"Edibles" is the catch all word for orally administered cannabis. Orally administered
cannabis is different from inhaled cannabis in ways that give it certain advantages such
as increased potency and a longer duration of effect. It also has some disadvantages
which can make it a bit difficult to use.
Differences Between Inhaled and Ingested Cannabis
Inhaled cannabis is very rapidly absorbed into the bloodstream and distributed to the
body. Effects and peak levels of cannabinoids in the blood occur in minutes. This almost
immediate effect makes it easy to titrate, meaning administering small doses until the
desired effect is achieved. It is relatively easy for a patient to get the dose correct. The
effects of inhaled cannabis tend to dissipate within an hour.
Edibles are ingested and digested. The absorption of substances from the gut, of
course, takes longer. It can also be quite variable in patients with peak blood levels and
effects usually take from 1-4 hours to take effect. In some patients it may be even
longer. Orally taken cannabinoids are more potent than inhaled versions. After gut
absorption into the bloodstream, THC is metabolized to a different form in the liver
before being released into the circulation to the rest of the body. This form is much more
powerful than the inhaled form that is immediately released into the circulation and is
Thinking About Edibles
Well, it seems that edibles are the way to go for patients with chronic, constant pain.
Long lasting relief to improve functioning is the main treatment goal- break out the
gummies! Not so fast there, pilgrim...
I usually recommend patients only start orally administered cannabis products after they
are used to the side effects of cannabis and have become "tolerant" by the inhalation
route. This is important because of the advantages of the high potency and long
duration of action become disadvantages if the patient takes a dose that has a larger
than anticipated effect. Instead of being "over treated" for an hour the effects can last
the better part of the day. Sure, the pain symptoms may be gone but the side effects of
cannabis over treatment impair daily activities. Patients will experience less intense side
effects if tolerant.
Edible Dosing and Titration
Tinctures are really the best route to transition to oral cannabis. A tincture is an extract
of cannabinoids using an ingestible solvent such as grain alcohol. When administered
under the tongue, absorption into the bloodstream and distribution to the liver is rapid.
Instead of the hours for edibles to be absorbed from the gut, the tincture delivered
sublingually works in about 45 minutes. This makes titration of dose which relieves
symptoms but minimizes side effects relatively easy. Tinctures are covered in more
detail in a following blog.
The more commonly available gummies and candies are different. Tolerant patients
taking their first edible dose of cannabis should really plan a day to thoughtfully begin
their titration. Commercially available edibles are usually available as a specified dose
of THC with or without a specified dose of CBD. The THC and CBD combination will
likely have fewer side effects. THC alone can produce or worsen anxiety and paranoia
and the addition of CBD will help to minimize this effect. I encourage patients to take
notes on their first titration for two reasons. First it makes one really focus on their pain
levels. Second, most tolerant patients will find that relief of their pain symptoms occurs
before the psychoactive effects. This is the endpoint we are looking for- the sweet spot
of symptom control without impairing side effects. Doses should be small, about 2.5mg.
I suggest around a two hour interval between doses for most patients. The dose is given
every dosing interval until the endpoint is reached. After that, the patient should pay
close attention to how long the effects last. If two doses of 2.5mg reach the endpoint
and it lasted eight hours, the patient can essentially put themselves on a scheduled
dose of 5mg three times per day.
Quick Start Guide
This has just been short introduction to orally administered cannabis focusing on the
commercially available edibles currently available in Arkansas dispensaries. Discussion
of other forms and preparations of oral cannabis will roll out as they become available. If
you are going to give them a try, the advice above should help you achieve the
response you are seeking. Remember, "start low and go slow" with edible cannabis.
Brian Nichol MD