Composition and Use of Cannabis Extracts for Childhood Epilepsy in the Australian Community

Abstract

Recent surveys suggest that many parents are using illicit cannabis extracts in the hope of managing seizures in their children with epilepsy. In the current Australian study we conducted semi-structured interviews with families of children with diverse forms of epilepsy to explore their attitudes towards and experiences with using cannabis extracts. This included current or previous users of cannabis extracts to treat their child’s seizures (n = 41 families), and families who had never used (n = 24 families). For those using cannabis, extracts were analysed for cannabinoid content, with specific comparison of samples rated by families as “effective” versus those rated “ineffective”. Results showed that children given cannabis extracts tended to have more severe epilepsy historically and had trialled more anticonvulsants than those who had never received cannabis extracts. There was high variability in the cannabinoid content and profile of cannabis extracts rated as “effective”, with no clear differences between extracts perceived as “effective” and “ineffective”. Contrary to family’s expectations, most samples contained low concentrations of cannabidiol, while Δ9-tetrahydrocannabinol was present in nearly every sample. These findings highlight profound variation in the illicit cannabis extracts being currently used in Australia and warrant further investigations into the therapeutic value of cannabinoids in epilepsy.

Detection of Δ9 THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point‐of‐collection testing devices

“…For example, the ‘light cannabis' products that are legally available in a number of EU countries must contain less than 0.2% THC but may contain up to 40% CBD . Medicinal cannabis products containing both THC and CBD include Nabiximols (Sativex), a buccal spray with a 1:1 ratio of THC and CBD, as well as commercially available cannabis botanicals and extracts and homegrown illicit artisanal preparations . It is currently unclear whether CBD content might influence the performance of POCT devices or influence the underlying pharmacokinetics of THC in oral fluid.…”

Absence of entourage: Terpenoids commonly found in Cannabis sativa do not modulate the functional activity of Δ9-THC at human CB1and CB2 receptors

“…However, compelling evidence for cannabinoid-terpenoid interactions or synergy does not yet exist, and it is also worth noting the relatively low concentrations of terpenoids present in herbal cannabis. 5,13,15,16 With so many bioactive components present in cannabis, the systematic, granular elucidation of possible entourage effects poses a substantial combinatorial puzzle and scientific challenge. As a preliminary approach to addressing this challenge, the present study examined whether the effects of ∆ 9 -THC on its cognate cannabinoid receptors (CB 1 and CB 2 ) would be modified in the presence of terpenoids that are commonly found in cannabis, either alone or in combination.…”

QUANTIFICAÇÃO DE CANABINOIDES EM EXTRATOS MEDICINAIS DE Cannabis POR CROMATOGRAFIA LÍQUIDA DE ALTA EFICIÊNCIA

“…Em uma avaliação de 61 extratos de Cannabis consumidos por crianças portadoras de epilepsia em uma comunidade na Austrália foi verificado que os perfis de canabinoides naqueles produtos foram semelhantes aos achados no presente estudo, prevalecendo extratos com perfil THC, teores muitos baixos de CBD ou traços de canabinoides. 22 Em 2018 foi registrado o primeiro medicamento à base de CBD pela agência sanitária dos EUA (Food and Drug Administration) sob o nome comercial Epidiolex®. Este medicamento, produzido pela GW Pharma na apresentação de 100 mg mL -1 de CBD, é indicado para o tratamento de convulsões em pacientes a partir de 2 anos portadores das síndromes de Lennox-Gastaut e de Dravet com doses que vão de 5 a 10 mg/kg/dia.…”