Cannabis users have developed quite an appetite for edibles. The estimated market for cannabis-infused products (CIP) was between $650 and $850 million in 2014, with the biggest portion of that tied to edibles specifically, according to data from the Marijuana Business Factbook. Many dispensaries report that edibles account for at least a quarter of their overall sales, though that percentage can be much higher, reported Marijuana Business Magazine in January 2015, adding that some recreational stores in Colorado, for instance, say edibles make up nearly 60 percent of their total revenues.

Because Nevada is one of the few states to recognize patient cards from the other 23 states that legally recognize medical cannabis, edibles will be especially big business here, too. So why are patients so hungry for cannabis infused products (CIP)?

One reason has to do with consumption. CIP offer an alternative to smoking, which is the most common method of cannabis administration. Even though a recent comprehensive review on effects of marijuana smoking on lungs showed that cannabis smoking is not a major risk factor for Chronic Obstructive Pulmonary Disease (COPD) and airway cancer1, there are still significant negative connotations with smoking. Cannabis smoke is not by any means equivalent to tobacco smoke in terms of respiratory risk, however, cannabis smoke does contain a number of carcinogens, toxic gases, and particulates. Thus, if there is a better method of delivery such as vaporization or infused product, and less of the negative inferences, the better. It is also an alternative for patients who choose not to smoke.

Another reason for CIPs popularity with patients is that the effects are usually much longer than with its smoking counterpart; however, the onset is slower. With orally ingested cannabis, THC is metabolized in the liver to 11-hydroxy-THC, which is more potent and lasts much longer. These long-lasting effects are popular with patients who suffer from chronic conditions, such as persistent muscle spasms, seizures, and chronic pain. These products can also be consumed in places where smoking is not allowed, thus making them more appealing to a large number of patients.

Medicine for Every Taste
There are multiple forms that CIP is available to patients. The most common method is the route of administration and absorption by the body. Gastrointestinal absorption, eating CIP, is the most common form of administration. Since CIP has to be broken down in the stomach and absorbed, this can take some time. Thus, the effects of the medicine may not be felt for 45-120 minutes after ingestion and can last for several hours.

Oral absorption under the tongue (sublingual) or inside of the cheek (buccal) through saliva is another route of administration. This is usually achieved via a spray, lozenges, lollipops, gum, or tinctures (concentrated extract in liquid form). Oral absorption is much faster than gastrointestinal absorption because of the extensive capillary system in the oral cavity, which allows the medicine to enter the venous circulation thus bypassing the degradation in the liver with gastrointestinal absorption (first-pass metabolism). Given their more rapid onset, oral administered medicines also have a shorter duration of action.

Finally, there are the edibles that have a mixture of both oral and gastrointestinal absorption (hybrid). The patients sense a quicker onset with hybrids because of the initial oral absorption, followed later by the gastrointestinal one. Elixirs (sweetened liquid), sodas, and energy shots fall under this category.

Be Label Conscious
A good rule of thumb for patients who have not consumed edibles previously is to start “small and slow.” Labeling is another essential part of edibles. Knowing exactly the concentration of the ingredients, especially THC, will affect how much should be consumed. Nevada has very strict guidelines regarding labeling and independent testing that require laboratories to confirm product composition. Patients should start with a small amount and wait. For gastrointestinal absorption products, this can vary from 45-120 minutes. It is always easier to wait and take more later versus taking too much and experiencing side effects. Excessive consumption of edibles can lead to intense hallucinations, anxiety, elevated heart rate, and breathing problems such as hyperventilation.

Packaging has become a controversial topic in many states because manufacturers have imitated popular sweets, candy, and chocolate wrappers. Many advocacy groups see this practice replete with potential problems through confusion and potential mishap. Again, in Nevada, state and local municipalities have strict rules on products and packaging. For example, the packaging must be childproof and not resemble widespread candies and sweets that are commonly marketed to children.

A new culinary sector is being developed because of CIP. Chefs have entered this burgeoning entrepreneurial market experimenting with cannabis by using it as a flavor to create new dining experiences. Many cookbooks have been published on the topic as well. The health food industry is also getting in the game with companies manufacturing products with low calories, sugar-free, gluten-free, and vegan offerings.

As the thirst for CIP continues, with the overall market share for edibles estimated to be between 25-50 percent, depending on the state, according to Marijuana Business Factbook 2015, Nevada is predicted to have a hearty edible industry.

Dr. Pouya Mohajer is a Diplomate of the American Board of Anesthesiology with a subspecialty in pain medicine, and founder of Nevada Cannabis Medical Association.

1. Tashkin DP. Effects of marijuana smoking on the lung. Ann Am Thorac Soc 2013;10:239–247.