Eating a marijuana brownie metabolizes the weed differently than smoking a joint, which means the same bud could have different effects when eaten than it does when smoked. It also takes longer to feel the effects after ingesting the drug than it does after smoking it, which often leads newcomers to eat too much, thinking they aren’t getting anywhere. As drugs go, especially naturally occurring drugs, marijuana is one of the most complicated. Made from the cannabis plant, it contains more than 113 active ingredients, called cannabinoids. These cannabinoids all affect the body in some way, and not always in the same way.
Have treatment resistant PTSD defined as meeting DSM-5 diagnostic criteria for PTSD after failing on, or being unable to tolerate, Health Canada-approved medication or empirically supported psychotherapy for PTSD of adequate dose and duration, as determined on a case-by-case basis by the site investigators. The purpose of this study is to evaluate the safety and efficacy of vaporized cannabis in participants with chronic, treatment-resistant posttraumatic stress disorder.
In the first study, heavy chronic daily cannabis smoking (average 10 joints/day for average of 12 years) was associated with reversible and regionally selective downregulation (20% decrease) of brain cortical (but not subcortical) cannabinoid CB1 receptorsReference 501. In the second study, cannabis dependence (with chronic, moderate daily cannabis smoking) was associated with CB1 receptor downregulation (i.e. ~15% decrease at baseline, not under intoxication or withdrawal) compared to healthy controlsReference 334.
Pancreatic tissue isolated from patients with acute pancreatitis has been reported to have a marked upregulation of CB1 and CB2 receptors in the acini and ducts as well as elevated levels of the endocannabinoid anandamide but not 2-AGReference 1296. However, the authors did note a bias in the patient selection criteria, which could have explained the apparent lack of effect. A subsequent double-blind, randomized, placebo-controlled, parallel-group clinical study in a population of mostly female patients with IBS-D (Rome III criteria) further investigated gene-treatment interactions on colonic motility in this sub-set of IBS patientsReference 1203. Neither the 2.5 mg b.i.d. nor the 5 mg b.i.d. doses of dronabinol had any statistically significant effects on gastric, small bowel, or colonic transit.
Irritable bowel syndrome (IBS) is the most common functional GI disorder encountered in clinical medicineReference 1188. It is a spectrum of disorders characterized by the presence of chronic abdominal pain and/or discomfort and alterations in bowel habitsReference 1188Reference 1189. Symptom patterns can be divided into diarrhea predominant (IBS-D), constipation predominant (IBS-C), and an alternating pattern (alternating constipation/diarrhea) (IBS-A)Reference 1189Reference 1190. While the pathophysiology of IBS remains unclear, the disorder is thought to be caused by dysregulation of the ‘brain-gut axis’ in response to psychological or environmental stressors or to physical stressors such as infection or inflammation, and is characterized by altered gut motility and visceral hypersensitivityReference 1188.
According to the study authors, negative psychoactive effects were minimized by starting patients at a low dose (2.5 mg Δ9-THC once a day, for three days) followed by gradual dose escalation (up to a maximum of 7.5 mg dronabinol per day). Anorexia is ranked as one of the more troublesome symptoms associated with cancer, with more than half of patients with advanced cancer experiencing a lack of appetite and/or weight lossReference 658Reference 659. While it is anecdotally known that smoking cannabis can stimulate appetite, the effects of smoking cannabis on appetite and weight gain in patients with CBD gummies cancer cachexia have not been studied. The results from clinical trials with oral Δ9-THC (dronabinol) or oral cannabis extract are mixed and the effects, if any, appear to be modest (reviewed inReference 314. Another subsequent inpatient study employed even higher doses of dronabinol ( mg total Δ9-THC daily, for four days) and smoked cannabis (~800 mg cannabis cigarettes containing 2.0 and 3.0% THC, administered four times per day, with an estimated mg total Δ9-THC daily in the cigarette, over a total study period of four days)Reference 223.
Similar to energy drinks and protein bars which may contain vitamin or herbal additives, food and beverage items can be infused with CBD as an alternative means of ingesting the substance. In the United States, numerous products are marketed as containing CBD, but in reality contain little or none. Some companies marketing CBD-infused food products with claims that are similar to the effects of prescription drugs have received warning letters from the Food and Drug Administration for making unsubstantiated health claims. In February 2019, the New York City Department of Health announced plans to fine restaurants that sell food or drinks containing CBD, beginning in October 2019. Cannabidiol can be taken into the body in multiple ways, including by inhalation of cannabis smoke or vapor, as an aerosol spray into the cheek, and by mouth.
Low levels of THC metabolites have been detected for more than five weeks in the urine and feces of cannabis usersReference 446. The degree of Δ9-THC consumption does not appear to influence the plasma half-life of Δ9-THCReference 401Reference 491. Following oral administration, THC and its metabolites are also excreted in both the feces and the urineReference 78Reference 462.
