Palliative cannabis for kids

Could medicinal cannabis provide effective pain management for dying Australian children?

A pilot study by Murdoch Children’s Research Institute is set to explore the use of medicinal cannabis to reduce symptoms in children and adolescents who are undergoing palliative care for non-cancerous conditions.

The research has attracted $75,000 in funding from the latest round of the Victorian Medical Research Acceleration Fund (VMRAF), with additional support provided by the medicinal cannabis company Cannatrek.

The study will involve 10 participants, aged six months to 21 years, who are receiving care in the Victorian Paediatric Palliative Care Program, and have symptoms that are affecting their quality of life, with recruitment starting later this year.

The project, led by Murdoch Children’s Associate Professor Daryl Efron, will investigate the feasibility and acceptability of a medicinal cannabis clinical trial into easing the symptoms of children undergoing palliative care for non-oncological conditions.

About 70% of patients managed by the Victorian paediatric palliative care service have non-oncological conditions including severe cerebral palsy, metabolic and genetic conditions, neurodegenerative disorders, and progressive cardiac disease.

Professor Efron said that if medicinal cannabis was shown to be effective it would represent an important treatment breakthrough for this patient group.

“Medicinal cannabis is a new therapy with great hope, but there is little evidence from clinical trials, particularly in children,” he explained.

“In our experience, parents are interested in obtaining medicinal cannabis for their child’s symptoms, but physicians are reluctant to prescribe it because of the lack of quality research and there is an urgent need for clinical trials to properly evaluate the role of medicinal cannabis for use in these highly vulnerable patients.

“The trial will evaluate the study design spanning recruitment strategy, medication tolerability, duration and outcomes to determine acceptability and feasibility for participating families and our research team.”

The data collected will then be used to design a full-scale multi-centre trial, part of an emerging program of research at the Murdoch Children’s into medicinal cannabis for children with an intellectual disability, Tourette Syndrome, and other developmental conditions such as autism.

Professor Efron said paediatric patients undergoing palliative care experience a range of debilitating symptoms that have a significant impact on well-being and quality of life including pain, irritability, gastrointestinal symptoms, seizures, spasticity, and dystonia.

“These symptoms are difficult to control with currently prescribed medications, most of which cause significant side-effects,” he said.

The WA Optimal Paediatric Palliative Care Pathway estimates there are approximately 2,000 children with life-limiting conditions in WA and for each of those children, there are numerous family members including parents, siblings and extended family who will be affected in their own lives.

Professor Efron explained that life-limiting conditions in children frequently included a different disease and symptom profile to that occurring in adults.

“Many of these life-limiting conditions are rare with no definitive diagnosis, making accurate prognosis difficult, and potentially curative treatment may be part of the child’s and family’s life, but not their entire focus,” he said.

“Care is provided based on the needs of the child and family, not based on the child’s diagnosis.

“It typically involves multiple service providers across a wide range of services including tertiary, secondary and primary sectors, and care is likely to include periods of symptom management and/or respite throughout this trajectory that may not be linked to end-of-life care.”