Is it safe-and ethical-to prescribe THC to youth?
José Alexandre S. Crippa, Jaime E. C. Hallak
Psychopharmacology October 14, 2026 DOI: 10.1007/s00213-026-07186-6 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Cannabis |
| Key findings | The authors contend that evidence for THC-containing medicinal cannabis in children and adolescents is limited by small samples, heterogeneous formulations, and short follow-up, and that long-term neurodevelopmental safety data remain scarce. They argue that observational findings on recreational cannabis cannot be directly extrapolated to regulated medicinal use, and that risk-benefit assessment should be individualized, weighing disease severity and treatment refractoriness against response and tolerability. |
Abstract
The medical use of cannabis-derived products in children and adolescents has expanded beyond established indications for purified cannabidiol (CBD), with increasing investigation of CBD-rich extracts containing Δ9-tetrahydrocannabinol (THC) for neuropsychiatric conditions. Although preliminary studies suggest potential symptomatic benefits, the evidence remains limited by small samples, heterogeneous formulations, short follow-up, and insufficient assessment of long-term neurodevelopmental outcomes. Unlike CBD, THC directly activates CB1 receptors as a partial agonist, a pharmacological property underlying both its therapeutic and psychoactive effects. Following oral administration, THC undergoes extensive first-pass metabolism to the psychoactive metabolite 11-hydroxy-THC, with substantial interindividual variability in pharmacokinetics and pharmacodynamics supporting individualized dosing according to clinical response and tolerability. Experimental studies raise concerns regarding THC exposure during neurodevelopment, while observational studies associate frequent, high-potency recreational cannabis use with cognitive impairment, psychosis, and other adverse psychiatric outcomes. These findings cannot be directly extrapolated to regulated medicinal cannabinoid use, which differs substantially in product composition, dosing, administration, therapeutic indication, and clinical monitoring. Nevertheless, long-term neurodevelopmental safety data for medicinal THC exposure in children and adolescents remain limited. These uncertainties must be weighed against the consequences of inadequately treated disease, particularly severe drug-resistant epilepsy. Accordingly, the risk-benefit assessment of THC-containing products should be individualized, considering disease severity, treatment refractoriness, available evidence-based alternatives, therapeutic response, and tolerability. Long-term prospective studies and improved patient-selection strategies are needed to better define the role of THC-containing medicinal products in pediatric populations.
Comparable studies
Other narrative reviews on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Causal association between cannabis and psychosis: examination of the evidence | 2004 | Review | |
| Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. General (historical and pharmacological review) | 2018 | Review | |
| Psychiatric effects of cannabis | 2001 | Review | |
| Beyond THC: The New Generation of Cannabinoid Designer Drugs | 2011 | Review | |
| Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug | 2006 | Review |