There is a certain irony for me in this topic. I have a history of choosing poor names for my companies, and while in the early 2010s I thought that inhaleMD was a good way of avoiding pigeon-holing myself as a cannabis doctor (I actually thought it would sound like a pulmonary clinic) I guess I wasn’t actually fooling anybody. However, it did reflect my view at the time that most cannabis treatment should be done via inhalation. I’ve come a long way, baby, since then and so have the scientific data.
When I first started in this field, I typically recommended inhalation about 75% of the time and oral ingestion (gummies) about 25% of the time. My thinking, following the data and over 12 years of clinical experience, as completely reversed those numbers. Now it’s almost always oral ingestion and less commonly inhalation.
However, inhalation most definitely has its place and we’ll discuss its role and the decision-making process here.
Decision Making
Contrary to the advice you’re likely to be given at the store or by a friend, the way you take cannabis should be chosen, not by personal preference, but by what is going to work best for the illness we need to treat.
Like most medications, cannabis behaves differently depending on how you take it. In the hospital or emergency room we often give medications by IV because they work faster that way. However, we often give the same medication by mouth when the patient goes home since rapidity is no longer paramount, and in fact, longer duration of action becomes more important to the treatment. We need to use the method that is most likely to lead to the benefit we seek.
Additionally, some routes of administration pose greater risk to the patient and that risk factors into the decision-making.
Oral Ingestion (Taking Gummies by Mouth)
Taking a gummy is familiar to almost everybody – it’s pretty similar to taking a pill. In fact, some gummies are small enough you could swallow them whole. When you take cannabis by mouth, like any other pill, it takes a while to kick in. This is usually about an hour, which again, is like most other medications. Cannabis can be a bit more unpredictable due to generally poor absorption, but is generally useable.
A nice benefit of oral ingestion is that, once absorbed from the gut, it visits the liver first (this is called First Pass Metabolism) where the active ingredient that you took (delta-9 THC) is converted into another chemical called 11-hydroxy-THC. 11-hydroxy-THC works longer and so we get better coverage for the symptoms we’re addressing.
I think of orally ingested cannabis (aka gummies) as the long-acting form of cannabis. It’s particularly good for chronic problems like pain, mood, insomnia, and appetite stimulation.
Another important benefit of oral ingestion is safety. Dosing cannabis properly, just like any other medication, is key to getting the benefit but also to remaining safe. When using gummies that are, say, 5 milligrams each the dosing is pretty simple. If you’re supposed to take 10mg, then you need to take 2 gummies. It’s pretty rare for someone to accidentally or mindlessly take more than a set number of gummies. This helps prevent overdoses and, more importantly, unintentional dose escalation over time.
When Would You Want to Use Inhalation?
Inhalation has its uses! When necessary, there’s no other way really. Let’s remember that when I talk about inhalation I mean vaporized whole flower, not smoking nor vaping which unnecessarily expose you to nasty toxins and heavy metals.
The main use-case for inhalation is acute or episodic problems where the rapidity of onset of the medicine is of paramount importance. Thankfully, this isn’t that common. A good example is a Migraine headache or acute nausea and vomiting. In those cases, getting effective medication working as fast as possible is best. In neither case do you want to take a gummy and wait an hour or so. Inhalation starts to work in about 10 minutes.
On the other hand, inhaled cannabis works for a relatively short period of time, about 3-4 hours. Again this is good for a headache since after the headache abates, we’d like the medicine to wear off too. However, this makes it lousy for those chronic problems I listed in the oral ingestion section above. In fact, for example, using a short-acting medication for chronic pain can actually make the pain worse. Our brains, wily critters that they are, will often learn when the medication is going to wear off and exacerbates the pain when it comes back. Hence, long-acting medications are better.
There are other downsides to inhalation as well. Clearly there is some start-up cost to getting a good vaporizer machine, and there is a bit more process to filling, using, and maintaining the machine.
More important, however, is the risk associated with inhalation compared to oral ingestion. Dosing by inhalation can be done quite precisely and I teach my patients how to do so. But, it requires paying attention and the discipline to adhere to the regimen exactly. While taking, say, two gummies is pretty obvious, taking 2 puffs on the vaporizer feels less obvious. This leads to the very real possibility that 2 puffs becomes 3 puffs and then over time becomes 4 puffs and so on. It’s quite common for someone who should be on 2 puffs to suddenly find themselves at 5-6 puffs (which is clearly 3 times the intended dose). Risk of accelerating tolerance, dependence, and even addiction rise once over 4 puffs. With inhalation it’s just easier to exceed the regimen and to exceed the safe range.
The Bottom Line
Gummies, or orally ingested cannabis medicines, are usually the right answer (despite the name of my practice). Inhalation definitely has its place, but it’s less common than one might think. Since dosing and adherence to the plan is critical to getting best and safest results, inhalation poses some additional risk. Regimens should be tailored to the medical needs of the patient, which includes assessment and discussion of risk.
Consult with a Qualified Massachusetts Medical Marijuana Expert Today
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically.
Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them.
For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.