The goal of this post is to provide our patients with the education necessary to make informed choices as to the best way to receive (ingest) their medicine.
The availability and types of medical cannabis delivery systems that are available to patients today has grown exponentially since the early days of “rolled joints”, “water pipes” and “bongs”. Today’s delivery systems include: vaporizing systems (Vapes), infused products, edibles, nebulizers, tinctures and lotions. The use of these alternative delivery methods will provide patients with more choices, other than smoking, to receive their medication.
The first step to determine the right delivery system, is to consult with your healthcare provider. Some delivery systems, such as smoking or even vaporizing, may not be suitable given your medical condition.
So it is very important that you discuss your options with your healthcare provider.
The most common method of ingesting cannabis in the United States is to smoke it in a joint (cigarette), a pipe or a type of water pipe known as a bong. Smoking is a quick and efficient way to deliver an optimum therapeutic dose of Cannabinoids because the patient is able to feel the effects almost immediately and can stop as soon as the desired relief is achieved. The trade off is an increased risk of Bronchitis or other respiratory irritation.
Vaporization is an effective way to deliver the therapeutic components of cannabis without the toxic by-products of combustion. The delivery method of vaporization has grown in popularity as a substitute to smoking cannabis. The vegetable material is placed in the vaporization device and heated to a temperature of at least 350- 400 F. This causes the essential oils to volatilize or evaporate into a pure vapor, which is then collected and inhaled. The resulting vapors contain no tars, hydrocarbons, benzene, carbon monoxide or other toxic pyrolytic by-products of combustion. Respiratory risks associated with smoking are largely eliminated.
Eating Cannabis (Medibles)
In some cultures people prefer to ingest cannabis by eating or drinking it. Eating or drinking medical cannabis is especially recommended for those patients with respiratory conditions since it avoids the risks of bronchitis or lung irritations associated with inhaling smoke. Always consult with your healthcare provider for the recommendation that is right for you.
Two important facts about medical cannabis that must
be kept in mind if you plan to eat it.
1- Some cannabinoids must be activated by heat. Eating it raw will not deliver the full therapeutic benefits. Many people however do eat raw cannabis and report they receive benefit from doing so. Again, always check with your healthcare provider if you are uncertain.
2- Cannabinoids are soluble (dissolve) in fats and alcohol but not water. The cannaboids, or the therapeutically active components in medical cannabis, cannot be extracted by brewing a tea or soaking in water. They must be either suspended in a fat such as vegetable oil or “butter”.
In today’s medical cannabis edibles market, the assortment of available products ranges from baked goods, candies, sauces, ice cream and drinks. All of these products have been laboratory tested for accurate active ingredient amounts and will contain the %’s of cannabinoids contained in the item as well as the medical cannabis strains extracted. Patients should never consume an edible item without first checking labels on the item for strength and ingredients. If the edible item does not contain medical content labeling information, do not purchase or consume.
When consuming a medical cannabis edible/infused product, you should be aware that the therapeutic benefits of the cannabinoids will take longer to feel. Unlike smoke or vapor which produce immediate effects, edible items may take up to 2 hours or longer before the optimum therapeutic effects are felt by the patient. This delay in the effects of reaching the brain can sometimes result in the patient consuming too much or even overdosing. If it is your first experience with an edible, make certain you discuss with your healthcare provider or dispensary client services agent as to the correct dosage. For example, if you have purchased a “brownie” cut the brownie into quarters and consume a single quarter waiting two hours to feel the effects. You can always increase the amount if the desired effects do not occur after eating a single quarter.
Digestive processes alter the metabolism of cannabinoids and produce a different metabolite of THC in the liver. That metabolite may produce markedly different effects or negligible ones, depending on the patient. Onset of effects are delayed and last longer due to a slower absorption of the cannabinoids.
Because edibles may have the appearance of “everyday foods” it is especially important to keep them out of sight of children. Keep all medicines in a secure location. Children are curious by nature and there have been documented reports of children being taken to emergency rooms after ingesting what they thought were “sweets”. Be a responsible patient!
Tinctures and Sprays
Less common but growing in popularity are medical cannabis products that are available in liquid forms such as tinctures and sprays. Tinctures use ethanol alcohol (e.g. pure grain alcohol, not rubbing alcohol) to extract the cannabinoids. You use droplet amounts, and it is absorbed through the mucous membranes of the mouth. Sublingual sprays are another way of using a tincture. Ethanol alcohol is used to create the liquid and it is applied via a pump which sprays the cannabis-alcohol solution under the tongue.
Cannabis Topicals (applied to the skin)
Cannabinoids combined with a penetrating cream can enter the skin and body tissues and allow for direct application to the affected areas (e.g. allergic skin reactions, post-herpes neuralgia, muscle strain inflammation, etc). Cannabinoids in cannabis interact with CB1 and CB2 receptors which are found all over the body, including the skin. Both THC and Cannabidiol have been found to provide pain relief and reduce inflammation. Topical cannabis use does not produce a psychoactive effect, which is different from eating or inhaling the medicine.
Different types of cannabis topicals include:
1-Salve: cannabinoids heated into coconut oil combined with bees wax and cooled. Rub directly on skin.
2-Cream: cannabinoids heated into shea butter combined with other ingredients and cooled. Rub directly on skin.
Pharmaceutical Cannabis 6,8
Pharmaceutical cannabis or cannabinoid drugs are those that have been standardized in composition, formulation and dose. These are drugs which have been developed to meet federal regulatory requirements for prescribing by physicians.
The active psychoactive THC ingredient is a synthetic version.
Dronabinol (Marinol) is a prescribed capsule classified as a Schedule III drug used to treat nausea and vomiting caused by chemotherapy and loss of appetite and weight loss in people who suffer from HIV/AIDS. It contains a synthetic version of THC, suspended in sesame oil and does not contain CBD or other cannabinoids.
Sativex is a prescribed oromucosal (mouth) spray to alleviate various symptoms of MS and cancer, including neuropathic pain, spasticity, overactive bladder and other symptoms depending on the country. Derived from two strains of cannabis, the principal active cannabinoid components are THC and CBD suspended in ethanol.
6. Cannabis Business Daily, www.mmjbizdaily.com
8. Israel Comprehensive Study on Cannabis, www.cannabis.org