Cannabis tinctures | Adobe Stock
By Marcella McClure
In my previous column, we talked about smoking, vaping and dabbing. But yes, there is more to the ingestion of cannabis. What about edibles, tinctures and salves?
There are many types of edibles that are infused with cannabis extracts on the market today: candies, cookies, drinks, and even pills to swallow. High dosage edibles used to be available to patients in California, but since cannabis became legal for recreational use, only low-dose edibles are available to anyone. There is a 10-milligram THC limit on any one piece of an edible, be it a cookie, a mint, a drink, or a pill. Edibles come in either five or 10 milligram dosages. Most cannabis-infused candy bars come with 10 pieces, or 100 milligrams total, of THC. (If you need a refresher on what THC is, refer to my previous columns here and here.)
Self-reporting surveys indicate that patients use between 20 to 60 milligrams per day of THC for pain and inflammation reduction. Many patients, especially older ones, find eating enough low-dose edibles to be effective medicinally often requires them to consume too much sugar and calories for their health. Patients hope that future changes to the law will allow them the high-dosage edibles they used to be able to purchase. These levels of cannabis edibles would not be available to recreational users. The National Organization for the Reform of Marijuana Laws (NORML) supports this change in law for cannabis use by patients.
Tinctures are various preparations (alcohol- or oil-based) of cannabis extracts that are sprayed or dropped into the mouth, usually under the tongue. Traditionally tinctures were alcohol-based, but now oil-based cannabis tinctures are more common. Most tinctures are flavored with good-tasting natural oil, like cinnamon or citrus, as pure cannabis oil is not a pleasant taste to many people.
There are a huge variety of salves, lotions and lip balms on the market, all made from cannabis extract, various plant oils and beeswax. THC, CBD and terpenes can be absorbed through the skin and provide relief from pain and inflammation in a localized manner. THC cannot reach the brain through the skin, so there is no way to get high from using a cannabis extract salve.
Dermal patches are new to the market and few patients have any experience with them. There is little to report at this time.
Many patients, especially older ones, find eating enough low-dose edibles to be effective medicinally often requires them to consume too much sugar and calories for their health. Patients hope that future changes to the law will allow them the high-dosage edibles they used to be able to purchase.
But Dr. Marcie, what happens to the THC, CBD and terpenes when they are inhaled versus eaten? Are both methods efficient at delivering these compounds to the endocannabinoid system?
Great question! This question deserves a complex answer. It depends on many factors, including the state of the patient. For example, a full stomach slows absorption of cannabis.
Inhaled cannabis (smoked or vaped) goes into the lungs, then the bloodstream and the heart pumps it throughout the body to the endocannabinoid receptors. As blood circulates through the body, some of it passes through the liver and back into the bloodstream. The liver metabolizes the THC into different forms. One of these changes makes THC more psychoactive. Most of the inhaled THC has already been distributed throughout the body before ever going through the liver, so only a small amount is made more active in the liver.
Inhalation rapidly and efficiently delivers THC, CBD and terpenes to the endocannabinoid system. The effects are of short duration, about three to four hours. Effects can be felt within two to 10 minutes of smoking or vaping and last several hours. Inhalation releases about 50 to 60 percent of the THC in cannabis to the bloodstream. This process is the same for tinctures placed under the tongue. They do not go through the digestive system, and are efficient and fast-acting. Tinctures that are swallowed go through the same process as edibles.
Aah, edibles! They are quite different than smoking or vaping.
Eating a candy or cookie infused with cannabis puts it into the digestive system, where its compounds undergo metabolism in the liver, and are distributed to the bloodstream. This is a much slower process of delivery than inhalation but lasts longer. The effect of edibles are usually felt 30 to 60 minutes after ingestion and can last eight to 12 hrs depending on the dose. Eating cannabis only releases about 10 to 20 percent of the THC into the bloodstream. Eating cannabis is not an efficient way to get THC, CBD or terpenes into the bloodstream, but this amount still produces a high.
There is another major difference between inhaling and eating cannabis that is important to know about.
Inhaled cannabis goes directly into the bloodstream and quickly to the brain. You get high fast. You get pain relief fast. And then it is gone. All eaten cannabis goes through the liver prior to entering the bloodstream. In the liver, the THC is converted to a more psychoactive form. This more potent form of THC reaches the endocannabinoid system more slowly and with some unintended consequences. Some people take too much of an edible as they want the effect to happen faster. This is a mistake. Too much edible can cause disorientation, confusion, panic, or even perceptions of fear and dread, and can land a novice patient in the ER. The rule is to eat some food if too much edible has been ingested. Longtime patients swear that pepper will end any feelings of anxiety or discomfort. A rule of thumb is to start with a low dose, five to 10 milligrams, and then wait a half hour to an hour to see the effect.
There are many anecdotes about the differences between smoking/vaping and ingestion. I will end this column with just one for your amusement, dear reader. It seems that about 20 to 30 percent of the people who use edibles experience a very noticeable increase in their libido.
And until next time; save the holy weed from the damn greed.
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