Parents and adolescents often ask primary care and mental health providers about Cannabidiol (CBD) for anxiety, sleep or other symptoms or behaviors. Here, we discuss the latest in community standards, the state of the evidence, and encourage primary care providers to be prepared to educate families on the limited role CBD should play for children and adolescents.
CBD is a phytocannabinoid naturally occurring in cannabis plants. It is typically thought to have little to no euphoric effects. It does have some activity on Cannanaboid receptors, and is a 5HT1A (serotonin receptor) agonist, which many argue conveys CBD anxiolytic properties. CBD (Epidiolex) is FDA approved for children 2 years and older for the treatment of seizures associated with Lennox-Gastaut Syndrome or Dravet Syndrome. There have been critical reviews, systematic reviews, case series and at least one small double blinded study from Japan, that argue for the role of CBD in treating anxiety, sleep and other psychiatric symptoms (Mandolini et al., 2019; Shannon et al., 2019; Bonaccorso Et al, 2019; Masataka, 2019).
owever, the limited strength of the evidence, numerous risks associated with non-FDA approved CBD products and the know risks associated with the CBD molecule outweigh the possible benefits for the use in children and adolescents outside of FDA approval. In March of 2020, the FDA noted (FDA Statement) concerns “about potential harm from CBD products, including potential liver injury, interactions with other drugs and male reproductive toxicity, as well as side effects such as drowsiness. In addition, there is still much we do not know about other potential risks. For example, other than the approved prescription drug, we know little about the potential effects of sustained and/or cumulative use of CBD, co-administration with other medicines, or the risks to vulnerable populations like children, pregnant and lactating women, the elderly, unborn children and certain animal populations.”
In 2019, The American Academy of Child and Adolescent Psychiatry issued a policy statement on the “Use of Medical Marijuana in Children and Adolescents with Autism Spectrum Disorder for Core Autism Symptoms or Co-Occurring Emotional or Behavioral Problems”, recommending “Against the use of medical marijuana or isolated cannabinoids for core symptoms or co-occurring emotional or behavioral problems in children and adolescents with Autism Spectrum Disorder”. The policy clarifies “That families should be educated about risks and discouraged from using marijuana and cannabinoids for Autism Spectrum Disorder”, and recommends against federal approval “in the absences of scientific evidence”.
There will likely continue to be questions that arise, but at this point, the community standard is to educate families about the risks, and avoid use outside of FDA approved indications.
American Academy of Child and Adolescent Psychiatry Policy Statement, 2019: “Use of Medical Marijuana in Children and Adolescents with Autism Spectrum Disorder for Core Autism Symptoms or Co-Occurring Emotional or Behavioral Problems”. Available on the internet https://www.aacap.org/AACAP/Policy_Statements/2019/Use_of_Medical_Marijuana_in_Children_and_Adolescents_with_Autism_Spectrum_Disorder_for_Core_Autism_S.aspx
Bonaccorso S, Ricciardi A, Zangani C, Chiappini S, Schifano F. Cannabidiol (CBD) use in psychiatric disorders: A systematic review. Neurotoxicology. 2019;74:282–298. doi:10.1016/j.neuro.2019.08.002
FDA Statement, March 5th, 2020. “FDA Advances Work Related to Cannabidiol Products with Focus on Protecting Public Health, Providing Market Clarity”. Available at https://www.fda.gov/news-events/press-announcements/fda-advances-work-related-cannabidiol-products-focus-protecting-public-health-providing-market
Mandolini, G. M., Lazzaretti, M., Pigoni, A., Oldani, L., Delvecchio, G., & Brambilla, P. (2018). Pharmacological properties of cannabidiol in the treatment of psychiatric disorders: A critical overview. Epidemiology and Psychiatric Sciences, 27(4), 327–335. https://doi.org/10.1017/S2045796018000239
Masataka, N. (2019). Anxiolytic Effects of Repeated Cannabidiol Treatment in Teenagers with Social Anxiety Disorders. Frontiers in Psychology, 10(November). https://doi.org/10.3389/fpsyg.2019.02466
Soares, V. P., & Campos, A. C. (2017). Evidences for the Anti-panic Actions of Cannabidiol, 291–299. https://doi.org/10.2174/1570159X14666160509123
Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041