Should Children Have Access to Medical Marijuana?
Medical marijuana for adults has gained acceptance across the United States. A recent survey of a randomized sample of over 1,000 registered voters revealed that 85% of Americans think adults should be allowed to use marijuana for medical purposes if a physician prescribes it (Fox News Poll, 2013). Today, 20 states and the District of Columbia (see Figure 1) have legalized medical marijuana (ProCon.org, 2014).
Legal Medical Marijuana States, Including the District of Columbia
What about children? Should they, too, have legal access to medical marijuana? Certainly, Zaki's life-altering story would make one think so. Anecdotal evidence indicates the effectiveness of medical marijuana in the treatment of various disorders or diseases. For instance, a liquid, non-psychoactive form of marijuana was found to reduce seizures for children with Dravet's syndrome, a rare form of childhood epilepsy (Melville, 2013). Reports have suggested possible benefits of using marijuana in the treatment of children with autism (Gillette, 2013), cancer (Szalavitz, 2012), attention-deficit hyperactivity disorder (Centonze et al., 2009), as well as other conditions.
Unfortunately, there is limited high-quality evidence about the efficacy of medical marijuana. For example, a 2012 Cochrane review of all published randomized-controlled trials involving the treatment with marijuana or one of marijuana's constituents in people with epilepsy stated that no reliable conclusions could be made at present regarding the efficacy of cannabinoids as a treatment for epilepsy (Gloss & Vickrey, 2012). All of the reports were of low quality.
Importantly, there are virtually no data about the safety of using marijuana or cannabinoids with children (Melville, 2013). While some experts caution that the effects of the drug on child development are unknown, others point out that the same is true for other medications used to fight pain and nausea that are currently given to children with cancer, as well as for powerful antipsychotic drugs that are used in long-term treatment of childhood mental illness (Szalavitz, 2012). Morphine, oxycodone (Oxycontin®), and other opioid drugs that are sometimes used to treat the severe pain that accompanies life-threatening cancer and other diseases can cause overdoses.
Addiction rates are often lower with marijuana than those with opioid drugs, and the severe physical withdrawal symptoms associated with opioids are not seen with marijuana. Opioids can cause nausea and vomiting, while marijuana reduces the risk of these symptoms that frequently occur as side effects of radiation or chemotherapy (Szalavitz, 2012).
Clark (2003) considers the failure to give an effective therapy to seriously ill patients, whether adults or children, as a violation of the core principles of both medicine and ethics:
Medically, to deny physicians the right to prescribe to their patients a therapy that relieves pain and suffering violates the physicianpatient relationship. Ethically, failure to offer an available therapy that has proven to be effective violates the basic ethical principle of nonmaleficence, which prohibits the infliction of harm, injury, or death and is related to the maxim primum non nocere ("above all, or first, do no harm"), which is widely used to describe the duties of a physician. Therefore, in the patient's best interest, patients and parents/surrogates have the right to request medical marijuana under certain circumstances, and physicians have the duty to disclose medical marijuana as an option and prescribe it when appropriate. The right to an effective medical therapy, whose benefits clearly outweigh the burdens, must be available to all patients, including children. (p. ET 1)
Acknowledging that children may benefit from medical marijuana, individuals and groups are advocating for legalization of its use with children. Moms for Medical Marijuana an alliance of mothers, community leaders, and concerned parties – are advancing the equal treatment of medical marijuana patients and providers (Moms for Medical Marijuana, n.d.). Medical organizations, such as the American Academy of Pediatrics (AAP), while opposing the legalization of marijuana, supports rigorous scientific research regarding the use of cannabinoids for the relief of symptoms not currently ameliorated by existing legal drug formulation (Jacobs et al., 2004).
Pediatr Nurs. 2014;40(2):59-60. © 2014 Jannetti Publications, Inc.