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Pros and Cons of Medicinal Cannabis Edibles

Edible forms of medicine are not unknown in Australia. You may have seen them in your local pharmacy in the form of ‘gummy’ vitamins, chocolate squares of intestinal worming medicines or even echinacea lollipops. Interestingly, conventional medicine is beginning to look toward edible formulations.

Most recently a solid chocolate-based benzodiazepine medicine has been successfully trialled at Perth Children’s Hospital as a pre-anaesthetic for paediatric patients preparing for surgery. The trial was so successful they plan to extend this formulation to other medications including antibiotics(1).

Australia is still in its infancy in regard to medicinal cannabis, and the landscape is changing rapidly, however, there are currently no approved pharmaceutical grade medicinal cannabis edibles offered in Australia.

Internationally, various jurisdictions have allowed CBD infused drinks and edibles as either over-the-counter or off-the-shelf products in community supermarkets and THC infused products through dispensaries, however, these food products are poorly regulated in the USA. In 2015, researchers from the John Hopkins School of Medicine found that 60% of labels on edible products containing THC contained less than the amount listed on the label while 23% contained higher amounts of THC than listed on the label(2). This poses a problem for consumers seeking accurate, consistent, quality-controlled cannabis edible products for medicinal use.

Although non-prescription cannabis-based medicines remain illegal in Australia, an array of websites provide detailed instructions and recipes to create hempseed and cannabis infused edibles at home. Anecdotal reports indicate that families, in a bid to improve the taste and ease administration, carefully infused measured doses of cannabis-based medicines into ‘gummy’ jellies. It can be incredibly difficult to administer precise doses in edibles, however, in some conditions a titrated effect is desired and patients are advised, especially those new to medicinal cannabis, to consume a small amount of the edible and wait up to two hours to assess the effect before consuming another small amount of the edible. The onset of effects is usually 90 minutes, offering a longer and sustained effect peaking in 2-3 hours and lasting up to 6 – 8 hours. This would not be the best mode of administering medicinal cannabis if it was a condition requiring acute rapid relief.

The compounds within the cannabis-based medicine are digested in the stomach and metabolised through the liver (first-pass) with approximately 4-20% of the dose of THC and/or CBD being available 2-6 hours after consumption. Research pertaining to ingestion of cannabis based edibles is lacking, leading to uncertainty regarding absorption rates and bioavailability(3). Medicinal cannabis edibles need to be treated like any other medication, stored out of reach of children and animals, as well as ensuring the product remains in the original packaging to ensure it is not mistaken for a regular snack to avoid accidental ingestion.

References

Salman S, Tang EKY, Cheung LC, Nguyen MN, Sommerfield D, Slevin L, Lim LY, von Ungern Sternberg BS, 2018, A novel, palatable paediatric oral formulation of midazolam: pharmacokinetics, tolerability, efficacy and safety, Anaesthesia, Vol 73, No 12.

Vandrey R, Raber JC, Raber ME, Douglass B, Miller C, Bonn-Miller MO, 2015, Cannabinoid Dose and Label Accuracy in Edible Medical Cannabis Products, JAMA, Vol 313, No 24, p.p.2491-3.

Ko GD, Bober SL, Mindra S, Moreau JM, 2016,Medical cannabis—The Canadian . perspective. Journal of Pain Research, Vol 9, p.p. 735–744.

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