CBD: What Parents Need to Know
Parents are giving it to kids to combat anxiety and other problems. But there are risks, and little research to support it.
What You’ll Learn
- Is CBD safe for kids?
- What are the risks of giving kids CBD?
- Can CBD help kids who have mental health disorders?
- Quick Read
- Full Article
- What do we know about CBD?
- Concerns about CBD
- Is CBD safe?
- CBD oil for anxiety
- CBD and autism
- Research boom
These days, you can find CBD everywhere. Some people believe that it can treat everything from chronic pain and cancer to anxiety and ADHD. But is it safe for kids?
CBD is still pretty new, so there’s very little research about its safety or how well it works, especially for children. So far, there’s only one marijuana-derived medication that has been approved by the Food and Drug Administration. It’s called Epidiolex, and it’s used to treat a rare form of epilepsy in patients who are at least two years old.
Because CBD is so new, there also aren’t a lot of rules about what can and cannot be included in CBD products. So, there’s a huge variety in the quality of products. You may even find different amounts of CBD in different packages of the same product.
Since there isn’t a lot of research about CBD, doctors say there are some risks with using CBD for kids. For example, CBD products may contain things other than CBD, and those things could be harmful. Plus, we don’t yet know if CBD works well with other medications or how much you should give your child.
Although a few studies have found that CBD oil might work for anxiety, they only looked at healthy people who were put in situations that made them anxious. There are no studies yet on people with chronic anxiety. Researchers are also exploring CBD for kids with autism spectrum disorder. The results are good so far, but more research needs to be done before we can know if it’s safe and effective.
CBD is everywhere. From corner stores and bars to medical marijuana dispensaries, it’s being offered for its reputed ability to relieve pain and make people feel better.
Though CBD — full name cannabidiol — is extracted from marijuana or hemp, it doesn’t contain THC, the chemical in marijuana that has psychoactive effects, so it doesn’t make you feel high.
Available in the form of vaping, oils, lotions, cocktails, coffee, gummies — you name it — CBD has been touted as a treatment for complaints as far-reaching as chronic pain, cancer, migraines, anxiety and ADHD. You know it’s gone mainstream when even Consumer Reports has issued guides on how to shop for CBD and tips for safe CBD use.
Not only are adults experimenting with CBD for whatever is bothering them, increasingly parents are turning to CBD to help their kids focus, sleep, calm down and more.
But popular use of CBD is blowing up with very little research into its safety or its efficacy, especially in children. The first and only marijuana-derived drug approved by the Food and Drug Administration, Epidiolex, is used to treat a rare, severe form of epilepsy in patients two years of age and older. And since cannabis is in the early stages of legalization and regulation, there is a huge variety in the quality and dosage of products — risks associated with using products that have not been vetted by the FDA.
What do we know about CBD?
For millennia, hemp plants have been used for medicinal purposes around the world. In 1851 marijuana was classified by the United States Pharmocopeia as a viable medical compound used to treat conditions like epilepsy, migraines and pain. But since marijuana and cannabis-related products were made illegal in the US in 1970, there has been a dearth of research about either marijuana or CBD. Its classification as a Schedule 1 drug made it nearly impossible to get federal funding to study cannabis.
“The biggest problem is there’s a lot that we still need to know, especially in kids,” says Paul Mitrani, MD, a clinical psychiatrist at the Child Mind Institute. “In regards to treating mental health disorders in children and adolescents, there’s a lack of evidence to support its use.”
Dr. Mitrani, who is a pediatrician and child and adolescent psychiatrist, says it’s an area worthy of investigation but recommends that parents wait until further research is done before giving a child CBD.
Concerns about CBD
While anecdotal evidence of the benefits of CBD is common, there are risks associated with using these products, especially in children. Some of the concerns:
- Products are unreliable in delivering a consistent amount of CBD. They could have less, or more, than advertised, and most do not offer independent verification of active contents. Analysis of products for sale show that many do not have the amount of CBD that they advertise. “So you can’t depend on the quality of what you’re getting,” notes Dr. Mitrani.
- How much is absorbed? Very little is known about how much CBD is actually delivered to the brain in a given product. Various delivery systems — vaping, taking it orally, eating it in baked goods, etc. — have different rates of delivery. Even the oils that the CBD is dissolved in can result in varying effects. “Effects can vary a lot based on the delivery system used and the amount people are exposed to can be inconsistent,” Dr. Mitrani says.
- Products may contain things other than CBD, and they could be harmful. Lab testing — which provides information about CBD levels, THC levels (if any), and contaminants in the product — isn’t mandatory for CBD products in every state. Without a CoA (Certificate of Analysis) it’s that much harder to verify the safety of the product. Bootleg CBD may be connected to recent lung illnesses and deaths that have been attributed to vaping. The CDC and the American Medical Association recommend avoiding vaping entirely while the cause of these illnesses is determined.
- CBD may be safe itself, but it may interact with other medications a child is taking, that are also metabolized in the liver.
- If it’s used for sleep, Dr. Mitrani worries that while it may potentially help with sleep, “your child may become tolerant to it and possibly experience worsening sleep problems if stopped.”
- Since CBD use — especially for kids — is a still so new, few people are familiar with dosing for children, so determining how much to give your child would be tricky. Clinical doses versus what you might find at a coffeehouse could vary dramatically.
- The legality of cannabis products and CBD is still murky. CBD derived from hemp is federally legal, while CBD derived from marijuana plants is subject to the legal status in each state — and remains federally illegal. Meanwhile, the FDA issued a statement making clear that products that contain CBD — even if they are derived from legal, commercial hemp — cannot claim to have therapeutic benefits or be sold as dietary supplements unless they have been approved by the FDA for that use.
Is CBD safe?
Last year the World Health Organization, acknowledging the explosion in “unsanctioned” medical uses of CBD, reviewed the evidence for its safety and effectiveness. The WHO report concluded that “CBD is generally well tolerated with a good safety profile.” Any adverse effects could be a result of interactions between CBD and a patient’s existing medications, the WHO noted.
The report found no indication of potential abuse or dependence. “To date there is no evidence of recreational use of CBD or any public health-related problems associated with the use of pure CBD.”
As for effectiveness, the WHO noted that several clinical trials had shown effectiveness for epilepsy, adding: “There is also preliminary evidence that CBD may be a useful treatment for a number of other medical conditions.”
CBD oil for anxiety
In 2015 a group of researchers led by Esther Blessing, PhD, of New York University, investigated the potential of CBD for treating anxiety. In a review of 49 studies, they found promising results and the need for more study.
The “preclinical” evidence (ie from animal studies) “conclusively demonstrates CBD’s efficacy in reducing anxiety behaviors relevant to multiple disorders,” Dr. Blessing wrote. Those include generalized anxiety disorder, PTSD, panic disorder, social anxiety disorder and OCD.
The review notes that the promising preclinical results are also supported by human experimental findings, which also suggest “minimal sedative effects, and an excellent safety profile.” But these findings are based on putting healthy subjects in anxiety-producing situations and measuring the impact of CBD on the anxiety response. Further studies are required to establish treatment with CBD would have similar effects for those who struggle with chronic anxiety, as well as what the impact of extended CBD use may be.
“Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders,” Dr. Blessing concludes, “with need for further study of chronic and therapeutic effects in relevant clinical populations.”
CBD and autism
A group of Israeli researchers have been exploring the use of CBD to reduce problem behaviors in children on the autism spectrum. A feasibility study involving 60 children found substantial improvement in behavioral outbreaks, anxiety and communication problems, as well as stress levels reported by parents.
The researchers, led by Adi Aran, MD, director of the pediatric neurology unit at Shaare Tzedek Medical Center, went on to do a double-blind, randomized, placebo-controlled trial with 150 participants with autism. In this trial, just completed but not yet analyzed, patients were treated CBD for three months.
In the US, research has been given a boost by changing guidelines and laws. In 2015 the DEA eased some of the regulatory requirements that have made CBD, as a Schedule 1 substance, difficult to study. “Because CBD contains less than 1 percent THC and has shown some potential medicinal value, there is great interest in studying it for medical applications,” the DEA said in announcing the change.
And in approving the first CBD-based drug, Epidiolex, last year the FDA expressed enthusiasm for the research boom that is sure to come, paired with stern words for the flood of marketers of products claiming unsubstantiated health benefits.
“We’ll continue to support rigorous scientific research on the potential medical uses of marijuana-derived products and work with product developers who are interested in bringing patients safe and effective, high quality products,” the FDA pledged. “But, at the same time, we are prepared to take action when we see the illegal marketing of CBD-containing products with serious, unproven medical claims.”
Cbd oil for kids with severe afhd
Karen Sampson Hoffman
YOU’VE SEEN THE POP-UP ADS or you’ve heard a friend talk about CBD oil as an alternative treatment for ADHD. Every online community and social media platform seems to have someone praising the compound or offering to sell it. But what is it, and does it really have any proven benefits for managing ADHD symptoms?
Cannabidiol oil, most often referred to as CBD oil, is a product of the marijuana plant. The plant family is called cannabis, and cannabis products can include CBD oil along with smoked, vaped, or eaten products. CBD oil is just one of more than 85 compounds in cannabis and is regarded by some enthusiasts as having medicinal benefits.
It is not THC (tetrahydrocannabinol), the compound in cannabis that creates euphoria and delivers the “high” of marijuana use. CBD oil is not supposed to contain any THC, meaning the oil needs to be highly refined to make it suitable for use, and therefore is not a natural product. One reoccurring concern, however, is that some products on the market can have trace amounts of THC present, making them unsuitable for use by children and teens and by any adult concerned about possible addiction.
So what about CBD oil as an alternative approach for ADHD symptom management? Some claim that CBD oil, a cannabis product, can be used to treat the symptoms of ADHD. There is limited research showing an improvement for some people who have epilepsy and some people who experience anxiety who use CBD oil, so it is thought to also have benefits for people with ADHD.
What the research says
Researching CBD oil specifically for ADHD is relatively new. Some research has been conducted on smoked and ingested marijuana for ADHD, and the findings in general either do not indicate a benefit or are inconclusive. For both epilepsy and anxiety, there is more research that shows promise. A new medication made from cannabis for seizures caused by Lennox- Gastaut syndrome and Dravet syndrome was approved by an advisory committee for the FDA, but does not have FDA approval.
. This was a very small sample study of thirty people with ADHD who received a trial cannabinoid/CBD medication. The participants were evaluated for symptom levels and IQ performance on standardized tests. There was insignificant improvement on cognitive function and symptom reduction, and nominal improvement on impulsivity and hyperactivity. The researchers expressed concern that the participants did not follow instructions to avoid all other medications or alcohol use that could have affected the study results. The research authors stated that their results were inconclusive. . This study showed poor cognitive function outcome for young adults who began using cannabis before the age of sixteen, including young people with an ADHD diagnosis. When evaluated for working memory, verbal memory, decision-making and recall, these young users had poor performance on all points. They made more mistakes when asked to complete questions or tasks. Most concerning, the authors write, “Individuals who initiate use of cannabis before age sixteen may be at higher risk for developing persistent neuropsychological deficits because their brain is still developing, especially the prefrontal cortex which is associated with several executive functions including planning, verbal fluency, complex problem-solving, and impulse control, each with its own developmental trajectory.”
- Adverse Health effects of Marijuana Use. A review article for The New England Journal of Medicine by National Institute on Drug Abuse Director Nora Volkow, MD, and her colleagues, details the known health effects of marijuana use. THC is a concern for health, as are other components of the plant. Adverse effects include decreased cognitive abilities and exacerbated co-occurring mental health disorders and substance abuse. Dr. Volkow lists several health conditions that might be able to be treated by cannabis products, including chronic pain and inflammation, multiple sclerosis, and epilepsy. She does not include ADHD as a health concern that can be treated by cannabis products. In fact, she writes, “[H]eavy use of marijuana results in impairments in memory and attention that persist and worsen with increasing years of regular use.”
Not a natural product
Some advocates for CBD oil claim that its effects on the body are gentler and more effective than medications for ADHD because it is a natural product, made from a plant.
The cannabis plant has been selectively grown for generations, and grown in specific conditions, to maximize its different aspects. Industrial hemp is grown for its fibers, which are used for rope and different types of cloth. Another type of industrial hemp is grown specifically for its seeds, which are then used in some foods and in products contain hemp oil.
Contrary to some marketing claims, CBD oil is not made from industrial hemp plants. Hemp for fiber is harvested before the plant is mature, ensuring stronger fibers, and once a plant begins to form seeds, it stops producing cannabinoids to focus its energy into seed production.
Industrial hemp, because of these needs, cannot produce cannabidiol oil in sufficient amounts for commercial use. Instead it is often extracted from phytocannabinoid-rich hemp, which has ideally had THC bred out of it. This plant retains many of the characteristic of the marijuana plant. This plant is a recently developed variant of the cannabis family and only goes back to the 1990s. To the untrained observer, it resembles the marijuana plant.
CBD oil can be made from either PCR hemp or from the marijuana plant because of the similarity between the two variants. In the manufacturing process, the plant is broken into pieces and a chemical solvent, a grain or wood alcohol, petroleum, or naphtha, is used to extract the compounds in the plant. The whole material is decanted and the liquid is mechanically separated, drawing off the oils and resins. The solvent is then reused. There is also a process using carbon dioxide that bursts the plant cells and captures the oils and resins from through a series of filtering chambers. Other extraction methods use heated oils that “cook” both the oil and plant.
The oils and resins are then further refined to separate the CBD from other compounds; this could be a combined mechanical and chemical process. It must also be tested to make sure all THC has been removed, especially when the marijuana plant is used rather than PCR hemp.
The entire process relies on heavily refining the product to make it suitable for human consumption. And the more “pure” the product, the greater the amount of refining it must go through. So while synthesized from a plant, it must go through multiple mechanical and chemical processes to become usable and has very little resemblance to the plant it started from. The more “pure” the CBD product, the less natural it is–the final product does not exist in a natural form. You cannot chew on a leaf of a cannabis plant and receive any benefits from CBD oil.
Thoughts from an expert
John Mitchell, PhD, has heard all about ADHD and cannabis product use. He is a researcher and assistant professor at the Duke ADHD Program. He’s not surprised by the current interest in CBD oil for ADHD symptoms and is not impressed by arguments in its favor.
“There is some efficacy in childhood epilepsy,” he points out, “but when you look at the literature for anything else, especially psychiatric disorders, there’s not strong support to say yes, this should be a go-to treatment, especially for ADHD.”
He says the interest stems from people’s desire to have more choices in treating medical conditions and in the changing perceptions on marijuana use. He points to several states that have made medical marijuana legal and a few states that are considering legalizing recreational marijuana use.
“This interest in CBD is coming out more broadly in these perceptions of lack of harmfulness and the changing perceptions of marijuana use in general,” says Dr. Mitchell. “For a lot of different disorders—PTSD, ASD, some addictions—[some people] are interested because it might have therapeutic effects when you isolate the CBD. But those studies are preliminary. When you look at the published literature on CBD there’s nothing—it’s limited to one study.”
He reminds anyone interested in CBD oil or cannabis products that there have not been the studies showing effectiveness or safety for these products when it comes to ADHD management.
“When parents or adults look into CBD oil for someone with ADHD, it’s not just that there’s a lack of evidence out there right now,” he says. “There have been no treatment studies. There are no randomized trials that show it works. And there are other treatment options available for kids and adults with ADHD. These are unregulated products. If these are not well-regulated products, how do we know that we’re really getting what’s being advertised?”
“When parents or adults look into CBD oil for someone with ADHD, it’s not just that there’s a lack of evidence out there right now,” says researcher John Mitchell, PhD, from the Duke ADHD Program. “There have been no treatment studies. There are no randomized trials that show it works. And there are other treatment options available for kids and adults with ADHD. These are unregulated products. If these are not well-regulated products, how do we know that we’re really getting what’s being advertised?”
What about the question of CBD oil being a more natural option than a medication? It comes from a plant, after all.
“Natural doesn’t necessary means it’s less harmful,” says Dr. Mitchell. “If I were a parent, I would want it to be pure. Which means it’s actually less natural, because it has to be refined.”
Other considerations, he says, include how well-refined a CBD oil might be—are the THC and other potentially harmful components fully removed—and the fact that there are no longer-term studies on CBD oil use for children or adults. He adds that there are well-researched and effective non-medication treatment options, such as parent training and lifestyle adjustments, that are shown to be effective in managing ADHD symptoms.
There is also the question of CBD oil becoming a “gateway” to marijuana use by a young person. Dr. Mitchell says a young adult who took CBD oil as a child might not see the difference between it and marijuana use for symptoms management. Marijuana use has well-researched effects on physical and mental health and can make ADHD symptoms worse, he says.
“The literature shows there are harmful effects,” says Dr. Mitchell. “There are impacts on cognitive ability, motivation. Especially for those who are younger and smoking more, there is an impact on IQ.”
Leaping beyond the data
The research on CBD oil and other cannabis products as a possible intervention for ADHD does not show effectiveness for managing symptoms, and actually shows increased mental and physical health risks. There haven’t been any studies on the use of CBD oil in children; neither have there been studies on long-term effects. So while some people are using it and have shared their results publicly, researchers and medical professionals have not found evidence that it is an effective treatment for ADHD. The research does not show that CBD oil works for ADHD management.
“We don’t want to misrepresent things, and with CBD oil, it is getting misrepresented,” says Dr. Mitchell. “When people say this works for ADHD, this is going way beyond the data. That’s too big of a leap.”