Edible cannabis: countdown to the rocket launch

Less than a year ago, cannabis was legalized for recreational consumption. This was a measured, calculated legislative and policy change that passed under the world's watchful gaze. Canada did not blow up in an incandescent ball of flames and smoke. Neither did the nation walk around in a stoned zombie trance of cannabis intoxicated citizens. But there is no room for complacency. Cannabis literacy has been inconsistent among critical knowledge groups, whether for employers, health professionals, or within families. While licensed products provide a supply of tested and quantified cannabis, the labels indicating "THC, total THC, milligrams and percentages" are confusing to consumers. Consider THC as the car, "total THC" is the maximum achievable speed under the optimal driver, weather, and gas conditions. A heating process—decarboxylation—is required to activate THC from buds to achieve the total. In the absence of clear evidence, "CBD" has also become a sexy panacea for all manner of ills and ailments known to mankind and their pets. Edibles, infused beverages, and cannabis extracts are the next cannabis legislative hurdle. Before their legalization, a number of people would have already experienced the "Trojan horse" effect of edible cannabis. For the unsuspecting or inexperienced consumer, the delicious and benign chocolate bear, gummy bear, or butter spread may be full of surprises. Unlike smoked or vaped cannabis with a close-to-spontaneous effect on the brain, and the familiar waft of terpenes (unique cannabis aromas), the edible does not give early-warning "smoke signals." Loaded with different potencies of THC and CBD, a dark chocolate bar may pack a greater punch than several joints or bong hits. A small gummy bear could easily be more potent than several blunts. Domestic confectionery infused with 80 per cent to 90 per cent THC concentrate could easily hit the body harder, or discharge a mental rocket higher than a 15 per cent THC joint. The edible consumer may be oblivious until between 30 minutes and three hours after use. One may be heading home sober after a party when the high hits, leaving one experiencing perceptual changes and paranoia. On long road trips, impairment may not manifest upon departure, but the effects may be felt 250 kilometres later despite the traffic police officer's vigilance. Health Canada has proposed regulating edibles that allow a maximum of 10 mg of THC per portion. However, it will take considerable literacy and self-awareness to gauge individual dose responses. With pre-rolled, government-approved cannabis, my research identified up to 65-fold difference in milligram potency between low potency joints (1/3 gram) and high potency joints (one gram). What is the equivalence of a joint, chocolate bar, cannabis beer, vape or concentrate extract? Messaging will require skilful application of solid, liquid, and gaseous cannabinoid science in generally understandable terms, using adroit educators and knowledge translators across multiple media. Preference for edibles has increased from 34 per cent to 42 per cent between 2017 and 2018, along with a reduction in smoked cannabis from 94 per cent to 89 per cent over the same period, according to the government's Canadian Cannabis Survey. Perceived risk of harm (66 per cent) is also lower than for smoked cannabis (72 per cent). There is no recognized and generally accepted etiquette for edible consumption. "Start low and go slow" has been a well-rehearsed mantra, encouraging safe and responsible use of cannabis products. Practical application of this approach to edibles will be a challenge, given the range of products. With alcohol, drinking vessels and etiquette have evolved over centuries to reflect alcohol strength and to temper consumption, through the use of small liquor shots, wine glasses and beer mugs. Likewise, inhaled cannabis has a loose degree of equivalence to joint sizes and bong bowls. Do we have any equivalence for edible cannabis? No. This still has to evolve, and many lessons will be learned. If edibles pose a panoply of options for experienced cannabis users, we should spare a thought for young children with developing brains experimenting with sweet products and presenting with cannabis intoxication to emergency rooms. While Health Canada will ensure responsible and unattractive packaging, the onus will be on parents to ensure homemade "treats" are out of reach. Likewise, the growing elderly population using ingestibles alongside medication for age-related ailments poses a specific risk. With edibles, the advice would be to start with a small nibble, served with a large portion of knowledge in bite-size chunks, which allow time for it to percolate around the body and brain while learning from the feeling. We are in dynamic times, and future cannabis consumption may require a conversion app for edibles and a THC test kit as consumers patiently and mindfully pause, look, and listen to their body and mind. Oyedeji "Deji" Ayonrinde is an associate professor at Queen's University's department of psychiatry and psychology. He is also the medical director of Heads Up, an early psychosis intervention program. The Hill Times