How Cannabis and Cannabinoids Work
Cannabinoids can be produced in one of two ways, either internally by the body, or externally by plants. Endocannabinoids, and the endocannabinoid system (ECS) are cannabinoids and receptors that are naturally produced by the body. Phytocannabinoids are cannabinoids that are produced by plants.
Researchers have identified over 120 cannabinoids produced by the cannabis plant. Of these, less than 50 are produced by the plant in significant amounts. Most of them are present at very low levels, making it difficult for scientists to accurately detect them.
It is a mistake to assume that a single cannabinoid, like THC, is the ‘best’ or ‘most beneficial’ medically. The varying effects of cannabis-based medicinal products, including those that contain THC and those that do not, is due to the varying levels of different cannabinoids and other chemicals produced by the cannabis plant.
The Relationship between Cannabinoids and Terpenes
Terpenes are another set of compounds naturally found in the cannabis plant. These compounds are among the most common plant chemicals found in nature and are considered safe as food additives by the FDA. They are also what is responsible for the different smells of plants and their oils. There are over 100 different terpenes identified in the cannabis plant, and when working synergistically with cannabinoids, produce different effects.
The way that different cannabinoids and terpenes, at various concentration levels, interact with the ECS and result in different effects on the body is called the entourage effect. The entourage effect suggests that the various cannabinoids and terpenes ingested when taking medicinal cannabis products modulate one another, changing the way the ECS responds to the medicinal cannabis product in question.
It naturally follows that it’s critically important for medicinal users of cannabis to understand what they are ingesting if they wish to receive the best benefits possible. A high percentage CBD product may offer some benefits to the user, but those benefits will likely fall short of the full medicinal potential. Depending on the ratio of cannabinoids and terpenes, cannabis products can be made to target specific and desired medicinal effects.
How to Ingest Medicinal Cannabis Products
The method by which patients ingest medicinal cannabis products results in different medical benefit onset times.
Vaporizing: When cannabis products are vaporized or burned and inhaled, the inhaled medicinal compounds reach peak blood-level concentrations within six to seven minutes of inhalation.
Under the Tongue: ublingual (under the tongue) administration of cannabis products results in peak blood-level concentration in approximately 4 hours, although the initial onset of the medicines’ effects may occur 5 to 15 minutes after administration.
Swallowed: Gastrointestinal administration, which occurs when cannabis products are swallowed, has been shown to be somewhat slow and inconsistent. Maximum blood-level concentrations are generally observed within two hours, but have been observed to take as long as 7 hours.
Critically, a portion of the cannabinoids and terpenes are destroyed by stomach acid and digestive enzymes. This is unavoidable when swallowing cannabis medicine, and new patients should start with low doses to understand how their body responds over time as the medicine is digested.
When Not to take Medicinal Cannabis
Lack of formal clinical research (due to the long-standing global restrictions on cannabis research) gives us limited evidence-based data to follow when it comes to determining restrictions of use of medicinal cannabis products. For that reason, it is wise to always proceed with caution.
If the patient is on any medication, prescription or otherwise, a medical practitioner should be consulted.
Similarly, patients who are pregnant, suspect they are pregnant or trying to become pregnant should consult their physician.
Lastly, patients should consult a physician if they have concerns or are unsure about any unexpected response or reaction to medicinal cannabis products.
When using medicinal cannabis, patients should strive to achieve a consistent level of medicinal compounds in the body over time. Tinctures offer an exceptional delivery mechanism when administered sublingually and then swallowed to be further absorbed in the gastrointestinal system.
New patients should begin dosing at the lower end of the suggested serving size. Studies have shown that high doses delivered consistently over time result in a reduced density of cannabinoid receptors in the body. In other words, if you use too much, too often, your body may develop a tolerance for the beneficial effects of the congested compounds. Therefore, as a general guideline when using medicinal cannabis products: use the least amount of medicine necessary to treat symptoms. Following this guideline will help reduce the chance of developing a tolerance for medicine.
With cannabis, less is often more. Of course, that does not mean patients should be afraid to medicate, or should use too little - but awareness of the impact of excessive use is critical to the long term performance of medicinal cannabis products.
Everybody responds differently to cannabis medicine and patients should feel comfortable experimenting with dosing size of non-THC cannabis products to determine what works best for them. For patients using THC-based products, a different set of guidelines should be followed that we do not address appropriately here.