A reality of the current political and legal environment is that while marijuana and cannabis-based products remain not approved for human consumption at the federal level in the United States, several states have authorized use for constituents. While state lines represent meaningful cultural and geographical identity markers, the reality is that patients and families readily cross state lines to access medical interventions and care.
Methods:
We present the case of a six-year-old child with intractable seizures and severe neuropathic pain managed on medical marijuana (MM) in her home state of Colorado; where medicinal use of marijuana is authorized at the state level; traveling across state lines to access surgical care in Nebraska where MM is prohibited.
Conclusion:
The case report shares the communication and creativity invested in adequate symptom management for this child weaned off of MM perioperatively. The case recognizes the unique complexities of shared symptom management goals within state-specific care models.
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References
1.
TattertonMJ, WalkerC: The prevalence of nonprescription cannabinoid-based medicines in british children's hospices: Results of a national survey. J Palliat Med, 2019 [Epub ahead of print]; DOI: 10.1089/jpm.2018.0522.
2.
AnanthP, MaC, Al-SayeghH, et al.: Provider perspectives on use of medical marijuana in children with cancer. Pediatrics, 2018; 141:e20170559.
3.
MeadA: The legal status of cannabis (marijuana) and cannabidiol (cbd) under U.S. Law. Epilepsy Behav, 2017; 70:288–291.
4.
MauroPM, Santaella-TenorioJ, PerlmutterAS, et al.: Correct knowledge of medical cannabis legal status in one's own state: Differences between adolescents and adults in the United States, 2004–2013. Addict Behav, 2019; 88:23–28.
5.
Agricultural Improvement Act of 2018, §12619.
6.
Agricultural Marketing Act of 1946, §297A(1).
7.
Neb. Rev. Stat. §28–405, Schedule I, (c)(7).
8.
Neb. Rev. Stat. §28–405, Schedule V, (d).
9.
Neb. Rev. Stat. §§28–463 to28–469.
10.
Bonn-MillerMO, LoflinMJE, ThomasBF, et al.: Labeling accuracy of cannabidiol extracts sold online. JAMA, 2017; 318:1708–1709.
11.
PorterBE, JacobsonC: Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy Behav, 2013; 29:574–577.
12.
SekarK, PackA: Epidiolex as adjunct therapy for treatment of refractory epilepsy: A comprehensive review with a focus on adverse effects, 2019; 8; Doi: 10.12688/f1000research.16515.1.
13.
TzadokM, Uliel-SiboniS, LinderI, et al.: CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience. Seizure, 2016; 35:41.
14.
SzaflarskiJP, BebinEM, CutterG, et al.: Cannabidiol improves frequency and severity of seizures and reduces adverse events in an open-label add-on prospective study. Epilepsy Behav, 2018; 87:131–136.
15.
BergamaschiMM, QueirozRH, ZuardiAW, et al.: Safety and side effects of cannabidiol, a cannabis sativa constituent. Curr Drug Saf, 2011; 6:237–249.
16.
PertweeRG: Ligands that target cannabinoid receptors in the brain: From THC to anandamide and beyond. Addict Biol, 2008; 13:147–159.
17.
LeoA, RussoE, EliaM: Cannabidiol and epilepsy: Rationale and therapeutic potential. Pharmacol Res, 2016; 107:85–92.
18.
DevinskyO, CrossJH, LauxL, et al.: Trial of cannabidiol for drug-resistant seizures in the dravet syndrome. N Engl J Med, 2017; 376:2011–2020.
19.
DevinskyO, MarshE, FriedmanD, et al.: Cannabidiol in patients with treatment-resistant epilepsy: An open-label interventional trial. Lancet Neurol, 2016; 15:270–278.
20.
GeffreyAL, PollackSF, BrunoPL, et al.: Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia, 2015; 56:1246–1251.
21.
NielsenS, SabioniP, TrigoJM, et al.: Opioid-sparing effect of cannabinoids: A systematic review and meta-analysis. Neuropsychopharmacology, 2017; 42:1752–1765.
22.
WareMA, WangT, ShapiroS, et al.: Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ, 2010; 182:E701.
23.
WilseyBL, DeutschR, SamaraE, et al.: A preliminary evaluation of the relationship of cannabinoid blood concentrations with the analgesic response to vaporized cannabis. J Pain Res, 2016; 9:587–598.
24.
AndreaeMH, CarterGM, ShaparinN, et al.: Inhaled cannabis for chronic neuropathic pain: A meta-analysis of individual patient data. J Pain, 2015; 16:1221–1232.
25.
BachhuberMA, SalonerB, CunninghamCO, et al.: Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA Intern Med, 2014; 174:1668–1673.
26.
BriscoeJ, KamalAH, CasarettDJ: Top ten tips palliative care clinicians should know about medical cannabis. J Palliat Med, 2019; 22:319–325.
27.
Committee on Substance Abuse. American Academy of Pediatrics: The impact of marijuana policies on youth: Clinical, research, and legal update. Pediatrics, 2015; 135:584–587.
28.
PazosMR, MohammedN, LafuenteH, et al.: Mechanisms of cannabidiol neuroprotection in hypoxic-ischemic newborn pigs: Role of 5ht(1a) and cb2 receptors. Neuropharmacology, 2013; 71:282–291.
29.
CastilloA, TolonMR, Fernandez-RuizJ, et al.: The neuroprotective effect of cannabidiol in an in vitro model of newborn hypoxic-ischemic brain damage in mice is mediated by cb(2) and adenosine receptors. Neurobiol Dis, 2010; 37:434–440.
