The Endocannabinoid System
The human endocannabinoid system consists of an extensive network of cannabinoid receptors (most notably the CB1 and CB2 receptors) found in the brain and throughout the body’s central nervous system, immune system, endocrine system and much more. Additionally, the body also produces its own endocannabinoids (over 120 known endocannabinoids), of which Anandamide and 2-Arachidonoylglycerol (2-AG) are best known, and which are structurally similar to THC and CBD.
The endocannabinoid system is responsible for regulating many of the body’s natural functions including:
- Appetite
- Inflammation
- Mood
- Pain
- Sleep
- Stress
- Weight
While currently ongoing, there is still much research to be done to fully understand the endocannabinoid system and its role in maintaining homeostasis within the human body.
Cannabis Medicine Applications
Research regarding the potential therapeutic applications of cannabis medicine has expanded exponentially in recent years due to an easing of legal restrictions and other barriers to research worldwide.
Studies have indicated a variety of therapeutic treatment potentials to help manage patient symptoms and conditions such as:
- Acute Pain
- Amyotrophic Lateral Sclerosis (ALS)
- Anxiety
- Arthritis
- Attention Deficit Hyperactivity Disorder (ADHD)
- Autism Spectrum Disorder (ASD)
- Autoimmune Disorder
- Bipolar Disorder
- Cachexia / Poor Appetite
- Cancer Related Pain
- Chronic Fatigue
- Chronic Pain
- Crohn’s Disease
- Depression
- Endometriosis
- Epilepsy
- Fibromyalgia
- Headache / Migraines
- HIV / AIDS
- Inflammatory Bowel Disease (IBD)
- Irritable Bowel Syndrome (IBS)
- Inflammation
- Insomnia / Sleep Disorders
- Menstrual Pain/Cramping
- Mood Disorders
- Multiple Sclerosis (MS)
- Muscle Spasticity
- Nausea and Vomiting
- Neuropathic Pain / Nerve Damage
- Palliative Care
- Parkinson’s Disease
- Polycystic Ovary Syndrome (PCOS)
- Post Traumatic Stress Disorder (PTSD)
- Seizure Disorders
- Spinal Injuries
- Stress
Experienced Effects
Each individual may react somewhat differently to cannabis medicine. Effects experienced from products containing THC may include:
- Decreased Blood Pressure
- Drowsiness
- Euphoria
- Heightened Sensory Experiences
- Increased Appetite
- Increased Heart Rate
- Relaxation
Potential Side Effects
Cannabis products can cause side effects in some patients. While there are no known instances of overconsumption being fatal, an excessive dosage of THC can potentially result in mild to moderate side effects including:
- Anxiety
- Chest Pain
- Confusion
- Dizziness
- Drowsiness
- Dry mouth
- Fatigue
- Fainting
- Headache
- Impaired Short-Term Memory
- Nausea / Vomiting
- Overwhelming Euphoria
- Paranoia
- Psychotic Episode (in individuals with a predisposition).
- Rapid Heartbeat (Tachycardia)
- Shallow Breathing
- Time-Distortion
If side effects are experienced, patients can often manage this by adjusting dosage, and if needed, altering method(s) of consumption and/or the type of cannabis medicine being used. In order to maximize therapeutic benefits and minimize potential side effects, patients should gradually adjust their dosage beginning with a very low dose until optimal effects are achieved.
Patients are reminded to ‘start low, and go slow.’
Cannabis And Other Medications
Cannabis can interact with a number of other drugs and herbal wellness products. Patients should use caution when using cannabis along with medications such as:
- Allergy Medications
- Amiodarone
- Antibiotics
- Antidepressants
- Antifungals
- Antimycotics
- Antiretroviral Drugs
- Calcium Antagonists
- Cimetidine
- Cold Medications
- Heart Medication
- HIV Protease Inhibitors
- Isoniazid
- Macrolides
- Narcotic Pain Medications
- Proton pump Inhibitors
- Sedative-Hypnotics
- Seizure Medications
- Sleeping Aids
- Stomach Acid Inhibitors
Pharmaceutical Cannabis Products
Extracts & Synthetics
- Full Spectrum Cannabis Extract
- THC Distillate
- CBD Isolate
- Synthetic Cannabinoids – Nabilone (Cesamet)
Derviative Products
- Infused Edible Oils / Gel Capsules
- Tinctures
- Sublingual Spray / Patch
- Topical Creams
- Transdermal Patches
Methods Of Administration
Advancements in technology have changed how cannabis medicine is consumed with the dual aims of harm reduction and maximizing bio-availability and absorption to minimize effective dosage requirements.
Cannabis medicine can now be consumed using a variety of different delivery methods. The onset time and duration of a cannabis product can be strongly influenced by the intake method(s) recommended for a patient’s treatment.
Inhalation
Inhaling cannabis vapour is the fastest method by which a patient can experience the onset of effects and symptom relief.
Vaporization – Achieved by using a device designed to only heat cannabis flower/extracts enough to release the cannabinoids and terpenes as vapour without causing combustion. The resulting vapour is inhaled and absorbed immediately by the lungs.
- Onset of Effects – Typically 10 seconds to 1 minute.
- Duration of Effects – Typically 4-6 hours.
- Ideal for breakthrough symptom relief.
*NOTE: Currently, Government of India regulations prohibit the sale of electronic nicotine delivery systems. This prohibition directly impacts patient access to therapeutic vaporizer devices used for the delivery of cannabis medicine. Therefore, physicians at this time are advised to focus on alternative delivery pathways such as ingestible medical cannabis products.
Smoking – Unfortunately combustion is still globally the most common intake method used by cannabis consumers due to simplicity and limited access to more sophisticated methods of delivery. The inhalation of toxic compounds during smoking can pose serious health risks due to the release of tar, ammonia, carbon monoxide and other chemicals. Smoking should never be recommended as a delivery method for cannabis medicine patients.
Ingestion
Ingested cannabis is metabolized by the liver resulting in a slower onset time and longer duration of effects than inhalation. As the liver breaks down THC, it changes into 11-hydroxy THC, resulting in a substantially higher absorbed concentration of 11-hydroxy THC than when consumed via inhalation.
Infused Oils/Capsules – Created by decarboxylating or ‘activating’ cannabis and infusing it with a fatty- oil/fatty-acid to increase bio-availability.
- Onset of Effects – Typically 60-90 minutes. Up to 2 hours.
- Duration of Effects – Typically 6-10 hours. Peak effects 2-3 hours following consumption.
- Ideal for preventative treatment or symptoms that persist throughout the day/night.
Nano-Emulsion Formulations – Newly developed as a method to reduce effect onset time (approx. 15min) and reduce effect duration (approx. 4hr).
Cooking with Infused Cannabis Oils/Ghee – While it is possible to use infused cannabis in everyday cooking to receive your daily dosage, it is not recommended for several reasons:
- Difficult to achieve and maintain accurate dosing.
- Degradation/Destruction of cannabinoids and terpenes when heated beyond initial decarboxylation.
- Substantially increased chances of accidentally exposing a family member, child, or others to medication not meant for them.
Consumers need to be aware of the need for added caution when ingesting cannabis products as one can more easily ingest a dose that is larger than desired than when consuming via inhalation.
It is also important to note that infused cannabis oils are not suitable for vaporization.
Sublingual / Buccal
Sublingual and buccal administration are two methods of absorbing cannabis products via the mouth and directly into the bloodstream. These methods of delivery allow cannabinoids and terpenes to avoid the digestive system which can decrease overall effectiveness. Typically found in the form of an oral spray or strip/film, these products are applied directly under the tongue or between the gums and cheek.
*NOTE: With the exception of product formulations utilizing nano-emulsion technology (not yet available in most jurisdictions), traditional formulations of infused cannabis oil are best consumed via ingestion, rather than sublingual absorption.
Topical / Transdermal
Topical cannabis products are created by infusing activated cannabis extracts with creams and other excipients that are easily absorbed through the skin. These products are considered non-psychoactive and are typically prescribed for localized pain management and inflammation.
The human endocannabinoid system consists of an extensive network of cannabinoid receptors (most notably the CB1 and CB2 receptors) found in the brain and throughout the body’s central nervous system, immune system, endocrine system and much more. Additionally, the body also produces its own endocannabinoids (over 120 known endocannabinoids), of which Anandamide and 2-Arachidonoylglycerol (2-AG) are best known, and which are structurally similar to THC and CBD.
The endocannabinoid system is responsible for regulating many of the body’s natural functions including:
- Appetite
- Inflammation
- Mood
- Pain
- Sleep
- Stress
- Weight
While currently ongoing, there is still much research to be done to fully understand the endocannabinoid system and its role in maintaining homeostasis within the human body.
Research regarding the potential therapeutic applications of cannabis medicine has expanded exponentially in recent years due to an easing of legal restrictions and other barriers to research worldwide.
Studies have indicated a variety of therapeutic treatment potentials to help manage patient symptoms and conditions such as:
- Acute Pain
- Amyotrophic Lateral Sclerosis (ALS)
- Anxiety
- Arthritis
- Attention Deficit Hyperactivity Disorder (ADHD)
- Autism Spectrum Disorder (ASD)
- Autoimmune Disorder
- Bipolar Disorder
- Cachexia / Poor Appetite
- Cancer Related Pain
- Chronic Fatigue
- Chronic Pain
- Crohn’s Disease
- Depression
- Endometriosis
- Epilepsy
- Fibromyalgia
- Headache / Migraines
- HIV / AIDS
- Inflammatory Bowel Disease (IBD)
- Irritable Bowel Syndrome (IBS)
- Inflammation
- Insomnia / Sleep Disorders
- Menstrual Pain/Cramping
- Mood Disorders
- Multiple Sclerosis (MS)
- Muscle Spasticity
- Nausea and Vomiting
- Neuropathic Pain / Nerve Damage
- Palliative Care
- Parkinson’s Disease
- Polycystic Ovary Syndrome (PCOS)
- Post Traumatic Stress Disorder (PTSD)
- Seizure Disorders
- Spinal Injuries
- Stress
Each individual may react somewhat differently to cannabis medicine. Effects experienced from products containing THC may include:
- Decreased Blood Pressure
- Drowsiness
- Euphoria
- Heightened Sensory Experiences
- Increased Appetite
- Increased Heart Rate
- Relaxation
Cannabis products can cause side effects in some patients. While there are no known instances of overconsumption being fatal, an excessive dosage of THC can potentially result in mild to moderate side effects including:
- Anxiety
- Chest Pain
- Confusion
- Dizziness
- Drowsiness
- Dry mouth
- Fatigue
- Fainting
- Headache
- Impaired Short-Term Memory
- Nausea / Vomiting
- Overwhelming Euphoria
- Paranoia
- Psychotic Episode (in individuals with a predisposition).
- Rapid Heartbeat (Tachycardia)
- Shallow Breathing
- Time-Distortion
If side effects are experienced, patients can often manage this by adjusting dosage, and if needed, altering method(s) of consumption and/or the type of cannabis medicine being used. In order to maximize therapeutic benefits and minimize potential side effects, patients should gradually adjust their dosage beginning with a very low dose until optimal effects are achieved.
Patients are reminded to ‘start low, and go slow.’
Cannabis can interact with a number of other drugs and herbal wellness products. Patients should use caution when using cannabis along with medications such as:
- Allergy Medications
- Amiodarone
- Antibiotics
- Antidepressants
- Antifungals
- Antimycotics
- Antiretroviral Drugs
- Calcium Antagonists
- Cimetidine
- Cold Medications
- Heart Medication
- HIV Protease Inhibitors
- Isoniazid
- Macrolides
- Narcotic Pain Medications
- Proton pump Inhibitors
- Sedative-Hypnotics
- Seizure Medications
- Sleeping Aids
- Stomach Acid Inhibitors
EXTRACTS & SYNTHETICS
- Full Spectrum Cannabis Extract
- THC Distillate
- CBD Isolate
- Synthetic Cannabinoids – Nabilone (Cesamet)
DERIVATIVE PRODUCTS
- Infused Edible Oils / Gel Capsules
- Tinctures
- Sublingual Spray / Patch
- Topical Creams
- Transdermal Patches
Advancements in technology have changed how cannabis medicine is consumed with the dual aims of harm reduction and maximizing bio-availability and absorption to minimize effective dosage requirements.
Cannabis medicine can now be consumed using a variety of different delivery methods. The onset time and duration of a cannabis product can be strongly influenced by the intake method(s) recommended for a patient’s treatment.
INHALATION
Inhaling cannabis vapour is the fastest method by which a patient can experience the onset of effects and symptom relief.
Vaporization – Achieved by using a device designed to only heat cannabis flower/extracts enough to release the cannabinoids and terpenes as vapour without causing combustion. The resulting vapour is inhaled and absorbed immediately by the lungs.
- Onset of Effects – Typically 10 seconds to 1 minute.
- Duration of Effects – Typically 4-6 hours.
- Ideal for breakthrough symptom relief.
*NOTE: Currently, Government of India regulations prohibit the sale of electronic nicotine delivery systems. This prohibition directly impacts patient access to therapeutic vaporizer devices used for the delivery of cannabis medicine. Therefore, physicians at this time are advised to focus on alternative delivery pathways such as ingestible medical cannabis products.
Smoking – Unfortunately combustion is still globally the most common intake method used by cannabis consumers due to simplicity and limited access to more sophisticated methods of delivery. The inhalation of toxic compounds during smoking can pose serious health risks due to the release of tar, ammonia, carbon monoxide and other chemicals. Smoking should never be recommended as a delivery method for cannabis medicine patients.
INGESTION
Ingested cannabis is metabolized by the liver resulting in a slower onset time and longer duration of effects than inhalation. As the liver breaks down THC, it changes into 11-hydroxy THC, resulting in a substantially higher absorbed concentration of 11-hydroxy THC than when consumed via inhalation.
Infused Oils/Capsules – Created by decarboxylating or ‘activating’ cannabis and infusing it with a fatty- oil/fatty-acid to increase bio-availability.
- Onset of Effects – Typically 60-90 minutes. Up to 2 hours.
- Duration of Effects – Typically 6-10 hours. Peak effects 2-3 hours following consumption.
- Ideal for preventative treatment or symptoms that persist throughout the day/night.
Nano-Emulsion Formulations – Newly developed as a method to reduce effect onset time (approx. 15min) and reduce effect duration (approx. 4hr).
Cooking with Infused Cannabis Oils/Ghee – While it is possible to use infused cannabis in everyday cooking to receive your daily dosage, it is not recommended for several reasons:
- Difficult to achieve and maintain accurate dosing.
- Degradation/Destruction of cannabinoids and terpenes when heated beyond initial decarboxylation.
- Substantially increased chances of accidentally exposing a family member, child, or others to medication not meant for them.
Consumers need to be aware of the need for added caution when ingesting cannabis products as one can more easily ingest a dose that is larger than desired than when consuming via inhalation.
It is also important to note that infused cannabis oils are not suitable for vaporization.
SUBLINGUAL / BUCCAL
Sublingual and buccal administration are two methods of absorbing cannabis products via the mouth and directly into the bloodstream. These methods of delivery allow cannabinoids and terpenes to avoid the digestive system which can decrease overall effectiveness. Typically found in the form of an oral spray or strip/film, these products are applied directly under the tongue or between the gums and cheek.
*NOTE: With the exception of product formulations utilizing nano-emulsion technology (not yet available in most jurisdictions), traditional formulations of infused cannabis oil are best consumed via ingestion, rather than sublingual absorption.
TOPICAL / TRANSDERMAL
Topical cannabis products are created by infusing activated cannabis extracts with creams and other excipients that are easily absorbed through the skin. These products are considered non-psychoactive and are typically prescribed for localized pain management and inflammation.
