Dr. Hussain is the director of the UCLA Infantile Spasms Program and assistant professor of pediatrics. The focus of his research and clinical practice is infantile spasms and other forms of epileptic encephalopathy. An important arm of his research efforts is the evaluation of new candidate therapies for treatment of infantile spasms, including pharmaceutical, synthetic, and artisanal cannabinoids. Dr. Hussain received a career development award from the Epilepsy Therapy Project and is the inaugural recipient of the Elsie and Isaac Fogelman endowed chair in pediatric neurology at UCLA.
The efficacy of pharmaceutical cannabidiol (pCBD) is supported by clinical trials but limited to several severe childhood epilepsy syndromes. In contrast, artisanal cannabidiol-enriched extracts (aCBD) are largely supported by uncontrolled studies and parent reports. The prescribed dosage of pCBD is typically one order of magnitude higher than the recommended cannabidiol dosage using aCBD. The entourage effect and other factors that may affect dosage are discussed. The safety of pCBD is more rigorously established in placebo-controlled studies but treatment-emergent adverse events (TEAEs) reported with pCBD and aCBD are divergent. Although FDA approval of pCBD will mandate less restrictive Drug Enforcement Agency (DEA) scheduling, most forms of aCBD will likely remain more highly regulated from the federal perspective. Given federal oversight/DEA licensing of almost all hospitals, inpatient use of aCBD will likely continue to be discouraged or even forbidden. Health insurers are unlikely to provide reimbursement for aCBD, and the potential coverage of pCBD is uncertain, and will likely differ when prescribed on- and off-label.