“Show me the math:” US doctor calls for THC standardization in edibles

Jordan Tishler, a medical marijuana doctor, is calling for the standardization of THC, the psychoactive component in cannabis. 

Dispensaries do provide some numbers on THC on their labels, however, these figures are not standardized with – plus or minus –  inaccuracies in their dosages. This could pose as a problem for medical marijuana patients, who take edibles to treat their ailments.

“When we feel ill and we take medicine, is it going to work in the same way every time we take it? Like how we can count on Tylenol or Advil,” Tishler, president of the Massachusets-based InhaleMD clinic told a crowd during his presentation at Toronto’s O’Cannabiz conference on Friday.

“To predict cannabis effects, dosing really matters,” the Harvard-graduate emergency medicine physician said.

In a 2015 study, published by the Journal of the American Medical Association (JAMA), it was estimated that 16 per cent  to 26 per cent of patients using medical cannabis consume edible product.

What it found that of the 75 products purchased – from 47 different brands – about 17 per cent were accurately labeled, 23 per cent were unlabeled, and 60 per cent were overlabeled with respect to THC content.

Even though oral consumption lacks the harmful by-products of smoking, difficult dose titration can result in overdosing or underdosing, highlighting the importance of accurate product labeling.

There are 29 U.S. states that have already legalized medical marijuana and nine others where the recreational use is now legal. But standardization so far is lacking.

For medical marijuana patients, Tishler says most people reap the green herb’s benefits at a 10 mg mark for THC, far less than what recreational users anticipate.

While the 10 mg level is considerably low, it can also be high for elderly patients.

“I am not saying everyone is getting their relief at 10 mg,” Tishler said. “But I tend to start my patients at even lower, and we work our way up till 15 mg .”

Unlike recreational users, who go as high as 100 mg, “the intoxication that comes with most cannabis use is viewed as an unwanted side effect [for medical marijuana patients].”

“They are looking for a specific relief, making reliability as paramount,” he added. “This is something we are still wrapping our head around in this field.”

He urged producers in the industry to start describing marijuana’s components in a “meaningful way.”

Need to count calories

In this Sept. 26, 2014, file photo, smaller-dose pot-infused brownies are packaged at The Growing Kitchen in Boulder, Colo. (File image via AP)
In this Sept. 26, 2014, file photo, smaller-dose pot-infused brownies are packaged at The Growing Kitchen in Boulder, Colo. (File image via AP)

Not only how much cannabis people need to know that they get from labels, but “we really need to tell patients how many calories” are in their edibles and if it has gluten for example.

“’Take two brownies and call me in the morning’ is not a practice of good medicine,” he said especially for those who are overweight or are suffering from diabetes.

Massachusetts became the eighteenth state to legalize medical marijuana when voters passed a ballot in 2012.  In 2016, Massachusetts voters elected to legalize recreational cannabis.

“Massachusetts at the beginning… Chocolate bars were plus or minus 50 percent [in THC], I don’t know what do to with this, avoid – I guess –  is the answer.”

Bioavailability is also key

“Last year, my big thing was let’s talk about dosing. I think we are still talking about dosing, which I think is a good thing, but really bioavailability is really the next step,”  he said.

Bioavailability can be defined as the proportion of a drug that enters the circulation when introduced into the body and so is able to have an active effect.

“How do we know if we take 10 mg, it actually gets into us,” he said. “In certain products, it is absorbed, in some other products, it is not.”

He said in tinctures and other oil-based products, “it is usually absorbed half as well as an actual edible or a well-made edible.”

“So we need to provide the manufacturer with this kind of information about our products, so when people go and buy it, they know.”

He added:

“This kind of feels like in grade school when we had to show our math. This is how to show your math.”

As the trend to legalize both medical and recreational marijuana continues – luckily for its users – when it comes to overdosage, marijuana is not “lethal.”

“If you take too much is a bummer but it is not the end of the world,” he said. “When I take care of elderly people, they will never trust me again” if they felt “floored” and “overwhelmed” with a high dosage.

“1, 2, 4, 5 mg is a good start for the elderly population as well as for wellness seekers,” he said, emphasizing – again – for the need for correct figures.