The first thing to note is that on the package it states 15mg/g CBD and 1mg/g THC, meaning that it has 15mg of CBD in each gram. This is somewhat confusing as the bottle is in ML, and grams are a unit of weight. This is a recent change for Health Canada, which up until recently was mg/ml. As this is an Organic Extra Virgin Olive Oil formulation, the molecular weight of this is .92 of a ML; meaning that the weight of the formulation in the bottle is 27.6 grams. This then means that entire contents of the 30ml vessel will contain 409.5mg (+/- 15%). Health Canada has made these changes as temperature and elevation effect the total volume. (think of taking a plastic bottle of water onto a plane. When you are “in the air” the fluid in the bottle will take up more room. When you place the cap on the bottle and check it again as you are landing, the bottle will have “sucked in”…. the volume changed but the weight remained constant.) Label restrictions are very specific and we are not allowed to include any additional information on the bottle to clarify.
THIS IS CANNABIS, OUR WAY.
How cannabinoids move through the body
Determining how a medicine is going to work for an individual patient is very important to medicine safety and efficacy. The way the cannabinoids THC and CBD move through the body (pharmacokinetics) varies depending upon how it is taken. The duration of their action is influenced by close size, dose form, and the route of administration – the lungs, mouth, gut or the skin.
Absorption and distribution
THC and CBD are mainly found in cannabis in their inactive acid form. To activate THC and CBD a carboxyl group must be removed by heat. In practice, this so called ‘decarboxylation’ occurs by heating cannabis flower in a vaporizer, or heating the cannabis flower extracts before being placed into a solution.
The absorption of inhaled cannabinoids results in a maximum (peak) blood concentration within minutes (see figure). Effects in the brain start within seconds to a few minutes, and reach a maximum after 15-30 minutes. They taper off within 2-3 hours.
Absorption is slower when cannabinoids are ingested. Lower, more—delayed peak concentrations occur with oral ingestion. The effects in the brain are delayed for 30-90 minutes, and reach their maximum after 2-3 hours. They last for about 4-12 hours.
Bioavailability describes the proportion of a medicine entering blood circulation after administration. The bioavailability of oral THC and CBD is low. By comparison, the inhalation of cannabinoids has been shown to be more effective and reliable compared to oral administration.
Pharmacokinetics is abbreviated as PK. It is the study of the movement of medicine within the body. The acronym ADME is used to describe a medicine’s Absorption, its Distribution. Metabolism, and final excretion from our body.
The distribution of cannabinoids in the body are ruled by their lipophilicity (their fat solubility) and binding to blood proteins. THC is distributed widely throughout the body. particularly to fatty tissues. The body storage of THC increases with increasing frequency and duration of use.
Metabolism and elimination The cannabinoids are mainly metabolized by a collection of liver enzymes called cytochrome P450 (CYP450). The same as many other medicines, these enzymes chemically alter the cannabinoids to remove them from our body
(excretion). Besides the liver, other tissues like the heart and lungs are also able to metabolize cannabinoids, albeit to a lesser degree.
Dosage forms and their administration
Like other medicines, medicinal cannabis is available in different dose forms (e.g., inhalation, oral, transdermal) to meet different patient requirements. How medicinal cannabis is administered or taken depends on its close form.
The dose form is really important. It can influence patient behaviour in different ways, including if patients actually take their medicine and adhere to their daily regimen
Inhalation-by the lung
Using a vaporizer or inhalation medical device. Cannabinoids are inhaled (from cannabis flower) as a vapour which then enter the bloodstream from the lungs.
Inhalation has proven to be an efficient administration route. The inhaled vapour is quickly absorbed by the lungs. The immediate onset of action means it is the preferred choice for many patients. The vapour contains cannabinoids and terpenes in consistent. measurable quantities. The speed of onset simplifies titration — the ability to achieve the correct dose without side effects – and achieve fast relief from symptoms. The amount of cannabinoids delivered depends on the depth of inhalation and breath hold. While inhalation results in higher blood levels of cannabinoids, their effects compared to oral administration is shorter in duration.
Given the risks from smoking, patients nowadays seek reliable, affordable and portable vaporizers or inhalation devices. Research dedicated to advancing vaporizer and inhalation technology has seen major developments in device quality.
Medical vaporizers for the administration of cannabis flower – instantly we think of e~cigarettes or vape-pens – are in fact quite different. The vapour does not contain nicotine, liquid propylene glycol, glycerol nor synthetic flavours. There is also no large, socially intrusive, toxic vapour cloud. These vaporizers (or inhalation devices) offer patients an effective, safe, and easy to use delivery system.
Ultimately, smoking medicinal cannabis is harmful to patients’ health and is therefore not recommended.
Toxic pyrolytic compounds are produced when the plant material is smoked (i.e. combustion). Typically cannabis flower is rolled into a ‘joint’ cigarette, and cannabinoids are inhaled as smoke into the lungs. The medicine enters into the bloodstream from the lungs. Smoking cannabis results a rapid onset of action. The effect is noticed within minutes. While smoking results in higher blood levels of cannabinoids, their effects compared to oral administration is shorter in duration. Furthermore, unless it is fully standardized, the amount of THC and CBD in cannabis flower can vary greatly between batches. The amount of THC delivered also depends on the depth of inhalation, puff volume and duration, and breath hold.
Pharmaceutical quality cannabis flower for vaporization to deliver consistent therapeutic levels of cannabinoids, the product must be of pharmaceutical quality. This cannabis flower is genetically and chemically standardized according to pharmaceutical standards. From a patient safety perspective, it is free of microbial contaminants, pesticides, impurities and heavy metals. These are qualities that make the vapour safer for inhalation into the lungs.
Oral- by the mouth
Dose form Cannabinoids (whole plant extracts or individual cannabinoids) taken by mouth and either swallow/(xi (oral), or absorbed from under the tongue (sublingual). When swallowed, the medicine enters into the bloodstream via the stomach. intestines and the liver. When absorbed from under the tongue, the medicine bypasses the liver and enters into the bloodstream directly.
Oral preparations are familiar dose forms. They are similar to other medicines patients already take, and are easy to administer. As a result, concentrated cannabis extracts are becoming increasingly popular.
An increasing number of patients are using extracts of cannabis flower. Whole plant cannabis extracts contain cannabinoids and terpenes in a concentrated dose form. Often they are called ‘oil’ because of their dark viscous appearance. The extract is dissolved in an oil (e.g., olive, sunflower, peanut) to act as a carrier and ease administration.
A single dose can be dispensed from a dropper and placed under the tongue. It is absorbed from the lining of the mouth (termed sublingual absorption) where upon it enters the bloodstream.
Sublingual delivery increases total available dose. This means smaller doses are required for the same effect. compared to swallowing capsules or drinking tea.
Sublingual dose forms can provide a reliable uniform dose.
Sprays are also administered under the tongue just as oils. An example is Sativex, a standardized (oromucosal) form of a pharmaceutical product, made from two strains of cannabis. One strain produces mainly THC and the other mainly CBD. Exacting proportions of the active compounds THC and CBD are dissolved in an alcohol solution. This is placed in a metered-dose bottle which is sprayed under the tongue.
An alternative oral dose form are capsules. These typically contain exacting concentrations of single cannabinoids (i.e. THC and CBD) dissolved in a carrier oil. The capsule is swallowed, breaks open, the drug is released and finally absorbed in the stomach and intestines. The rate (time) of absorption can be unpredictable, and varies depending on, for example, if food is present, and if the patient is mobile (able to exercise/walk freely). Interestingly, THC itself slows the rate of gastric emptying (from the stomach to intestine). Oral administration (by swallowing) results in slower onset of action, lower total blood concentration, and a longer duration of effects compared to inhalation. Total cannabinoid content is affected by liver metabolism and stomach contents. This means oral dosing can be less unreliable and unpredictable.
Tea or infusion
A proportion of patients consume medicinal cannabis as a tea (cannabis flower infused in hot water). Teas are swallowed and the cannabinoids are absorbed in the stomach and small intestine. Similar to oral dosing, the total cannabinoid content is affected by liver metabolism and stomach contents. This means dosing by tea may be unreliable and unpredictable.
Furthermore, tea typically has a low concentration of cannabinoids, the tea composition is effected by boiling time, volume of tea prepared, and the length of time in storage. This means dosing by tea can provide a less certain therapeutic effect.
Other whole plant dose forms include edibles such as cookies/brownies. It is difficult to obtain a consistent cannabinoid composition in edibles. Patients can easily overdose, particularly as the time to effect may be 2-3 hours and patients may ingest a second dose if they are awaiting effects.
The therapeutic effect is less certain than standardized oral products and it usually takes longer to achieve. As a result, edibles are not considered a therapeutic product.
Transdermal- by the skin
Transdermal literally means across the skin. The typical dose forms include creams which are applied to the skin surface or a mucous membrane; and, transdermal patches which are a medicated adhesive patch applied directly on the skin. A specific dose is then administered gradually over a set time.
Transdermal dose forms are being investigated for their clinical use and application. Currently they are being used to treat certain skin conditions and for localized muscular or joint pain.
Given that most cannabinoids dislike water (are highly hydrophobic), it can be difficult to achieve a reliable dose form that is applied to the skin and can achieve appropriate blood concentrations. However, novel nanotechnology may overcome this. Dose forms such as creams are intended for local application and action. These do not require achieving penetration through the skin into the blood stream.
Medicines must have a clearly defined composition. GMP— certified, fully standardized medicinal cannabis contains a constant composition active ingredients. batch-to—batch. This means the same dose can be taken each time. Doctors can better monitor dosage, condition progress, and reduce the risk of overdose and side effects. These products are also free of microbial contaminants (moulds, fungi, and bacteria), pesticides, and heavy metals. These are qualities which are especially important for people with weakened immune systems, and which make the products safe for vaporization and inhalation into the lungs. Finally, standardization allows the comparison of different clinical trials and studies across time. it is a critical factor for building the evidence base of medicinal cannabis.
Batch-to-batch consistency is a challenge. The cannabis plant is chemically complex and can vary greatly from plant-to-plant. Growing standardized cannabis means consistently achieving a balance of all potential active (specifically the cannabinoids and terpenes).
Quality and standardization
The quality of medicinal cannabis can vary greatly. This poses risks and uncertainties to patients and their prescribers. So, why is quality so important?
Cannabis has been used in human clinical studies and found to be relatively safe for most people, compared to other medicines. However, some patients taking cannabis have had worsened symptom control and new side effects such as sleepiness, abnormal liver function and diarrhea. Absolute safety does not exist for any medicine. All medicines can pose a risk of side effects and possibly adverse effects (resulting in harms). In particular, large doses of THC and potent synthetic cannabinoids have been shown to pose a risk of harm (e.g. postural hypotension resulting in a fall, or a mild to severe psychotic event).
The safest and most reliable products are of pharmaceutical-duality. These products meet good manufacturing practice (GMP) standards. GMP is the highest standard of medicine manufacture. GMP is an assurance of consistently high-quality products and production processes. For medicinal cannabis, GMP practices should start
from the very first step, cultivation. right through the entire production process to the finished product. It is not just about the packaging of cannabis flower, or the production of an oil extract. Under GMP, each part of the medicine production and testing process must be clearly documented. Personnel, premises and materials must meet the highest standards. These processes provide patients and prescribers with the safest and most reliable products.
A pharmaceutical-quality product could be, for example, cannabis flower for inhalation, a capsule for swallowing or a spray for the mouth. Each product type will require a slightly different set of tests for quality. These tests are often published. The pharmacopoeia monographs, for example, are the most reliable published methods for the analysis of medicines. These monographs explain the standards for potency, quality and so on. Medicinal cannabis products are required to be independently tested by specialized laboratories. The tests laboratories undertake often include:
The identification of cannabis – Medicinal cannabis products typically must be derived only from the cannabis plant. An important first step is to test the plant material to confirm it is actually cannabis, and not an adulterant or substitute.
The identification of active ingredients – There are numerous components of the cannabis plant. This test typically requires identifying THC and CBD, and often the terpene content.
The absence/presence of microorganisms – During cultivation, the cannabis plant can host harmful microorganisms like fungi and bacteria which can end up in the finished product. This may require decontamination treatment by gamma irradiation to eliminate microorganisms such as Staphylococcus Aureus and Escherichia Coli. The process must not affect the quality of the finished product.
The absence/presence of pesticides – Many different types of pesticides can be used in cannabis cultivation, but none are approved for use in cannabis. This test ensures the finished product does not contain pesticides which are very harmful to patients’ health.
The absence/presence 0f heavy metals – The cannabis plant can quickly take up heavy metal referred to as heavy metal bio—accumulation, Every batch must be checked for the presence of heavy metals such as arsenic, cadmium, lead and mercury.
The absence/presence of foreign matter – It is essential that the final plant material (and the finished product dose form) is free from impurities such as dust, dirt and other contaminations.
The total water content — For cannabis flower which is intended to be inhaled by vaporization, the final water content is important. The right amount of moisture (water content) in dried cannabis flower assures an easy inhalation process during vaporization.
The endocannabinoid system
Like in the case of the opioid system reacting to opioids (morphine, codeine), humans have a distinct receptor system for cannabinoids. The endocannabinoid system (ECS) contains cannabinoid (CB) receptors and influences the activity of many other body systems. The phytocannabinoids of the cannabis plant work in a similar way to our naturally produced endocannabinoids.
The human brain and other organs contain naturally occurring cannabinoid (CB) receptors and the chemicals that bind to them. This is called the human endocannabinoid system (ECS). The ECS role is to maintain our body’s ability to function normally by influencing the functioning of other systems. It plays a critical role in our nervous system, and regulates multiple physiological processes. This includes the adjustment of our response to pain, appetite, digestion, sleep, mood, inflammation, and memory. The ECS also influences seizure thresholds (i.e. in epilepsy), coordination, and other processes such as the immune system, heart function, sensory integration (touch, balance, sense of space), fertility, bone physiology, the central stress response system (the HPAA), neural development, and eye pressure.
Humans produce their own cannabinoids, the endocannabinoids. These endocannabinoids act on, or stimulate, the cannabinoid receptors. These compounds act in a similar way to phytocannabinoids which also bind to the receptors.
The plant cannabinoids are called phytocannabinoids. They are the unique constituents of the cannabis plant. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main constituents. There are other cannabinoids, but currently far less is known about them.
The other main compounds in cannabis are the terpenes. These are aromatic compounds which give cannabis varieties distinctive smells and tastes. Terpenes may have additive therapeutic action, meaning they may work together with cannabinoids to modify or enhance medicinal effects. To date more than 120 different terpenes have been identified in cannabis. Unlike cannabinoids, all major terpenes present in cannabis (e.g. myrcene, alpha—pinene, and beta-caryophyllene) can be found abundantly in nature.
It is thought that the terpenes work together with cannabinoids to modify or enhance their effects. This is known as the ‘entourage effect’.
Over 500 chemical compounds are produced by the cannabis plant. Of these, at least 100 are unique to the cannabis plant —- the cannabinoids. The plant-derived cannabinoids are termed phytocannabinoids. The major phytocannabinoids, and those we know most about, are delta-9—tetrahydrocannabinol (THC) and cannabidiol (CBD). THC possesses psychoactive effects, while CBD is non-psychoactive (i.e. it does not alter perception or consciousness).
The cannabinoids are biologically active chemicals. The concentration of cannabinoids varies throughout the plant (excluding seeds and roots). The highest concentration is found in the unfertilized female flower.
The biological activity is mainly linked to the major cannabinoids THC and CBD. Although THC and CBD have unique activities, it is becoming clear that a wider range of cannabinoids and other constituents of the cannabis plant may be involved in its various therapeutic effects. These include the cannabinoids tetrahydrocannabivarin (THCV), cannabichromene (CBC), and cannabigerol (CBG). These minor cannabinoids are thought to subtly modulate or enhance biological effects when taken therapeutically. This effect may be the result of them working on their own, or working together with THC and CBD.
The cannabis plant, its makeup and chemistry
Like other plants, cannabis is made up of hundreds of chemical compounds. It also comes in many different types. Some people refer to indica, sativa, or ruderalis types. But all of these belong to the same species: Cannabis sativa L. – a member of the Cannabaceae family. Many people are familiar with cannabis by the name hemp. Another of its close relatives is Humulus Iupulus L., better known as hops, a key ingredient of beer.
Cannabis is said to originate in the arid climates of Central Asia (Eurasian steppe), most likely the Hindu—Kush region. Straddling the borders of Pakistan and Afghanistan, the 800—kilometer—long mountain range was an integral part of the ancient Silk Road. The Silk Road provided a network of trade routes connecting Eurasia. The road and maritime trading routes moved various goods, including cannabis, in its various forms (hemp fibers, oil-rich seeds, intoxicants, and medicines), to the east beyond the Korean peninsula and west beyond the Mediterranean Sea. Nowadays, cannabis can be found growing in places all around the world, except in humid, tropical rain forests.
There are male and female cannabis plants, each with a distinct way of blooming. The cannabis plant has a lifespan of one year. The plant typically reaches a height of two to three meters (seven to 10 feet), after which it blooms and the growth ceases. After fertilization, the seeds mature and the plant dies.
More than 700 cultivated varieties (cultivars) of cannabis are thought to exist. The difference between distinct cannabis varieties is not solely determined by the cannabinoid content, but also the specific terpene content. These chemical constituents act as distinct biochemical markers, and can be used to ‘map the current chemical diversity of cannabis‘. By analyzing the concentrations of these compounds, researchers can identify specific cannabis plants with defined chemical profiles. For the purposes of medicine development, these particular plants can be used in clinical trials to determine their specific biological actions, and later introduced as new varieties to the existing product range.
Such analytical insights have led to a better understanding of cannabis taxonomy (scientific classification of plants).
In the past, the distinction between sat/’va and ind/ca has presented much debate. The classification was based upon differences in chemical composition, especially the differences in terpene content. However, to date there is no conclusive research displaying distinct ancestral lines for Cannabis ind/ca or sativa. So, although cannabis plants can significantly differ from one another, the scientific emphasis has shifted to a hypothesis that all cannabis falls under Cannabis sativa.
Medicinal cannabis history
Cannabis is one of the oldest known medicinal plants.
It is described in ancient handbooks on plant medicine. Archaeological evidence indicates the plant spread from Asia to Africa and on to the Middle—East. Eventually it arrived in Europe around 500 BC. It was later used widely for industrial purposes and was integral to early shipping as hemp fibre. History states that the therapeutic use of cannabis was introduced to Europe in around 1840 by an Irish doctor called William O’Shaughnessy. While in India he observed its widespread therapeutic use. In the following decades cannabis gained a short period of popularity in Europe and the United States. Dozens
of different cannabis preparations were available. These products were recommended for conditions including menstrual cramps, asthma, cough, insomnia, labour pains during birth, migraine, throat infection and withdrawal from opium use. At the time no tools existed for quality control and standardized preparations. Patients often received a dose that was either too low having no effect, or too high resulting in unwanted side effects. These drawbacks meant the therapeutic use of cannabis was largely taken over by standardized opium-based drugs such as codeine and morphine. Cannabis gradually disappeared from all Western pharmacopoeias. In the late fifties the World Health Organization (WHO) claimed that cannabis and its preparations no longer served any useful medical purpose.
What are the possible side effects of medical cannabis treatment?
Cannabis can cause side effects in some people, but each person may react differently.
Mild to moderate side effects may include:
- Dry mouth
- Sleepiness or drowsiness
- Unusual tiredness
**Cannabis can cause euphoria, which, depending on your medical needs, may or may not be a desired effect. Talk to your healthcare professional if you find euphoria bothersome.
Start low and go slow.
You should adjust your dose of cannabis until you find what works best for you. Start at a very low dose and increase it slowly. If you experience side effects, they can usually be managed by changing your dose, class of cannabis, manner of using cannabis, or strain.
How do I take different types of cannabis?
There are 3 ways to take different types of medical cannabis.
3 ways to take different types of medical cannabis
|Form||Portable or desktop vaporizers||Cannabis oils You can make your own edibles using dried cannabis or cannabis oils||Cannabis cigarette (joint), pipe, water pipe (bong)|
|Effects||Immediate effects (within minutes) Shorter duration (up to 4-6 hours)||Delayed effects (within 1-2 hours) Longer duration (up to 6-10 hours)||Immediate effects (within minutes) Shorter duration (up to 4-6 hours)|
|Ideal for symptoms that require immediate treatment or following eating.||Ideal for symptoms that persist throughout the day or night||Ideal for symptoms that require immediate treatment or following eating.|
What’s the difference between medical cannabis and cannabis from other sources, like dispensaries?
Guidance and support from a medical professional
Strict quality and safety standards
Tested concentrations of THC to CBD
May be eligible for insurance coverage
Compassionate pricing options
Other sources(i.e., illicit dispensaries, dealers, homegrown cannabis)
No medical guidance or support
No quality or safety standards
No insurance coverage – all out of pocket
Inconsistent or unknown THC to CBD concentrations
What is the difference between indica, sativa and hybrid?
3 main categories of cannabis
Cannabis products labelled as “sativa” may cause less drowsiness than products labelled as “indica.” Consider taking during the day
Cannabis products labelled as “indica” may cause more drowsiness than products labelled as “sativa.” Consider taking at night
Combination of “sativa” and “indica” . Contains aspects of both types and produces a mixture of effects.
Use as recommended by your healthcare professional.
“I’ve had a bad experience with cannabis and I’m afraid to use it again. What should I do?”
If you’ve had an unpleasant experience with cannabis before, it may have been because you are sensitive to the effects of THC. While THC may be used by patients with various medical conditions, some patients may experience undesirable effects from cannabis products high in THC.
What do THC and CBD do?
The amounts of THC and CBD vary in different dried cannabis and cannabis oil products. THC binds to receptors in the brain and central nervous system. THC is the main psychoactive component of cannabis. There is evidence to support its efficacy in a variety of medical conditions and symptoms.
CBD affects how brain receptors send and receive signals to communicate throughout the body. CBD is non-psychoactive. CBD may help counteract the effects of THC, so if you are sensitive to THC you many want to choose products higher in CBD.
What causes the effects of cannabis?
The cannabis flower produces chemicals called “cannabinoids”, which include tetrahydrocannabinol (THC) and cannabidiol (CBD), and other chemicals called terpenes (which add flavour) and flavonoids (which add colour). It is thought that all of these chemicals work together in the body to create what scientists call an “entourage effect.” This effect is present in dried cannabis, and in cannabis oil that maintains a full cannabinoid and terpene profile.
How does cannabis work?
Cannabinoids like THC and CBD interact with a natural system of receptors throughout the body called the “endocannabinoid system” to provide the effects that patients look for in managing their symptoms.
The endocannabinoid system is responsible for many normal functions including:
Which types of products are included in 2.0 legalization?
Here are the medical cannabis categories that have been legalized:
Medical cannabis extracts include a variety of products that can be produced when the medical cannabis flower is processed into a concentrated liquid or solid form (think medical cannabis oil, vape, shatter and hash).
Extracts may legally contain a maximum of 1000 mg of THC per immediate container, while there is no limit for CBD.
Because certain cannabis extracts contain a high concentration of THC, Health Canada recommends starting with one or two puffs of a vape or joint with 10% (100 mg/g) or less THC.
Creams And Lotions
Topical medical cannabis products are infused with cannabis extracts and designed for external applications (think lotions, creams and oils for hair, skin and nails).
Medical cannabis extracts are applied topically, so the effects will generally only be felt locally on the area the product is used.
Topicals may legally contain a maximum of 1000 mg of THC per immediate container, while there is no limit for CBD.
Edible medical cannabis products are foods and beverages that have been infused with medical cannabis extracts (think chocolate, cookies, tea and soft chews).
The maximum THC each immediate container of edibles may legally contain is 10 mg, while there is no limit for CBD.
Because the onset of effects can be delayed, Health Canada recommends looking for products that contain 2.5 mg of THC or less.