Cannabis Edibles

In June 2019, Cannabis Regulations were amended to include the production and sale of cannabis edibles, extracts and topicals. In consideration for the time required for producers to familiarize and comply with the new regulations, these products are proposed to be available no earlier than mid-December 2019. As one of the most accessible healthcare professionals, pharmacists can support patients by providing proper education on the safe use of cannabis products. 

Edibles v.s. Smoking Cannabis

Edibles are an alternative route of administration and are considered to be more economic, discreet and efficient compared to smoking, and for some, less harmful to the lungs.

  

Onset

Effect lasts

Intensity of effect

Edibles

30 minutes to 2 hours

Up to 12 hours, with residual effects that can last up to 24 hours

Stronger and more intense euphoric effect due to the higher TCH content

Smoking/vaping

Seconds to minutes

Up to 6 hours, with residual effects that can last up to 24 hours

Less intense compared to edibles

Dosage and Administration

Forms of edibles: 

 

Route of absorption

Onset

Effect lasts

Examples

Gastrointestinal uptake

Stomach

Up to 2 hours

Up to 8 hours

brownies, cookies, chocolate bars 

Oral uptake

Saliva

Almost immediately

2 to 3 hours

lollipop, gum, tincture

Hybrids

Stomach and saliva

Almost immediately

Up to 8 hours

Elixir, soda, energy shots

Overdose Prevention

New users of edibles should take a “Start Low- Go Slow” approach, with the recommended dose for cannabis-native patients around 2.5mg of THC or less to minimize side effects. The “ideal” amount differs from person to person.

Regulations of Edibles Compared to Other Routes of Administration (Link to the federal guidelines on cannabis edibles):

  • Edibles have lower THC content - the main psychoactive component of cannabis - with a limit of 10mg per package compared to other routes of administration which contain 1000 mg per package
  • Packaging is similar across all routes of administration, which should be plain and child-resistant 
  • Labeling is similar across all routes of administration and must include: cannabis symbols for products containing THC, a health warning message, allergens, ingredient list, equivalency to dried cannabis to determine public possession limit and THC/CBD content.
  • Edibles require an additional nutrition facts table, while other routes of administration require a section on intended use. 
  • According to Health Canada, cannabis edibles, extracts and topicals may not contain alcohol (except for ingested extracts), nicotine or added vitamins and minerals (except for topicals)
  • According to Health Canada, there is not enough data on the therapeutic effects of orally administered cannabis products or topicals.7 No cannabis edible products, extracts or topicals are allowed to make any health, dietary or cosmetic claims.

Precautions

Edibles contain cannabis and similar precautions should be taken as for inhaling or ingesting (see previous post on general cannabis use).  In general, cannabis is not recommended for:

  • Age < 25 (legally accessible to persons ≥ 19 years of age)
  • Pregnancy or breastfeeding
  • Known hypersensitivity to cannabis, THC, CBD or any other cannabinoid
  • Psychiatric disorders or substance abuse (past or current)
  • Cardiovascular diseases such as hypertension or arrhythmias
  • Severe liver or renal disease
  • Respiratory illnesses (if inhaling)

Potential Drug Interactions 

In general, cannabis products have the potential to interact with antidepressants, antibiotics, antifungals, blood pressure and HIV medications and should be avoided with alcohol and other sedating drugs as they can increase impairment and adverse effects such as drowsiness. No studies have yet specifically investigated how drug interactions with cannabis edibles can differ from other forms of cannabis products.

Potential Side Effects 

Similar to inhaled cannabis, side effects can occur with edibles.  Some side effects include:

  • Impaired short-term memory and judgement
  • Neurological effects (e.g., drowsiness, motor co-ordination) which can impede the ability to drive
  • Irritation of mucosa or skin depending on the route of administration
  • Cardiovascular effects such as increased heart rate
  • Anxiety, acute panic reactions, paranoia, and/or hallucinations
  • Increased risk of dependence, withdrawal symptoms
  • Exacerbation of psychiatric disorders, such as anxiety and depression, especially with the use of cannabis products with a high THC content
  • For youth and younger adults (individuals under 25 years of age), cannabis, predominantly due to THC, can be more harmful especially during this period of brain development3
  • Elderly can have an increased susceptibility to the CNS effects of cannabis.

Pregnancy and Lactation

Since cannabis edibles contain cannabinoids, such as THC, they can affect pregnancy and lactation. Cannabinoids cross the placenta so using cannabis products while pregnant may possibly lead to elevated risk of premature birth, low birth weight, and developmental problems in the newborn.9 Until more is known about the effects of cannabis edibles on pregnancy, it is advisable to avoid regular or even occasional use.  Cannabinoids can also be present in breast milk and may pose potential risks to the nursing baby, so consumption of cannabis edibles should also be avoided during breastfeeding.

Conclusion

For cannabis products, different routes and forms of intake can lead to different effects. Specifically, edibles can have a slower onset and longer duration of action compared to smoking/vaping. Therefore, a “Start Low – Go Slow” approach is highly recommended, especially for cannabis-naïve patients. Pharmacists should advise consumers of the potential risks associated with cannabis, and a similar level of precaution should be taken with every type of cannabis product.

 

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