Utilization, tolerability, and perception of medical cannabis use in patients with seizures

The aim of this study was to describe patterns of use and patient choice of medical cannabis products for the treatment of seizures. Included were individuals certified with seizures and dispensed medical cannabis products between July 1, 2015, and December 31, 2023. Data were abstracted from dispensing records and self-reports at each visit describing cannabis use, seizure frequency, comedications, adverse events, perception of benefit and affordability, regimen (as needed, scheduled use, or mixed), and categorized by age and gender from 1,940 individuals. Most patients were adults (68.4%) and Caucasian (80.5%). Seizure-only patients (N = 1284) were mainly prescribed a single formulation (79.5%) and used one route of administration (87.7%) on the last recorded visit. Over the study timeframe, formulation and route differed by year for those patients with a seizure-only qualifying condition. Interestingly, most patients (86.8%) were dispensed products containing both CBD and THC. There was substantial variability in dispensed doses among seizure-only patients in the program, with CBD doses ranging from 0.001 to 33.1 mg/kg/day and THC doses ranging from 0.002 to 12.6 mg/kg/day in the scheduled dosing subgroup. A majority of patients (87.0%) were dispensed high CBD-to-THC total daily dose ratio and the CBD total daily dose in pediatric patients was significantly higher (p < 0.05) than in other age groups. The median daily CBD dose dispensed to patients was 2.5 mg/kg/day (IQR: 3.6) and was approximately 75% lower than the recommended maintenance dose (10 mg/kg/day) of the FDA-approved commercial CBD purified product. A higher percentage of older adults (≥60 years) reported adverse events than other age groups. Seizure frequency improved in 67.6% of patients over the study period. Among patients who reported concomitant medication use at their last visit, 76.2% were taking at least one antiseizure medication in addition to medical cannabis. Overall, patients thought medical cannabis was beneficial, but not that affordable and often chose cannabis products that contained THC.