Marijuana Edibles: Everything You Need to Know
Florida’s medical marijuana community may soon have access to edible forms of cannabis. After more than three years of delays, a finalized version of the Medical Cannabis Edibles rules was posted to the Florida Administrative Code, with an effective administrative date of March 16, 2020. CannaMD has contacted Florida’s leading medical marijuana treatment centers (MMTCs), who say they’re now just waiting on the Department of Health to issue rules regarding packaging and other essential requirements.
Once edibles are available in Florida, a growing number of medical marijuana patients may consider these products an attractive alternative or complement to smoked or vaporized marijuana.
Why Do People Like Marijuana Edibles?
As both medical and recreational marijuana become legal in a growing number of states, so too does the popularity of edible forms of cannabis. Data from Colorado, which was among the first states to legalize marijuana, indicates that edible cannabis-infused products account for some 45% of all cannabis sales. (These figures do not include homemade edibles made from cannabinoid-infused oils, so the actual percentage of use may be higher!)
A nationally representative study of adult cannabis users reported that nearly 30% of all users had consumed cannabis in edible or beverage forms. Because these figures represent users who obtain marijuana products through both legal and non-legal sources, it is likely skewed towards combustable rather than edible products, as smoked marijuana is more easily obtained in areas where sales are not yet legal.
In Canada, where both smoked and edible forms of cannabis are legal on a national basis, a 2019 study indicated that over 25% of all users preferred edibles. It has also been shown that individuals using cannabis for medical purposes are more receptive to edible products, and that edibles are more popular with older adults.
For patients who are unable to receive inhaled cannabis medications due to conditions such as asthma and COPD, or who simply dislike the taste of burnt marijuana, edible forms of the product provide a viable alternative.
The generally perceived benefits of edible cannabis include:
- The ability to deliver measured dosages
- A longer duration of effects as compared to smoking or vaping
- No need for additional equipment such as vape pens or pipes
A 2016 peer-reviewed manuscript on the subject outlined several additional potential benefits of edible cannabis:
Anecdotal reports attribute increased interest in edibles to several perceptions shared by users: (1) edibles are a discreet and more convenient way to consume cannabis; (2) edibles offer a “high” that is calmer and more relaxing than smoking cannabis; and (3) edibles avoid the harmful toxins and health risks that come with smoking cannabis.
However, the authors also went on to note:
[S]cientific evaluation of the accuracy of these perceptions is incomplete.
More cautionary advice comes from a commentary published in the Canadian Medical Association Journal:
Although edibles are commonly viewed as a safer and more desirable alternative to smoked or vaped cannabis, physicians and the public should be aware of several risks related to the use of cannabis edibles.
Among the concerns noted in the commentary:
- Identification and regulation of dosages
- Safety of production and packaging
- Risks of over-consumption and accidental ingestion
- Risks from the consumption of illicit or homemade edibles
In light of these concerns, it’s worth taking a closer look at the characteristics of edible cannabis, and the potential pros and cons of these products as compared to smoked and vaporized marijuana.
How Does Your Body Process Edibles?
It is generally accepted that edible forms of cannabis take effect slower than smoked marijuana, and that these effects last longer. The reason for these differences lies in the way the body processes edible forms of cannabis. Smoked and vaped marijuana is absorbed directly into the bloodstream by way of lung alveoli, with effects taking place quickly and reaching peak concentrations within as little as 10 minutes.
By contrast, edible cannabis enters the bloodstream by way of the digestive tract and is metabolized by enzymes in the liver before entering the bloodstream. This is a slower process, which typically takes from 30 to 90 minutes for the initial psychoactive effect of edibles to be felt, with peak effects occurring within 2 to 4 hours after ingestion. In addition, a number of factors may influence the time of uptake and duration of an edible’s effect, including an individual’s weight, metabolism, gender, and eating habits.
Both smoked marijuana and edible forms of cannabis are processed by the liver, where enzymes convert Δ9-THC to a compound known as 11-hydroxytetrahydrocannabinol, or 11-OH-THC. This compound is a more potent psychoactive metabolite than THC, and it occurs in higher quantities within the blood when cannabis is eaten rather than smoked. This increase in the production of 11-OH-TH may account for the more pronounced and longer-lasting effects of edibles as compared to an equivalent dose of smoked marijuana.
Offsetting this increase, however, is evidence that the overall percentage of THC and other cannabinoids available to the body through edible consumption can be significantly lower than a form of an equivalent-strength product that is smoked or vaped.
How Does Marijuana Get in Your Bloodstream?
In some cases, the difference in absorption between smoked and edible ingestion of cannabis can be quite dramatic. In a study published in the journal Psychopharmacology, it was shown that when equivalent amounts of Δ9-THC were administered by smoking cannabis and ingesting edibles, smoking yielded peak plasma levels of Δ9-THC that were 5 to 6 times higher than from edible ingestion. This significant difference in rates of absorption are due in part to the metabolic process known as hepatic first pass, which occurs when orally administered drugs are metabolized by liver enzymes to the point where some or most of the active ingredient is absorbed by the liver, and does not reach the bloodstream.
Research on a synthetic form of Δ9-THC revealed that only 10 to 20% of orally-administered dosages reached the bloodstream. This phenomenon was attributed to extensive first-pass metabolism. Another study from 2019 reported that only 6 to 10% of the Δ9-THC present in an orally-administered product reached the bloodstream.
The bioavailability of edible cannabis is also influenced by the way the product was processed and prepared. When raw cannabis is subjected to heat, non-psychoactive cannabinoids such as THC-A and CBD-A are converted to THC and CBD through a process known as decarboxylation. When marijuana is smoked or vaped, the decarboxylation process occurs at the time of delivery when the product is heated or burnt. Decarboxylation of edible forms of cannabis requires baking or some other form of processing by heat. Variations and inconsistencies in this process can create significant differences in the levels of THC and other cannabinoids present in the final product. Such variation is more common in homemade edibles, but has also been reported in laboratory-prepared products.
Both anecdotal evidence and research indicate that the bioavailability of edible cannabis increases when it combined with fats and oils. A 2016 study compared equivalent dosages of THC and CBD administered in a lipid-free formula and a lipid long-chain triglyceride-based formula. Results showed that the absolute bioavailability of THC was 2.5 times greater with the lipid-based formula, and the bioavailability of CBD was 3 time higher. The study postulates that this effect was due to these cannabinoids’ ability to associate with the body’s natural chylomicrons and circulate through the intestinal lymphatic system, thereby avoiding hepatic first-pass metabolism.
Based on this research, the authors concluded that:
[C]o-administration of dietary lipids or pharmaceutical lipid excipients has the potential to substantially increase the exposure to orally administered cannabis and cannabis-based medicines. The increase in patient exposure to cannabinoids is of high clinical importance as it could affect the therapeutic effect, but also toxicity, of orally administered cannabis or cannabis-based medicines.
In simple terms, this means combining edible cannabis with a fatty meal, or adding it to a butter-rich cookie or chocolate could increase the absorption of THC, CBD, and other cannabinoids. This would have the effect of turning a barely effective product into a highly effective one, but could also increase the risk of elevating a stronger dose to a toxic level. And that is one of the reasons why identifying appropriate dosages remains one of the greater challenges of edibles.
Marijuana Edibles: Dosage
Determining appropriate dosages of edible cannabis is complicated not only by variations in individual reactions to a given product, as noted earlier, but also by variabilities in processing and labeling. A California study sampled some 75 commercially available edible products obtained from dispensaries in San Francisco, Los Angeles, and Seattle. These included baked goods, beverages, candies and chocolates with package labels that provided specific THC content.
The authors reported that:
Of the 75 products purchased, 17% were accurately labeled, 23% were under-labeled, and 60% were over-labeled with respect to THC content. Non-THC content was generally low. Forty-four products (59%) had detectable levels of CBD; only 13 had CBD content labeled. Four products were under-labeled and 9 were over-labeled for CBD. The median THC:CBD ratio of products with detectable CBD was 36:1, 7 had ratios of less than 10:1, and only 1 had a 1:1 ratio.
They went on to conclude:
Edible cannabis products from 3 major metropolitan areas, though unregulated, failed to meet basic label accuracy standards for pharmaceuticals. Greater than 50% of products evaluated had significantly less cannabinoid content than labeled, with some products containing negligible amounts of THC. Such products may not produce the desired medical benefit. Other products contained significantly more THC than labeled, placing patients at risk of experiencing adverse effects. Because medical cannabis is recommended for specific health conditions, regulation and quality assurance are needed.
Inaccuracy in labeling is dues to a number of factors, including the lack of standardization in formulation, variations in quality control occurring during the production process, and the manner in which the product is handled and stored. This variability, particularly in home-made and small-batch products, highlights the importance of obtaining edible cannabis from known and regulated sources.
Current best practices for the administration of edible forms of medical marijuana rely on the process known as titration. This process is described in an advisory for health care professionals published by the Canadian Government which advises that:
Patients with no prior experience with cannabis and initiating cannabis therapy for the first time are cautioned to begin at the very lowest dose and to stop therapy if unacceptable or undesirable side effects occur.
Consumers of [edibles] should a very minimum of 30 minutes, but preferably 3 hours, between bites of cannabis-based oral products (e.g. cookies, baked goods) to gauge for strength of effects or for possible overdosing.
Subsequent dose escalation should be done slowly, once experience with the subjective effects is fully appreciated, to effect or tolerability. If intolerable adverse effects appear without significant benefit, dosing should be tapered and stopped.
There are no universal standards for THC content in what is considered a single-dose serving of edible cannabis. The California Department of Public Health has stipulated that single-serving edibles products cannot exceed 10 milligrams of THC and packages of edibles could not exceed 100 milligrams of THC. Colorado, Washington, and Canada have set similar standards, but these limits can be deceiving to unaware consumers, as some products such as chocolate bars may represent multiple servings.
A report commissioned by the Colorado Department of Revenue based on clinical research findings suggests that 1mg of THC in an edible product creates similar effects to 5.7 mg of THC in smokable marijuana. Canada has also created general guidelines for both smoked and edible cannabis used for medical purposes. The most concise figures in these guidelines apply to pharmaceutical oils such as Marinol, with patients taking an average daily dose of 20 mg TCH, with a recommended daily maximum dose of 40 mg THC.
While edible marijuana is generally perceived to be a safe and effective way to provide medication, there are some concerns associated with its use. Chief among these is the possibility of overindulgence due to a lack of understanding of potency or the delay in effect as compared to smoked or vaped marijuana. Also of concern is the accidental ingestion of cannabis products by children who mistake these products for candy.
Following its state’s legalization of marijuana, Colorado has seen a significant increase in hospitalization for cannabis toxicity, with edible products being responsible for the majority of these incidents. These risks can be mitigated by a combination of consumer education, clear product labeling, and child-safe packaging methods.
General concerns for edible cannabis are summed up in a paper published by the independent research group, RIT International:
The need for additional regulation of edibles is evident given the frequency of cannabis overdoses and accidental pediatric exposures. Such risks can be reduced through standardization of product formulations, adequate quality control measures, and appropriate product labeling.
In summary, on the production side, much remains to be done to ensure that edibles provide a consistent dosage. On the labeling side, more should be done to ensure that consumers are better educated on how edibles affect the body and that they are aware of how to use edibles safely to avoid concerns such as unintentional “highs” or “highs” lasting longer than anticipated.
A lesser concern associated with edibles is product integrity, as the improper processing of cannabis extracts used in edible products can lead to contamination of clostridium botulinum and other toxins. Currently, edible cannabis products do not fall under FDA regulations, but various state agencies have set standards for production and handling. The Denver Department of Environmental Health noted potential consumer safety concerns for CBD products produced by unregulated facilities, and has published a notification which details safe production methods required for the commercial manufacturing of cannabis-infused products.
How to Get Your Medical Marijuana Card
Edible cannabis offers Florida’s medical marijuana community the potential for an expanded range of treatment options that will hold broad appeal for some patients. The keys to the success of such treatments will be consumer understanding of the proper use of edibles, informed communication with qualified medical professionals, and the obtaining of medication from known and trusted sources.
When edible cannabis becomes available in Florida, CannaMD is ready to provide patients with the proper certification and resources needed to obtain treatment. Our network of state-licensed, board-certified physicians is always available to answer your questions, provide advice, and streamline the process of qualification for medical marijuana.
To find out if you qualify for medical marijuana, simply complete our free online application or call (855) 420-9170!