Cannabis is medicine — don’t make it taste good

Peter Grinspoon, MD

Contributing Editor

Most of the clinical fiascos I’ve seen and heard about associated with cannabis consumption have involved the use of cannabis edibles, going back to the days when two bohemian college roommates visited Amsterdam, took two “space cakes,” waited 30 minutes, took two more, and spent the next 20 hours clinging to each other and hiding in the closet. I asked, “How was Amsterdam?” In unison, they replied, “We don’t know.”

I was surprised recently to be accused of “reefer madness” when I suggested, on Twitter, that cannabis shouldn’t be formulated into gummy bears or other succulent treats that a young child or a pet could gleefully over-consume. According to my logic, if cannabis is, or can be used as, a medicine, one should make it look and taste like a medicine. If we wouldn’t put ibuprofen into a candy, why would we put a psychoactive substance like THC into a chocolate bar? To me this is a no-brainer, but some people appear to take any limitation on their inherent right to consume medicine (or get stoned) by eating a gummy bear quite seriously.

Edibles have fueled the debate about cannabis safety

The topic of cannabis edibles is a flashpoint in the debate over how cannabis should be legalized and regulated, with arguments of personal freedom and responsibility clashing with concerns for public health. As with many things cannabis-related, the issue is highly politicized, and usually, when a new study comes out about some cannabis-related benefit or harm, such as levels of teenage usage, crime rates, medical uses, or driving statistics, there isn’t consensus on either the validity of the data or the implications of the data. It can be difficult to get a clear picture of the true benefits and dangers of cannabis.

Availability of edibles and emergency room visits

A recent study in the Annals of Internal Medicine discussed ED visits that were “deemed at least partially attributable to cannabis,” meaning that other conditions and factors could have been contributing to the admission. The study authors suggest that visits for cannabis edibles in the ED have been steadily rising in Colorado as a consequence of legalization of cannabis. Another explanation for the perceived increase in cannabis-related ED visits is that with legalization, patients are finally able to state the true reason they are in the ED without fear of getting in trouble with law enforcement or social services for using an illegal drug.

Personally, I believe the premise that ED visits are up for cannabis, in part because of the availability of edibles, and because of the many anecdotal stories I have heard through lifelong involvement with this issue. For example, an acquaintance, who is trying to be open-minded about a family member who uses medical cannabis, consumed that family member’s THC-infused medicinal chocolate bar which he found, unmarked, in the fridge, and ended up in the emergency department with a panic attack. This should never happen. By leaving a medicated but unmarked edible lying around, you put someone else’s well-being at risk. What if that person tried to drive? Then even someone else could have been harmed. The same goes for cannabis-infused barbecue sauce, pizza, honey, etc. I would suggest that these items are intrinsically too dangerous, in terms of accidental or incidental risk to others, to market and sell.

On social media, some people defend this type of risk, or the risk of exposure of a small child or a pet to some cannabis-infused treat, by saying, most commonly, “People should be responsible,” “A few irresponsible people shouldn’t ruin it for the rest of us,” or “Parents should just not leave it out around their kids.” Not to be cynical, but after practicing as a primary care doctor for 25 years, I can say with confidence: not all adults act like responsible adults. Also, even responsible adults can make mistakes. Any unmarked “spiked” consumable risks the well-being of anyone who is not aware of that fact.

Edibles are not for novice cannabis users

The main benefit of cannabis edibles is that they are long-acting — up to 12 hours — which can be helpful for chronic pain or chemotherapy patients. But the long-acting nature of edibles can also explain some of their menace: if you have consumed too high a dosage, you are stuck with it for a long time, and, if this is causing a panic attack, it can be extremely uncomfortable. It also can be difficult to gauge one’s dose correctly, as edibles can take from 30 to 200 minutes to kick in, and people often make the mistake of re-dosing too early, leading to an over-dosage and a miserable experience.

Edibles don’t always have the same effect every time

Edibles take effect more rapidly on an empty stomach, and their absorption depends on the amount of fat in your last meal. They aren’t always labeled accurately in dispensaries and, when cooked at home, the cannabis isn’t always evenly spread throughout the brownie batter. The effects of edibles are chemically different from that of smoked cannabis, because orally consumed cannabis passes more directly through the liver (versus the lungs) and the THC, which causes the high, is chemically converted to a different cannabinoid, called 11-hydroxy-THC, which has a different, and potentially stronger, psychoactive effect.

What if you’ve unknowingly consumed too much?

In clinic, with medical cannabis patients, I try to steer clear of problems with edibles altogether by advising all but the most experienced cannabis users to flat-out avoid them, and by reminding all patients to “start low and go slow.” If a medical or recreational cannabis user finds oneself in the unenviable situation of having consumed too large a dosage of a cannabis-containing edible, the best practice is to sit in a calm, quiet place, practice some mindfulness, hold the hand of a friend, drink plenty of water, try some CBD if you have it (which may antagonize the effect of the cannabis). Many people believe that consuming CBD helps negate the effects of THC, but this has not been definitively proven. Remind yourself that this will wear off, and you will be fine. This method almost always works. However, if you start to develop a full-blown panic attack, difficulty breathing, chest pain, or start having any unusual psychiatric symptoms, you must at that point consider having a friend take you to the emergency department.

If it can be used as a medicine, make it look like a pill

I believe there are a few sensible regulations that would reduce the problems caused by cannabis edibles: make them look and taste like medicine, in pill form, in pill bottles, with specific labeling that specifies exact dosages and with childproof packaging. This could go a long way toward helping us protect our pets and our kids, as well as those who find a benefit from cannabis and those around them. Sensible regulation of edibles may move us toward finding a larger patch of common ground on which to construct future cannabis policies.

Comments:

  1. Jack Jackson

    Edibles, far and away, have proven to be the easiest and most consistent way for me to consume my small doses of medical cannabis each day. Please, please, please do not try to take them away! Massachusetts already has strict requirements for packaging and labelling designed to protect the children and others. The rest is up to responsible adults to store their cannabis products safely. And yes, some people are not responsible. We will never be able to legislate our way out of that.

  2. Kingofterps

    What’s so wrong about cannabis for adults that tastes good? Do you feel the same way about alcohol that tastes good? Both should be kept away from children like a thousand other things….

  3. Carl Shulgin

    I am required to eat upwards of 20 cannabis cookies daily to relieve my diverticulosis. I’ve tried oils, they don’t have the same effect.

    Eating the cannabis mass itself, with activated cannabinoids, is the solution.

    So, I ask you this… how am I to make these cookies “unattractive” to children, and edible to myself, at the same time?

    I have to choke down upwards of 20 of these a day, and people have remarked that my cookies are among the tastiest they’ve ever had.

    Nothing tastes “great” after having eaten thousands of them, though.

    Considering I already have problems with eating, both in terms of the action itself, and in terms of appetite from stomach problems, what would be your solution to this thorny problem?

    • Peter Grinspoon, MD

      These days, there are a wide variety of options for consuming medical cannabis (in a state where it is legal), including pill form (why wouldn’t this work?), vaporization, sublingual drops, tinctures, inhalers, topical patches, suppositories, etc.; it’s hard to imagine that a cookie is the only delivery option!

  4. EnlightenedQ

    The most powerful public comment we responded to while forming regulations in my state came from a father of three veteran with a shattered pelvis. He said “do you know what my medicine used to look like? Stickers. You know what it came in? A box” He then brought all three kids up to talk about Daddy’s medicine is only for those who need it. The woman who followed him reported the 1252 (number slightly estimated as this was 4 years ago) children that had died eating colorful detergent bubbles. We also had plenty of people talk about their terrible experiences on antidepressants where they were not told to stop their medication due to side effects, such as suicidal ideations, being “normal”. Overregulation will never substitute for adequate education and our public servants as well as our doctors are not educated nearly enough, nor by the right people. Holistic health is just that… It’s not a crusade against candy, it’s an understanding of the root causes of conditions and the therapeutic approaches one can take depending on their need for specific bioavailability and biodelivery routes. Can we stay focused, please?

  5. Yan

    I 100% agree your points.
    But, unfortunately, cannabis-food isn’t industrial product, it is the product of policy…….

  6. James Hayashi, MD

    Uhm you can get bubble gum flavored ibuprofen at any Walgreens or Target, maybe you need to get out more.. Edibles have been a big problem but Colorado is mandating that suppliers need to have strict quality control of products and the oral dose cannot exceed 10 mg. Yeah you get a different effect on an empty stomach but this is true of almost all meds. Being a cancer survivor I found inhalants give you a wild dosage spike and oral medication actually gummies worked best.

  7. TJ Doogan

    I am not a doctor or have any fancy degree but i do work in the industry in Colorado and would disagree with this article in a few ways. Edibles started as putting cannabis material in to an oven with cake, brownie, or rice crispy for a yummy treat that would get you very high depending how much you took. Yes that could be scary but it has come such a long way since 2012. As we are still developing and learning how the different doses effect different people. It is up to the budtenders and different stores to be educated and want to educate the tourists or the first time users on proper doses. Legalization and edibles has been great as they stopped doing the whole sour patch kid gummies and gummy bear infused and moved to just squares or drops with THC marks on them. Many people use cannabis for recreational reasons also and love the exotic flavors and types of “adult candy.” Have some self control not to eat the whole bar. Furthermore they do make tablet forms of THC and CBD and they are very properly dosed with percentages but it is often cheaper to go purchase the gummirs as to extract and infuse the cannabis into the pill form is more costly than a gummy. Either way lots and lots of research and regulation still needs to be done but Colorado has done a great job for starting the path.

    • Peter Grinspoon, MD

      Thanks for sharing your thoughts. It’s a balance, but I’d put the safety of kids and pets over ‘people enjoying the exotic flavors and types of “adult candy.”‘ Also, bud tenders aren’t very rigorously trained, and don’t always make the right recommendations for cannabis naive people.

  8. Judy Siano

    Any anecdotal evidence that CBD helps ALZ?

    • Peter Grinspoon, MD

      I read a study the other day about how CBD is neuroprotective and, theoretically, could protect against ALZ, but this was based on an animal model, and these, sadly, often don’t translate into humans with respect to ALZ. Clearly needs more study, sooner rather than later.

  9. Patricia Frye, MD

    I spend an inordinate amount of time teaching patients that sugar and processed foods are inflammatory. Why would I suggest that they eat a Rice Krispie Treat to treat their pain?

  10. Larry

    Cough medicine, daily vitamins, Tums, Benadryl, the list goes on and on. Medicine and nutritional supplements have been made to taste good forever. Arguments about cannabis safety are all nonsense at this point.

    • Peter Grinspoon, MD

      I think it can be dangerous to make ANY meds, supplements or vitamins taste appealing to kids…

      • Dusty

        Yes, it could be. However that does mean it shouldn’t be legal. There are and have always been alcohol products that are highly appealing to kids. When I was young I ate a whole bottle of Children’s asprin BC it was delicious. Advil has a sweet candy coating. The point is it’s up to companies and parents to properly and compliantly package and store cannabis products, as well as teach their children.

  11. The Cannabis Geek

    I’m a recreational user and enjoy the playful nature of fancy edibles. There are plenty of bigger threats to kids which we tolerate, so before you trample on my freedoms I want to see you calling for alcohol to be illegal, guns to be illegal, and how about junk food? How about airplanes? Just ride a bike everywhere if you care about harming kids.

  12. azure

    you could say the same about large pickups (or most motor vehicles), their lack of visibility of small children (people in large pickups seem to back over children they know fairly often), ATVs (young children regularly injure themselves riding them), or motor vehicles altogether—emission of particulates & compounds that make children living w/in 100′ of a busy road far more likely to develop asthma and once having done so, to experience exacerbations of asthma.

    • Peter Grinspoon, MD

      Just because other things are dangerous for kids doesn’t mean that edibles aren’t…

      • azure

        My point is if you believe it’s important to regulate cannabis edibles, why are you (or other MDs) not also arguing for more pollution control measures? Air pollution and say, TCDD, pthalates are far more ubiquitous then pot edibles, and as or more hazardous to children (and adults).

      • Peter Grinspoon, MD

        I know many physicians who work on environmental issues. In fact, I spent 5 years working at Greenpeace before medical school. But, I’m not clear what this has to do with cannabis edibles. I’ve also worked against nuclear weapons, which can end civilization, but that doesn’t mean that edibles aren’t problematic…

  13. Steve Stacey

    Thanks for this important post! Health Canada is currently developing policies for our country’s legalization of edibles. Your article’s suggestions are not denying people the opportunity to benefit from ingesting cannabis orally – only from simultaneously enjoying it as a food treat. Eating food and taking cannabis orally are not hand-in-glove by any means, and keeping them separate makes total sense.

  14. Sherry Hewins

    I agree with you. Before all this legalization kicked in, I had a very bad experience consuming too many pot brownies. I was a pot smoker, but this was not fun.

    I think it would be somewhat better to put in in gummies, but have them in a labeled bottle, like they do gummie vitamins. Definitely not a chocolate bar, way too easy for even someone who knows what it is to eat too much.

    I have seen a dog that had consumed marijuana, and it was truly frightening. We thought he had some kind of neurological damage until we figured out what happened.

Post a Comment:

This blog aims to provide reliable information as well as healthy dialog about the topics covered. We do not provide responses to personal medical concerns nor do we endorse any recommendations offered in the comments. We reserve the right to delete comments for any reason, particularly those that do not relate directly to the contents of this post, are commercial in nature, contain objectionable or inappropriate material, or otherwise violate our Privacy Policy. Promotional URLs will be removed from comments. Comments on this blog do not represent the views of our editors or Harvard University, and have not been checked for accuracy. All comments submitted to this site become the non-exclusive property of Harvard University.