The ingestion and absorption of cannabis can be accomplished in many different ways. These include smoking, vaping, tinctures, transdermal patches, pills or capsules, intravenous injections, lotions, suppositories, trans-oral, nasal inhalation, and edibles which pass through the digestive tract. Some of these methods may overlap and appear similar, although there can be subtle differences between them.
Our purpose is to investigate true edibles and the use of medical cannabis that can be ingested similar to foods, which is taken into the mouth, chewed and then swallowed.
A chief distinction here should be drawn concerning the use of edibles, as one must also consider similar techniques - trans-oral, nasal, and sublingual ingestion techniques which are not true edibles. Trans-oral ingestion refers to cannabis products that are predominantly designed to be taken into the mouth and then dissolve rapidly. These products can dissolve or be absorbed within seconds to minutes, and are not designed to operate through the digestive tract. Products such as this can be labeled as “troches” i.e. those made by Verano, and come in THC only, or THC and CBD together. Note that a balancing dose of THC along with CBD is less likely to cause an overdose of THC when consumed as an edible. These troches can also be referred to as gummies, chews, or losenges . This type of edible should be allowed to stay in your mouth for complete dissolution, as the oral mucosa (cheeks, tongue, floor of mouth, oropharynx) is readily able to absorb the contents directly into the bloodstream without passing through the stomach or digestive tract. Any swallowed material is still going to be effective, but will require more time to take effect and be metabolized and absorbed differently, as it goes through your stomach. Nasal ingestion occurs using a spray bottle with cannabinoids and inhaled into the nostrils for rapid absorption directly into the nasal capillaries and bloodstream, for a relatively rapid effect. Sublingual use of cannabis would involve using a tincture made from an extract or oil, and drops placed under the tongue for direct absorption into the large bed of capillaries in the floor of your mouth. These techniques are similar to edibles, but do not involve digestion. Instead, they are primarily absorbed directly into the bloodstream relatively rapidly for onset within 3-20 minutes.
True edibles are swallowed similar to food and can encompass hundreds of different products from cookies, brownies, chocolates, teas, wine, or any type of baked goods in which cannabis has been incorporated. The dosing of edibles can be a bit difficult as the exact cannabinoid contents are sometimes hard to ascertain in different products, and also there can be a different response based on stomach contents and each person’s metabolism. Typically THC breaks down into delta-8 tetrahydrocannabinol when smoked or vaped, or oral absorption, but true edibles go through a first pass in your digestive tract and liver and are metabolized differently. The metabolite of THC ingested into your digestive tract is delta-11 tetrahydrocannabinol, which can be strongly psychoactive for some, but relatively inert for others. In fact, while some individuals are very susceptible and receive a nice benefit from edibles, others feel little or no effect, even when given the same dose.
Let’s look at several important features of edibles…
*Onset and duration of action
The rule of thumb when doing an edible is to go slow and ingest a low dose initially. It is important to allow adequate time for the first dose to work and this can take anywhere from ½ hour to 3 hours. Quicker onset will occur on an empty stomach than a full stomach. Ingesting a little water or food along with the edible is advised to enhance absorption. Edibles have a relatively long duration of action and the after effects in a naïve or new user can last for 24 hrs. or longer. Edibles can also impart a slight hangover effect, especially if done late in the day or at night before going to sleep. Depending upon dose and bioavailability of the edible ingested, the usual duration of action is between 6 and 12 hours.
*Dosing of edibles
The dosing of edibles creates a unique and sometimes difficult problem due to the variability in digestion, the differences in absorption, and the actual amount of cannabinoids in milligrams (mg) ingested can often be difficult to calculate. Naïve users require a very cautious approach to dosing, where only 1-5 mg of THC should first be used. Moderate users can do 5-15 mg in general, and experienced users can tolerate up to 100-150 mg per dose or more. Some patients do not respond to edibles, even at high doses. A very common occurrence is for individuals to ingest a second or third dose while the initial dose had not yet taken effect. This can lead to an adverse overwhelming reaction, as the doses become additive. When this occurs an emergency room visit can be a possible outcome, although there is little real danger unless a true cannabis allergy is the cause.
*Storage, labeling, and packaging
Edibles should always be stored in childproof containers and labeled as “Medical Cannabis” or the like, and out of the reach of children. Often edibles can be kept in the refrigerator to prevent degradation or melting and preserve freshness. It is important to note that some gummy bear type edibles or gels, chews, or troches will melt if left in your car in hot weather. If this happens simply refrigerator or cool then back down and they will solidify again. Please label all products that look like regular food (i.e. pot brownies) to prevent accidental ingestion by an unsuspecting individual. Never give an edible to someone without clear approval and instructions for use. Packaging should clearly list the contents and amounts of cannabinoids for the user to understand the dose he is taking. The THC and CBD dose in milligrams should be easily seen on the packaging. Some labels give dosing for each piece, while others give an amount for the whole package. Don’t get carried away because you are hungry, and look at this as medicine not food!
*Cooking with edibles
Many patients will create their own edibles, either by using infused oil or butter. There are several techniques to create infused oil using olive, coconut, or other similar compound. Another popular technique is infusing butter with cannabis and then using the butter for cooking – and this allows a wide variety of foods that can be created including chocolates, cakes, baked goods, cookies, pancakes, etc.… A magic butter machine and decarboxylating machine can also be employed. Remember that cannabis must first be de-carboxylated using heat to transform the THCA to THC before being used in cooking, although the cooking process itself can decarb the cannabis, as in the case with brownies using ground cannabis leaves or flowers.
*Plan for using edibles
The exact result from an edible is often hard to predict, but repeated doses with known products can sometimes give a reproducible effect that one can plan for. For new users, or new products please plan ahead for any potential outcome. It is best to allow at least 8 hours of free time, in a controlled environment, in case there are any unwanted or unexpected side effects. Also it is nice to have someone friendly available whom you trust in case you overdose with unwanted psychoactive effects.
*Treatment for edible overdose
While one patient may tolerate 200 mg of THC in an edible form, another patient could overdose on as little as 5 mg of THC. As mentioned previously, there are also individuals where edibles have little or no effect. If you feel you have taken an overdose, then it is recommended to immediately take a counter-acting dose of CDB either by pill, capsule, tincture, vape or smoking. You would want to ingest between 15-30 mg of CBD, and allow 20 minutes to take effect. Soon you will feel relaxed as the adverse effects of THC overdose are mitigated by the CBD. CBD can also be ingested concurrently with edible THC to lessen the chance of THC overdose. An adverse effect from CBD would be rare and unusual, even in doses of 100-500 mg, so the THC content is the cannabinoid to monitor carefully….