Edibles: Why Am I So Stoned?
by DR. ANDREW TALBOT
Let’s discuss some basic concepts of the oral route of administration of cannabis. This means any form of oral ingestion in which the medicine is swallowed. Oral administration is most commonly associated with cannabis “edibles”; foods made with cannabinoids. It also includes pills/tablets and tinctures (if swallowed…more on that later) or even decarboxylated flower.
Under law, legal edibles MUST be “gelatinous cube, gelatinous rectangular cuboid, or lozenge in a cube or rectangular cuboid shape.” This means that they must be gummies or lozenges in a particular shape. Rings, pucks, gummy bears, or other shapes technically are not legal. Nor are any infused baked goods (e.g., “brownies”), fruits, chocolates, or other candies legal.
Edibles may be labeled with their cultivar/chemovar or strain (sic) but much more commonly are seen with merely the dose of THC and CBD they contain. They may be labeled as Indica, Sativa, or Hybrid dominant. In my opinion, this has very little meaning for edibles as the THC and CBD molecules are identical in each of these types of cannabis. Without full spectrum cannabis and “minor” compounds, the various kinds of edibles should have little difference.
Oral ingestion may be a desirable method for patients new to cannabis. In my experience, many patients feel it to seem less “illicit-feeling” than the inhalation route. It requires no devices, is easy to dose, is quite discreet as there is hardly any odor. Patients can expect to begin to experience effects 1-3 hours after ingestion. At 6-8 hours duration, these effects generally last much longer than inhalation. There are some potential problems with it, though. The delayed onset can make it difficult to dose, and the titration is risky as some inexperienced users may try to “re-dose” before the full effects have begun.
There is another, more serious concern that I have with oral administration: the enhanced psychoactive effects. Warning: Biochemistry ahead.
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When cannabinoids are swallowed, they are absorbed into the bloodstream, entering the hepatic portal system. That means that the blood flows first to the liver, where the absorbed contents undergo “first-pass metabolism.”
In this process, the liver transforms most of the THC from its most commonly known form, called delta-9-THC, into 11-hydroxy THC (11-OH-THC). That also happens when delta-9-THC is inhaled, but it happens about ten times more after ingestion. This is important because 11-OH-THC crosses the blood-brain barrier far more quickly than delta-9, making the 11-OH about 4-5 times more psychoactive than delta-9. This is not necessarily a bad thing; it just may be an issue if not anticipated. Becoming densely stoned likely causes significant impairment in functioning, the opposite of what I am seeking for my patients in chronic pain.
My advice to my patients is to generally avoid oral use of THC during the daytime because of its impairing effects and duration. It is excellent though for nighttime (or bedtime) use for patients with pain and difficulty sleeping. Depending on timing and effects desired, for most patients, probably a multi-pronged approach is best… one that involves a little bit of both inhalation or sublingual administration and oral ingestion.
By no means do I intend to condemn oral use of cannabinoids, just to point out that impairment is not my intention for patients in pain as I seek to help them maximize their function.
I’d love to hear about your oral ingestion experiences of cannabinoids if you are willing to share. Thanks for tuning in.
Andrew Talbott, MD
TRUCE Medical Advisor
The Utah Bee Advisory Board member
Board Certified in Anesthesiology and Pain Medicine
The updated article was originally posted on TRUCE.