Is it safe-and ethical-to prescribe THC to youth?

Crippa J.; Hallak J. · Psychopharmacology · 2026

**Background & Methods** This is a narrative review examining the safety and ethics of prescribing THC-containing cannabis products to children and adolescents. The authors synthesize evidence from preliminary clinical studies, experimental research on neurodevelopment, and observational data on recreational cannabis use to inform risk-benefit assessment in pediatric populations. **Key Findings** • THC acts as a partial agonist at CB1 receptors, producing both therapeutic and psychoactive effects that differ mechanistically from CBD. Following oral administration, THC undergoes extensive first-pass metabolism to the psychoactive metabolite 11-hydroxy-THC with substantial interindividual variability in pharmacokinetics and pharmacodynamics. • Preliminary evidence suggests potential symptomatic benefits for neuropsychiatric conditions, but findings are limited by small sample sizes, heterogeneous formulations, short follow-up periods, and insufficient assessment of long-term neurodevelopmental outcomes. • Experimental studies raise concerns about THC exposure during the critical neurodevelopmental window, while observational data from recreational cannabis use associates frequent, high-potency exposure with cognitive impairment, psychosis, and adverse psychiatric outcomes. However, these findings cannot be directly extrapolated to regulated medicinal use, which differs in product composition, dosing, administration, indication, and clinical monitoring. **Dosage & Administration** Not reported. The review emphasizes that THC dosing should be individualized according to clinical response and tolerability, accounting for substantial interindividual variability in pharmacokinetics and pharmacodynamics. **Safety & Adverse Effects** Concerns include cognitive impairment and psychosis, particularly with frequent, high-potency exposure. Long-term neurodevelopmental safety data for medicinal THC in children and adolescents remain limited. The authors note that adverse effects observed in recreational cannabis studies may not directly apply to regulated medicinal formulations. **Evidence Quality** This is a narrative review with limited evidence quality. The authors acknowledge substantial gaps: small sample sizes in preliminary clinical studies, heterogeneous formulations preventing standardization, short follow-up periods, and insufficient long-term neurodevelopmental outcome assessment. The review distinguishes between recreational and medicinal cannabis contexts but emphasizes that uncertainty persists. The authors conclude that individualized risk-benefit assessment is warranted, particularly for severe drug-resistant epilepsy, and call for long-term prospective studies and improved patient-selection strategies to define the appropriate role of THC-containing products in pediatric practice.

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