****NOTE**** Although the personal pronoun "I" is used throughout this article, at no time does it refer to me. This article originated from Robin Hackett, a Colorado medical marijuana
dispensary owner and cannabis
adviser to the NoCoMAC and has been previously published.
As a cannabis adviser/dispensary owner, I have seen hundrends of medical cannabis patients each month for 18 months I have documented how each patient responded to different cannabis treatments. All of the patients experienced various levels of suffering caused by their diseases, injuries/symptoms (qualifying medical conditions of the state of Colorado) but each patient reported a reduction in their suffering with the addition of some form of MMJ edible medicine. Unfortunately, most "bud tenders" in MMJ dispensaries do not have the complete knowledge to help people with their range of symptoms. As a result, many patients do not know the benefits of MMJ edible therapy or how to use edibles to achieve maximum results. Some people give up on using MMJ edibles in their treatment because they have had a bad experience with them. This may be due to taking the wrong dose fore their individual tolerance, similar to taking the wrong dose of a prescription drug
. Other patients stop using MMj edibles because they do not think that the edibles are effective in treating their problems. When asked why they felt that the cannabis (MMJ) edible did not work, Patients responded that it was because "they did not feel a head high (feeling stoned) associated with the MMj edible." Another reported reason was that the patient felt too stoned (high) and that this was not a pleasant feeling.
There are approximately 100 known cannabinoids
in the cannabis plant. the two most widely studied have been THC and CBD. both are therapeutic and work well together. THC is psychoactive
, producing the "head high", while CBD is generally considered to be non-psychoactive. CBD rich buds/edibles in ratios of 2 to 1 or more-when compared to THC levels-usually produces therapeutic effects without the head high or stoned feeling.CBD is a pain reliever, anti-inflammatory, anti-anxiety, anti-nausea, neuroprotective, antispasmodic, etc.
In my experience, medical cannabis (MMJ) edible therapy is the best way to help with the therapeutics of longer lasting relief of the qualifying conditions allowed by Colorado for MMJ use. It should be noted that most MMj edibles sold in MMj dispensaries now in Colorado are rich in THC, while very low in CBD levels. the patient needs to pay close attention to the labeling of the MMJ edible considered for use and also personal experience with a particular product, as well as asking questions of the bud tender regarding particular lab testing methods and accuracy, are vital. NOT ALL MMJ EDIBLES ARE CREATED EQUAL! Nor do they produce consistent results. There are a few quality edible products being sold that are coinsistent in therapeutic effects and potency, however, you will have to discover these through other methods, such as product/dispensary reviews.
So, how do you know what the right dose is for you and your symptoms? The information given should help you safely find the dose that is right for you.
: Why would I want to use medical cannabis edibles for my symptoms?
: Smoking or vaporizing cannabis is considered "spot" or short-term medication (the relief lasting two to four hours). Studies have shown that patients who eat MMJ cannabis, or MMJ edibles, receive MORE of the anti-inflammatory, neuropathic (nerve) pain, and other forms of relief. medical benefits can last from four to eight hours, in some cases.
: How much do I need to eat each day in order to receive the benefits of MMJ edible cannabis therapy?
: The challenge in cannabis dosing is like in any other medicine, and medical cannabis will react differently in each individual. This is due to the medicine ingested and the digestion process itself. The first step in formatting the dose that is best for the patient is first to determine what type of patient you are.
WHAT TYPE OF PATIENT AM I?
TYPE 1 PATIENT
Is new to medical cannabis therapy and has no tolerance or is very sensitive to the effects of cannabis. This patient needs to first develop a tolerance to THC before they can start medicating for therapeutic or symptom relief. They should begin be taking very small doses at bedtime. The patient can begin with 10 mg for 14 days, followed by 20 mg for 7 days. This low dose may or may not help the symptoms, but will help the patient establish a tolerance to THC. After the 21 days, the patient is then considered as a Type II patient. Note-in my experience, patients typically gain a tolerance to THC after about 14 days, so if the patient finds a higher dose is needed for relief, they can safely increase the dose every two weeks or so.
TYPE II PATIENT
Has moderate to medium symptoms. This patient has used cannabis but has a low tolerance to the effects of THC and may prefer not
to feel the "stoned" effects common with cannabis usage. This patient can medicate safely at bedtime with any type of edible that they might enjoy, and in the 20 mg to 50 mg range. If daytime doses are necessary for additional relief, the use of low THC/high CBD products is indicated, with a ratio of 1 to1 often considered best by many. (see "do I need to dose during the day?" for suggestions on daytime dosing.)
TYPE III PATIENT
Is the typical patient who has medium to severe symptoms. This patient is experienced with cannabis and has a good tolerance to the effects of THC. The patient may enjoy the effects of THC all day, although some may prefer not to feel the effects of THC during commitments such as work, chores, or childcare. this patient may choose to take between 20 mg and 100 mg at bedtime, or may choose to take their dose broken up throughout the day, as well as at bedtime.
TYPE IV PATIENT
Has severe or extreme symptoms. This patient has a significant tolerance to the effects of THC and can function well with high dose MMJ edibles. Type IV patient dosing might appeal to those patients who enjoy the intense effects of High THC content edibles. this type of patient may eat from 100 mg to 300 mg a day, either as a single dose or broken up into several doses throughout the day.
****NOTE****the following is a departure from the author and is my personal opinion.
TYPE V PATIENT
For those of us in which "10" on the pain scale is a beginning and not a maximum value. This patient swims in a sea of cannabinoids. In fact, the navigators in the book series "Dune"
couldn't hold a stick to us! The tolerance of this patient is such that the effects of THC are not noticeable unless under the influence of truly massive quantities. This patient will start
their dosages at 200 mg to 300 mg at once, and will often take several doses of this size throughout the day, often compounding that with smoked or vaporized MMJ as well. It is not unusual for this patient to take the equivalent of in excess of 1 gram of THC per day. This patient is significantly habituated to the effects of cannabis and will suffer considerable withdrawal
symptoms if usage is stopped for an extended period of time.
: How often must I medicate each day in order to relieve my symptoms?
: All patients have shown more benefit each day from a dose at bedtime more so than at any other time of the day. Dosing at bedtime has been shown to promote a higher quality, deeper sleep-the quality of your sleep directly effects the quality of your waking life, including mental sharpness, productivity, emotional balance, creativity, physical vitality, and even weight. No other activity has been shown to deliver so many benefits with so little effort! It also allows the patient to use larger doses of cannabis, while sleeping through the psychoactive effects of THC.
DO I NEED TO DOSE DURING THE DAY?
There are five main factors which need to be taken into consideration when deciding how often to dose with medical cannabis.
1. Severity of symptoms-some patients have such severe symptoms (or, lets be honest, tolerance) that they choose to medicate once or more a day. Some patients add smoking or vaporization therapy to help them deal with their issues during the day, while others use a properly-dosed
edible in the morning as well as at bedtime to ease their symptoms. And it goes without saying that vaporization is a much
healthier way to inhale medical cannabis than the traditional smoking a joint or a bong
hit while using butane
or friction matches.
2. THC tolerance-Some patients need strong relief but do not want to feel the psychoactive, or stoned, effects of THC, while others function better with
the THC effects. If you have a good tolerance to THC, you may want to experiment with daytime dosing until you achieve the desired results. WARNING!
THC-rich MMJ can impair motor and cognitive functions, and must
be used with caution when attention to detail of ANY kind is required! Driving, operating machinery of any kind, being in situations in which attention to detail is required.....all of these are situations where a persons full attention is required, and they are advised to use extreme caution and/or refrain from using THC-rich MMJ during the time period leading to the activity in question. If you do NOT like feeling the brain effects ofTHC, you would do best with a strong MMJ dose at bedtime, and then enhance your relief during the day by using a high CBD/low THC product in a 1 to 1 ratio, which is considered by some to be the ideal. There are currently several products commercially available that offer the same high CBD/low THC profile. They are the best for daytime relief of symptoms with much less (or none at all) of the head high. Again, these effects will vary with the individual patient and the MMJ product used. Quite often when treating patients with medical cannabis, one size does NOT fit all. In fact, this is the case with most patients, and they are advised to start any treatment regimen slowly, in order to experience exactly what will work best for them.
3. Lifestyle-Some patients need symptom relief, but cannot be inpaired by THC because of a variety of factors, such as job, family commitments/child care, or just daily tasks. this patienbt would do best dosing with MMJ at bedtime and enhance your symptom relief during the day using products that are low in THC and rich in CBD. usually, if the percentage ratio of CBD to THC as stated on the product label is not at least 2 to 1, CBD to THC, most patients will feel at least some
4. Gender-Women can store more cannabinoids in their fat cells than men can. Often, men will have to dose twice a day to get the same result as a woman dosing once a day.
5. Weight- Cannabis is the ultimate time release medication. it is stored in fat cells in the body and released into the bloodstream over time, which varies from person to person. Extremely thin people may need to medicate up to three times a day with MMj edibles to achieve a desired medical result, while a heavier person may receive medical relief with a strong medical dose at bedtime.
Can I use medical cannabis edibles in conjunction with vaporization/inhalation therapy?
Yes. In fact, the majority of patients use both. The average patient will take the same dose each day of edible MMJ cannabis, appox 20 mg to 100 mg (depending on what type of patient you are). Inhalation MMJ therapy can be used to control a greater range of, or more severe, symptoms on an "as needed" basis by a patient.. Treatment regimens may have to be adjusted frequently, given the occasional flare-up that is always a part of the chronic pain/MMJ patient's condition(s).
What do I do if I am ingesting an MMJ edible for the first time?
GO SLOWLY! Please keep in mind that MMJ edibles can be very strong in comparison to inhalation therapy. IN addition, the effects of ingesting cannabis can potentially last up to six times longer than can the effects of inhalation therapy. A person should take MMJ edibles with some food-preferably containing dietary fat, such as olive or cooking oil, butter, etc.-to help with the digestion and metabolism of the THC and the CBD. The amount of MMJ needed for symptom relief is different for each patient, and many patients are using too high of a dose of MMJ to effectively treat their condition.
How do I know which edible company is best for me or my needs/condition?
Not all MMJ edible companies are created equally! Some MMj edible companies test their products for accuracy in dosing of THC and CBD, but a lot of them do not. Lab testing is expensive, and Colorado state standards for accurate testing results do not currently exist. This is a very significant problem in the current MMJ edible market. The best way for a patient to protect themselves from these inferior products and bad side effects
as discussed above is to make sure that your MMJ center or dispensary demands quality lab test results from the edible manufacturer, in order that the patient can make informed decisions and use their medicine safely and wisely.
Again, the new MMj patient must proceed slowly when using MMJ edibles, in order to develop a tolerance to, as well as a knowledge of, what products work best and most consistently at the proper dosage, including the timing of the MMJ ingestion, to have the most symptom relief. Working only with certified and knowledgeable "bud-tenders" at a quality dispensary is suggested.
How do I read the labeling?
Buyer beware! The labels regarding the strength of the product may say one thing and not be consistent from one batch to another. This pertains to levels of both THC as well as CBD. Anytime a patient begins using a new edible, it is suggested that you begin with a low dosage until you know how you will respond to it. Just because the packaging says that it has a 100 mg dose of THC may not necessarily mean that it has 100 mg of activated
THC. It could have more, or many times less, than the actual number on the label. MMJ edibles vary in strength between different companies as well as from individual products within a specific MMJ company. It is quite dangerous for a patient to eat an MMJ edible product which claims to have 100 mg of activated THC, when in fact it may only contain 35 mg. The patient now believes that they have a tolerance to 100 mg of THC, but has only ingested 35 mg of THC,
which they have found to work well for them. Now, if this patient tries a product that actually has 100 mg of THC, they get too high and may suffer from anxiety and possibly panic because they have now taken a dose which is too high. This can be confusing, scary, and very uncomfortable for the patient, and not very good as regards the practice of medicine, as well.
How long until I feel the benefits
It typically takes between 30 to 90 minutes to fgeel the effects of MMJ edible therapy. You can expect to feel a slight increase in symptom relief the next morning after your first bedtime dose, and will usually feel more substantial symptom relief within the next 48 to 72 hours. Some patients will achieve substantial symptom relief within two weeks, while other patients may take up to two months before they are receiving the maximum benefits offerred by MMJ edible therapy.
What do I do if I have eaten too much?
DO NOT PANIC! You are NOT going to die, regardless of what your brain may be trying to convince you of. The most common side effects include increasing anxiety, racing thoughts, increased heart rate, possibly a panic attack
, nausea, vomiting, feelings of disorientation, and excessive drowsiness, There are some people within the MMJ community who will say that ingesting high concentrations of sugars such as those found in sodas and candy, or ingesting starches such as rice and pasta and drinking plenty of water may help to reduce the uncomfortable effects of an overdose or a bad reaction to cannabis.
The following is a listing of some of the cannabinoids found in marijuana
, as well as what they can be used for.
Delta 9THCA-aids sleep, inhibits cancer cell growth, suppresses muscle spasms.
Delta 9 THC-reduces vomiting and nausea, relieves pain, stimulates appetite, suppresses muscles spasms.
Delta 8 THC=relieves pain.
THCV-reduces convulsions and seizures, promotes bone growth.
CBD-antibacterial, inhibits cancer cell growth, neuro-protective, promotes bone growth, reduces seizures and convulsions, reduces blood sugar levels, reduces function in the immune system, reduces inflammation, reduces risk of aterial blockage, reduces small intestine contractions, reduces nausea and vomiting, relieves pain, reduces anxiety, slows bacterial growth, suppresses muscle spasms, tranquilizing, treats psoriasis, vasorelaxant.
CBDA-reduces inflammation, inhibits cancer cell growth.
CBG-aids sleep, inhibits cancer cell growth, promotes bone cell growth, slows bacterial growth.
CBGA-reduces inflammation, relieves pain, slows bacterial growth.
CBC-inhibits cancer cell growth, promotes bone tissue, growth, reduces inflammation, relieves pain.
CBCA-reduces inflammation, treats fungal infections.