Despite Research Gap, Medical Marijuana Use Supported at End of Life in Pediatric Cancer

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Little scientific evidence exists to back up the how and why of medical marijuana use.
Little scientific evidence exists to back up the how and why of medical marijuana use.

In states where medical marijuana has been legalized, its use has been embraced by many physicians for pediatric patients with cancer. Although medical marijuana may provide symptomatic relief where other therapies have failed, little scientific evidence exists to help physicians understand how and when medical marijuana should be used in the management of pediatric disease symptoms, according to an article published in JAMA.1

When medical marijuana was legalized in Massachusetts in 2012, physicians across the state received an overwhelming number of requests from patients as well as family members of patients regarding the use of the therapy for managing symptoms. Currently, physicians rely on anecdotal data from patients for modification of medical marijuana recommendations. Many physicians understand the risks of marijuana on a child's cognitive development; however, the benefits ultimately outweigh these risks in patients with terminal illness.

In 2015, investigators from the Dana-Farber Institute and Boston Children's Hospital, led by Prasanna Ananth, MD, MPH, a pediatric oncologist and assistant professor of pediatrics at the Yale School of Medicine, created an electronic survey, which was administered to physicians at 3 large cancer centers.2 The survey was designed to assess the clinician perspectives regarding the use of marijuana for medical purposes, particularly among children with cancer.

Approximately 30% of physicians who were surveyed reported that they were asked for medical marijuana by patients or by a patient's family member. Of these, up to 79% of requests were for nausea, whereas 52% were for anorexia and 26% were for pain relief. The majority of clinicians (92%) were willing to recommend medical marijuana to children with cancer, particularly those nearing end of life.

Despite growing legality across the United States, some clinicians are hesitant to recommend marijuana therapy because of its schedule I controlled substance classification under the Drug Enforcement Administration. According to the survey, many physicians were unsure about the state and federal regulations concerning legalized medical marijuana.

Approximately 59% of surveyed physicians understood that certifying patients with a medical marijuana card was against federal laws, and only 5% of physicians correctly identified state-specific regulations regarding access, cultivation, and possession. Ultimately, the survey found that the lack of research regarding formulation, potency, and dosing of medical marijuana was a barrier to therapy recommendation.

Dr Ananth noted that, ultimately, clinicians need more information to field inquires related to marijuana therapy. “I think the approach has long been to either decline to comment, or just say, ‘I'm not sure I can recommend that,'” Dr Ananth concluded. “That might have been an okay response when medical marijuana wasn't legal, but now that it's legal and patients are seeking very valid channels to access it, we have to, as physicians, come up with a response that feels safe.”

References

  1. Peachman RR. Clinicians support medical marijuana use in children with cancer, but lack knowledge. JAMA. 2018;319(9):852-853.
  2. Ananth P, Ma C, Al-Sayegh H, et al. Provider perspectives on use of medical marijuana in children with cancer. Pediatrics. 2018;141(1):e20170559.

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