Patient Education
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The information below is also provided in a printable PDF version that can be used for cannabis education purposes:
What is the Endocannabinoid System?
The endocannabinoid system (ECS) can be viewed as a lock and key
system, providing the foundation for how cannabinoids interact with our mind and body. The ECS acts as a regulator of all bodily systems, including, but not limited to those that regulate sleep, mood, appetite, memory, and reproduction, working to bring the body into balance or homeostasis.
The ECS is made of two main receptors located across the body, the CB1 and CB2, which act as “master conductors” of signals throughout the whole body, intuitively delivering cannabinoids to the parts in the body that need them most. Cannabinoids exist within the body already, and are called endocannabinoids. Using cannabis introduces phytocannabinoids to the body via the ECS. Yes, the body and cannabis both produce cannabinoids!
Components of the Cannabis Plant
Cannabis is a complex plant with various components that contribute to the flavor, aroma, and effect of various cultivars (commonly known as “strains”). These components include:
Cannabinoids
Join to the CB1 and CB2 within the body (i.e.THC and CBD)
Terpenes
Produce flavor, aroma, and various therapeutic and medicinal effects
Flavonoids
Influence the color of cannabis with a few therapeutic properties
Thiols
Believed to be what provides the “skunky” smell of cannabis
Aldehydes
May influence terpenes by chemically changing their makeup
Esters
Provide some fruity flavors and may modulate and mitigate the effects of terpenes
Cannabinoids in Cannabis
While there are potentially over a hundred phytocannabinoids in cannabis, the following can commonly be found in products at medical cannabis dispensaries:
THC (Tetrahydrocannabinol)
Most commonly known for the psychoactive and medicinal effects
CBD (Cannabidiol)
Non-intoxicating cannabinoid with various medicinal benefits to bring homeostasis
CBDA (Cannabidiolic acid)
The un-activated precursor or rawform of CBD with various medicinal benefits
CBC (Cannabichromene)
Believed to interact with CB1 & CB2 differently than other cannabinoids
CBG (Cannabigerol)
Commonly found in high-CBD cultivars with potential medicinal benefits
THCA (Tetrahydrocannabinolic acid)
The un-activated precursor or raw form of THC with various medicinal benefits
CBN (Cannabinol)
Occurs when THC oxidizes (is exposed to air) or when cannabis ages
Why Are Terpenes Important?
Terpenes are responsible for the various flavors, aromas, and effects of different cultivars (“strains”) of cannabis. Terpenes are the aromatic compounds found in the essential oils of all plants and hold various therapeutic and medicinal properties.
*Much of the research on terpenes as they exist in cannabis is preliminary, however, terpenes have been researched for centuries for their medicinal and therapeutic properties and effects.
Myrcene
Flavor: Balsam Peppery Spicy
Medical Benefits: Sedative, pain relief, antimicrobial, antioxidant
Found in: Thyme, mango, lemongrass, ylang-ylang, parsley, hops, verbena
Limonene
Flavor: Citrusy Sweet
Medical Benefits: Anti-anxiety, antioxidant, anti-inflammatory, anti-tumor
Found in: All citrus fruits
Linalool
Flavor: Spicy, sweet, floral, woodsy, citrusy
Medical Benefits: Sedative, anti-anxiety, opioid addiction, anti-inflammatory, anti-convulsant
Found in: Lavendar, citrus, birch, coriander, rosewood
Alpha Pinene
Flavor: Piney, woodsy, earthy
Medical Benefits: Anti-inflammatory, bronchodilator, focus, memory
Found in: Basil, cedar, pine needles, parsley, orange rind
Humulene
Flavor: Woody, hoppy
Medical Benefits: Anti-inflammatory, antibacterial, insect repellant, anti-tumor
Found in: Hops, sage, balsam fir
Beta Caryophyllene
Flavor: Peppery, spicy, woody
Medical Benefits: Pain relief, anti-inflammatory, digestion, alcoholism support
Found in: Black pepper, cloves, hops, basil, oregano, rosemary
Nerolidol
Flavor: Woody, waxy, citrusy, floral
Medical Benefits: Sedative, neuroprotection, antibacterial, antifungal
Found in: Jasmine, tea tree oil, lemongrass
Geraniol
Flavor: Sweet, floral, fruity, citrusy
Medical Benefits: Pain releif, anti-inflammatory, insect repellant, antibacterial, antifungal
Found in: Rose, lemongrass, peaches, blackberries, citronella
The Entourage Effect
The Entourage Effect describes the interaction of cannabinoids and terpenes within cannabis, with the idea that these compounds create greater effect on the body while working together than working separately in their isolated form.
“2 + 2, instead of equaling 4, it gives you an 8 in terms of the benefit.”
– Dr. Ethan Russo
It’s suggested that terpenes need to be in concentrations of 0.5% or higher to have pharmacological benefit.
Factors that Affect the Cannabis Experience
Everybody is different and every BODY is different. Therefore these aspects may impact how cannabis is experienced within the body and mind:
THC:CBD Ratios
Medical cannabis patients can choose various cannabinoid ratios in products, which may affect the level of psychoactivity or intoxication from THC:
THC:CBD Ratios
While tolerance levels vary, products are available in various milligrams of THC, dictating the psychoactive/intoxicating effect:
Low: 2.5mg-10mg
Medium: 10mg-25mg
High: 25mg-50mg
Patients who are looking for a targeted cannabis experience for a medical condition are advised to explore various cannabinoid ratios, potencies, and terpene profiles.
How Do Methods of Consumption Differ?
There are many ways to consume cannabis other than smoking it. However, not all methods of consumption will result in the same experience with the plant, and it is important that the medical patient know the differences between onset, duration of the effects, and what mechanisms are used for each method. Here we will break it down:
Inhalation
Onset: Immediate to 15 minutes
Duration: 2-4 hours (or more)
Administration: Joint, bong, pipe, vaporizer, concentrates
Tips: Inhale a few puffs and assess how you feel before inhaling more. Remember that concentrates can pack a big punch in terms of potency.
Oral (Edibles)
Onset: 45 minutes to 3 hours
Duration: 4-8 hours (or more)
Administration: Chocolate, candy, infused foods, beverages, capsules
Tips: Edibles affect everyone differently due to the different enzymes in our stomach that break things down. Start low and go slow, and ensure adequate time has passed before dosing again.
Sublingual (Under the Tongue)
Onset: 15-60 minutes
Duration: 2 to 8 hours (or longer)
Administration: Oil sublingual strips
Tips: Be sure to use an incremented dropper to be able to understand your dose and titrate (adjust) as needed. Be weary of using alcohol-based tinctures sublingually as it may burn.
Topical
Onset: 15-60 minutes
Duration: 2 to 8 hours (or longer)
Administration: Cream, ointment, salves & balms, moisturizer, serums
Tips: Some topicals will have different absorption rates or levels of bioavailability. It is best to look at the ingredients of topical products and understand manufacturing processes that increase absorption.
Transdermal
Onset: Variable (onset and effects may vary)
Duration: 24-72 hours depending on the patch and time-release technology
Administration: Patches
Tips: Patches that have time-release technology are ideal for long lasting effects and relief. Look for time-release technology for an even and balanced experience.
Suppository
Onset: 15-60 minutes
Duration: Up to 8 hours depending on cannabinoid content
Administration: Vaginal, Rectal
Tips: Insertion can be difficult – try a few different methods and read up on helpful tips on using suppositories.
Remember that cannabis can affect everyone differently, with a variety of factors that may impact the experience and outcomes. Be open to trying different cultivars (“strains”), products, doses, and methods of administration until you find what works for your desired outcomes.
Getting the Most From Your Medical Cannabis Experience
Here are a few tips to help ensure you achieve some of your intentions for using cannabis medicine:
1. Try different methods, doses, and cultivars
2. Journal your experiences with different products/doses and share with your doctor
3. Understand the terpene content of various products
4. Counteract too-powerful effects of THC with CBD
5. Don’t over consume cannabis products or take higher doses than needed (be patient)
6. Empower yourself by educating yourself on the emerging research
Consult with your doctor before using cannabis medicine to ensure that there are no interactions between cannabinoids and prescribed medications.
