Methods of Medicating

Smoking
Vaporizing
Oral
Apothecary

Smoking

“CANNABASICS”

Advantages

Smoking is the most common method of using cannabis (though vaporization is catching up). Cannabinoids, such as THC, in smoked cannabis reach the bloodstream within five seconds of inhalation. Peak blood levels of cannabinoids are achieved within five to ten minutes after smoking. The biggest advantages to smoking cannabis are the speed of effects and the ability to accurately gauge the dose.

Risks

Smoking cannabis can produce adverse lung effects. Chronic cannabis smoking can trigger bronchitis, lung and throat inflammation. However, there is no current, published evidence that cannabis smoking leads to emphysema or cancer.

Techniques

Cannabis cigarettes (joints or blunts) are not very efficient, since only about a third of the available cannabinoids is absorbed by this method. Experienced cannabis smokers tend to be twice as efficient as novices at extracting cannabinoids from cannabis cigarettes. Waterpipes (bongs) are more efficient than cigarettes, delivering over 50% of available cannabinoids. Because waterpipes deliver large volumes of smoke, the dose is difficult to gauge. Small glass pipes are the most efficient smoking method, as their small bowls encourage manageable doses. All glass pipes should regularly be cleaned of cannabis tar by scrubbing them with 90% rubbing alcohol and salt, then rinsing with water.

Effective Smoking Technique / Strategies

To properly smoke cannabis, you must both inhale and exhale normally. Studies have shown that breath holding beyond ten seconds does not increase cannabinoid absorption. Use the smallest dose of cannabis that produces medicinal effects. Wait at least ninety minutes between doses of smoked cannabis. When smoking, herbal cannabis flowers with higher cannabinoid content reduces exposure to irritating tars.

“CANNASIEUR”

There are over 1500 constituents in cannabis smoke, and some of these are known carcinogens.If you choose to smoke cannabis, try these harm reduction approaches. Only smoke medical cannabis that has been screened for the absence of pathogenic molds. Medical cannabis stored while wet can become moldy. Some of these molds, such as aspergillus, can be harmful, even fatal, if ingested. At Phytologie, all cannabis is screened for these molds.

Know the potency of your cannabis and control your dose. A UCLA study, “Effects of varying marijuana potency on deposition of tar and delta 9-THC in the lung during smoking” suggests that smoking cannabis with higher THC content reduces exposure to irritating tars, since less cannabis is smoked to deliver the effective dosage. Regardless, always use the smallest dose of medical cannabis that provides symptomatic relief. Use a pipe and avoid blunts. Cannabis cigarettes are inefficient and only deliver 10 to 27% of their THC content. THC collects in the butt of the joint, condensing up to 50 percent of its THC, making consistent dosage difficult. Blunt wraps contain highly addicting nicotine and tobacco byproducts, and should never be used for medical cannabis administration. Instead, use a clean glass pipe with enough cannabis for a single inhalation, as it reduces waste and enables more consistent and predictable dosage.

Bong pipes can deliver too much medicine and too much tar. Always use less cannabis when smoking a bong pipe, since bongs are designed to deliver smoke deep into the lungs, increasing the likelihood of over medication and coughing. Coughing is not a sign of effective dosage, only overdosage. While water used in bongs can reduce throatirritation caused by smoking, the water also removes more THC than it reduces the amount of inhaled tar. Water bongs are not that efficient, because THC tends to condense in the pipe’s water. If throat irritation is an issue, try using ice instead of water to cool the smoke.

Don’t hold your breath. Holding your breath to absorb more THC from smoked cannabis doesn’t work. THC quickly passes through the human lung into the bloodstream. Breath holding only coats your lungs with potentially irritating tars. Simply inhale deeply, and then exhale. Breath holding is a difficult habit to break, but you’ll expose yourself to fewer irritating tars.

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Vaporizing

“CANNABASICS”

Advantages

Cannabis vaporizers heat cannabis flowers or concentrates to a temperature at which cannabis active ingredients boil off, forming a vapor, below the temperature at which cannabis burns. When cannabis burns, over 1500 compounds are formed including toxic chemicals such as benzene and carbon monoxide. Vaporization does not produce these toxins. Vaporization delivers THC and other cannabinoids to the human bloodstream as rapidly as smoking.

Risks

Poorly flushed cannabis can contain high amounts of nitrogen fertilizer residues. These nitrogen residues can form ammonia when vaporized. We work closely with our providers to assure your cannabis is correctly flushed at the end of cultivation to remove these residues.

Systems and Techniques

The most extensively tested vaporizer is the Volcano, manufactured by Storz &Bickel in Germany. The Volcano works by blowing temperature-controlled hot air though a screened filling chamber containing finely ground cannabis. The resulting vapor is collected within an inflatable, detachable bag. The patient then inhales the vapor through a valve on the detached bag. There are other vaporizers available including handheld systems. High-quality vaporization requires precise temperature control. Tests indicate that efficient vaporization of cannabinoids from cannabis occurs at 200?C to 210?C in the Volcano.

E-Pens

E-pens are inexpensive portable vaporizers that are usually used to vaporize cannabis oils and waxes. Some e-pens can also be loaded with cannabis flowers or hashish. Cannabis waxes and oils can be very thick and easily clog e-pens. To avoid clogging, some e-pens are loaded with mixtures of cannabisoil and a carrier such as propylene glycol. While propylene glycol is considered safe as a food additive, the FDA has expressed concern that it might not be safe to inhale it. More study is needed to confirm its safety.

Effective Vaporization Techniques / Operation

Operating a vaporizer is straightforward: inhale, hold for three seconds, and then exhale. Coughing usually means the vaporizer temperature is set too high, or that the cannabinoids have been exhausted. It can take three or four inhalations from a vaporizer to exhaust the cannabinoids in a single load of herbal cannabis. Many patients mistakenly assume that all of the cannabinoids have vaporized, once the floral taste diminishes. Vaporized cannabinoids have very little taste, so some patience when vaporizing is warranted.

“CANNASEUR”

Phytologie believes that vaporizing cannabis is a safer approach than smoking. Vaporizers work by allowing hot air to flow through ground cannabis or cannabis extracts, below the temperature at which cannabis begins to burn. The hot air boils off these medicinally active ingredients, such as THC, allowing the resulting vapor to be inhaled and absorbed. Vaporizers allow medicinal cannabis to be inhaled and delivered to the bloodstream quickly, while eliminating exposure to the combustion products created by smoking cannabis.

Several studies and many patients indicate that vaporization is much more efficient that smoking. One study indicated that vaporization with a Volcano vaporizer delivered 56% of the available THC, while smoking has been shown to only deliver as little as 27%.

Studies have been conducted in Europe with the Volcano balloon vaporizer system. Various models of vaporizers vary in their performance from the Volcano, but the following information may help to optimize the use of other vaporizers. The optimal temperature for vaporizing THC from ground cannabis flowers in a Volcano is 210° C/410°F. THC begins to boil at 157° C/315° F, so this optimal temperature setting for the Volcano will achieve rapid and more complete THC vaporization from thecannabis. On the “classic” Volcano model, 210°C is reached by setting the device to 7.5. Higher temperatures than 210°C do not appear to increase the dosage of THC per balloon filling. Avoid setting the vaporizer temperature so high that the vapor begins to taste scorched like burnt popcorn. Properly vaporized medicinal cannabis should taste floral, because of the terpene content of the vapor.

After consulting your physician concerning dosage, start with a vaporizer load of 200 milligrams (about one teaspoon) of ground cannabis containing between 13 and 18% THC by dry weight. All Phytologie medicinal cannabis strains are assayed for their THC content. Ask your Phytologie counselor for the THC results of those assays, to help you and your physician adjust your dosage to meet your medical needs.

Some vaporizers use less cannabis per load than the Volcano and may be more efficient.

Don’t pack the cannabis too tightly into the vaporization chamber, since the goal is to allow the hot air to directly contact and flow around the ground cannabis.

In the European study, the Volcano vaporizer set to 210°C filled with 100 mg of 18% THC ground cannabis flowers, produced a dose of 8 mg THC in the first Volcano balloon, approximately 4 mg THC in the second balloon, with approximately 2 mg of THC in the residue.

Because each Volcano balloon can be filled to contain enough vapor for several inhalations, you can limit the size of each inhalation to achieve more careful and precise dosage, therefore avoiding the chance of overmedicating. Start with small inhalations of vapor and wait thirty minutes between each inhalation in order to confirm appropriate dosage. It is possible to maximize symptomatic relief and minimize unwanted psychoactive side effects, though careful vaporization dosage control.

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Eating and Drinking

“CANNABASICS”

Advantages

Cannabis has been used as an oral medicine for thousands of years. When properly dosed, cannabis is very effective both orally and beneath the tongue. When taken orally, THC is transformed by the liver into 11-hydroxy-THC, which feels different than smoked cannabis. It can take 45-180 minutes after eating cannabis for peak blood levels of THC to be reached. When taken beneath the tongue (sublingually), THC is absorbed directly into the bloodstream. Oral THC is effective for 2-3 times longer than smoked or vaporized cannabis.

Risks

Absorption of oral cannabis is slow and the rate of absorption varies widely among different patients. The effects can take over three hours to be felt in some patients. In the majority of patients, onset takes 30-90 minutes. Peak blood levels of THC can be reached in 75 minutes to 7 hours, which is why each patient needs to understand how they react individually to oral cannabis. The biggest risk when using oral herbal cannabis products is overmedication. Overmedication with oral cannabis can be an extremely unpleasant experience, especially given how long these effects can last. Cannabis dispensaries often carry oral cannabis products of known dose, but patients should be careful when using cannabis edibles with dosage guidance such as “10x”, when “x” is not defined.

Forms

Raw cannabis contains its cannabinoids in the form of acids. For acidic THC, heat is required to convert it to a form that is psychoactive. Once converted into a form that is psychoactive, THC can be incorporated into various products/forms.

Baked goods: The most common form of edible cannabis medicines are baked goods, such as cookies, cakes and brownies that have been infused with cannabis or cannabis extractions. Great care should be observed to take a manageable dose. Always start with a one-tenth portion of any edible to get a sense for its dosage.
Chocolate: Because of its fat content, chocolate is simple to infuse with cannabinoids and the dose can be well distributed through the chocolate.
Hard candies: Dissolved beneath the tongue, these candies can deliver a dose directly and quickly into the bloodstream.
Vegan, sugar-free, and gluten-free – There are many cannabis infused products that are intended for restricted diets. In the case of severe sensitivity to gluten, such as in celiac disease, great care must be observed to ensure inadvertent trace exposure to gluten.

“CANNASEUR”

Delta-9 THC vs. delta-11-OH-THC. Smoking delivers delta-9-THC, the psychoactive drug found in cannabis, to the brain within minutes. When eaten, the liver metabolizes delta-9-THC, before it reaches the bloodstream. When eaten, some delta-9-THC is destroyed by stomach acids and in liver metabolism, while the rest is converted into a potent THC metabolite: delta-11-hydroxy-THC, which exhibits different drug effects than delta-9-THC. This is why oral cannabis feels different than smoked cannabis.

Raw cannabis is not very psychoactive. Raw cannabis flowers and extracts contain most of their THC in the form of an acid: THCA. Heating cannabis converts THCA from its acidic form into its neutral form: THC. This process is called decarboxylation. Smoking, cooking or vaporizing heats cannabis to a temperature at which decarboxylation takes place. Overheating cannabis in the presence of air can convert THC into CBN, a much less potent drug, which is why cannabis should be stored in a cool place like wine is.

Overmedicating on oral cannabis is common. Use a small dose of oral cannabis. Ask your Phytologie counselor for tips on using oral delivery cannabis products. Overmedication can result in hallucinations and acute anxiety. One-gram of average medical cannabis flowers contain around 150mg of THCA, but the actual amount can range from 20mg to 300mg. Depending on how efficiently the THCA is decarboxylated, when used in edible form the actual dosage of available THC can vary widely. Choose an oral cannabis medicine with a known and consistent content of THC.

Oral cannabis effects take longer to be felt and last longer. It can take as long as four hours to feel the effects of oral cannabis. Always for wait for the effects to completely manifest before taking another dose.

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Apothecary

Topicals

Topical creams and rubs made from medical cannabis can be useful for treating skin irritation and inflammation. Both THC and CBD are effective when used topically.

Tincture

A tincture is a liquid extract of cannabis, typically made with grain alcohol (ethanol) or glycerin. Cannabinoids and terpenes produced by the cannabis plant are easily dissolved in ethanol, less so in glycerin. Tinctures should always be shaken well. Cannabis tinctures taken beneath the tongue are rapidly absorbed into the bloodstream and the effects are closer to smoked or vaporized cannabis than conventional cannabis edibles.

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