Abstracts

Rationale: Despite a high interest in the use of Cannabidiol (CBD) in the treatment of pediatric epilepsy, little scientific evidence is available concerning its efficacy, dose, product availability, labeling accuracy, concentration, and cost. Beyond select experimental trials, no FDA approved CBD concentrate is available for treatment purpose, forcing families who seek CBD treatment to receive their product from several other sources. As of July 1st 2016 new laws governing use and acquisition of CBD from medical dispensaries have been enacted in Washington State resulting in a decreased availability in concentrated CBD products. To assist our families who are giving their children CBD we have undertaken a study on the practical aspects of obtaining CBD from available sources. Methods: CBD containing products were identified through the Internet, local dispensary websites, and visits to local dispensaries. Capsules, oil extracts, tinctures, gels, candy, cookies, chocolate, and other ingestible CBD containing products were reviewed and included in this study if the CBD to Tetrahydrocannabinol (THC) ratio was greater than or equal to 1:1 or if labeled CBD concentrated but had no TCH reported concentration.  The following products were excluded: products without labeling, CBD containing leaves, vaping oils. The following parameters were recorded from included products: total cost, concentration of CBD, concentration of THC, ratio of CBD to THC, and total cost per milligram (mg) of CBD. If the same product was priced at different costs at different locations, average price was recorded. A literature review of published studies using CBD to treat refractory pediatric epilepsy was performed to determine a projected therapeutic dose. For cost comparison purposes the median household income for Washington was found from the Office of Financial Management. Results: 176 products were reviewed. The ratios of CBD to THC included: 51% had no reported information on THC concentration, 11% reported less than 0.3% THC, 38% reported CBD to THC ratios greater than or equal to 1:1 with a ratio range of 1:1 – 25:1, and an average ratio of 4.3:1. The range of total milligrams (mgs) of CBD per product sold was 5 mgs to 12,000 mgs, with a median value of 100 mgs per product.  Cost per mg of CBD ranged from $0.06 - $4.00 with average cost of $0.47.  A review of 7 published studies where CBD was used to treat pediatric patients with epilepsy revealed a dosing range of 2 mg/kg/day to 50 mg/kg/day. For the purpose of cost calculations a dose of 20 mg/kg/day was chosen as potentially therapeutic in a 20 kg child. Thus the estimated yearly cost was $ 68,620 as compared to the median household income of $62,108  in the state of Washington as of 2015. Conclusions: The cost to give a potentially therapeutic dose of community acquired Cannabidiol (CBD) would be beyond the financial resources of most families in Washington State and is estimated at approximately $68,620 per year. Funding: none.