The Different Methods Of Cannabis Ingestion

Ingestion is one of the many avenues of consumption for medical cannabis, and is one of the most discreet and effective methods available to patients. Without the telltale smoke, odor, and evidentiary ash, patients can intake the medicine they direly need without infringing on the social space of others. Steve DeAngelo discusses his three questions to help an individual evaluate their use of cannabis as a wellness product in his new book The Cannabis Manifesto. Question number three asks the user if their consumption will negatively impact someone around them. Regardless the specific vessel, ingestion will not infringe on any adjacent social spaces. Ingestion of cannabis can be accomplished by adding cannabis to virtually any of the typically ingested retail edible products. Including but not limited to: baked goods, snacks, drinks, tinctures, lozenges, soups, candy, and even gum. Some patients may not be able to smoke at all due to their illness directly, or the fact that they are placed on supplemental oxygen. Furthermore, ingestion removes the carcinogenic aspect of smoke, which is harmful to a patient’s lungs. Ingestion offers an avenue more in line with most doctors’ oath of “do no harm”.

Ingestion can be a tricky avenue for first time consumers of cannabis. This is because the effects of ingestion take so long to be felt, and are more intense as compared with smoking or vaping. It could be better for first time users of cannabis to choose smoking or vaporization, simply because the perceived effects are nearly instantaneous. The quick onset can allow a user to more easily perceive, and then control, their level of medication. Chris Goldstein puts it so eloquently when he says “Newbies, stick with doobies”.

Ingestion can happen via two methods: sublingually orally inside the mouth, or gastrointestinally inside the digestive tract, but can also happen via both methods in a hybrid situation. Medicine which is chewed and swallowed, for example cookies or brownies, will be absorbed gastrointestinally. Medicine which is held in the mouth or applied under the tongue, for example gum, or drops of an oil or tincture, will instead be absorbed sublingually. In each of these two methods the onset and the duration of the effects will be different. Gastrointestinal absorption will be felt by the patient typically from 1-2 hours, and the effects last from 4-8 hours. Sublingual absorption will be felt by the patient typically from 5-30 minutes, and the effects last from 2-4 hours. An example of a hybrid absorption situation would be a food item which is held in the mouth, but is swallowed as it melts, like a sucker.

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It is important to note that when THC is absorbed through ingestion, it passes through the liver, which metabolizes delta-9 THC into 11-hydroxy THC, the latter being 3-4 times more potent than the former and better at crossing the blood-brain barrier. With this general mathematical relation, it can be understood why smoking and ingesting the same amount in mg of THC can have vastly different effect on the patient.

Most edible preparations of cannabis will include the use of heat during the manufacturing process. This is important to note because the heat will decarboxylate the acidic cannabinoids and increase the bioavailability of the chemicals. The natural form of THC in the plant is found with an additional airplane-style “remove before flight” tear away tail, referenced as the “acidic” or “-a” form as THC-A and CBD-A. The “-A” must be removed for the psychoactive effects of THC to be felt by the patient. It may come as a surprise to many, but simply chowing down on some flower cannabis straight out of the bag will not lead to a strong psychoactive high. This is because the flower has not been heated and “decarbed”. While the acidic form of the molecule is not psychoactive, but still believed to hold medicinal value. The cannabis juicing movement believes in the medical value of the whole plant. By removing heat from the equation, there is no modifications to the natural terpenes, flavonoids, proteins, and the ideal ratio of omega-3 and omega-6 fatty acids. Typically only cannabis juices and alcohol based tinctures are prepared without the use of heat. Those familiar with the process of making homemade cannabis edibles know that decarboxylation is a key step prior to making your most effective medicated canna-oil or canna-butter. When “de-carbed” oil or butter is used to make edibles, the cannabinoids will be in their famous forms as straight THC and CBD, without the “-A” modifying the molecule.

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Rick Simpson Oil (RSO) is another, less widely known, form of cannabis for ingestion. This form is special, as it is a whole plant extract, and like juicing, will as a result allow for the full entourage effect in the patient’s system. RSO is rumored to be, in underground medical circles, a cure for cancer. While there have been a parade of anecdotal cases to support Rick’s claim, the claim that RSO can cure cancer has not been independently verified via certified double-blind scientific trials. It is an quite interesting coincidence to observe that the United States Governmental body, National Cancer Institute (NCI), states on its website “Cannabis has been shown to kill cancer cells in the laboratory” (11th bulleted point down in the list). NCI stops short of making the conclusion that cannabis kills cancer in humans, but only notes the effect occurring “in the laboratory”.

Ingestion is especially well-paired with those patients who are looking to medicate the gastrointestinal tract directly, as the case with Crohn’s disease or other gastrointestinal diseases and disorders. By directly applying the medicine to the GI tract, the medicine is not taking the “long route” through the lungs and the bloodstream, but can instead interact with the patient’s tract directly. Several factors can influence the rate and at which uptake absorption of the cannabinoids occurs inside the GI tract, including the amount of overall food present in the tract, and the type of edible preparation.

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It is worthwhile to point out that concentrates, such as shatter and wax, are not intended to be ingested directly. Butane hash oil (BHO) is similar to RSO, but made with butane in place of alcohol. This method typically also does not include heat, as the butane evaporates off at room temperature. Ingestion of BHO would not be similar to RSO, as BHO has not been ‘decarbed’, and therefore will be less psychoactive when ingested. BHO is usually smoked or vaporized, both methods ‘decarb’ the product as it is heated during the process. It is not recommended to eat concentrates as there is likely residual solvent inside the product, especially if it was sourced illegally. When illegal concentrates are produced, there is a high likelihood that residual solvent, or contaminants present in the solvent used, will remain in the final product. These unwanted chemicals will cause the user to become sick when ingested. The method of extraction preferred in the cannabis industry is supercritical fluid CO2 closed-loop extraction. This method allows for the best control and end product, and can be adjusted to remove a specific part of the plant while leaving others behind. This is the method chosen by most professional cannabis kitchens, as it avoids the possibility of solvent aftertaste in professional cannabis edibles because there is virtually no residual solvent. Cresco Labs partnered with Mindy Segal, who teamed up to make the best possible edibles using supercritical fluid CO2 closed-loop extraction. This method uses pressure to put CO2 into a supercritical hybrid-gas-liquid state, where it “diffuses through solids like a gas but dissolves compounds like a liquid”.

It is important when taking any medicine for the first time, for a patient to exercise a raised level of caution, and as the saying goes “start low and go slow”. Another cautionary saying goes “you can always eat more, but you can eat less”. If the level of perceived effects were to be quantitatively rated from one to ten, it is highly recommended that a patient aim to land at a level one their first time medicating. If as a patient you are barely able to feel the effects your first time medicating via ingestion, that is a great thing, and you have chosen the best route. Keep in mind, a patient may possibly have some anxiety or fear of the unknown their first time medicating via ingestion, but especially if it is their first experience with cannabis ever. Couple a slight anxiety with a high dosage of THC, and the patient is likely to experience a paranoid state. Raphael Mechoulam, the scientist who first isolated and discovered the molecule delta-9-THC, found out first hand during his experiment that cannabis affects everyone differently (please watch this entire video after reading this article). So if a patient is to start out at a level one, and work up through the levels of perceived effects from there, they will be able to learn to match their medical condition with the proper level of medication, without experiencing unwanted anxiety-like side effects.

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Cannabis is not allopathic, but biphasic, meaning the effect is not a linear progression. A small dose of THC will make a patient feel euphoric and hungry, but a large dose will inversely make the same patient feel anxious and not hungry. This is inverse to a typical allopathic understanding of a drug, where a single dose has an measured effect, and ten doses would have ten times the same measured effect. Even long-time patients with a high tolerance to smoking, can be overwhelmed by their medication when trying ingestion for the first time. Even patients who have mediated via ingestion for a long time period could experience unwanted side effects if dosing is not carefully watched, and they move into the far side of the biphasic effect.

If you clicked the “his experiments” link above, and watched the video about Mechoulam’s self-testing of cannabinoids, then you saw in his experiment each subject ingested 10mg of THC. In the cannabis industry a 10mg dose is considered a single dose. It is crucial that a patient clearly and specifically understands the amount of THC in an edible, the plant’s only psychoactive cannabinoid, before ingesting the medicated item. This can be especially challenging for patients who make their own, or consume others homemade medicated edibles. It is possible the amount of CBD will also be labeled, or even be the main cannabinoid. The presence of CBD in conjunction with CBD is thought to buffer the effect of THC, and keep the patient from feeling an overwhelming mental effect. It is especially difficult to quantify the THC amount in a homemade item because it is mainly a function of the potency of the source cannabis. THC percentages can range as much as 1-30%, resulting in a vastly varying amount of mg of THC per one gram of cannabis. Furthermore, concentrate extraction can be done with flowers, or also from the “scrap” trimmings and leaves, with less potency via the second method. Edible cannabis preparations found in legal retail stores are required by law to be clearly labeled and consistently dosed, regardless of the source material and the extraction process. It is the sole responsibility of the patient to heed caution, follow recommendations, start slow, and dose low.

While an overdose death from THC or any cannabinoids may be impossible, it is possible for patients to feel negative side effects like extreme anxiety or paranoia, and fluctuations in cardiovascular function, which can exacerbate an already nervous patient. Patients can panic when they feel an overwhelming effect, leading some to hospital visits by patients feeling as though they may die. Unlike opioids, it is not possible for cannabis to be fatal, even in large doses. This is due to the fact that there are no CB1 receptors in the brainstem, where automatic body functions are managed. A person would need to consume 1,500lbs of cannabis in 15 minutes in order to die from overdose. This is physically impossible, as 1,500lbs of cannabis would fill a dump truck, and this leads the scientific community to conclude an overdose death is not possible. In all of recorded history, there has not been a single case of a cannabis overdose fatality.

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Colorado made prompt updates to their laws regulating cannabis edibles dosing and packaging after a first-time consumer of edibles accidentally fell to his death while having a panicked reaction. After the investigation, it was discovered this was as a result of the individual not following the dosing recommendations from the dispensary where the edibles were procured. With quickness rarely seen in government, the state of Colorado required cannabis edibles manufacturers, via new regulations, to modify the way in which they packaged edibles. The goal was to provide consumers a situation in which they can not consume multiple dosages of THC in a single serving edible. Simply put, it is hard to eat ⅙ of a delicious cookie. If the effects of ingestion were as quick as with smoking, then the risk of over medicating would be much lower. Due to the fact that the effects via ingestion can take so long to be felt, the inexperienced or first time user may attempt to speed up the perception of felt effects by ingesting more product, which results in a longer and stronger effect, but not quicker.

Here is a summarized list of advice when it comes to cannabis ingestion:

  • Watch the mg of THC carefully!
    • The simplest comparison would be to the proof or ABV% stated on bottles of alcohol. A new consumer would be ill advised to consume a high proof or high percentage ABV beverage quickly. Similarly a new consumer of cannabis edibles needs to be personally responsible to ensure they understand and control their consumption of THC, regardless of the avenue of ingestion.
  • Aim to land on a level 1 for your first time ingesting, or anytime you consume someone’s homemade edibles for the first time, and then work up from there.
    • Start low, and go slow!
    • You can always eat more, but you can’t eat less!
  • Wait a minimum of 3 hours after ingesting cannabis before concluding how much effect you feel from it, and deciding to ingest more.
  • When making homemade medicated edibles ALWAYS clearly label them!
  • Medicated items for ingestion should be stored with as much consideration and protection as other items prohibited for children.
    • Under lock and key!
  • Do not consume medicated edibles on an empty stomach.
    • Most oral medications would have in their included paper insert the recommendation to not take the medicine on an empty stomach. The same advice goes for medicated edibles, as an empty stomach would allow for an extremely high rate of absorption uptake, potentially resulting in the patient feeling the effect too strongly.
  • Do not mix alcohol and cannabis edibles.
    • Especially for first time users of either.

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