Concerns raised over lack of guidelines for medics regarding use of substances like cannabis oil

By Gordon Deegan

The lack of guidelines to assist medical and nursing staff with the safe use of potentially psychogenic substances, like cannabis oil, has been highlighted by the authors of a new paper.

A paper in the September issue of the Irish Medical Journal (IMJ) reveals how the parents of a five-year-old girl suffering from seizures administered their daughter with cannabis oil every night in order to deal with the condition.

The girl, 5, who was admitted post-operatively to the Paediatric Critical Care Unit (PCCU) at Our Lady’s Children’s Hospital in Crumlin.

Our Lady’s Children’s Hospital in Crumlin where the girl was admitted.

The three authors of the paper report that the girl had a history of refractory seizures and the girl’s parents had obtained the cannabis oil from the US and were administering it to her at night, in addition to her regular anticonvulsant medication.

The girl’s parents reported decreased seizure frequency since they started administering the cannabis oil.

The child was in hospital to have her tonsils removed for the management of significant obstructive sleep apnoea (OSA) which the medics in the IMJ paper state was “possibly exacerbated by the sedative properties of cannabis”.

The medics report that the admitting surgical and critical care teams were unaware that the child was regularly receiving cannabis until 14 hours after admission to hospital.

The medics state that “although there have been many anecdotal reports on the effectiveness of cannabis for medicinal use, there is a paucity of robust scientific data demonstrating the efficacy of cannabis products as a therapy”.

They state that the PCCU and the hospital do not currently have any guidelines to assist medical and nursing staff with the safe use of this potentially psychogenic substances.

The medics state that after discussion with the child’s parents, they agreed an administration regimen for the cannabis oil and the timing of which was separate to regular sedative medication in view of the child’s history of OSA.

The medics state that the case raises ethical and legal issues but that they “must also consider parental autonomy and their role as advocate for their child during admission to critical care”.

The medics report that “the child’s postoperative course and stay in PCCU was uncomplicated”.

The medics report that in this case, the child was receiving Charlotte’s Web hemp oil that includes low concentration of tetrahydrocannabinol (THC) which is subject to the Misuse of Drugs legislation.

The medics state:

In a case such as this, clinicians should consider contacting the Health Products Regulatory Authority (HPRA), and seek legal and pharmacist advice within their hospital.

The medics state that the use of Complementary and Alternative Medicines (CAM) have grown in popularity over the last two decades and point out that “as clinicians we need to be aware that parents may be using (CAM) therapies to treat their children and be prepared to discuss these options openly with parents in the PCCU.”

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