In the Journals

Physicians should counsel patients on safe use of cannabis edibles

Lawrence C. Loh

Physicians need to better promote open discussions with patients who express interest in cannabis on their use of edibles, enable counseling on safe consumption, and discourage the use of homemade products, according to a commentary published in the Canadian Medical Association Journal.

“Physicians should routinely question patients who ask about cannabis about their use or intended use of edible cannabis products so that they can counsel these patients regarding child safety, potential for accidental over-consumption and delayed effects, and potential for interactions with other substances such as alcohol, benzodiazepines, sleeping aids and opioids,” Jasleen K. Grewal, MD, and Lawrence C. Loh, MD, MPH, both of the University of Toronto, wrote. “Physicians should advise strongly against driving after consuming cannabis edibles, particularly if other drugs have been used.”

Canada’s new cannabis regulations, legalizing the production and sale of cannabis edibles, took effect on Oct. 17, 2019. However, despite their recent legalization, a sizeable proportion of cannabis users have reported using these edibles in the past, according to Grewal and Loh. The authors cited the 2019 National Cannabis Survey, which found that 27% of respondents who reported using the drug in the past 3 months had consumed it in its edible form.

In addition, edibles are “commonly viewed as a safer and more desirable alternative to smoked or vaped cannabis,” they added.

Marijuana plant 
Physicians need to better promote open discussions with patients who express interest in cannabis on their use of edibles, enable counseling on safe consumption, and discourage the use of homemade products, according to a commentary.
Source: Adobe

Because of these attitudes, Grewal and Loh stressed that physicians should help make patients more aware of the various risks associated with edible cannabis, including a prolonged latency and duration of the drug’s effects, compared with inhaled forms, increasing the risk for over-consumption. In addition, although the new regulations aim to address the previous variability in dosing — and dosing information — by introducing mandated standards and limiting the amount of THC in each unit sold to 10 mg, individual responses to the drug can vary and over-consumption may still occur.

“The legalization of mass market cannabis edibles in Canada presents a valuable opportunity to review the various health risks associated with ingesting cannabis,” Loh told Healio Rheumatology. “Edibles have unique concerns that differentiate their use from inhaled cannabis.”

“Specifically, the delayed onset of effects increases the likelihood of over-consumption, particularly among cannabis naive individuals, youth and the elderly,” he added. “The appealing nature of some of these products — eg, cookies, gummies and brownies — increases the risk that children or pets might accidentally ingest these if presented with the opportunity.”

For these reasons, Loh noted that he and Grewal recommend that individuals who do not currently use edible cannabis avoid starting, now or in the future. For those who do consume edible cannabis products, the authors advised starting with low doses and “going slow,” ideally with other people present who may be able to respond to an unforeseen reaction.

“Providers should also be explicitly carving out and asking about cannabis use in the way that we have for tobacco and alcohol in decades in order to identify patients that might benefit from counseling and further screening for problematic use patterns,” Loh said. “They should also be assisting public health agencies in monitoring and evaluating patterns of use in the community to identify the effectiveness of regulation and policy and any need for change.”

The authors added that “physicians should discourage the use of illicit or homemade cannabis edibles.” Risks associated with these products may include spreading foodborne illness, variable THC concentrations that may lead to overdose or over-consumption, poisoning from pesticide residue and the possibility that illicit cannabis products may be contaminated with other drugs, such as narcotics.

“The persistent availability of illicit edibles raises concerns around mold, pesticide residues and cross-contamination with other drugs,” Loh said.

“As little is known about the effects of cannabis use in older adults, researchers should aim to identify relevant risk factors and interventions for this group,” the authors wrote. “All populations will benefit from ongoing monitoring and surveillance to evaluate the effects of legalized cannabis edibles. Continued advocacy for effective regulation of edibles will help to control the availability of both legal and illicit products and mitigate their effects on individual and community health.” – by Jason Laday

Disclosure: Grewal and Loh report no relevant financial disclosures.

Lawrence C. Loh

Physicians need to better promote open discussions with patients who express interest in cannabis on their use of edibles, enable counseling on safe consumption, and discourage the use of homemade products, according to a commentary published in the Canadian Medical Association Journal.

“Physicians should routinely question patients who ask about cannabis about their use or intended use of edible cannabis products so that they can counsel these patients regarding child safety, potential for accidental over-consumption and delayed effects, and potential for interactions with other substances such as alcohol, benzodiazepines, sleeping aids and opioids,” Jasleen K. Grewal, MD, and Lawrence C. Loh, MD, MPH, both of the University of Toronto, wrote. “Physicians should advise strongly against driving after consuming cannabis edibles, particularly if other drugs have been used.”

Canada’s new cannabis regulations, legalizing the production and sale of cannabis edibles, took effect on Oct. 17, 2019. However, despite their recent legalization, a sizeable proportion of cannabis users have reported using these edibles in the past, according to Grewal and Loh. The authors cited the 2019 National Cannabis Survey, which found that 27% of respondents who reported using the drug in the past 3 months had consumed it in its edible form.

In addition, edibles are “commonly viewed as a safer and more desirable alternative to smoked or vaped cannabis,” they added.

Marijuana plant 
Physicians need to better promote open discussions with patients who express interest in cannabis on their use of edibles, enable counseling on safe consumption, and discourage the use of homemade products, according to a commentary.
Source: Adobe

Because of these attitudes, Grewal and Loh stressed that physicians should help make patients more aware of the various risks associated with edible cannabis, including a prolonged latency and duration of the drug’s effects, compared with inhaled forms, increasing the risk for over-consumption. In addition, although the new regulations aim to address the previous variability in dosing — and dosing information — by introducing mandated standards and limiting the amount of THC in each unit sold to 10 mg, individual responses to the drug can vary and over-consumption may still occur.

“The legalization of mass market cannabis edibles in Canada presents a valuable opportunity to review the various health risks associated with ingesting cannabis,” Loh told Healio Rheumatology. “Edibles have unique concerns that differentiate their use from inhaled cannabis.”

“Specifically, the delayed onset of effects increases the likelihood of over-consumption, particularly among cannabis naive individuals, youth and the elderly,” he added. “The appealing nature of some of these products — eg, cookies, gummies and brownies — increases the risk that children or pets might accidentally ingest these if presented with the opportunity.”

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For these reasons, Loh noted that he and Grewal recommend that individuals who do not currently use edible cannabis avoid starting, now or in the future. For those who do consume edible cannabis products, the authors advised starting with low doses and “going slow,” ideally with other people present who may be able to respond to an unforeseen reaction.

“Providers should also be explicitly carving out and asking about cannabis use in the way that we have for tobacco and alcohol in decades in order to identify patients that might benefit from counseling and further screening for problematic use patterns,” Loh said. “They should also be assisting public health agencies in monitoring and evaluating patterns of use in the community to identify the effectiveness of regulation and policy and any need for change.”

The authors added that “physicians should discourage the use of illicit or homemade cannabis edibles.” Risks associated with these products may include spreading foodborne illness, variable THC concentrations that may lead to overdose or over-consumption, poisoning from pesticide residue and the possibility that illicit cannabis products may be contaminated with other drugs, such as narcotics.

“The persistent availability of illicit edibles raises concerns around mold, pesticide residues and cross-contamination with other drugs,” Loh said.

“As little is known about the effects of cannabis use in older adults, researchers should aim to identify relevant risk factors and interventions for this group,” the authors wrote. “All populations will benefit from ongoing monitoring and surveillance to evaluate the effects of legalized cannabis edibles. Continued advocacy for effective regulation of edibles will help to control the availability of both legal and illicit products and mitigate their effects on individual and community health.” – by Jason Laday

Disclosure: Grewal and Loh report no relevant financial disclosures.