Episode #3 of the Medical Cannabis Podcast: A Beginner’s Guide is about how to get the phytocannabinoids from the cannabis plant into our Endocannabinoid system. This article highlights some of the main points we discuss in Episode 3.
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The podcast and this article are for educational purposes only and are not to be taken as medical advice. We have provided some information on how to take Cannabis as medicine and it provides you some background knowledge, so you can have a more educated conversation with your doctor about medical cannabis. Please speak to your doctor for medical advice.
“But I don’t want to smoke pot!”
In order for Cannabis to work as a medicine, we need to get the cannabinoids from the Cannabis plant into our system so they can interact with our Endocannabinoid system.
We call these ways of getting it into our system “routes of administration”.
Until now popular belief was that the only way to make use of medical cannabis was by smoking it.
A lot of patients that I speak to say, “Well I don’t want to smoke pot!” They envision clouds of thick smoke hovering over their head while strangers give them dirty looks.
There is good news because there is more than one way to get the Phytocannabinoids from the plant into your Endocannabinoid system. There are more discrete options, and other options for people who don’t want to smoke it.
This when you heat up the solid plant material until it becomes a vapor (gaseous state) and you inhale the vapor into your lungs.
It is still delivered into the lungs like smoking, and it starts to work quickly and achieves drug blood levels similar to smoking, but without the “combustion byproducts.”
You aren’t heating it to the point where it catches on fire and burns (so it’s not smoke).
It usually has less smell than smoke plus Health Canada said it delivers less tar, less carbon monoxide and less polycyclic aromatic hydrocarbons than smoking.
But long term data is still being accumulated.
Cannabis can be baked or made into edible products such as cookies, brownies and gummy bears.
Some people do find relief with these products, but for most people they are not the best ways to medically consume cannabis.
The problem can be uniformity of dose and whether a dose can be replicated.
For instance, if you have one bite of cookie today, and then one bite tomorrow there is no guarantee that the bite size will be equivalent.
Will today’s bite be bigger than tomorrows? This means your day-to-day dose will fluctuate.
If you are taking something as medicine you want to maintain consistency, and know how much you’re taking.
The solid material from the Cannabis plant (primarily the flowers or buds of the plant) can be put through an extractor resulting in a Cannabis oil.
This Cannabis oil will have an established amount of Cannabinoids per milliliter.
For instance, when you consume 0.5mL of the Cannabis oil per day, you’ll know exactly how much THC and how much CBD you are consuming. (Because in Canada at least a reputable, legal product has to state the amount of THC and CBD in it.)
You can draw up the oil into an “oral syringe” -available from pharmacies – that has the amount of milliliters written on the side of the syringe.
The oil can be swallowed, it can be put onto a cracker or other food item then swallowed, or it can be placed under the tongue. (Under the tongue is considered a different route of administration…it’s called sublingual. And we touch on this further below.)
But they know how much they’ve consumed. That is key. That can be replicated. And the dose can be adjusted by small increments as required.
The topical route of administration is when you apply a cannabis product to the skin: such as a cannabis cream or cannabis ointment.
There are a lot of CB1 and CB2 receptors in the skin.
Some people use Cannabis creams to help with pain and itch, while others use Cannabis creams or ointments to help with a skin condition such as psoriasis, eczema and acne.
I have seen some amazing results for skin conditions, but this is what we call anecdotal evidence. There currently isn’t a large amount of research on topical Cannabis products yet, but I’m sure that will change.
How long does it take to work and how long does it last?
Inhaling cannabis (via smoking or vaporizing)
It is a fast way to get it into your system.
It can start to have an effect within minutes (5-10 minutes), and achieves a high level of the drug entering your bloodstream, but it doesn’t last very long (usually 2-4 hours). You can envision this like a shark-tooth pattern: goes up quickly but comes down quickly.
If someone is using a vaporizer it is recommended they start with one inhalation only, and wait at least 15 minutes before repeating the dose. They want to gauge how it is affecting them before they inhale more.
And they could repeat again after 15 to 30 minutes if they need to. And then stop once they achieve their therapeutic outcome. (E.g. stop once the migraine has stopped.)
A quick acting route of administration like this can be beneficial for medical conditions that require prompt treatment. Examples that come to mind are migraines, muscle spasms from MS, or if the patient is nauseous from chemotherapy (and they wouldn’t want to take anything orally anyway).
Cannabis Oils (oral)
Swallowing cannabis products takes longer to start to work.
It may take 1-3 hours or so to start having an effect, but it lasts longer than inhaling it. The effects after swallowing cannabis may last 6-12 hours.
This slow onset but long duration of action is well suited to treat chronic health conditions such as arthritis or autoimmune conditions where the symptoms are constantly at about the same level of discomfort all the time.
Many patients that use Cannabis oils will take it in what’s called an “around the clock” fashion.
This means they regularly take it two to three times per day at the same time per day. Example, every day at 8AM they take X amount of oil, and at 8PM they take Y amount of oil. (Notice the morning dose and bedtime dose don’t have to be the same…every patient is different so the patient has to “experiment” and find the dose that works best for them).
This “around the clock” dosing is intended to provide a nice even level of pain control or symptom control.
What about breakthrough pain if already using Cannabis oils?
If the patient has “breakthrough pain” which is pain that flares up and gets really intense – beyond what the “around the clock” dosing can handle – then a patient could use a vaporizer to provide quick relief.
In medicine they call this “PRN” which means “as needed.”
The patient wouldn’t vaporize all the time: they’d only do it when needed to treat the breakthrough pain.
Be careful how much you consume and how quickly
There are many reports of people swallowing a THC-containing product and then taking more of it a short time later because they believed it wasn’t “doing anything.”
You have to remember that taking Cannabis by mouth takes time to start working.
It is important that you wait a few hours before consuming more oral cannabis products.
If you consume even more of it then by the time it starts to “kick in” you will have consumed too much and may experience some undesired THC effects like rapid heartrate, dizziness, and sensory distortions.
So various routes of administration can be combined.
Under the Tongue or in the Mouth
Placing the Cannabis oils under the tongue (called sublingual) or absorbing into the lining of the mouth (called buccal or oromucosal) will start to work quicker than swallowing the oil.
It may start to work within 45 minutes and is estimated to last about as long as swallowing it.
In Canada there is a prescription medication called Nabiximols (brand name Sativex) which is a liquid spray made from Cannabis at a set concentration of approximately 1:1 THC to CBD. Patients can spray the liquid into their mouth and it gets absorbed through the lining of the mouth.
You may not overdose but there can be Adverse Effects
We mentioned in Episode #2 that there are little to no Cannabinoid receptors in the respiratory drive center of the brain. This means Cannabis won’t shut down your breathing.
But to someone who isn’t used to taking Cannabis THC at higher doses can cause some unwanted effects such as dizziness, fast heart rate, anxiety, paranoia, and sensory disturbances.
It can get you “high” or “stoned” and if this isn’t the effect you are going for then it can be off-putting.
These side effects can largely be avoided with prudent dosing.
If a patient starts at a low amount of THC and slowly increases their dose they may be able to build up a tolerance to the psychotropic effects of THC.
So in other words, they’ll be able to get the medical benefit of THC without getting high or stoned.
But it’s important to start low and go slow.
Another reason it is important to “start low and go slow” is to find your dosing “sweet spot.”
This is the dose that provides the most benefit for you without causing side effects, and hopefully without requiring too much product (because Cannabis products can be expensive).
Every person will require a different dose compared to someone else: even if that other person has the exact same medical condition.
The reason is because everyone’s Endocannabinoid system has as different tone (how well it is functioning) and everybody responds to Cannabis differently.
So you have to be responsible for finding the dose that works for you.
Careful dose increases – in small increments – over several days will be required.
You need to keep track of your doses in a journal and write down how that dose made you feel: did it improve your symptoms or were there any adverse effects?
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