CBD:THC for Pediatric Patients

 In Medical Cannabis

In the last four to five years I’ve started seeing a lot of kids with seizure disorder and/or autism (most of them with both). For these  patients, I definitely see them every 3 months instead of once a year and as always I make sure that somebody (their neurologist or primary care provider) is following their illness.

For both autism and seizure disorder, what seems to be most effective, is CBD for the seizures because you can really ramp up the dose (if needed), and give all the medicine they need to help the seizures, without getting them intoxicated. If there’s autistic behavior, sometimes they get a little violent when they get older, in which case some of the parents report that giving them a little THC with their CBD helps make them happier, less violent, and they actually learn better.

Then it’s a matter of dosing, because the way you dose for CBD would be different from the way you dose for THC. After I’ve done the initial evaluation, I help parents figure out dosing. It’s not that complicated. I get my dosing formula from two sources: GW Pharmaceuticals, a company in England that is doing the Epidiolex study. Epidiolex is a CBD predominant medicine by GW Pharmaceuticals, and they’ve been allowed to do some U.S. trials on patients with two forms of seizure disorders: Dravet’s Syndrome and Lennox-Gastaut. These studies are being done at UC San Francisco, and New York University. I use a combination of their dosing guidelines as well as the dosing guidelines of Dr. Bonni Goldstein, an Emergency Medicine-trained Pediatrician in the Los Angeles area, who has seen a lot of kids with seizures and autism. Between the two of those dosing regimes I’ve come up with the CBD dosing guidelines I use for these patients. Pediatrics

The amount of CBD for helping seizure can be anywhere from .5mg per pound of body weight per day, divided into 2 or 3 doses a day, and up to 10X that amount. There’s a wide range of what one can use. The dosing would be totally different if you need predominantly THC because with THC, I use the comparison to the synthetic THC that’s legal in all 50 states called Marinol (or dronabinol). Dronabinol comes in 2.5mg, 5mg, and 10mg. You can imagine for a cannabis-naive adult, a dose of 10 mg of THC might be a lot but for a kid you might very well give more than 10mg of CBD-predominant tincture. You can use a lot more CBD than one can tolerate THC. (No one has ever died from an overdose of THC, but you can feel unnecessarily intoxicated and sedated.) That’s the beauty of being able to use CBD because you get a lot of the benefits with almost none of the sedation or intoxication.

After I see the parents and the kids for the first visit, we follow-up every 3 months; I always tell the parents “The conversation is not over when you walk out of here. You can still call or email as many times as you need to because you’ll think of some more questions as soon as you walk out of here that you will wish you had asked.” It’s an ongoing relationship to help them figure out dosing. Unfortunately, with most of the products, even if it is well made, the formulations are quite a bit different. One company may have CBD:THC ratios of 1:1, 2:1, 4:1, 8:1 and a 16:1. Another may only have a 10:1 or a 20:1. In addition, the amount of CBD per milliliter may be quite different, even if the ratios were the same. It’s still useful to know exactly what that is though because then we can extrapolate and figure out how many milligrams we need to give and how many milliliters (ml) or cubic centimeters (cc) it takes to give that same amount that we’ve calculated.

There’s an ongoing conversation between the parents and myself when I’m seeing these kids.

I’ve found that the CBD does help the seizures at least as well as the prescription medications do. In addition, a lot of the prescribed medications these kids are getting are pretty toxic and often don’t even work in a particular patient.

Often, the parents come to see me because they’ve been offered these medicines and don’t want their kid to take them because they’ve read the side effects, or they have begun these drugs, and have experienced the side effects. It’s always a pleasure to try to help determine how much cannabis in the form of CBD and/or THC will help them.

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