. Various side effects of cannabidiol are gastrointestinal (nausea, emesis, diarrhea). In addition, there have been complaints of difficulty respiratory and psychogenic effects.
In adults, cannabinoids can help modulate chemotherapy-induced nausea and vomiting. However, none of these studies demonstrate the beneficial use of cannabis in children. Meanwhile, certain retrospective or observational studies and case reports show the effectiveness of cannabinoids in stopping recalcitrant seizures.
Large, randomized, controlled studies investigating the efficacy of pharmaceutical-grade cannabidiol (CBD) in pediatric patients with Dravet and Lennox-Gastaut syndromes revealed efficacy comparable to conventional anticonvulsants. The Food and Drug Administration (FDA) has approved the use of a CBD drug for Dravet and Lennox-Gastaut syndromes, however, the mechanism remains uncertain.
In up to 15% of patients, cannabidiol has been associated with adverse effects such as nausea, seizures, and increased serum alanine aminotransferase and aspartate aminotransferase. In addition, hyperamonemia and severe thrombocytopenia were documented. All of these side effects seemed to be dose dependent.
The management of these adverse effects involves the removal of the CBD drug. However, the long -term effects of CBD intake remain uncertain. In addition, pharmaceutical formulations may be subject to inconsistent regulation.
Delta-9-tetrahydrocannabinol (THC)
The observation revealed cases of Thc’s incidence and acute overdose. Between 2004 and 2014, it was reported that children under the age of 3 were admitted to a pediatric emergency room for accidental exposure to cannabis. Ten of the 29 babies admitted tested positive for cannabis in the urine and required acute attention. Among these, 87% of cases of poisoning occurred at home. Resin was the most common type of cannabis ingested. In addition, depending on the form ingested, the clinical appearance of a patient with acute THC intoxication may vary.
Pure THC in edible items can have substantially varied harmful effects than raw cannabis. After acute consumption, the most common symptoms in children are depression, disorientation, agitation, ataxia, lethargy, and coma. Dexmedetomidine has been shown to be a relatively safe and effective treatment for exposure to juvenile marijuana or natural cannabinoids, to help control acute THC toxicity.
Several systemic and psychological consequences have been linked to chronic cannabis use. The most common and serious side effects are: cannabinoid hyperemesis disorder, side effects related to the central nervous system, cardiorespiratory consequences, and an increased likelihood of bodily harm. While cannabis use during pregnancy has been linked to newborn neurodevelopmental problems and autism spectrum disorders.
Regarding the therapy of withdrawal syndrome, no study has been published on cannabis. However, behavioral treatments and various pharmacological drugs, for example, dronabinol, nabiximols, gabapentin, certain sedatives, and hypnotics, may be used in the treatment of withdrawal symptoms.
Since its legalization, the acceptability and use of cannabis have increased, as the drug has earned a reputation for safe use or the absence of harmful effects. However, strong parental vigilance is essential, along with peer discouragement when it comes to cannabis use, which can help prevent cannabis use among pediatric age groups.
Conclusion
This review summarizes existing research on cannabis use in children, including incidence, short- and long-term side effects, and widespread use. Legalization seems to have contributed to the projected “safety” of marijuana. However, the risks persist. The risks associated with marijuana use among children could be detrimental, and the potential for lasting neuropsychiatric complications requires prompt action and the spread of preventive awareness.
