Beyond the Smoke: All About Edibles

The legalization of cannabis across the nation has come with the introduction of edible cannabis products far beyond medical and recreational dispensaries. Now, sectors of the food industry are becoming hubs for serving up cannabis-infused delights. An edible is broadly defined as a food or drink product that’s made with cannabis. It may take the form of a pill, gummy, or prepared food product. Consumers flock to edibles for their versatility, ease of use, and longer-lasting effects. And while the selection of edible products available in medical and recreational dispensaries remains small due to strict regulations, many people are beginning to experiment with making their own edible products at home.1 Not only can this help to save the patients money, especially if they grow their own cannabis, but it can also open a world of culinary cannabis cooking techniques that many people enjoy.

In 2014, 1.96 million units of edible medicinal cannabis-infused products were sold in Colorado alone, accounting for 45% of total cannabis sales.2 This figure does not account for edible products made in consumers’ homes.

Unfortunately, homemade edibles made with THC come with their fair share of uncertainty, as lab-tested measures are often impossible to obtain, leaving room for uncertainty in dosing. This can potentially lead to overconsumption, which can be uncomfortable for the patient. Another growing concern for cannabis edibles is accidental pediatric exposure, which has occurred in some situations.2 However, this doesn’t stop consumers from choosing edibles as an alternative to smoking and an overall enjoyable way to medicate. By having a solid understanding of the mechanisms of edibles, providers can better guide their patients into safe, comfortable situations that allow them to enjoy the benefits of cannabis orally.

What Are Edibles Used For?
There are many ways to infuse cannabis into food, from adding it directly to the food to preparing fat-based infusions or alcohol-based tinctures. While it’s most common for edibles to be made with the cannabinoid THC, more and more food and drinks are made with other cannabinoids such as CBD and CBG.

Eating cannabis comes with its fair share of benefits, from nutrition and medicine to taste and experience. Nutritionally speaking, raw cannabis can introduce phytochemicals such as flavonoids and terpenes and may contain prebiotic and probiotic properties that improve the composition of the gut microbiome.1 Aside from the nutritional benefits, consumers ingest edibles both recreationally to feel high and medicinally to alleviate any unwanted and unpleasant symptoms associated with acute and chronic conditions. Among the most common reasons consumers choose cannabis edibles are to provide relief of pain and anxiety, to manage nausea and vomiting, for cancer treatment, to help manage side effects associated with cancer-related treatments, to stimulate appetite, and to treat epilepsy.2 Unfortunately, well-controlled clinical studies on the therapeutic effectiveness of cannabis edibles are limited, with most reports being anecdotal in nature.

Another benefit both consumers and clinicians can agree on is that consuming edibles does not come with the potential health consequences associated with smoking, the most common form of consumption.2 Consumers report using edibles both medically and recreationally because of their discreteness, convenience, lack of smoke, and longer-lasting experience.3 These long-lasting experiences are preferred by those patients who use cannabis to treat chronic pain as they experience longer-lasting relief. A study of daily recreational cannabis smokers published in Neuropsychopharmacology similarly demonstrated that oral Δ9-THC resulted in a longer duration of pain relief than the relatively transient effect produced by smoked cannabis.4

Homemade vs Store-Bought Edible Products
There are a growing number of medical and recreational patients who choose to make their own cannabis edibles at home. The benefits of making homemade edibles range from cost savings for the patient to expanded product options that can be freely created in a home kitchen. Homemade edible products can be made from homegrown cannabis, a flower purchased from a dispensary, or premade products such as oils that are readily available in many dispensaries. For consumers who want to make their own cannabis edibles at home, there are a few important steps in the process. If consumers start with a dried cannabis flower, either homegrown or from a dispensary, they must first decarboxylate the product. While that sounds intimidating to beginners, the process is as simple as placing the cannabis in a mason jar and baking it in the oven for a selected amount of time. This process uses heat to convert the nonintoxicating THCA to the intoxicating THC, or CBDA to CBD, or CBGA to CBG, respectively. Because each cannabinoid decarboxylates at a unique temperature, the recommendations for this process can vary.5

The most common recommendation for a THC-dominant flower is to bake it in the oven for 40 minutes at 240° F to convert the maximum amount of THCA into THC. Once the process is complete, this decarboxylated plant material can be ground and added directly to food like any other herb or spice. Consumers can then take the process one step further and diffuse the cannabis flower into a fat or an oil preparation or extract the trichomes with grain alcohol. The fat preparation or alcohol preparation can then be used directly in a recipe, such as cookies or brownies, or to make full-extract cannabis oil. Each process should be chosen based on the consumer’s taste and texture preferences and dosing requirements.

Potential Drawbacks
While homemade edibles offer more flexibility for patients, the main drawback compared with store-bought edibles is the inability to obtain accurate or consistent dosing. Without lab testing, it’s nearly impossible to estimate the final potency of a homemade product, making it difficult for patients to accurately dose their medication without some experimentation. For experienced cannabis edible consumers, this may not be an issue. However, for consumers who are new to edibles, it may be best to advise them to start with store-bought products labeled with proper dosages so they can discover what their perfect dose is for their own personal tolerance level before venturing into the world of homemade options.

Anecdotally, consumers report that they do not believe edibles present any negative health consequences. But there are drawbacks to consider. As expressed by consumers, these include delayed effects, unexpected and unpredictable highs, and the inconsistency of the distribution of THC in the product.3 The intoxicating experience associated with orally consumed THC can be different for many people than it is when THC is consumed through smoking or vaping. This is because, when eaten and digested, the cannabinoid Δ9-THC undergoes a chemical transformation into a stronger metabolite known as 11-OH-THC, which readily crosses the blood-brain barrier.2 This metabolite is more potent and may be responsible for the strong feelings of intoxication associated with edibles. While there are no documented cases of fatality, with THC overconsumption, patients can experience very unpleasant and uncomfortable experiences ranging from motor impairment, extreme sedation, agitation, anxiety, cardiac stress, and vomiting—experiences that can be very upsetting to the consumer and may impact their future treatment. These experiences likely contribute to the rise in emergency department visits in states where medical and recreational cannabis use is legal.6

What Providers Need to Know
With variations in edible experiences from patient to patient, it is important for clinicians to know how to educate their patients and how to guide them in a way that benefits their health and well-being. For many patients, edibles require a great amount of time and patience to find their ideal dose, and it is important that they know this ahead of time, as this process may often lead to frustration. There are no standard dosing recommendations, leaving most clinicians to recommend the golden rule of “starting low and going slow.” This rule means it is recommended to start with a very small dose, no more than 5 mg to 10 mg of THC, to start. Then gradually titrate the dosage up as needed until the patient feels the desired relief. This titration is easier to do with edibles purchased from a dispensary, as they are labeled with proper dosages. If a patient is working with homemade edibles, “starting low and going slow” is still helpful advice, regardless of whether or not the patient knows a guestimate dose. Keep in mind that cannabis edibles do not affect each person the same way. One individual may feel relief with 10 mg of THC, while another may not feel relief until they reach a dose of 50 mg or more. In addition, some individuals may never feel the effects of edibles at all, requiring them to return to alternative administration routes. Treating the patient as an individual and working with their own unique circumstances, medical conditions, and preferences can greatly improve patient outcomes. As a clinician, providing edible education to patients can help guide them toward the path of a safe and enjoyable edible experience.

— Emily Kyle, MS, RDN, CDN, CLT, HCP, is a certified holistic cannabis practitioner.

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