This is an interesting topic to explore, as prior research has shown promising outcomes from oral CBD as adjunctive therapy in children with Dravet and Lennox-Gastaut syndromes (serious epileptic conditions). The authors in this study report a reduction in seizures and disease burden, but their findings need to be read with limitations of research kept in mind.

The study was a nonrandomized, before-and-after design, therefore participant assignment was neither randomized nor masked; there was no control group so it’s impossible to know the extent that placebo effect contributed to the positive outcomes reported. Additionally, a number of authors report financial conflict of interest, including consultancy work, employment and stock ownership in the pharmaceutical company whose CBD formulation was used in the study. The sponsor (pharmaceutical company) was responsible for the design and conduct of the study, including involvement in data collection and analysis. We need more well-designed (double-blind placebo-controlled trials) and independent research in this space.

Despite decades of negative publicity and propaganda against one of nature’s most mysterious plants, medicinal uses of cannabis are once again attracting attention largely thanks to the Marijuana legalisation movements. As more clinical data is being established around medicinal uses of cannabis, what is even more interesting is the consensus that as a medicine, cannabis is very well tolerated. If one carefully critiques the scientific manuscripts on harms of cannabis (1960-2018), it would be apparent that the studies were largely biased especially around inclusion criteria of participants/patients (eg predisposed health conditions) and types/dosages of cannabis used. Today, we know that unlike any other drug, patients develop tolerance to cannabis side effects but not to the actual therapeutic effect. That means that over time, a titrated dose can be maintained without the need to increase dose or frequency and that cannabis medicines are very well tolerated over time.

Dosage form and delivery route of cannabis are major factors which will influence the efficacy of proposed treatments as one could expect significantly different uptake (bioavailability) and pharmacological effect (eg oral cannabis causes 4 times more psychoactive side effects) from them. While oral administration of cannabis remains popular, alternative dosage forms of cannabis such as transdermal gels have been used to treat paediatric drug resistant seizures with some success. These patients also suffer from other comorbidities such as sleep disorders, autism, gut and movement problems and respiratory tract conditions all of which could also benefit from medicinal cannabis. 

Some limitations of the study are acknowledged by the authors in the article itself. With all the limitations in legislation and access to patients, it is not always possible to design the perfect experiment involving medicinal cannabis.