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Dosage Forms

Cannabis contains many compounds. Here are brief descriptions of some terms most useful in understanding the differences between medical marijuana products:

 

THC: Tetrahydrocannabinol is the cannabinoid that produces the "high." THC is associated with psychoactivity (or psychotoxicity, depending on the situation), euphoria, relaxation, anxiety, memory impairment and pain relief. Short-term studies show clinical applications improving pain, appetite, nausea and sleep in specific conditions. When talking to patients, it is helpful to describe the effects as impairment or intoxication, and mention that taking too much can make patients feel uncomfortable.

 

CBD: Cannabidiol CBD is not psychoactive and pre-clinical data suggests anti-inflammatory, analgesic, anti-nausea, anti-emetic, anti-psychotic, anxiolytic, and anti-epilepsy properties.  Per the World Health Organization, there is no current evidence of that oral CBD administration in humans results in clinically relevant THC-like subjective or physiological effects, or appreciable plasma concentrations of THC or its metabolites.   At present no public health problems related to misuse, abuse or dependence, including no concern related to “ driving under the influence”.

 

Terpenes: These are the volatile organic chemicals that give marijuana its aroma and taste.

 

Other molecules: other molecules are found in varying ratios between strains of marijuana. Some examples include CBN and THC-A. 

 

Currently, under Pennsylvania law, six forms of medical marijuana are available for patient consumption. Patients have access to pills, extracts, liquids, topicals, patches, and flower.  Each of the six forms of medical marijuana provides patients with different benefits that are more suitable for treating certain conditions and gives patients a variety of options. Medical marijuana, in any of its forms, should be used responsibly due to its psychoactive nature and health care practitioner (pharmacist or physician) dosage recommendations should be followed closely.

 

1. Pills/Capsules

Medical marijuana pills, also known as capsules, provide the benefits of concentrates and flower, but without the added health risk from inhaling vapor. Medical Marijuana pills feature two main compounds: THC and CBD. The main difference between the two is that THC contains psychoactive properties (which can impair thinking, reasoning and coordination), whereas CBD contains little to none. Those who want to receive the health benefits without the sensation of a “high” typically opt for pills with a higher CBD content and lower THC content. Effects experienced by users can vary, but it is generally reported that capsules help alleviate inflammation, pain, and nausea. Capsules may also help combat insomnia, and other ailments associated with the 23 approved medical conditions in PA.

 

The dosage for pills is stated on the bottle in milligrams, and with the help of a pharmacist the patient can determine the dose in each pill, allowing patients to control consumption levels..

The onset of action of pills is slower than with inhaling products.  It take between 1 -2 hours before a person feels the effects of medical marijuana taken by mouth.  This can make it dangerous if patients do not wait enough time after taking a dose, prior to taking another one.  

 

Benefits for taking medical marijuana by mouth include: 

 

  • the effects lasting longer, up to 6-8 hours
  • the drug is processed into more of a longer lasting chemical that is stronger at relieving pain
  • Taking medical marijuana by mouth is safer and more discrete than vaporizing product

 

2. Liquids/Tinctures

Medical marijuana liquid extracts are created by soaking the plant material in a liquid in order to pull out and concentrate the active ingredient.  The products are often very strong and potent, so it is important to read the bottle to understand how much THC and CBD are in liquid amounts that are measured out (think children’s cough syrup). 

Liquid medical marijuana is typically a shade of green, ranging from light to dark depending on the plant material from which it was extracted. This form is most commonly taken by mouth or under the tongue by placing a dose measured in an oral syringe.  Taking medical marijuana liquids by mouth offers the similar benefits as taking medical marijuana capsules.

Mouth sprays are also available and the liquid can be used in an electric vape pen. While edibles are not an allowed form to be sold in Pennsylvania, a measure amount of liquid could be mixed with food to help a patient be able to take it (such as children or patients with swallowing issues)..

Patients looking for a quick, vapor-free, and easy method of ingestion that presents a range of options (put under the tongue, mix with food, vaporize) may find a benefit from liquid products.

 

3. Topicals

An increasingly popular method of consumption, topicals move away from the typical means of oral ingestion and instead focus on localized pain relief, anti-inflammation, and pain reduction. Topicals come in gels, creams, and ointments that are applied to the skin. This method works by binding to networks of receptors found throughout the body, although they only penetrate to this network and do not reach the bloodstream. Since they do not reach the bloodstream, topicals are non-psychoactive. Various topicals provide different benefits, experimenting with available options may be necessary to find the one most beneficial to the patient.

 

4. Extracts

Extracts are formed by heating the plant’s oily extracts in order to obtain inhale (remove) high concentrations of specific molecules from the plant. Extracts are significantly stronger and more potent than the plant material from which they come. They are consumed through inhalation or vaporization and usually come in the following forms:
Shatter - Smooth, solid, and transparent extracts that are typically higher in THC.

Wax - Opaque, soft extracts that are typically lower in THC.

Oil - Sticky, liquid extracts that have varying THC levels.

Budder - Creamy, butter-like extracts that are typically higher in THC.

Resin - Dark, gooey extracts that are typically higher in THC.

 

Compared to other forms of consumption, extracts provide similar medical benefits. Extracts focus on drawing out particular molecules from the plant, giving patients a variety of options to choose from—each molecule present in the particular medical marijuana extract offers different effects for different needs. For instance, CBN may be used to aid in sleep, and THC-A may provide pain relief.

 

5. Patches

Medical marijuana patches are applied to a venous area of the body. Cannabinoids then enter the bloodstream for long-lasting, effectives.  Different patches contain various amounts of different cannabinoids, including CBD, CBN, THC, and THCA. Different cannabinoids have different effects, and more information is emerging, for example CBN is sedating and the patches can aid in sleep.  One of the main benefits of patches compared to other forms of administration is the length of time over which they work. Patches can provide all day or night relief since the slow release of the cannabinoid provides long-lasting effects. Effects from smoking or vaping fade relatively quickly in comparison.  One concern is the lack of traditional pharmacokinetic testing data with these PA grower processor specific products.

  

6. Flower

Medical marijuana flower, also known as dry leaf, is consumed through vaporization in Pennsylvania. Leaves from the marijuana plant are dried to produce a consumable product. Marijuana has upwards of 70 cannabinoids, all of which have varying effects on the body. Similarly to its pill form, flower comes with varying ratios of THC and CBD. The previously mentioned health benefits are present in both, but THC contains psychoactive properties, whereas CBD does not.

Each form of medical marijuana consumption comes with its own set of benefits and effects. These 6 options give patients a variety of ways in which to treat different conditions. Medical marijuana, in any of its forms, should be used responsibly due to its psychoactive nature and dosage recommendations from your doctor or pharmacist should be followed closely. 

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