Medical Cannabis Utilization in Children – A Study Based on a Nationwide Cohort

Nir Treves¹Noa Yakirevich-Amir²Karel Allegaert³Johannes Nicolaas Van Den Anker⁴Elkana Kohn⁵Maya Berlin⁵Ariela Hazan⁵Elyad Davidson²Matitiahu Berkovitch⁵Omer Bonne⁵Orit Stolar⁵Ilan Matok^1*

• ¹Hebrew University of Jerusalem School of Medicine, Jerusalem, Israel
• ²Hadassah University Medical Center, Jerusalem, Israel
• ³Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
• ⁴Children's National Hospital, Washington, United States
• ⁵Shamir Medical Center Assaf Harofeh, Tzrifin, Israel

Introduction: This study aimed to evaluate the utilization of medical cannabis in a pediatric population and compare short-term persistence rates with those in adolescents and young adults. Methods: In this retrospective, nationwide cohort study supplemented by data from an open-label study of children with ASD, patient cases under 12 years of age who received medical cannabis treatment between 2018 and 2022 were analyzed. The primary outcome assessed was treatment persistence within the first three months. Secondary outcomes included changes in THC ratios, amounts dispensed, and reasons for treatment discontinuation. Results: The patient population consisted of 1,341 children using medical cannabis for ASD (751), epilepsy (330), Tourette syndrome (165), and pediatric cancer (95). Out of 3,007 consecutive medical cannabis sessions, the adjusted hazard ratio for discontinuation in the first three months was 0.83 (95% CI [0.71-0.96], p=0.01) for young adults compared to children. Approximately 60-70% of children discontinued therapy within the first six months. Significant alterations in THC ratios or dispensed amounts were observed in most sessions within the initial six months. In the open-label study dataset, most treatment discontinuations were primarily attributed to adverse effects and a perceived lack of therapeutic efficacy Conclusions: Our findings suggest that short-term persistence of medical cannabis therapy is lower in children compared to adolescents and young adults. Moreover, many pediatric patients required adjustments to their THC ratios and showed a high frequency of treatment discontinuation. These observations underscore the importance of targeted strategies to improve medical cannabis treatment effectiveness and adherence in the pediatric population. Although MC may offer therapeutic benefits for pediatric patients, our findings emphasize the importance of careful patient selection and close medical follow-up to optimize clinical outcomes.