Q: If I start my special needs child on medical cannabis for his seizures, what happens during the school day?
A: That is one of the critical issues that parents like yourself face with respect to medical cannabis therapeutics. Despite the individual states recognizing that there are children who need medical cannabis, at the present, it is often prohibited in schools.
We know that intractable seizures are one of the main reasons parents seek alternative therapies like medical cannabis. Over my years of practicing medicine, I have seen many children with special needs that also have Drug-Resistant Epilepsy (DRE) which is defined as failure of adequate trials of two tolerated and appropriately chosen anti-epileptic drugs (AED) whether as monotherapies or in combination to achieve sustained seizure freedom.
This is a very debilitating condition where children sometimes endure hundreds of seizures a day, and it negatively affects children’s cognitive development. Often parents find that FDA-approved conventional anticonvulsant medications can either sedate their children so badly they become zombies or throw them into medication-induced rages causing self-harm. And while medical cannabis, for many young patients, has been a godsend, the issues around its federal illegality still create problems, especially when it comes to school.
And these children do need to be in a structured school environment. Research shows that for this population of children, participation in high-quality, school-based education programs can boost early learning and socialization, which is key for the quality of their lives going forward. Additionally, many FDA-approved seizure medications have been found to have cognitive side effects in children that also create learning problems. In contrast, early studies on cannabis-based medications for seizures, which often respond to the non-psychoactive component of cannabis, CBD, have not been found to have these side effects.
And while many parents have had to resort to leaving work to take their children out of school to administer these medications, it is not tenable, and it is very disruptive to these children and their parents. Therefore, it is critical to keep these children in school and on their cannabinoid medications with the least disruptions possible.
There are already policy recommendations in place, about other chronic conditions requiring medications during the school day from the American Academy of Pediatrics. That is why I believe medical cannabis should be treated like any other medication given during school hours, especially for these children. However, as a physician and parent, I am cognizant of the particularly difficult issue this creates with a federally illegal substance despite the legality of medical cannabis within one’s state.
Aside from legal issues, there are also questions on how to address school personnel’s need for specific instructions from the certifying physician on standardized dosing, timing, and delivery of medical cannabis administration. While it may seem straightforward, it really is not. That is because, frankly, the medical science of cannabis is not there yet for physicians to have these specific standardized recommendations for dosage, delivery, and timing of these medicines. And this is what makes school personnel, especially the school nurses, leery of administering these medications to students.
Additionally, at the present, there is a paucity of human pediatric clinical trials to outline standardized evidence-based recommendations. I recommend a starting dose and explain gradual increases in dosing for symptom relief, with very close follow-up with patients to address any adjustments and questions. I have found out that I am in the minority for this, many clinics are just certifying patients in about 15 minutes with very little education and almost no follow-up. Patients and parents are often left to their own devices to muddle through the process of trying to create their own personalized medical regime for their children.
Recently, the National Association of School Nurses outlined a position paper stating that only FDA-approved cannabis medications such as Epidiolex may be given at school. And while that can be a great start in recognizing the benefits of cannabinoid medications for these kids, unfortunately, once parents finally painstakingly find a winning combination of medical cannabis products to stop or reduce their child’s seizures, they do not want to take a chance and change medications.
All of this makes creating guidelines for laws to give medical cannabis in schools very tricky. One thing is for sure: creating liability protection for schools, their personnel, and their nurses is critical to calming the anxiety around this issue as we move forward advancing this medical science.
Dr. Leigh Vinocur is a board-certified emergency physician who also has a cannabis consulting practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a graduate of the inaugural class, with the first Master of Science in the country in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.
Originally published on greenstate.com, May 10, 2022.
