CRx MAGAZINE

Winter 2020

Cooking With Cannabis

Culinary use of cannabis is trending. Here’s what you need to know to help your patients cook up edibles for therapeutic use.

The rapidly expanding legal medical and adult use cannabis markets have increased the type and variety of commercially available cannabis products. As the availability of these products increases across the nation, so do the many different ways consumers choose to consume cannabis.

The most common administration routes for consuming medical cannabis include sublingual absorption, topical absorption, inhalation, and oral ingestion. While all forms remain popular administration routes, one method is rapidly emerging as a societal trend for medical and adult use cannabis consumers alike: the culinary application.

From brownies to gummies, candies to teas, the culinary applications of medical cannabis are limitless and of great interest to both distinguished chefs and the everyday cook. Oral consumption of cannabis is both discreet and long lasting, often proving to be the preferred method of administration for many medical cannabis patients.

Health care practitioners are aware that each cannabis administration route has unique characteristics that make it more or less appropriate for each specific patient and circumstance. They also know that certain application methods carry more risks than do others, especially the oral consumption, digestion, and metabolism of THC in the form of edibles or capsules.

It’s clinicians’ responsibility to have these important conversations with their patients long before they ultimately choose an application method that’s right for them. Consumers must be educated about the potential safety considerations with respect to oral consumption of medical cannabis, as cannabinoids such as THC can undergo a chemical transformation that may make stronger metabolites during the digestive process, with effects that may last longer compared with other administration routes.1

A stronger, longer effect is ideal when users are aware and dose appropriately, but conversely can cause serious health and safety considerations when this isn’t the case. People who use medical cannabis for long-lasting chronic pain or sleep disorders tend to prefer oral consumption because it lasts longer, and many find that they can consume less overall.2 However, those with less experience consuming THC or those with lower cannabis tolerance may struggle to find a happy medium with oral ingestion of cannabis without experiencing unwanted negative side effects.

It’s important for clinicians to be aware of considerations for cooking with medical cannabis and safety concerns and factors that affect the bioavailability of consumed cannabinoids. Furthermore, they must be able to provide practical nutrition recommendations to patients who combine cannabis with culinary medicine.

Culinary Considerations
Many consumers are already familiar with commercially available hemp-derived cooking products such as hemp seed oil and hulled hemp hearts, both of which are readily available in most grocery stores in America. While these products contain nutritive properties, they naturally don’t contain any cannabinoids.

Consuming raw cannabis and juicing the raw leaves of the cannabis plant is also gaining popularity as a “superfood trend” among those with access to fresh cannabis plants. Consuming cannabis in its raw form has many potential health benefits similar to those of other dark green leafy vegetables such as kale due to the plant’s rich source of phytonutrients, vitamins and minerals, terpenoids, and cannabinoid acids, all of which are believed to help maintain basic cell function. Conclusive nutritional analysis of raw cannabis is lacking, but that doesn’t stop patients from adding it to smoothies, juices, and more.

Many new medical cannabis users may not realize that raw cannabis consumed orally will provide little to no activated forms of THC or CBD. While raw cannabis contains nutrients and other potential health compounds, in its fresh raw state, it doesn’t naturally contain THC or CBD, the two most popular cannabinoids people typically expect to ingest when eating cannabis. This is because raw cannabis flower contains tetrahydrocannabinolic acid (THCA), a nonintoxicating substance that can only be converted into the intoxicating substance THC through the decarboxylation process.3

Decarboxylation occurs when cannabis is exposed to heat, light, cofactors, or solvents, all of which can be manipulated within the patient’s own kitchen. Decarboxylation also converts cannabidiolic acid (CBDA) into CBD, although both forms of this cannabinoid remain nonintoxicating in their respective states.

Without decarboxylation, patients may not experience the full range of beneficial health effects of cannabinoids such as THC and CBD. Before incorporating cannabis as an ingredient in various culinary applications such as cooking, baking, oil extraction, and more, it’s important to understand cannabis decarboxylation and why it must occur during the cooking process in order for consumers to experience the health benefits of THC and CBD.

Decarboxylation With Heat
A safe decarboxylation process is the first step any at-home cannabis cook needs to take before transforming medical cannabis into an oil, butter, tincture, or other preparation.

The key to decarboxylating correctly is to heat the cannabis flower at a low temperature over a long period of time to allow complete decarboxylation to occur without destroying the other beneficial plant matter such as terpenes and flavonoids. Patients can often do this in their kitchens by placing the raw cannabis flower on a sheet pan and baking it in the oven. It’s believed that the THCA in cannabis begins to decarboxylate at approximately 220° F after roughly 30 to 45 minutes of exposure, with full decarboxylation typically taking longer.4

For the more patient cook, skilled decarboxylation will take place at a lower temperature for a longer period of time based on the particular plant strain to preserve the volatile monoterpenes and sesquiterpenes that may possess potential health benefits of their own.5 There are few conclusive time and temperature recommendations available, with chefs having their own preferred time and temperature formula preferences. That’s because each cannabis strain is unique, containing different ratios of cannabinoids and terpenoids, making a generalized time and temperature recommendation a guess at best.

Once the raw cannabis flower has been decarboxylated, it can be used in a wide variety of culinary applications, much as dried herbs are used. Many patients, for example, will make their own tea or spice blends with their decarboxylated cannabis flower.

Decarboxylation With Fat
Cannabis decarboxylation with heat in a home kitchen may not be ideal for some patients due to the strong odor often associated with cooking cannabis. A more popular method is to decarboxylate cannabis in a slow cooker or on the stove by introducing heat and solvents, such as oil, to create an activated cannabis oil that can then be used in a variety of different application methods such as culinary recipes. These concentrated cannabis extracts are popular among medical and adult use cannabis consumers because they are versatile and relatively easy to prepare at home.

Using a plant-based cooking oil such as olive or coconut oil is ideal for medical consumers who want to make their own cannabis oil at home. When compared to other solvent extraction methods, including ethanol, petroleum, and naphtha extraction, olive oil was found to be the most appropriate choice for preparing cannabis oils for medical use. The cooking oil extraction method is preferred to other solvent extraction methods because it reduces the amount of toxic substances remaining after the use of solvent extraction methods such as ethanol.6

Making homemade cannabis oil with the fat and heat extraction method is relatively simple with a slow cooker or a stove-top water bath. To prepare the oil, the cannabis flower is added to a glass Mason jar and combined with the desired amount of olive or coconut oil, topped with a tight-fitting lid, and shaken well. The glass jars are then placed inside a large cooking pot or slow cooker, which is then filled with water to cover the Mason jars. Heat from the slow cooker or stove top is then gently applied at a low temperature, not to exceed 245° F, for up to eight hours. The amount of cannabis flower and cooking oil needed will vary depending on the strain of flower and the desired concentration of the final product. After the cooking process, the cannabis plant matter is strained and separated from the oil and discarded or repurposed. This leaves a concentrated cannabis oil that can be used in a wide variety of culinary applications.

For the advanced culinary cannabis connoisseur, the heat decarboxylation method is often combined with the fat decarboxylation method to ensure maximum cannabinoid activation and terpene retention.

Temperature Controls
Tight temperature control is important when using medical cannabis in culinary applications. While heat is needed to decarboxylate the acids into the active form of cannabinoids our bodies can use, extreme temperatures can destroy many of the important plant materials, such as terpenes, that contribute to positive health outcomes.5

Each individual terpene may have its own therapeutic health benefits, but also carries its own sensitivity to heat. Heating cannabis above 300° F runs the risk of denaturing many important plant compounds.7

Safety Considerations & Bioavailability
Combining medical cannabis with culinary applications presents important clinical considerations. For many individuals, the most difficult piece of the oral cannabis consumption puzzle is accurately assessing how the consumed product will affect the user and for how long the effects will last.

Dosing Accuracy
One positive consideration of the edibles that are obtained from a medical cannabis dispensary is that the products will have a label that clearly identifies the exact concentration of various cannabinoids, including CBD and THC. This is an advantage for patients because they’re able to accurately assess and track how much of each cannabinoid they will orally consume.

Unfortunately, even in medical dispensary settings, regulation of medical cannabis edibles and quality assurance varies greatly from state to state and is not always guaranteed. A study conducted in 2015 found that more than 50% of the products evaluated had significantly less cannabinoid content than labeled, with some products containing negligible amounts of THC.8

Patients who purchase raw cannabis flower from a dispensary and plan to cook with it at home face a similar dilemma. It will be nearly impossible to accurately assess the total cannabinoid concentration of the final product, making accurate dosing difficult without sending the final cooked product out for lab analysis. Both situations create the potential for the patient to underdose or overdose, which will ultimately prevent the patient from experiencing the desired medical benefits.

Additionally, it can be difficult and time consuming for patients to titrate to their ideal oral cannabis dosage because the onset of effects is delayed in comparison to sublingual, topical, or inhalation administration routes. Orally ingested cannabis is slower to take effect, with the typical onset ranging anywhere from one to two hours or longer. While the effects are delayed, they tend to manifest more strongly and last longer with peak onset of effects setting in between 1.5 and three hours post exposure. The effects can last anywhere from six to eight hours or more, the duration varying greatly from patient to patient.1

When working with patients, there are many strategies skilled clinicians can apply to ensure their patients don’t experience any unwanted side effects of consuming medical cannabis edibles. The most critical strategy is providing patients with the education they need to make an informed and educated decision. This includes having an honest discussion about the delayed onset of effects seen when orally consuming cannabis and a conversation about waiting through this time period before consuming any more cannabis to prevent any compound effects.

Clinicians must work with patients over time, as finding the ideal oral cannabis dosage can be a lengthy and time-consuming process for some individuals.

Cannabinoid Bioavailability
Cannabinoids that are introduced to the gastrointestinal tract through oral consumption have a 6% to 10% bioavailability rate. Once digested, delta-9-THC is absorbed into the bloodstream and travels to the liver, where it undergoes first-pass metabolism. During this process, enzymes hydroxylate delta-9-THC to form 11-hydroxy-THC (11-OH-THC), a potent intoxicating metabolite that crosses the blood-brain barrier, causing potentially unwanted side effects for many unknowing culinary cannabis consumers.2

There are many factors—including personal genetics, metabolism, body weight, and health conditions—that also affect the bioavailability of orally consumed cannabinoids and differ from person to person. This makes accurate dosing and assessment even more difficult. Both route of administration and individual physiological factors such as absorption and rates of metabolism and excretion can have an effect on the bioavailability of cannabinoids in culinary creations.9

Safety Considerations for THC Edibles
Patients preparing their own medicinal oils, butters, edibles, or capsules at home run the risk of experiencing an intoxicating or even hallucinogenic effect that’s unique to the oral ingestion of cannabinoids. When cannabis is orally consumed and then passed through the digestive system, cannabinoids eventually reach the liver, where they undergo what’s known as the hepatic first pass.

During this process, enzymes from the cytochrome P450 pathway in the liver hydroxylate delta-9-THC. While more than 40 different metabolites are formed from THC metabolism, 11-OH-THC poses a particular safety risk to patients due to its activity as a potent intoxicating metabolite.10 This magnified intoxicating experience can include disorientation or dizziness, short-term memory issues, slow reaction time, and drowsiness, especially for individuals who are unaware of the potential for such effects.

While this process takes place in all humans, unfortunately, due to the vast differences in everyone’s metabolism, it’s impossible to predict who will experience the effect and how strongly they will experience it.

A Multidisciplinary Approach
Securing or creating a cannabis edible is just the first part of the patients’ process in the culinary application of medical cannabis. Cannabis edibles help bridge the gap between plant-based medicine and plant-based nutrition and ultimately allow patients more control over their overall health.

This presents clinicians with an excellent opportunity to incorporate nutrition-based changes into the patient’s overall plan of care. Referring to a registered dietitian nutritionist can help the culinary cannabis consumer learn new ways to not only practice culinary cannabis but also manage and prevent chronic health conditions through the use of appropriate medical nutrition therapy interventions.

For many patients, cannabis is just one tool in their holistic wellness toolboxes. In order to see maximum therapeutic effects, other tools must be used in conjunction with cannabinoid therapy, including proper nutrition, good sleep hygiene, and positive social interactions. Combining a multidisciplinary team approach with medical cannabis and culinary application is ideal for optimal patient outcomes.

— Emily Kyle, MS, RDN, CDN, CLT, HCP, is a certified holistic cannabis practitioner.

References

1. Vandrey R, Herrmann ES, Mitchell JM, et al. Pharmacokinetic profile of oral cannabis in humans: blood and oral fluid disposition and relation to pharmacodynamic outcomes. J Anal Toxicol. 2017;41(2):83-99.

2. Barrus DG, Capogrossi KL, Cates SC, et al. Tasty THC: promises and challenges of cannabis edibles. Methods Rep RTI Press. 2016;2016.

3. Sirikantaramas S, Taura F, Tanaka Y, Ishikawa Y, Morimoto S, Shoyama Y. Tetrahydrocannabinolic acid synthase, the enzyme controlling marijuana psychoactivity, is secreted into the storage cavity of the glandular trichomes. Plant Cell Physiol. 2005;46(9):1578-1582.

4. Bennett P. What is decarboxylation, and why does your cannabis need it? Leafly website. https://www.leafly.com/news/cannabis-101/what-is-decarboxylation. Published April 30, 2016. Accessed November 4, 2019.

5. Tetali SD. Terpenes and isoprenoids: a wealth of compounds for global use. Planta. 2019;249(1):1-8.

6. Romano LL, Hazekamp A. Cannabis oil: chemical evaluation of an upcoming cannabis-based medicine. Cannabinoids. 2013;1(1):1-11.

7. Decarboxylation 101. CNBS website. https://www.cnbs.org/cannabis-101/cannabis-decarboxylation/. Accessed November 4, 2019.

8. Vandrey R, Raber JC, Raber ME, Douglass B, Miller C, Bonn-Miller MO. Cannabinoid dose and label accuracy in edible medical cannabis products. JAMA. 2015;313(24):2491-2493.

9. Bruni N, Della Pepa C, Oliaro-Bosso S, Pessione E, Gastaldi D, Dosio F. Cannabinoid delivery systems for pain and inflammation treatment. Molecules. 2018;23(10):E2478.

10. Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-1804.

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