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Medical cannabis, which exerts its pharmacologic activity through the endocannabinoid system (ECS), has recently been used in children to treat certain diseases beyond epilepsy. This second section of a three-part series contains a comprehensive review of the evidence-based treatment for neurodevelopmental disorders, movement disorders, and pain disorders. In this comprehensive review, PubMed, Embase, and Clinicaltrials.gov (1966–May 2020) searches were performed using the key search terms cannabis, neurodevelopmental disorders, child and adolescent psychiatry, spasticity, movement disorders, and pain. Only articles pertaining to cannabis and the pertinent disease states were extracted. Current published literature on the relevant disease states were largely limited to small pediatric trials and case studies. For diseases with limited pharmacologic treatment or clinical response, including Tourette syndrome (TS), refractory spasticity and Epidermolysis Bullosa (EB), the medicinal use of cannabis may be considered. The use of high CBD:THC ratios for the management of autism spectrum disorder (ASD) irritability appears promising. The formulations and doses evaluated in the studies commonly had increasing dose titration and varied by disease state. Further clinical investigations in pediatrics using robust clinical trial designs are necessary to elucidate the role of cannabis, including optimal dosing, formulation and duration of use, to ensure safety and efficacy.

A critical narrative review of medical cannabis in pediatrics beyond epilepsy, part II: neurodevelopmental, movement, and pain disorders