Cannabidiol use: We do not know the potential to harm

September 24, 2019

I totally agree with Dr. Schuman’s perspective in his article that “it is inappropriate and irresponsible for pediatricians [and I include, PNPs] to encourage the use of cannabidiol (CBD) until more studies are available” to assure the safety and efficacy of CBD are clearly established in rigorous randomized controlled clinical trials (RCTs).

Pediatric nurse practitioners (PNPs) provide quality healthcare by evaluating the literature and the most recent clinical practice guidelines to determine the best treatment for their pediatric, adolescent, and young adult patients. Nurse practitioners who are nurse scientists and researchers, as well as NPs in clinical practice expect that there is rigor in all research related to recommendations for clinical practice. I totally agree with Dr. Schuman’s perspective in his article, Cannabidiol use in children, that “it is inappropriate and irresponsible for pediatricians [and I include, PNPs] to encourage the use of cannabidiol (CBD) until more studies are available” to assure the safety and efficacy of CBD are clearly established in rigorous randomized controlled clinical trials (RCTs). Furthermore, the RCTs must include evaluation of the potential to harm, especially in relation to neurocognitive functions, intellectual capacity, and the developing vital body organ systems exposed to CBD ingestion.

Decisions must be based on strong clinical evidence

Children and adolescents are among the most vulnerable populations in the United States. They do not have a personal voice. Children and adolescents depend upon their parents, their providers, their educators, and elected officials to make good decisions. Decisions that are not supported by strong clinical evidence based on research have the potential to lead to unpredictable and untoward adverse outcomes that cause harm in the immediate future or later in adult life. The current vaping crisis in adolescents and adults presents solid evidence of what can happen when decisions are not based on clinical evidence and profits are placed before the health and well-being of those who purchase the products.

Pressure to use of CBD

Over the past few years, state legislatures have been approached by lobbyists and individuals who often have an interest in personal profits or desire to use the drug, calling for the legalization of marijuana and CBD medications. Some states have put forth legislation placing pressure on other states to follow this trend. Are we heading down the correct path? Even in states without legalization that have seen  a reduction in arrests for possession of marijuana, innocent individuals walking on the street, including young babies in strollers and children on scooters, are directly exposed to marijuana through the inhalation of the secondhand smoke. Now, as Dr. Schuman reports, Americans are convinced that CBD should be prescribed for children with many conditions including anxiety, pain, sleep disorders. Each of these diagnoses have substantial clinical testing of evidence-based interventions that are effective and do not cause harm to the child/adolescent.

Have the discussion face-to-face

I also agree with Dr. Schuman that our history questions for parents, children, and adolescents must respectfully ask about their use of CBD and their access to the various forms of the drug available for purchase on the internet. Practice having conversations with colleagues and staff members in ‘simulation scenario fashion’ so you are prepared to respond to differing opinions and clearly present clinically based evidence, or the lack thereof. Take the time to sit face-to-face and ask the difficult questions with your patients and parents. Locate the best resources about CBD and share the resources during your conversation. Use motivational interviewing techniques to enable children, adolescents, young adults, and parents to be actively engaged in the decision making regarding CBD. History always teaches us – let’s prevent poor decision making about the use of CBD – and direct history in the favor of our patients.