CANNABIS: an Introduction for Healthcare Providers by Terry Willard Clh, Phd & Jeananne Laing Clh

Wild Rose College of Natural Healing CANNABIS: An Introduction for Healthcare Providers By Terry Willard ClH, PhD & Jeananne Laing ClH

Cannabis: An Introduction for Healthcare Providers

Methods of Consumption

There are many different methods to consume cannabis. The prominent ways for intake are:

1. Inhalation 2. Ingestion 3. Sublingual 4. Suppository 5. Absorption

A few things to consider when choosing the right method for the user:

THE USER’s: • Age • Genetics • THC Experience (tolerance) • Purpose of use (goal) • Current & Past Health History • Current meds (pharma) • Form the cannabis is in

It is important to note that it is not a ‘one-size-fits-all’ medicine. It can be a highly individualized to best fit the user’s goals.

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No matter which method of consumption, ‘low and slow’ is the most important thing to consider. Start with quite low dosage and slowly increase if the goal is not achieved. Starting with ¼ dosage is a good place to start and increase every 2 – 5 days if the goal is not achieved. As a person gets use to the cannabis, often the tolerance goes up and a person needs more cannabis to get the same effect. Some people take up to a week to acclimate to a dosage level.

THE MEDICINE: • Strain Category (Indica, Sativa, Hybrid, CBD) • Cannabinoid Profile (THC, CBD, and others) • Ratio THC/CBD • Terpene Profile

METHODS Juicing Some people like to take in the raw herb in the form of a juice. In the past this was considered a non-starter, as most people were looking for the THC levels. Since there is no THC in the plant (only its acid precursors), people said juicing didn’t work. True. If you want THC, cannabis material has to be carboxalized (transformed by heat). Nonetheless, the phytocannabinoid acids in the plant have an array of uses on their own. CBD can be made in the body directly from the acid. In most people, they obtain a critical dosage of CBD, with less amount of cannabis (a cost saving).

CBDA (cannabidiolic acid) THCA (tetrahydrocannabinolic acid)

• Non-psychotropic for most people • the ‘raw’ cannabinoids • Anti-inflammatory • Antioxidant

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• Anticancer • Strong immune booster • Improved intestinal function • Improved neural function • Neuroprotective • Rebuilds bone • The body does not convert THCA to THC (that happens through a heating process outside the body) • However, the body can convert CBDA into CBD, especially when taking juice from the fresh leaves • Drinking juiced fresh cannabis leaves creates up to 4x more serum CBD than other methods of consumption • Juice has a short shelf life 4-12 hours • It can be frozen. • Best consumed with other fresh juices • CBDA shows promise as an anticonvulsant, anti-nausea and anti- emetic agent, analgesic and anti-inflammatory. • CBDA may also have antibacterial, antioxidant and cancer preventing properties

Inhalation This is by far the most popular method of ingestion, partly due to tradition, but it does create the quickest effect. When taking cannabis into the body through the lungs there is a quick onset 3-5 mins, with effects lasting 2-4 hours. The problem is inhaling may aggravate chronic bronchitis.

Vaporizing vs Smoking: • Vaporizers heat the dried cannabis enough to boil (turn to vapor) cannabinoids, terpenes and some flavonoids, but not hot enough to combust, thus avoiding the carcinogens associated with inhaling smoke • Easier for patients to manage their dosage • It is considered one of the best routes to get the entourage effect, as on some vaporizers you can specify the temperature, thus obtain certain terpenes. • It often increases scent and especially taste, increasing pleasure to many patients • Patients that have problems with coughing from other forms of inhaling may find vaporizing less of a problem. • The temperature is substantially lower in vaporizing than smoking • Plasma concentrations for THC and CBD are the same whether smoked or vaporized • Vaporizing uses a lot less product

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Vaping is not Vaporizing: Do not confuse e-cigarette (with e-juice) type ‘vaping’ devices with cannabis vaporizers that are specifically designed for use with dried cannabis flowers. • Note that the term ‘vaping’ has come to be associated with e- cigarette type devices, • Several brands of cannabis e-cigarettes are available in the unregulated market, • Often these cannabis e-cigarettes contain highly potent THC products dissolved in toxic solvents used in the manufacturing process. • Vape products that contain a liquid form of cannabis are unregulated and currently not legal.

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Boiling temperatures of Cannabis’ common cannabinoids, terpenes, flavinoids & phytosterols

CBG (Cannabigerol) 52°C 126°F CBDV (cannabidivarin) 65°C 149°F THCA (tetrahydrocannabinolic acid) decarb starts at 90°C* 90°C 194°F Humulene 107°C 225°F Caryophyllene 129°C 264°F CBDA (cannabidiolic acid) decarb starts at 80°C* 130°C 266°F Beta-sitosterol (phytosterol) 134°C 273°F Pinene 155°C 311°F THC (tetrahydrocannabinol) 157°C 315°F Myrcene 167°C 333°F Limonene 176°C 349°F Apigenin (flavinoid) 178°C 352°F CBD (cannabidiol) (160°C - 180°C) 180°C 356°F Cannflavin (flavinoid) 182°C 360°F CBN (cannabinol) 185°C 365°F Terpinolene 187°C 369°F Linalool 198°C 388°F CBC (cannabichromene) 220°C 428°F THCV (tetrahydrocannabivarin) 220°C 428°F Terpineol 221°C 430°F Combustion (200°C - 230°C) 230°C 451°F Quercetin (flavinoid) 250°C 482°F

*NOTE: It takes "3 hours at 100°C to convert THCA fully into THC and 4 hours at 98°C. At high temperatures above 160°C only about 10 minutes and at 200°C only seconds are needed to convert THCA fully into THC."

REFERENCES: 1 US National Library of Medicine, National Center for Biotechnology Information, PubChem Open Chemistry database. https://pubchem.ncbi.nlm.nih.gov/ 2 McPartland, John & Russo, Ethan. (2001). Cannabis and cannabis extracts: Greater than the sum of their parts?. J Cannabis Therapeutics. 1. 103-132. 10.1300/J175v01n03_08. 3 Wikipedia. https://en.wikipedia.org/ 4 Project CBD. www.projectcbd.org 5 Cerilliant Analytical Reference Standards. www.cerilliant.com 6 Kerstin Iffland, Michael Carus and Dr. med. Franjo Grotenhermen, nova-Institut GmbH. Decarboxylation of Tetrahydrocannabinolic acid (THCA) to active THC. http://eiha.org/media/2014/08/16-10-25-Decarboxylation-of- THCA-to-active-THC.pdf

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Ingestion • Cannabis taken into the body through the digestive system. • Offers a slow onset 30 – 90 mins, due to being processed through the digestive system and liver. • The liver enzymes can change the chemistry and metabolite of the cannabis a great deal, thus the effect is often different than inhaling • Ingested cannabis can be much more potent than inhaled … always use caution with a new product or a THC-sensitive person. • Effects last 6-10 hours • Oils, tinctures (alcohol/glycerin), baking, drinks, tea, gummies, lollipops, capsules (oils, decarbed powder) • Wait at least 4 - 8 hours between doses • Must be taken with fatty food because cannabinoids are fat-soluble and won’t be effective unless properly digested. • If ingested cannabis is not properly digested, the person may not feel the effects from that dose until the next time they eat, which could be 12 – 14 hours later. Bad news if your cannabis dose for sleeping doesn’t kick in until you eat breakfast!

Sublingual • Taken into the body by allowing it to absorb under the tongue. • Medium onset 20 - 40 mins • The effects last 4 - 8 hours • Works best with alcohol tinctures better than oil-based infusion • High alcohol concentration can cause reactions with tender tissue under the tongue • Technology used in the supplement industry will soon be used to create truly sublingual cannabis tablets • Always inquire about the solvent used to create concentrates such as phoenix tears or RSO • Though acetone (commonly used as nail polish remover) is a potent solvent, and strips most everything from the plant (the good and the bad) into a concentration, it will also concentrate molds, leftover fertilizers and pesticides, and other contaminants.

Suppository • Taken into the body through the rectum or vagina • The potential for impairment can be more pronounced for some or not impairing at all for others USE CAUTION!

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• Used in cancer treatment as a way to get larger amount of cannabis medicine into the body

Absorption (Topical Application) • Taken into the body through the skin. • Psychoactivity is rare with salves and creams but THC-sensitive people are prone to impairment. • Best for surface or muscle conditions. • Can reapply as needed • Alcohol rubs / liniments absorb more readily and needs to be used with caution as psycho-activity more likely to occur