The Latest from Meredith Patterson, The Cannabis Nurse

Rules of Consumption: Take with Food

As a nurse who also teaches, I spend a lot of my time talking about medications and how to take them – as pills or capsules, crushed into applesauce or mixed into syrup for easier swallowing, sometimes as droplets sprinkled under the tongue.  Medicine – and the regime of taking daily medicine – is at the front of the mind for many people when asked about their health.  “What meds are you on?” is part of every patient interview.  My personal translation of that question is “what do you put into your mouth when you start your day”?

Medication administration has its own code of rules.  Some meds don’t mix well with others.  Some have to be taken with other drugs to augment the desired effect or to offset a side- effect.  When a nurse prepares medication for administration, she “pours them up” into tiny paper cups (charmingly called soufflé cups) and proffers them to her patients along with a glass of water.  In a healthcare facility, this is called a “med pass.”

The busiest med pass at any facility is in the morning, right after breakfast.  This is because medications are commonly prescribed once a day and morning is generally convenient.  The other reason is that many medications, unless instructed otherwise, are best taken with food because it makes the medicine work better – and without the side effect of an upset stomach.

Oral cannabis medications – be it a gummy candy, tincture, or oral spray – follow the same rule.  Look on any cannabis consumer website and you’re given fair warning.  Do not take on an empty stomach or be prepared for possible unpleasant side effects like a racing heart, feeling of paranoia, or nausea.    The experience may be intense but in a bad way (especially if THC is involved).

To top it off, if you’re using cannabis for strictly medicinal purposes and are more interested in non-psychoactive results from a compound like CBD, the desired absorption of cannabinoids is worse if you take it without eating first.

 Surprised?  To understand how all this works, grab a snack and let’s talk about organs and intestines, large and small.

Down the Hatch:  How Medicine (and Cannabinoids) are Absorbed

To understand the absorption of cannabinoids from cannabis edibles, we first must understand a few basic concepts of drug absorption and the effect of food.

 While your stomach is certainly teeming with digestive activity, you may be interested to find out that virtually nothing (except alcohol) is absorbed there. Your small intestine, the next stop, is the site of virtually all absorption, be it from a food, supplement or a prescription drug. Think of your stomach as a sort of holding tank that partially digests whatever you’ve consumed and then releases it into the small intestine at a steady rate.

I should mention that the liver is also involved as it is your body’s processor/filter and it’s where the absorbed compounds are metabolized. For example, THC is metabolized in the liver and transforms into a compound called 11-hydroxy-THC. This compound is stronger than THC, keeps its potency for a longer time and can be very sedating. This mechanism in the liver is responsible for why edibles have such variation in effect from one person to another. But that’s a story for another day.

When you eat a meal and then consume a drug, the result a slowing of this gastric emptying so that the passage to the small intestine is more limited.  In other words, a full stomach avoids dumping a substance too quickly into your system and circumventing effective absorption.

Oil and Water Don’t Mix – Drugs, Cannabis and Solubility

For a drug to work when taken orally, it must be able to have some form of solubility which means that it happily mixes with a fluid solution.   Think of grains of salt being mixed into water.  A low -solubility drug will typically take a longer time to be absorbed. Some cannabinoids, including THC, have very low solubility in water since they prefer dissolving into lipids or fats.  But when the cannabis consumer eats a meal, the food causes the gallbladder to release bile acids, which help to solubilize lipid-loving molecules like THC. This generally increases the rate and extent of absorption.

Time Factors – Slower but Longer-Lasting Effects

Consuming cannabis-infused edibles means the effects take a longer time to take place and the potency of effects gradually increases. The effects may be noticed at 45 minutes or can take up to 3 hours for full onset. Duration can last between 4 and 6 hours.

Looking at Research

A European study published in 2013 tested the effect of food on absorption of an oral cannabis spray called Sativex which is an extract containing a 1:1 ratio of THC and CBD. Although it’s in spray form, most of it ends up getting swallowed so the test results should translate to other cannabis edibles.

In this study, subjects were divided into two groups:  a fasting group who had no food for 10 hours before or 4 hours after dosing and a “fed” group who ate a high-fat meal within 30 minutes of dosing. Subjects were each administered 4 sprays.

The results? THC and CBD were rapidly absorbed in the fasted condition, reaching their peak plasma concentrations at 1.5 hours. For participants who had eaten a meal, these cannabinoids took much longer to absorb, with peak plasma concentrations not occurring until 4 hours after dosing.

But the more interesting part of this study unfolded when researchers looked at bioavailability (a measurement of the extent of absorption) of the cannabinoids.  Subjects who ate a meal before dosing had significantly more cannabinoids absorbed – 2.8-fold higher for THC and 4.1-fold higher for CBD – compared to the fasting group subjects.

Some Take-Aways Before You Order Take-Out

Eat before you eat:  When taking cannabis in edible form, eat a solid meal beforehand, preferably one with some fat to stimulate that helpful bile acid release.  Keep in mind that peak concentration effects will take longer, although the time varies for each person, so you might need to plan ahead to create the timing you desire.

Absorption considerations: If you are taking an edible mainly for CBD – even if it’s a combination product with THC, definitely eat a meal first since the boost in absorption, according to this study, is four times higher.  For THC alone, it’s your call as an empty stomach isn’t such an important factor as long as you get the dose right.

Follow the Low and Slow Mantra

Remember – the effect from edible cannabis is going to last longer so if a product is new for you, start with a tiny microdose (no more than half of a full dose).

Read the Packaging!

The potency of an edible product is indicated by the milligram (mg) amount of cannabinoids contained in the product. An edibles package should state both the milligrams per serving and the milligrams in the entire package.  It’s much like reading the number of calories per serving in a packaged food item. So, if an entire candy bar has 20 mg of a particular cannabinoid, a quarter of it would contain 5 mg.   Knowing the accurate dosage of an edible product and consuming at a measured pace is extremely important due to the delayed onset time and variable dosage options.

 Are Edibles Blazing a New Trail?

 You bet.  The Specialty Foods Association named cannabis edibles as one of the top 10 food trends of 2018 right up there with broccoli -stem slaw, cardamom and something called grilled haloumi.  Browse through a well-stocked cannabis dispensary and try not to drool over the chai teas, savory nut mixes, ranch tortilla chips, buttery popcorn, gum drops, extra-virgin olive oils, gourmet coffees, cacao, crackers, miso, and mint chocolate bars.  I feel like I’m in the buffet line on a cruise ship.

As the trend continues, the producers who create cannabis-infused edibles will continue to offer something for every appetite.  Just be sure to eat before you swallow.