In a study that is getting tons of press but really shouldn’t have surprised anyone, Andrew Monte, MD, PhD, of University of Colorado Anschutz, and his co-authors showed that although only about 0.3% of the THC sold in Colorado dispensaries is sold as edibles, these same edibles account for 10.7% of cannabis-related ER visits. This means that patients are much more likely to experience negative side effects if they eat their cannabis than if they consume it in another way. And since women are generally more sensitive to the effects of THC, they are at an even greater risk.
What does this mean for the many women using medicinal cannabis products, especially those that rely on edibles? Are cannabis edibles safe?
The challenges with edibles
Cannabis generally refers to any medicinal or recreational product made from the cannabis sativa plant. This includes marijuana, hemp, and isolates. There are hundreds of active compounds found in cannabis sativa. THC and CBD are the most famous and most powerful. At the right levels, they are both medicinal, but only THC can get you “high.”
An edible is any cannabis product that you swallow. This includes brownies, gummies, capsules, and oils (if you put them in liquid and drink them). For any of these products to take effect, they must first travel through your digestive tract and get metabolized by your liver.
There are three parts to this process that makes edibles potentially dangerous.
- Time of Onset: This digestive process can take anywhere between 30 and 90 minutes before a patient feels the effects of her cannabis. Some women may take additional doses of cannabis within this onset window, thinking that they haven’t taken enough when really they haven’t waited long enough. Then, when the effects do kick in, they discover that they’ve taken way too much.
- Potency: THC, the part of cannabis that gets you high, becomes more potent when it is metabolized by the liver, so it’s easy to get too high on lower doses.
- Long-lasting Effects: The effects of edibles can last up to 8 hours, and longer in rare cases. So if you do overdo it, you’re going to feel awful for a long, long time.
Interestingly, it is these exact same properties that can make edibles an ideal form of medicinal cannabis when taken properly.
Who should take edibles?
Really, anyone who would benefit from medicinal cannabis can take their cannabis as an edible. My patients who benefit the most are the ones who need consistent, long-lasting medication and the ones who benefit from the familiarity and ease of use of an edible product.
Edibles are exceptional for three groups of patients.
- Women with chronic conditions. Patients with pain, anxiety, nausea, or any other chronic cannabis-sensitive condition do best when we maintain consistent cannabis levels throughout the day and night.
- Women with sleep problems, particularly sleep maintenance issues where a patient may wake up in the middle of the night or early morning and have trouble falling back to sleep. For these patients, an edible at bedtime will keep cannabis levels in the blood at therapeutic levels throughout the night.
- Elderly or disabled patients who are already comfortable swallowing pills may prefer to just stick with capsules.
When I recommend edibles, I virtually always recommend capsules of full-spectrum hemp oil. I treat cannabis like all types of medicine — it should be precisely and consistently dosed. Capsules do this best. For microdosing THC, gummies that can be cut up into tiny doses are also useful.
For medicinal purposes, I recommend that patients avoid CBD coffee, candy, space cakes, and other cannabis-infused food products because it’s impossible to know exactly what you are taking.
So, how can you take cannabis edibles safely?
First off, you need to choose the right cannabis product. I recommend that virtually all of my patients start with a low dose of full-spectrum, high-CBD hemp oil in capsule form. Hemp is the type of cannabis that is extremely low in THC and is legal throughout the country. I strongly recommend full-spectrum over a CBD isolate (CBD-only) because a full-spectrum cannabis oil will be more effective at lower doses.
Next, time your doses. Remember, edibles take 30-90 minutes to kick in and then the effects can last up to 8 hours. So plan to take your first dose when you wake up, your second dose 6-8 hours later (mid-afternoon) and your final dose at bedtime. If you are having a bad symptom day and need to up your dosage, I highly recommend waiting for your current dose to kick in and then taking an additional dose of a sublingual (under the tongue) hemp oil, which takes effect in about 15 minutes. In this way, you can carefully compound your doses without risking an overdose.
Finally, take the right dose, which is the lowest dose that gives you adequate relief from your symptoms. In general, I start my patients on a full-spectrum product that contains 10mg of CBD. I will only introduce a small, microdose of THC for patients who are not getting adequate relief from full-spectrum, high-CBD hemp oil combined with supporting lifestyle and pharmaceutical therapies. And when THC is indicated, I generally recommend 1-3mg, taken as an edible about an hour before bedtime so that the patient sleeps through the likely minimal effects of the THC.
Yes, you can safely take cannabis edibles! Just make sure you take the right product, at the right dose, at the right time. When in doubt, start low and go slow. And wait 2 hours before you take more!
If you want help starting or fine-tuning your cannabis treatment plan or if you need help finding high-quality, reliable, full-spectrum hemp products, please make an appointment. I have been extensively researching the female endocannabinoid system and the best cannabis therapies. We are now carrying Endoca hemp and CBD products and I am excited to help you find the best cannabis therapy for your particular condition.
If you have questions about medical cannabis, let me know!
Monte AA, Shelton SK, Mills E, Saben J, Hopkinson A, Sonn B, et al. Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-2809
Barrus, Daniel G et al. “Tasty THC: Promises and Challenges of Cannabis Edibles.” Methods report (RTI Press) vol. 2016 (2016): 10.3768/rtipress.2016.op.0035.1611. doi:10.3768/rtipress.2016.op.0035.1611
Wiley, Jenny L et al. “Comparison of the discriminative stimulus and response rate effects of Δ9-tetrahydrocannabinol and synthetic cannabinoids in female and male rats.” Drug and alcohol dependence vol. 172 (2017): 51-59. doi:10.1016/j.drugalcdep.2016.11.035