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13 doctor focus cannapatientcare.com october 2022 | cannabis patient care of cannabis preparations; and the wide range of tolerated and potentially effective doses preclude concrete clinical recommen- dations on how to best use cannabis to treat cancer. This com- plexity also challenges future clinical trial design. Neverthe- less, informed by a recognition of how little we know, clinicians can effectively guide patients' parents in the use of cannabis for both palliation and potential anticancer effects in children. For most of my patients with cancer, our shared goal is to mitigate the symptoms of the disease and side effects of treat- ment, allowing them to complete a full course of convention- al therapy while maintaining a high quality of life. With some ti- trating and fine-tuning of the cannabis regimen, most patients are able to achieve this goal. I believe that, in many cases, the dose of cannabis that supports quality of life, sleep, emotional and spiritual health, and function would be the same dose that conveys any potential anticancer effects. This, however, may not always be the case, and sometimes patients wish to modi- fy their cannabis regimen after learning of cancer progression and lack of response to current therapies. This usually involves a more aggressive, high-dose regimen. Among the cases claiming spontaneous remission or arrest- ed progression related to cannabis monotherapy, most patients have used very high doses of cannabinoids, in the range 5–20 mg /kg/day. In my opinion, this approach requires a plan for surveil- lance to determine if the cancer is responding to the more ag- gressive dosing. By titrating up slowly, patients can often tol- erate these high doses, and some also experience progressive improvement in symptoms and quality of life as they reach high- er doses. Conversely, I see patients who received excellent symptomatic relief at low and moderate doses subsequently build tolerance and lose these benefits at the higher doses. Without any certainty that the higher doses are effective- ly fighting cancer, this trade-off is not, in my opinion, worth- while, especially when the financial expense of high-dose treatment is considered. Furthermore, I have clearly observed a few cases of an impressive response to low- and moder- ate-dose cannabis combined with other integrative strategies that typically include diet change and high-dose melatonin. Conclusion Children with cancer can safely use cannabis with a low risk of adverse effects and high likelihood of benefit. This medicine can drastically improve resilience to stress, emotional and spiritual well-being, and quality of life, while also improving prognosis by increasing the likelihood of completing a full course of conventional therapy and preventing some of the devastating long-term adverse effects of cancer treatment, such as neuropathy. Furthermore, cannabis may also help directly fight the cancer on its own or in combination with conventional treatments such as chemotherapy and radiation. While these reasons sound compelling to most clinicians and parents, they are not nearly as compelling as the direct observation of children who are fortunate enough to receive the opportunity to use cannabis for this purpose. The global improvements can be profound to witness. This compassion- ate treatment can deeply transform the inherently traumatic experience of facing cancer for the child, and for the family. I hope that pediatric oncology care continues to grow in its em- brace of cannabis as a solution, and predict that in the future a cannabis plan or referral will become standard of care. References (1) E. Fride, Neuroendocrinology Letters 25(1/2), 24–30 (2004). (2) E.B. Russo, in Handbook of Cannabis, R. Pertwee, Ed. (Oxford University Press, 2014) pp. 23–43. (3) A. Abrahamov, A. Abrahamov, and R. Mechoulam, Life Sciences, 56(23–24), 2097–2102 (1995). (4) A. Levine, K. Clemenza, M. Rynn, and J. Lieberman, Journal of the American Academy of Child & Adolescent Psychiatry 56(3), 214-225 (2017). (5) E. Power, et al., Psychological Medicine 51.2, 194-200 (2021). (6) S.S. Wong and T.E. Wilens, Pediatrics 140(5), Article e20171818 (2017). (7) A.E. Chang, et al., Annals of Internal Medicine 91.6, 819-824 (1979). (8) S.E. Sallan, N.E. Zinberg, and E. Frei III, New England Journal of Medicine 293(16), 795-797 (1975). (9) For a listing cannabis clinicians near you visit Cannabisclinicians.org locator URL (10) W. Masocha, Pain Research and Management doi: 10.1155/2018/5234943 (2018). (11) B. Waissengrin, et al., Therapeutic Advances in Medical Oncology 13, 1758835921990203 (2021). (12) D.A. Ladin, E. Soliman, L. Griffin, and R. Van Dross, Frontiers in Pharmacology 7, 361 (2016). (13) J. Kander, Cannabis for the Treatment of Cancer: The Anticancer Activity of Phytocannabinoids and Endocannabinoids (6th ed, 2020). about the author DUSTIN SULAK, DO, one of the first physicians in Maine to incorporate the legal use of cannabis as a medicine in 2009, is the founder of Integr8 Health, a medical practice that follows more than 8000 patients using medical cannabis. Today he is globally recognized by his peers as a pioneer of clinical applications, formulations, and usage protocols. He is the author of the first foundational text on the clinical use of cannabis and cannabinoid therapies, titled Handbook of Cannabis for Clinicians: Principles and Practice. Dr. Sulak is co-founder of Healer, a medical cannabis brand founded to address the challenges of helping patients and health providers get the best results with safe, reliably dosable products and education on how to best use them. Healer's distinctive product formulations and educational material are based on his work. Healer Whole Plant Hemp CBD, CBDA and CBG products are available nationwide at www.HealerCBD.com. Healer medical cannabis products are currently available in Maine and Maryland and for more informa- tion visit www.Healercannabis.com. For free education on how to use cannabis as medicine and for Healer's online training and certification program for healthcare providers, industry professionals and consumers, visit www.Healer.com.