The Massachusetts law, which went into effect January 1 though final regulations weren’t approved until May, specifies that for medical marijuana to be made available to children younger than 18, two state-licensed physicians, at least one of whom specializes in pediatrics, must agree the potential benefits of medical marijuana outweigh the risks. (Adult patients need only one doctor.) In addition, juvenile patients must have written consent from at least one parent or guardian who understands the potential benefits and harms and who will serve as caregiver. With those safeguards in place, young patients facing ailments ranging from cancer to autism to epilepsy may be treated with medical marijuana.
It’s about time, says psychiatrist and longtime medical marijuana advocate Dr. Lester Grinspoon, an associate professor emeritus at Harvard Medical School. Grinspoon explains that marijuana has been used to treat children in the United States since the 19th century, when an alcohol-based solution called cannabis indica was taken for pain from an ear infection or was rubbed onto an infant’s gums to ease teething. It was also used to treat seizures and epilepsy. He has reviewed more than 100 clinical papers on marijuana’s therapeutic value written between the 1840s and 1900; the literature includes marijuana’s use in children. More recently, he says, it has been employed to relieve the negative effects of chemotherapy, like nausea. And for children with autism, it can help mitigate the outbursts and destructive behaviors sometimes associated with the condition.
“I’ve been studying marijuana since 1967,” says Grinspoon. “I started to study it because I was so concerned about all of these young people who used marijuana, that they were harming themselves. I believed all the things everybody was told about it. My best friend at that time was Carl Sagan, and I would tell him not to smoke it, and he would say, ‘Oh, Lester, it’s harmless.’ ”
Grinspoon changed his mind after his own teenage son used marijuana when he was undergoing treatment for lymphocytic leukemia in 1971; the boy, Danny, died of the cancer in 1973. Danny found that medical marijuana eased his suffering from chemotherapy. That inspired Grinspoon to learn more. “I went to the Harvard library and started reading,” he says. “It fascinates me: one, the properties of the drug itself, and two, that I and so many others had been so misled about it.”
But some doctors argue that there may be special dangers for young people using medical marijuana. Dr. Sharon Levy, a pediatrician and addiction specialist who runs the Adolescent Substance Abuse Program at Children’s Hospital, is one of them. “We all know [medical marijuana] can relieve pain and stimulate appetite,” but it can also cause harm, she says. “Studies of adolescents exposed to marijuana recreationally link marijuana use to mental health and thought disorders,” she says. “Exposure to marijuana during adolescence is associated with IQ decline over long-term use.” She notes that “these weren’t randomized controlled studies, but this is the best that’s out there.”
“I’m a pediatrician and a parent,” she says. “I think what we have to evaluate is, if the child will survive, we need to protect their brains.” Children, she explains, are resilient. While parents might witness helpful effects in the short term, it’s “much harder to pick up on long-term effects.” If medical marijuana “relieves your child’s nausea but drops their IQ,” that’s problematic. (The subject is still a touchy one. Levy was the only doctor Children’s Hospital could make available to speak on the topic of medical marijuana; no nurse or doctor who has experience with terminally ill children could be found.)
Grinspoon sees things differently. “There are no double-blind studies,” he says, referring instead to decades of anecdotal evidence of its benefits in some children with cancer, autism, and epilepsy. “The question is: Is it more useful and less toxic than the pharmaceuticals the child is getting? There is no question the toxicity is very little. You just have to make sure not to give them too much to make them uncomfortable.” These days, he adds, cannabis growers are able to produce marijuana that doesn’t give the patient a psychoactive “high,” Grinspoon explains. “If I were prescribing for a child, I’d insist the child get a strain high in CBD,” or cannabidiol (as opposed to THC, short for tetrahydrocannabinol, the compound that pharmaceutical Marinol mimics).Continued...