Caregiver experiences of children living with a diagnosed neurological disability and using medical cannabis

Abstract

Medical cannabis (MC) has recently emerged as a potential treatment option for pediatric neurodevelopmental conditions and epilepsy. Medical cannabis within these conditions remains limited in evidence-based literature. Caregiver experience can play a valuable role in providing real-world evidence. Thus, this study sought to conceptualize primary caregivers’ experiences using medical cannabis to treat neurological conditions in their children. A qualitative multiple-case study design was used to ascertain caregiver experiences. Twelve primary caregivers were interviewed to identify four themes: lack of support, perception of efficacy, positive impacts on children and caregivers, and contribution to real-world evidence from caregivers. Caregivers reported symptom improvement in their children and improved quality of life for their child and family. However, caregivers identified a lack of support from the healthcare system as a challenge. This study highlights that while medical cannabis shows promise as a potential treatment option, there is a great need for more research and subsequent healthcare provider education. Significant barriers to caregivers acquiring knowledge and healthcare provider support put patients at risk. The healthcare system must develop better educational programs regarding the potential role of MC (such as the benefits and side effects in different patient groups and regulatory framework for prescribing) to support children and their families better.

Introduction

Families of children with neurodevelopmental disabilities often struggle to find a therapy that reduces symptoms or improves function (Lydon et al., 2015; Shaw et al., 2023). Lifelong conditions and a lack of evidence-based interventions are associated with significant emotional, family, and economic burdens, especially as parents become willing to try any intervention to improve their child’s outcomes (Karst and Van Hecke, 2012; Saunders et al., 2015; Shaw et al., 2023). Currently, there are limited treatment options for many neurological and developmental disorders, such as autism spectrum disorders (ASDs) (Masi et al., 2017; Shaw et al., 2023). Further, most conventional options fail to address the range and complexity of symptoms often experienced by children with neurodevelopmental disabilities, thereby increasing family stress (Masi et al., 2017; Mostafavi and Gaitanis, 2020; Ryan et al., 2020). Preliminary evidence for medical cannabis treatment in neurodevelopmental and behavioral conditions suggests some benefits (Campbell et al., 2017; Pawliuk et al., 2020). One retrospective study of 60 participants with autism spectrum disorder (ASD) reported behavioral outbreaks were improved in 61% of participants (Aran et al., 2019). Several other studies and reviews have noted similar improvements, most commonly in irritability and sleep issues (Holdman et al., 2021; Mostafavi and Gaitanis, 2020; Wong and Wilens, 2017).

Most research regarding cannabis and children relates to pediatric intoxication (Gaudet et al., 2022; Pediatric Society Canadian, 2020) and clinical management focusing on recreational cannabis legislation instead of the medical side of cannabis legislation (Campbell et al., 2017; Singer et al., 2020). Studies regarding cannabis-based therapies are usually small-scale observational studies or retrospective (Ryan et al., 2020; Shaw et al., 2023). The dual views of cannabis use, recreational versus medical, have resulted in discourse and reluctance to authorize medical cannabis for children within the medical community of Canada (Canadian Pharmacists Association, 2019; Shaw et al., 2023; Singer et al., 2020; Wilson and Rhee, 2022).

The majority of evidence for medical cannabis in pediatrics is for cannabidiol (CBD) in children with epilepsy (Devinsky et al., 2017, 2018; Miller et al., 2020; Thiele et al., 2018). The pivotal GW Pharma clinical trials in pediatric epilepsy showed significant reductions in seizures with CBD compared to placebo (Cannabis Laws and Regulations, 2020; Devinsky et al., 2017, 2018; Miller et al., 2020). Cannabidiol was also reported to be well tolerated, with mild adverse events reversible with discontinuation of CBD (Devinsky et al., 2017, 2018; Miller et al., 2020; Pawliuk et al., 2020; Singer et al., 2020; Thiele et al., 2018). Common short-term adverse events included vomiting, diarrhea, and dizziness, while common longer-term adverse events included changes in appetite and weight, fatigue, and somnolence (Pawliuk et al., 2020; Wong and Wilens, 2017). Literature remains sparse regarding the use of medical cannabis in most other pediatric conditions, apart from chemotherapy-induced nausea and vomiting (Abrahamov et al., 1995; Wong and Wilens, 2017).

Many healthcare practitioners (HCPs) have voiced concerns over safety and lack of evidence (Rieder et al., 2016; Shaw et al., 2023), including unknown long-term impacts and THC exposure potentially leading to adverse effects (Malach et al., 2022; Zolotov et al., 2018). Additionally, gaps in HCPs’ knowledge of how to safely dose and manage children on cannabis have routinely emerged as a prominent concern among HCPs (Ananth et al., 2018; Elliott et al., 2020; Shaw et al., 2023; Zolotov et al., 2018; Zylla et al., 2018). Healthcare education regarding medical cannabis appears to continue to focus mainly on substance use disorders, although some practice views of cannabis safety are limited to adults (MacCallum et al., 2021).

Randomized controlled trials (RCTs) are the current gold standard of evidence (Hariton and Locascio, 2018). However, there are significant drawbacks to depending on this type of evidence (Bothwell et al., 2016). Strict protocols to minimize bias often lead to unrealistic conditions that do not generalize to our real world. Cannabinoid-based medicine complexity, combined with the heterogeneous nature of neurological disorders, adds another challenge to research designs that should be highly controlled and uniform. Additionally, time and resources required to complete RCTs can significantly delay research progression. As such, there is great value in incorporating information from lived experience. Primary caregivers’ lived experience and knowledge in pediatric research are essential to providing real-world context and complementing high-quality evidence on RCT safety and efficacy. Further, caregiver insight can also be invaluable in guiding future avenues in research (Shaw et al., 2023). Families with children living with neurodevelopment and epilepsy issues are considering medical cannabis as a novel treatment option, have sought out novel approaches when reaching a crisis point with traditional treatment, and have landed on the potential benefits of cannabidiol (CBD) or a blended ratio of THC with CBD with or without the support of their primary caregiver (Ryan et al., 2020; Shaw et al., 2023). With the increasing interest in pediatric medical cannabis use, caregiver knowledge is crucial in building evidence and informing research endeavors (Mostafavi and Gaitanis, 2020; Poleg et al., 2019; Ryan et al., 2020; Shaw et al., 2023; Sholler et al., 2020).

Aim

The aim of this study was to explore primary caregivers’ lived experiences of children diagnosed with neurodevelopmental conditions and using cannabidiol treatments.

Methods

Study questions

Our questions included information regarding:

(1) Medical cannabis use: What type of cannabis product are you using with your child? Is your child supervised by a physician/pediatrician? From where do you purchase/obtain your product?

(2) Clinical characteristics and management: How have you and your family been affected as a parent/guardian of a child using cannabis-related interventions?

(3) Experiences and information needs:

(a) What chain of events led you to inquire and ultimately access a cannabis-related intervention for your child?

(b) What have you found rewarding and challenging with a child using a cannabis-related intervention?

Study design

This study was a qualitative multiple-case study research design that aimed to explore the experience of parents/guardians caring for a child who lives with a diagnosed neurological disability and using medical cannabis. The Institutional Review Board at Thompson Rivers University granted ethics approval to complete this study (REB#101739). Case studies help better capture themes from lived experiences to understand all participants through a common set of questions (Yin, 2017).

Population and setting

Participants were recruited from British Columbia, Canada, in March of 2019 through a purposive sampling of those experiencing the activities explored in the study, such as accessing medical cannabis for children. We recruited participants using parent/caregiver databases, websites, social media platforms, and word of mouth. Partnerships with provincial and regional non-profit and for-profit agencies allowed virtual poster recruitment of parents/guardians of children and youth who use medical cannabis. We further recruited using the snowballing method. Inclusion criteria for participation included two qualifiers: (1) self-identity being a guardian of a child living with the neurological disorder under 18 years old at the time of the study and (2) a child must have been formally diagnosed with a neurological disorder (no self-diagnoses by the caregiver) and using CBD as a form of treatment. Exclusion criteria were as follows: (1) one of the legal guardians of the child did not give consent to be part of the study and (2) the family did not live in British Columbia during the time of the study.

Data collection

Semi-structured interviews were conducted face to face or by phone between May 2019 and October 2020, along with field notetaking (Supplemental Material). All participants agreed to be audio-recorded and they were free to withdraw from the study at any time. All participants were given a pseudonym.

Data analysis

All audio data were recorded during the interviews and transcribed verbatim into text data. Once transcribed, the participant received the transcript for validation and could provide any additional thoughts (Vagle, 2014; van Manen, 2014). To protect privacy and adhere to sound ethical research, no identifiers of the families, especially details of their children, were noted in the research records of the family and their children. Service details used by families were generalized (specific healthcare services, location, or otherwise were omitted) to protect against participant exposure. There were no deception tactics.

Text data were analyzed using Yin’s data analysis process (2017). Yin’s analysis process adheres to these steps: (1) examining data, (2) identification of cross-case commonalities, (3) categorizing data into themes or patterns based on coding and word tables, which could include quotes, anecdotes, and phrases, and lastly, (4) creating themes from patterns. Both principal investigators (PIs) independently followed Yin’s analysis processes to assess transcripts for themes. Transcripts and field notes were independently reviewed twice and themed. After meeting to resolve differences and make agreements, the remaining research team members reviewed theme validity for consensus.

Findings

Participants self-identified as primary caregivers of a loved one with a diagnosed neurological disorder. Over 20 caregivers approached us to participate through the combination of the recruitment; 12 participants met the research criteria and participated in the study. Twelve semi-structured interviews were conducted by the first and second authors, lasting 60–90 min. Primary caregivers in the study included nine mothers, two fathers, and one grandmother who resided in British Columbia, Canada. They shared stories regarding 12 children living with diverse neurological conditions while using medical cannabis as part of their treatment plan. Children discussed in our study ranged from 10 to 18 years old. Most children had a comorbid or dual diagnosis, including rare genetic diseases. For example, six children had a formal diagnosis of autism spectrum disorder and an anxiety disorder. Four of the children with ASD also had a seizure disorder. Specific details, such as a rare diagnosis, are withheld to protect the confidentiality of the families. Times that medical cannabis (CBD or a CBD/THC ratio) had been used ranged from 3 months to 4 years.

Participants experienced four main themes: unsupported cannabis use, efficiency with medical cannabis, caregiver positive experiences, and caregiver real-world knowledge contributions.

Unsupported cannabis use

A recurrent challenge identified by all 12 participants interviewed was the uncertain support they received through accessing and using MC for their child. First and foremost, caregivers noted that most HCPs had limited knowledge of medical cannabis, especially as an adjunctive treatment for pediatric neurological disorders. Caregivers described the process of navigating the system as “the Wild West” (Stephanie, 32-year-old mother; Maya, grandmother, age not provided; Patrick, 47-year-old father) and “uncharted territory” (Angela, 42-year-old mother; Isla, 32-year-old mother; Kristen, 28-year-old mother). All participants reported being the ones to initiate MC discussions with their family physicians. Five participants had outright refusals of authorizations for MC from their original physician or pediatrician and sought new HCPs while still finding mixed support. Physicians gave mixed messages and guidance for MC use with children:

We both agreed to give cannabis a try… [We] were desperate and had done our homework with the best knowledge we could collect. The doctors were all over the place, no one had answers. Our GP wants nothing to do with us, we have been told it is far too complicated. (Noah, 42-year-old father)

Doctors are just not wanting to touch it because they have no idea, I respect that. Like a lot of them are like saying, “I don’t even know what dosage to start, let alone what to do.” (Patrick, 47-year-old father)

There is a great fear about child development, but if you are struggling, already having issues with development, what else do you got to? They [physicians/pediatricians] are fixated on the “they are still developing.”… I had a few say we are harming our child. (Isla, 32-year-old mother)

Access to cannabis use was met with additional barriers after a physician MC authorization. Through friends, Stephanie learned how to obtain MC for her child through a cannabis producer from across Canada. Lin’s physician was unaware of medical cannabis access points and processes after providing MC authorization for her child:

When we started, there was no licensed producer; we felt like criminals all the time. The system is so behind and doesn’t consider the work parents do, we struggle to be heard and it breaks us. It is not an easy journey, [sob], but it is worth everything. We have our little girl back. We order it online, on the American side, we have an exemption renewed every year that I can legally do this. (Lin, 42-year-old mother)

Lack of support from HCPs and barriers in knowledge acquisition revealed additional challenges with dosing and treatment, and caregivers practiced extensive trial and error for optimal therapeutic effects. Caregivers Angela, Lin, and Melissa added that incorrect dosing could exacerbate burdensome symptoms. Many caregivers adjusted treatment to find a “sweet spot” dose based on their close observation of changes in behaviors and symptoms. They would inform their physicians when to make MC authorization adjustments:

Our dosages are at no set ratio… we have adjusted over the years. At first, it was about 30:1 ratio, and then we got down to 50:1. It took time to get to the proper dosing, it takes time to figure out when it is best in the day to take it. Also, kids change, so it [dosing] changes. (Lin, 42-year-old mother)

We tried five different products over four years, we switched doctors to find a better way. (Noah, 42-year-old father)

It really is trial and error to find the right strain that works… It might take a few months to find that sweet spot, so keep an observation journal and watch for behaviours and triggers. (Melissa, 49-year-old mother)

The trial-and-error approach of testing out a product went hand-in-hand with the cautious practice shared by the majority of participants, “start low and go slow.” This uncertainty led to some caregivers discontinuing MC:

It was trial and error, there was no specific amount, that is what kind of deterred us…That is part of the reason why we stopped. (Angela, 42-year-old mother)

Efficacy with medical cannabis

Within this study, the majority of caregivers believed that MC positively affected their child’s symptoms. Positive outcomes included lowered seizure intensity and frequency, decreased hospitalizations, reduced anxiety levels, changes in aggressive behavior, improved verbal communication, and improved social functioning. Caregivers expressed widespread relief for the improvement seen in their children. Stephanie described CBD oil as “life-changing,” and Elvira noted that CBD helped them avoid trying a critical care center (a healthcare unit which provides specialized care for patients who are critically ill, or urgently need advanced monitoring and intensive treatments). Multiple caregivers reported improved verbal communication and social functioning as particularly impactful. Their children could articulate wanting help and were functioning better in social settings such as school:

She [daughter] leans in and says, “I love you!” She has never done it unprompted before. (Connie, 39-year-old mother)

Effective outcomes included reductions in anxiety levels, lowered seizure intensity and frequency, and changes in aggressive behavior:

We had so many changes related to her epileptic moments. We would have multiple hospital trips and have such serious episodes. Now, we are confident, we can manage stuff, we can go on holiday without stress of needing to go to the hospital. Or something else happening to her. It seems really effective, like really effective, compared to other medications that people are trying…There have been no side effects with cannabis. The side effects have been from the other medications, such as drowsiness. As soon as I lowered those, that went away. So, I feel it has been really just a great fit. I thought she was going to die from her seizures. [Now] it is so dramatically better. (Stephanie, 32-year-old mother)

He broke 10 TVs. …I couldn’t leave my house, and my daughter’s safety was in question. We went from being shut in to going on outings. Now, we can go to restaurants. (Kristen, 28-year-old mother)

Caregivers reported other people noticing their child’s positive changes related to MC:

[Child] sleeps better, no insomnia, is way better…. Becoming more verbal, communication is better. Better social behaviour. Happened immediately; School noticed right away. (Angela, 42-year-old mother)

We haven’t told the school that she is using CBD oil…they [school support workers] are like, wow, this was a great week, “she has had a really great day” and another good day, and another great day... It turned into a couple of good weeks. That is pretty exciting. (Connie, 39-year-old mother)

Despite most caregivers reporting positive outcomes, this was not the case for all participants. Medical cannabis was ineffective for two families who stopped after they saw no positive results, highlighting that cannabis is not a magic bullet. Inconsistency across experiences emphasizes the general agreement across caregivers that there is a great need for more research.

Caregiver positive experiences

MC also appeared to impact caregivers positively, noting improvements in stress levels when seeing positive outcomes in their child’s well-being, neurological symptoms, and behavior. Many expressed desperation to help their child, leading up to MC treatment, and were at a breaking point of not knowing what to do:

We had reached a crisis point. (Noah, 42-year-old father)

I was seeing a mental health nurse, we had just moved from Ontario a year ago, and I said, like I can’t deal with it anymore…[the mental health nurse] seen me last week and said he wouldn’t never have even recognized me from three months ago. I can leave him [child] with a respite worker, where that was not even an option before. So, I have a social life too now… I feel like a different person. (Kristen, 28-year-old mother)

I feel like a parent, not a basket case. I sleep solid, I can manage a part-time job. I am more in control. (Elvira, 46-year-old mother)

Caregiver real-world knowledge contributions

Finally, data demonstrated themes of valuing caregiver knowledge and engagement in treatment decisions. Caregivers expressed their intimate understanding of their child and real-life experiences managing their child’s symptoms, raising up to be the experts of MC:

I really feel like I’m on my own and researching everything myself and bringing it back to them [the doctors]. I really fall back on the group [social media sites] a lot. I have a good background on chemistry and totally understand terpene profiles. (Melissa, 49-year-old mother)

I became the expert as a parent. I was much more involved with her [child’s] medications because she didn’t have to have any [pharmaceutical medications] at the hospital; it is all happening at home. It is very collaborative. I feel like they [the doctors] trust my judgment. (Stephanie, 32-year-old mother)

Several participants explained that CBD has a biphasic characteristic:

If you have too low of a dose, you actually exacerbate what you are trying to treat. When you go with higher doses, there is a calming, sedating effect. (Angela, 42-year-old mother)

Symptoms worsen at the start if too low a dose. Dosing issues-low doses can make things worse; you know the Israeli studies [asking researchers if they are aware of the work of Ethan Russo], 70-150mg/day is the sweet spot, not lower. Sweet spot higher for seizures and ASD kids, can be [up to] 900mg/day. (Melissa, 49-year-old mother)

To be an expert, parents sought resources and took a lead in their child’s care with MC:

Families are so stressed out and the doctors don’t realize we cannot just wait it out. We need help now. Our children should not be made to wait. We have a good support network of families on Facebook, and we answer questions. Really, you are learning on your own. When it comes to a special needs child, we just become the researcher. We are wanting to help others, too. We have to, it gives us strength to move forward. (Lin, 42-year-old mother)

These data emphasize caregivers’ valuable contributions to medical cannabis knowledge and best practices with their children.

Discussion

Drawing on four themes from qualitative data obtained via semi-structured interviews, our critical analysis underscores the urgent need and practical insights for supporting families using MC for children with neurological challenges. This aligns with studies (Ryan et al., 2020; Shaw et al., 2023) that highlight caregiver frustration due to lack of support from healthcare practitioners. Caregivers often became experts in MC administration, seeking resources outside the physician’s office on dosing and access. They desired trustworthy HCPs for guidance on proper dosing, which echoes findings from similar literature (Ko et al., 2016; Ryan et al., 2020; Temple et al., 2019).

Our study also sheds light on the therapeutic potential of MC in children with neurodevelopmental conditions, as reported symptom improvements align with pediatric clinical trials and observational studies on CBD (Aran et al., 2019, 2021; Hausman-Kedem et al., 2018). Clinically significant improvements in motor skills, sleep, attention, hyperactivity, and emotional regulation have been documented in children with ASD and epilepsy using CBD (Fleury-Teixeira et al., 2019; Schleider et al., 2019; Siani-Rose et al., 2021). Many caregivers reported enhanced communication, possibly due to reduced anxiety and behavioral improvement. These findings suggest HCPs should assess a broader range of outcomes, including emotional and social factors, when evaluating CBD’s effectiveness in children.

Although the mechanisms of CBD in reducing seizures and improving brain function are not fully understood, the potential benefits for children with autism and epilepsy are promising. Studies (Zafar et al., 2021) show that whole-plant cannabis may reduce the need for antiepileptic drugs with minimal adverse events. This emphasizes the importance of further research on MC’s role in pediatric neurodevelopmental conditions.

A key finding of this study is the extent of caregiver self-treatment due to insufficient HCP guidance. While past research notes a need for HCP education on MC (Ko et al., 2016; Ng et al., 2021), our study highlights the hesitancy of physicians and the burden on caregivers to navigate MC alone. This lack of guidance can lead to dangerous situations, especially with high THC consumption, which is known to cause severe adverse events (Wong and Baum, 2019). High CBD doses, while generally less concerning, may also cause adverse effects like liver enzyme elevation and seizures (Dos Santos et al., 2020; Lo et al., 2023).

Recent literature stresses monitoring potential drug interactions with MC, particularly in children using medications like valproic acid or clobazam, which have been linked to CBD-associated hepatotoxicity (Eadie et al., 2024; Lattanzi et al., 2020). A standard of care approach for MC use in adults, including dosing, administration, and follow-up, should be applied to pediatric cases as well (MacCallum et al., 2021). Proper education and guidance can significantly reduce the risk of adverse events.

The lack of MC training in medical education is a shared concern among Canadian and U.S. physicians. Fewer than 10% of U.S. medical schools mandate formal MC education, leaving graduates unprepared to authorize or prescribe MC (Evanoff et al., 2017). Most deans from these schools (66.7%) indicated that their graduates were “not at all” prepared to authorize medical cannabis. A significant proportion of residents and fellows felt “not at all” prepared to prescribe (89.5%) medical cannabis or answer questions (35.3%) about its use (Evanoff et al., 2017). In Canada, HCPs report inadequate training in clinical indications, dosing, and monitoring of MC, exacerbated by inconsistent regulations across provinces (Huntsman et al., 2021). Professionals continue to lack sufficient knowledge about medical cannabis, including those in allied health and in healthcare-related post-secondary education (Zolotov et al., 2021). This highlights the need for improved education on product choice, dosing, and monitoring for clinical benefit and safety.

MC is not a cure-all, and more research is needed to determine its efficacy and safety for pediatric neurological disorders. Larger studies focusing on dosing regimens and administration methods are crucial to improving HCP knowledge and patient care, particularly for medically complex children.

Real-world evidence from this study provides valuable insights into the challenges families face when navigating the MC system. Caregivers’ deep knowledge of their children’s experience with MC can inform future research on its efficacy and safety in pediatric populations. Stigma, political agendas, and lack of knowledge from professionals may influence unregulated and unsupported care, further highlighting the need for better HCP training and education (Shaw et al., 2023).

Additionally, caregivers’ insights into MC use are invaluable for teaching HCPs in practice and training. Families want to feel heard and respected, take part in the decision-making of their child’s treatment plan, and help demystify medical cannabis and the stigma surrounding its use. Their experiences navigating the healthcare system offer crucial perspectives on the practical, emotional, and social implications of MC treatment for neurodiverse children. A comprehensive approach to caring for children using MC can improve their quality of life.

Study limitations

This study gathered primary data from caregivers (N = 12) willing to share their stories with MC and does not represent the spectrum of caregiver experiences that have had negative experiences. Caregivers of children who previously failed other treatment options and had challenges navigating the medical cannabis system may have been more motivated to participate in this study, potentially leading to sampling bias. Another limitation is that children using MC did not share their perspectives of the study, as our study focused on the caregiver’s experience and how the family navigated through the healthcare system with MC. We could not obtain families within the Ministry of Children and Family Development, as we would have had to obtain additional permissions. Finally, recruitment methods may have reduced the ability of caregivers with unique experiences and perspectives to participate in our study. Future studies using longitudinal designs are needed to better understand the support needs of families using MC as their children grow and change over time.

Implications for practice

This study adds to the limited but growing literature on the uses of medical cannabis for children. HCPs are encouraged to take more time to actively listen and decrease misunderstandings of parents demonstrating leadership in advocating for their children by seeking alternative therapies, such as cannabidiol, to improve their child’s quality of life. Access to MC is difficult and complex. Our research findings encourage our healthcare peers to change policies that directly influence cost, family access to treatment, and further research with MC. Stigma is an excellent deterrent for families. Stigma increases the risk for them to move their care into an underground network and hide their intervention activities from professionals because legitimate access to CBD has too many barriers or has been denied as a treatment route. Families in crisis are asking for access barrier removal and more funding for research in this area that will help ensure safe efficacy of MC for children. There is a need for further quantitative studies to explore the efficacy of CBD treatment for children with neurological conditions. As the awareness of potential therapeutic benefits of MC grows, there will likely be an increase in cannabis-related inquiries to HCPs from caregivers of children with debilitating conditions. It is vital to expand curricula using evidence-based, policy-informed methods to develop cannabis education. Multidisciplinary cannabis education will create HCPs equipped to address patient and caregiver concerns regarding medicinal cannabis.

Conclusion

The trials and tribulations described by the caregivers in this study may raise awareness of the need for closer HCP support than what is currently available and improved medical cannabis education and training for physicians. This will allow for improved knowledge and comfortability with MC in a patient-centered discussion and increase the quality of well-being and quality of life with children with neurodevelopment challenges and their families.

In addition, our findings have important implications for improving medical cannabis referral pathways, including a consultation with a cannabis-specialized physician and ongoing educational support for effective delivery of MC care. This new cannabis model should be integrated into an existing multidisciplinary standard of care for the pediatric population with neurodevelopmental disorders. This, in turn, will reduce the burden and stress experienced by families as they navigate a medical cannabis system.

Supplemental Material

Supplemental Material - Caregiver experiences of children living with a diagnosed neurological disability and using medical cannabis

Supplemental Material for Caregiver experiences of children living with a diagnosed neurological disability and using medical cannabis by Florriann Fehr, Nan Stevens, Jane Hailey, Lindsay A Lo, Carly A Pistawka and Caroline A MacCallum in Journal of Child Health Care