Every time I read a Facebook post or a WhatsApp on a support group, where a mother asks where she can find CBD oil for her child with ADHD (or as a colleague of mine remarked “for everything from asthma to hemorrhoids”), I cringe. Not only do we see the devastating effects on individuals’ mental health in clinical practice which ranges from amotivational syndrome (similar to depression), mood disorders, cognitive difficulties (which can mimic ADHD), and even psychosis, but we, as psychiatrists, are also fully aware that there is no evidence for the benefits of using cannabis in any form.
Although the use of cannabis has been legalised and decriminalised in South Africa, this does not mean it is good for you, or even safe! Cigarette smoking is legal. Drinking alcohol is legal (above a certain age of course). Very few people will still argue that it is “good” for you and even less will ever encourage a child to use it. Yet there is a sudden misinformed hype about cannabis, and specifically the use of cannabidiol (CBD) oil.
Complementary and alternative medications (CAMs) have never been more popular. Unfortunately, this hodgepodge of practices can leave patients and healthcare providers bewildered and confused, misguided by ill-informed information doing the rounds on especially social media.
What are CAMs?
- Health and wellness products and techniques not presently considered to be part of conventional Western medicine
- Complementary: used along with conventional medicine
- Alternative: used in place of conventional medicine
- CAMs includes mind-body medicine (such as meditation, acupuncture, and yoga), manipulative and body-based practices (such as massage therapy and spinal manipulation), and natural products (such as herbs and dietary supplements)
Is CBD oil a safe option?
There is a general perception that CBD oil is natural and harmless. However, neither of these is true. The purer the CBD oil with less THC – Tetrahydrocannabinol which is one of at least 113 cannabinoids identified in cannabis and is the principal psychoactive constituent of cannabis- and other harmful components, the more refined it is. In refining the marijuana plant to CBD oil, it goes through various chemical and mechanical processes making it less and less “natural”. Furthermore, there are very few products on the market (despite what the various companies’ marketing proclaim) which pass the stringent criteria for “pure” CBD oil. Many products still contain trace amounts of THC making it unsuitable for use by children, teens, and even adults.
There is clear evidence for the harmfulness of cannabis to the brain. Exposure to phytocannabinoids (cannabinoids derived from plant cannabis) disrupts normal brain development and maturation – and has a (lasting) negative impact on memory, attention, processing speed, and overall intelligence
These negative effects may be permanent. There is also strong evidence linking cannabis with adverse effects such as depression (and increasing the risk for suicide with 50%) see https://montrealgazette.com/news/local-news/cannabis-linked-to-depression-suicidal-behaviour-in-teens-mcgill-study), addiction, cognitive impairment, psychosis, and motor vehicle accidents as well as other health complications. This necessitated the South African Society of Psychiatrists (SASOP) to release a position statement warning the public of the potential dangers of cannabis use, and the conclusion that “available evidence does not support the strong positive public opinion and anecdotal reports favouring medicinal cannabis, except for its demonstrated benefits for chronic pain, spasticity due to multiple sclerosis and weight loss associated with HIV” (https://725cc624-3241-417c-afa5-33a5f7de3449.filesusr.com/ugd/cc5d8c_41ce4322d67044d1889fcc29927bce06.pdf)
If you are considering medicating your child or yourself with CBD oil for the treatment of ADHD please read this!
Six good reasons why not to use CBD oil
- It is not as natural as you think it is.
- The products available on the market are unregulated.
- There are no longer-term studies on the use of CBD oil for children or adults.
- There are well-researched, safe and effective treatment options – both non-medication such as lifestyle interventions and medication – available for (most) conditions including depression, anxiety, and ADHD.
- Cannabis and CBD oil have a negative impact on cognition, with younger individuals (children and adolescents) being even more at risk for persistent neuropsychological deficits since their brain, and specifically, their prefrontal cortices (responsible for planning, problem-solving, decision-making, recall and impulse control) are still developing into their early 20s.
- It is also possible that CBD oil becomes a “gateway” to the use of other substances. If a child has been using CBD oil, they may struggle to see the difference between the oil and smoking cannabis, and even the use of other even more harmful drugs.
Make sure you are informed. We are all pro integrative medicine where we combine and integrate the best of conventional (Western) medical care, with the best of evidence-based CAMs. However, supporting something that lacks evidence for benefit and rather demonstrates evidence of harm, is not only irresponsible, but it is also damaging the long-term health of our youth.