PRODUCTS and MEDICINES:
Optimizing Cannabis Consumption for the Texas Medical Program: A Vital Discussion
While actively participating in shaping the medical cannabis program in Texas, it is crucial to give greater consideration to the method of consumption. The discussion should focus on consuming cannabis in the healthiest and most effective way possible within state-run medical cannabis programs. Currently, Texas statutes, under the Texas Compassionate Use Program (TCUP), specify that cannabis/marijuana products must contain no more than 1% THC by weight and are exclusively for medical use. According to the statute, "medical use" involves administering cannabis through means other than smoking, which is defined as "burning or igniting a substance and inhaling the smoke." [1]
As we examine the current and potential future statutes, three main points merit attention regarding the method of cannabis use:
Inhalation: An Important Delivery Method for Medical Cannabinoids
Inhalation proves to be an effective way to introduce active medical compounds into the body. First, it facilitates rapid delivery of active ingredients into the bloodstream and the brain, unlike ingestible products, which require absorption through the digestive system, resulting in a longer onset time. Second, the half-life of active ingredients through inhalation is shorter compared to ingestible products like gummies, which is important especially with regards to the psychotropic medical cannabinoid compounds. Despite these positive variables, smoking cannabis can cause inflammation in the bronchial and lung tissues [2], and further research is required to explore formulations and sophisticated delivery methods that could minimize these side-effects.
For instance, transdermal patches could be argued as an effective and safe method of delivery for introducing cannabinoid compounds in the body, but as previously stated, this product delivery method lacks widespread adoption. There is something about the ritual of inhalation that humans have adopted that persists to this day. Yet, from the pulmonary health perspective, the healthiest way to consume cannabis is orally. Furthermore, there are patients with certain medical conditions that simply cannot inhale and have no other choice but to use edible formats. However, the reverse also exists when due to digestive system issues or the amount of oil that needs to be consumed to reach an effective dose, inhalation remains the preferred way for many. Ultimately, to meet the needs of all medical cannabis patients, various product formats, including inhalation devices will need to be made accessible in the state and federal markets.
Adequacy of 10 mg THC in Edibles versus Combustible Cannabis Products
In addition to the delivery method, state medical cannabis programs also need to examine product THC dosages based on weight. For example, 1% THC by weight corresponds to 10mg of THC per one gram of the product. Thus, 10mg is a considerable THC dosage. If a single-dose product weighs more than one gram, such as a two-gram gummy, it may contain 20mg of THC. Currently, Texas licensed producers offer 20mg THC gummy products to TCUP patients. Yet, for some patients, effective doses may need to be in hundreds of milligrams of THC per day. So, in an instance, where 200mg of THC as a daily dose may be deemed necessary by a TCUP physician, that patient would need to consume at least 20 milliliters, or two thirds of a fluid ounce of carrier oil or 20 grams of gelatinous substance (gummy) containing THC. Ingesting this much oil or gummies can be a heavy burden even for a healthy person. How do these cannabinoid concentrations compare to typical medical cannabis flower?
“A typical effective inhalation dose may be anywhere between 10mg to 200mg of THC, which may have different intoxicating level and effects depending on a patient’s sensitivity.”
Comparatively, a typical gram of cannabis flower can contain THC in the range of 5% to about 36% by weight. In jurisdictions allowing inhalable and combustible cannabis products, a usual dosage of cannabis flower ranges from a quarter of a gram to one gram. A typical effective inhalation dose may be anywhere between 10mg to 200mg of THC, which may have different intoxicating level and effects depending on a patient’s sensitivity. In mature cannabis markets, consumers often seek products that are at least 10% in THC by weight (or 100mg of THC in 1 gram of flower). So, in the markets that do not cap percentages of THC, two grams of flower or several milliliters of oil at higher concentrations can help patients reach effective doses in several hundreds of milligrams. That is in comparison to 20 milliliters that patient would need to ingest for a 1% THC product. Finally, inhaled cannabinoids (THC and CBD) have the fastest onset and shorter half-life, as compared to ingestion.
Some cannabis patients may prefer high-dose inhalation products, and for certain patients as mentioned previously, inhalation may be the only feasible way to consume phytocannabinoids. However, the 1% THC cap is not appropriate for traditional inhalable products, such as cannabis joints or typical vape cartridges. The good news is modern technologies offer devices that allow precise control over micro to macro doses of THC via inhalation without burning the plant matter, which will be discussed more below.
Cannabinoids: Heat, Don't Burn
Another important issue to remember when analyzing product formats and delivery methods is the temperature in which cannabinoids burn and how it impacts the efficacy of the product. Cannabis plant matter burns (ignites) at 400 degrees Celsius and above, while cannabinoids like THC, CBD, and CBN become volatile at much lower temperatures, all below 200 degrees Celsius. Several sophisticated vaporization technologies take advantage of this fact, enabling precise regulation of temperature and delivery of small doses, such as 0.5-10mg of THC per inhalation. These types of technologies do not use burning temperatures, have better control and tracking than the vape cartridges, and could be already utilized, even with the existing 1% or 10mg/gr weight limitations in Texas.
“…we are referring to patented new technologies that allow precise control and tracking of micro dosing using cannabis flower.”
To emphasize, we are not referring to the typical vape cartridges, which have little temperature control and dosage tracking and are common and prevalent in the nicotine and, especially, in the hemp-derived cannabinoid marketplace. Rather, we are referring to patented new technologies that allow precise control and tracking of micro dosing using cannabis flower. In Israel, for example, inhalable product formats are already approved by their health agency as medical cannabis consumption methods, even for hospitals and hospice environments. Indeed, large multinational companies are supporting these ideas even more [3]. Ultimately, stake holders of state-run medical and federal cannabis programs should seek to provide the safest, most effective, validated, and individualized product formats and regiments to patients that would be approved (even by the FDA) for use in a clinical setting to address a wide range of medical conditions.
In conclusion, while actively shaping Texas's medical cannabis program, we must prioritize exploring the healthiest and most effective methods of cannabis consumption. Inhalation offers swift delivery of medical compounds but concerns regarding burned cannabis matter causing potential inflammation requires further investigation. The adequacy of THC dosage in edibles versus traditional combustible cannabis products needs thoughtful consideration, and modern technologies present opportunities for precise micro dosing with cannabis flower. By adopting innovative methods, we can maximize the therapeutic benefits of medical cannabis while minimizing potential risks.
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REFERENCES:
1. Occupations Code Title 3. Health Professions Subtitle B. Physicians Chapter 169. Authority to Prescribe Low-THC Cannabis To Certain Patients For Compassionate Use.
2. Kaplan AG. (2021) Cannabis and Lung Health: Does the Bad Outweigh the Good?Pulmonary Therapy. PMID: 34697771
3. Philip Morris acquiring Cannabis inhaler developer Syqe Medical for up to $650 millio | Ctech (calcalistech.com)