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Food products containing cannabis extract edibles have emerged as a popular and lucrative facet of the legalized market for both recreational and medicinal cannabis.
The many formulations of cannabis extracts used in edibles present a unique regulatory challenge for policy makers. The most prominent difference between ingestion and inhalation of cannabis extracts is the delayed onset of drug effect with ingestion.
Consumers often do not understand this aspect of edible use and may consume a greater than intended amount of drug before the drug has taken effect, often resulting in profoundly adverse effects.
Written for the educated layperson and for policy makers, this paper explores the current state of research regarding edibles, highlighting the promises and challenges that edibles present to both users and policy makers, and describes the approaches that four states in which recreational cannabis use is legal have taken regarding regulating edibles. To provide a better understanding of the implications of increased use of edible cannabis products, we describe promises and challenges associated with use of cannabis-infused edibles and critically examine extant research on factors related to their use.
We have blended science and regulatory factors in order to provide an overview of edibles for the educated layperson and for policy makers. Although some of the issues discussed are relevant for other methods of cannabis use e. Further, our discussion primarily focuses on consequences of intentional use of edibles in adults.
Marijuana or cannabis is the most commonly used illicit drug in the United States, with 9. Further, the population of users is increasing, a finding that is associated with decreased perception of harm from cannabis use Johnston et al.
As additional initiatives to decrease or eliminate criminal penalties for possession of small amounts of cannabis are already pending in several states, this trend is likely to continue, at least in the short term. In , California became the first state to legalize medicinal use of cannabis. By April , 24 states and the District of Columbia had passed laws that allow medicinal use, and four states Alaska, Colorado, Oregon, and Washington had legalized recreational use, with several other states likely to vote on legalization later in The District of Columbia has decriminalized the possession of cannabis in amounts of 2 ounces or less but has not established a regulatory framework that allows for recreational cannabis sales D.
Although specific laws governing cultivation and regulating dispensaries vary across states Fairman, , most states distinguish between medicinal and recreational use of cannabis. Medicinal use of cannabis involves obtaining a prescription for cannabis from a licensed medical professional for treatment of a medical issue e.
Unlike medications approved through a formal data-driven process by the US Food and Drug Administration FDA , medicinal cannabis dosage is not specified. Possession of a medicinal cannabis card allows purchase, with details dependent upon state law e. Perhaps the largest area of difference between the two types of use is in the disparate regulatory requirements, including taxation. While medicinal and retail cannabis products are similar, regulations may vary between the two marketplaces.
Code Regs. While popular perception of cannabis use calls up images of smoking a joint or pipe, cannabis has been formulated to allow for other modes of administration, including oral and topical use. Edibles are food products infused with cannabis extract.
Edibles come in many forms—including baked goods, candies, gummies, chocolates, lozenges, and beverages—and may be homemade or prepared commercially for dispensaries. The extraneous plant material is then discarded. Recipes for using the resulting cannabinoid-infused oil abound on the internet and in various specialty publications. Cannabinoid-infused oil may also be purchased directly from many dispensaries and retail shops. Edibles have become popular among users in states where cannabis is legal for recreational or medicinal purposes or both.
For example, in Colorado in , 1. Because direct purchase of cannabinoid-infused oil or cannabis used to make homemade edibles is not tracked as an edibles purchase, the actual use of edibles is likely underestimated when examining purchase data. Furthermore, these data show sales but do not reflect the proportion of cannabis users who consume edibles. In addition, the extent to which the retail edibles were used by the purchaser or transferred to someone in another state for medicinal or recreational use is unknown.
Survey data can be used to determine an estimate of actual consumption of edibles, which account for a substantial percentage of current cannabis use in both medicinal and recreational user groups. In general, use of edible cannabis appears more prevalent in states that have legalized medicinal cannabis use, particularly those states that have had legalized medicinal use in place for a longer time, as well as in legalized-medicinal-use states with more dispensaries per capita Borodovsky et al.
In a nationally representative study of adults in the US, However, scientific evaluation of the accuracy of these perceptions is incomplete. The vast majority of research on the therapeutic efficacy of cannabinoids has been conducted using oral preparations formulated by pharmaceutical companies for the treatment of these conditions.
However, the increased state-level legalization of cannabis for medicinal or recreational purposes may serve as an impetus for funding additional high-quality studies on the effects of cannabis on health and in treatment of disease.
Despite initial support for the efficacy of oral cannabinoid medication, many medicinal cannabis patients prefer to smoke cannabis Grella et al. Further, in clinical trials of nabiximols, 80 percent of participants who reported adverse effects experienced these effects within the first 28 days of treatment, although incidence of adverse effects was reduced when dose was increased gradually reviewed in Robson, Both low and high doses 1.
By contrast, several double-blind studies report comparable subjective effects for dronabinol and smoked cannabis when dose and time after administration are taken into account Haney et al. Few laboratory studies have been undertaken using actual cannabis-infused edibles. Participants experienced drug effects that were rated as favorable, with peak responses occurring an average of 3 hours after ingestion and effects dissipating within 24 hours.
Physiological measures of drug effect i. Certainly, the continued use of edibles despite initial nonpreference by many users suggests other advantages of this route of administration. One of these advantages may be the longer duration of action for edibles Huestis, For medicinal cannabis users with chronic conditions, an extended duration of action might be helpful in the workplace because smoking cannabis in public is often still prohibited, even in states where medicinal cannabis use is legal e.
Code Ann. In addition, despite an overall increase in acceptance of cannabis, qualitative studies indicate that patients still report perception of stigma associated with its use Bottorff et al. Edibles avoid issues of odors and stigma because they can be consumed discreetly.
For example, medicinal users may choose to consume edibles during the work week and smoke or vape when not at work. Consumers may also favor edibles because they are easier to transport, particularly into states where their use is not legal.
One of the most significant factors in the decision to use cannabis-infused edibles is the perception that edibles avoid the harmful toxins and health risks that may be associated with smoking Murphy et al. Because the health risks associated with smoking tobacco are substantial reviewed in Center for Disease Control and Prevention, , the risks of smoked cannabis are often assumed to be similarly severe.
However, the accuracy of this assumption is unclear. Qualitatively, cannabis smoke and tobacco smoke seem similar in toxicity, given that both contain a variety of toxins and known carcinogens Moir et al. Although lung inflammation may predispose users to pulmonary infection, the degree to which these changes in lung function may lead to chronic pulmonary disease e.
At any rate, eating cannabis-infused edibles does not seem to affect pulmonary function or to increase cancer risk, which provides a solid rationale for choosing this route of administration as opposed to smoking cannabis, particularly for medical conditions such as cancer.
Yet use of cannabis-infused edibles is not without its own set of challenges. In addition to health issues that are likely confined to smoking cannabis, research has suggested that regular cannabis use may have detrimental effects on brain development, psychiatric health, and heart health Volkow et al. In the next section, we describe some of the challenges associated with use of edibles. Despite the potential promises of edibles for treatment of a variety of ailments, there are also dangers inherent in edible use that present challenges for users and policy makers.
Generally, in healthy adult users, psychotic symptoms brought on by an overdose of cannabis last only for the duration of intoxication, but in some cases, these symptoms can persist for as long as several days.
Factors directly related to the oral route of administration of edibles may contribute to this finding of a strong association between edible use and overconsumption. Edibles introduce cannabinoids through the gastrointestinal tract. Factors such as weight, metabolism, gender, and eating habits also contribute to how soon and for how long someone will feel intoxicated following oral ingestion Grotenhermen, ; Huestis, The lack of consistency and the delayed intoxication may cause both new and experienced users of cannabis to consume higher than intended amounts of the drug.
Edible products are responsible for the majority of health care visits due to cannabis intoxication, which is likely due to the failure of users to appreciate the delayed effects Monte et al. Similarly, dosage estimation for retail products may also be inexact e. Anecdotal reports from medicinal cannabis patients confirm that even daily users may consume a higher dose than expected Hudak et al. Patients reported that, having eaten the suggested serving size initially, they consumed the entire edible product after not feeling any effects.
They also reported that it was practical to consume the entire edible product in one sitting, just as they would a normal baked good Hudak et al. In order to minimize risk of accidental overdose, it is recommended that users of edibles gradually up-titrate their dose until they find an effective dose. Another concern surrounding the use of edibles is that some products available for retail sale are packaged to resemble commercially available products in forms that may be appealing to children e.
A review of data from the National Poison Data System from to found that decriminalization of cannabis was associated with increased reports of unintentional exposures in young children up to 9 years of age; Wang et al. Cannabis-related calls to poison control centers in decriminalized states increased by In contrast, the rate of cannabis-related calls to poison control centers in nonlegal states showed an average increase of only 1. However, despite the increases in calls to poison control centers, emergency room visits resulting from pediatric exposure to cannabis remain relatively low, even in decriminalized states.
In , the same emergency department treated eight children mostly under the age of 3 who ingested edible cannabis. The number increased to 14 children in Baskfield, Another emergency department in Colorado showed an increase in visits from 0 percent to 2.
Not unexpectedly, ingestion was the most common route of exposure resulting in most of these emergency room visits Wang et al. In addition to emergency room visits by children, the number of cannabis-related emergency room visits by adult non-Colorado residents compared with those by in-state residents has also increased since recreational cannabis use was legalized in Colorado.
Out-of-town patient visits to a hospital in Aurora, Colorado, for health issues following consumption of edibles almost doubled from 85 per 10, visits in to per 10, visits in ; statistically significant differences were not observed for Colorado residents during the same time period Kim et al.
Reports of inadvertent ingestion of cannabis edibles by adults are widespread. For example, a group of preschool teachers in California experienced nausea, dizziness, headache, and other symptoms after consuming brownies containing cannabis. One of the teachers had purchased the brownies from a sidewalk vendor and placed them in the breakroom Fogleman et al.
In focus groups with teenagers, females who did not use cannabis expressed more concern than female cannabis users and males users and nonusers about edibles and compared them to drinks that could be spiked with drugs Friese et al. Tragically, at least one death has occurred following ingestion of an edible cannabis product. However, having not felt intoxicated within 60 minutes, the man ate the whole cookie within 2 hours of ingesting the initial serving.
Similar requirements are in place for Washington State Wash. Another challenge related to edibles is the perception that they represent food products containing cannabis, when in reality the cannabis extracts used to produce edibles can be very different from the actual plant material used for smoking.
Myriad techniques are used to extract cannabinoids from the cannabis plant in a form that can be integrated into the countless forms that edibles can take, resulting in considerable variation in the amount and homogeneity of cannabinoids that make it into the final products. The cannabis plant contains hundreds of chemical constituents, including around cannabinoids Radwan et al. Other cannabinoids, most notably cannabidiol CBD , are believed to modulate these effects Russo, ; Schubart et al.
Yet, despite evidence of the value of including CBD in edibles, especially those intended for medicinal use, few edible manufacturers report the CBD content of their products. Further, even among products reported to contain CBD, many contain only trace amounts or none at all Vandrey et al.
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Food products containing cannabis extract edibles have emerged as a popular and lucrative facet of the legalized market for both recreational and medicinal cannabis. The many formulations of cannabis extracts used in edibles present a unique regulatory challenge for policy makers. The most prominent difference between ingestion and inhalation of cannabis extracts is the delayed onset of drug effect with ingestion.
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Your email address is used to log in and will not be shared or sold. Read our privacy policy. If you are a Zinio, Nook, Kindle, Apple, or Google Play subscriber, you can enter your website access code to gain subscriber access. Your website access code is located in the upper right corner of the Table of Contents page of your digital edition. Sign up for our email newsletter for the latest science news. And while the best CBD oil and tinctures are an excellent way of delivering this plant-based medicinal supplement, it might not be as appealing to first-time users as, say, a sour gummy worm. Keep in mind, you may feel lighter or delayed effects when you opt for an edible form of CBD rather than a sublingual under-the-tongue delivery. This is because medicine taken sublingually is able to get to the bloodstream more directly. In the digestive process such as when you eat a gummy , things tend to move a little more slowly. Hot tip: this can be a great tactic if you have issues with night waking or staying asleep.
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