Medical cannabinoids in children linked to more side effects, especially liver enzyme elevation and drowsiness
A meta-analysis of 23 RCTs found medical cannabinoids in children and adolescents were associated with 3x higher withdrawals from adverse events, 1.8x more serious adverse events, and significantly elevated liver enzymes.
Quick Facts
What This Study Found
Compared to control, cannabinoids in children increased risk of overall adverse events (RR 1.09), withdrawals due to AEs (RR 3.07), and serious AEs (RR 1.81). The most elevated specific risks were for liver enzyme increases (AST: RR 5.69; ALT: RR 5.67), somnolence (RR 2.28), and diarrhea (RR 1.82).
Key Numbers
23 RCTs, 3,612 participants (17.6% female, 57.3% male). Withdrawal from AEs: RR 3.07. Serious AEs: RR 1.81. AST elevation: RR 5.69. ALT elevation: RR 5.67. Somnolence: RR 2.28. Diarrhea: RR 1.82. Purified CBD was the most common intervention (47.8%).
How They Did This
Systematic review and meta-analysis searching MEDLINE, Embase, PsycINFO, and Cochrane Library through March 2024. Included 23 RCTs with 3,612 participants. Data pooled using random-effects models. PRISMA guidelines followed.
Why This Research Matters
This is the most comprehensive safety analysis of medical cannabinoids in children to date, published in JAMA Pediatrics. As off-label cannabinoid prescribing to children grows, clinicians need evidence-based safety data to inform treatment decisions.
The Bigger Picture
Cannabinoid prescribing to children has outpaced safety evidence. This JAMA Pediatrics meta-analysis provides the first pooled safety estimates from RCTs, revealing meaningful risks, particularly liver toxicity, that clinicians and parents need to weigh against potential benefits.
What This Study Doesn't Tell Us
Most studies focused on epilepsy (39.1%) and chemotherapy nausea (30.4%), limiting generalizability. Heterogeneity was moderate to high for some outcomes. Half the trials included mixed adult-pediatric populations. Long-term safety data remain absent.
Questions This Raises
- ?Are the liver enzyme elevations clinically significant or just laboratory abnormalities?
- ?Does the liver toxicity risk increase with longer-term use?
- ?Are specific cannabinoid formulations safer than others in children?
Trust & Context
- Key Stat:
- 5.7x higher risk of liver enzyme elevation in children
- Evidence Grade:
- High-quality meta-analysis of 23 RCTs published in JAMA Pediatrics. Moderate heterogeneity and mixed adult-pediatric populations in some trials are limitations.
- Study Age:
- Published in 2024 with evidence searched through March 2024.
- Original Title:
- Cannabinoids Used for Medical Purposes in Children and Adolescents: A Systematic Review and Meta-Analysis.
- Published In:
- JAMA pediatrics, 178(11), 1124-1135 (2024)
- Authors:
- Chhabra, Manik(3), Ben-Eltriki, Mohamed(2), Mansell, Holly(3), Lê, Mê-Linh, Huntsman, Richard J, Finkelstein, Yaron, Kelly, Lauren E
- Database ID:
- RTHC-05203
Evidence Hierarchy
Combines results from multiple studies to find an overall pattern.
What do these levels mean? →Frequently Asked Questions
Are medical cannabinoids safe for children?
This meta-analysis found they carry meaningful risks, including 3x higher treatment dropout from side effects, nearly 6x higher liver enzyme elevation, and more than double the drowsiness compared to placebo. Benefits need to be weighed against these risks for each patient.
What were the biggest safety concerns?
Liver enzyme elevations were the most striking finding (5.7x higher risk), followed by somnolence (2.3x) and diarrhea (1.8x). The 3x higher rate of withdrawals from adverse events suggests side effects are significant enough to stop treatment in some children.
Read More on RethinkTHC
- CBD-oil-quality-guide
- anxiety-medication-after-quitting-weed
- cannabis-chemotherapy-nausea
- cannabis-chronic-pain-research
- cannabis-epilepsy-CBD-Epidiolex
- cbd-anxiety-research-evidence
- cbd-for-weed-withdrawal
- cbd-vs-thc-difference
- medical-benefits-of-cannabis
- quitting-weed-before-surgery
- quitting-weed-medication-interactions
- quitting-weed-pregnancy
- quitting-weed-pregnant
- seniors-older-adults-cannabis-risks-medications
- weed-breastfeeding-THC-breast-milk
Cite This Study
https://rethinkthc.com/research/RTHC-05203APA
Chhabra, Manik; Ben-Eltriki, Mohamed; Mansell, Holly; Lê, Mê-Linh; Huntsman, Richard J; Finkelstein, Yaron; Kelly, Lauren E. (2024). Cannabinoids Used for Medical Purposes in Children and Adolescents: A Systematic Review and Meta-Analysis.. JAMA pediatrics, 178(11), 1124-1135. https://doi.org/10.1001/jamapediatrics.2024.3045
MLA
Chhabra, Manik, et al. "Cannabinoids Used for Medical Purposes in Children and Adolescents: A Systematic Review and Meta-Analysis.." JAMA pediatrics, 2024. https://doi.org/10.1001/jamapediatrics.2024.3045
RethinkTHC
RethinkTHC Research Database. "Cannabinoids Used for Medical Purposes in Children and Adole..." RTHC-05203. Retrieved from https://rethinkthc.com/research/chhabra-2024-cannabinoids-used-for-medical
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.