Daily Dose Q&A

2025-06-30
Even if an individual employs the same mode of administration over time, the effects of cannabinoids may change for that individual. Provide some reasons why this may be so.
The effects of cannabinoids may change over time due to multiple factors, including: 1. tolerance to the cannabinoids may develop 2. change in the patient's health status/ medical condition may change over time and lead to physiological changes in the endocannabinoid system (For example, inflammation impacts the ECS. Also, impaired G.I./liver function affects the absorption and metabolism of cannabinoids.) 3. The patient may start or stop taking a medication that interacts with cannabinoids or affects the metabolism of the cannabinoid-based product. 4. Physiologic changes in the endocannabinoid system take place as patients age.
Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02 Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/
2025-06-27
Some patients use cannabinoid-based medicines to treat nausea and vomiting. Is one of the side effects of cannabinoid-based medicines nausea and vomiting?
Yes.. The adverse event profile of cannabinoid-based formulations is dependent upon the ratio of CBD:THC, the presence of other cannabinoids and terpenes, and the dose consumed. The known common adverse effects of cannabinoid-based medicines include sedation/somnolence, dizziness, anxiety, cognitive dysfunction, nausea, vomiting, diarrhea, vertigo, increased or decreased appetite and dry mouth.
Brenneisen R, Egli A, ElSohly MA, Henn V, Spiess Y. The effect of orally and rectally administered delta9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients. Int. J. Clin. Pharmacol. Ther. 1996 Oct;34(10)446-52. https://pubmed.ncbi.nlm.nih.gov/8897084/
2025-06-26
How should a clinician monitor the outcome of cannabinoid-based therapy?
As suggested by the Australian Centre for Cannabinoid Clinical and Research Excellence, monitoring should initially involve reviewing the patient weekly in person, and via phone if required in the interim between clinical reviews. "There are three areas of outcomes that should be considered: 1. Symptom control - "A pre-defined measure of success should be negotiated with the patient prior to commencement of therapy. This can be measured by using a validated tool, for example by the Palliative Care Symptom Assessment Scale. " 2. Drug adverse events - "Careful monitoring of patients for adverse events and the need for a change in dosage is important. Adverse events may become apparent after commencement or after change in dose...Adverse events may be related to other concurrent medications. Doses of these medicines should be adjusted as appropriate. " 3. Pathology monitoring - "Drug concentrations of drugs where there is a potential or actual drug-drug interaction may be important. Cannabidiol may cause hepatocellular injury. Patient’s liver function biochemistry should be monitored prior to initiation and periodically as clinically indicated."
Prescribing Cannabis Medicines for Chronic Non-cancer Pain v2 September 2019 c10. - by the Australian Centre for Cannabinoid Clinical and research Excellence https://www.ces.edu.co/wp-content/uploads/2020/09/acre-prescribing-guidance-chronic-non-cancer-pain.pdf
2025-06-25
How long should the testing period of a cannabinoid-based drug be?
According to the European Pain Federation position paper on the appropriate use of cannabis-based medicines, a testing period of maximum 3 months should be considered both by patients and prescribers [or recommenders], to assess treatment efficacy and safety. At the end of this testing period, long_term treatment should only be considered with significant improvement and lack of safety issues.If a satisfactory outcome is achieved, the patient should remain under close medical surveillance for the duration of cannabis_based medicine therapy If the predefined treatment goals are not achieved and/or unacceptable burden of side effects occur and/or signs of abuse and misuse are observed, the specific cannabis_based medicines should be safely withdrawn and alternative options actively explored.
Huser, W, Finn, DP, Kalso, E, et al. European Pain Federation (EFIC) position paper on appropriate use of cannabis_based medicines and medical cannabis for chronic pain management. Eur J Pain.. 2018; 22: 1547Đ 1564. https://pubmed.ncbi.nlm.nih.gov/30074291/
2025-06-24
Considering the pharmacokinetics of orally consumed cannabinoid-based food products, how should the oral consumption of cannabinoids proceed?
According to Health Canada's document entitled Information for Health Care Professionals: Cannabis and Cannabinoids, consumption of oral cannabis should proceed slowly, waiting a minimum of 30 minutes, but preferably 3 h, between bites of cannabis-based oral products (e.g. cookies, baked goods) to gauge for strength of effects or for possible overdosing.
Information for Health Care Professionals Đ Cannabis (marihuana, marijuana) and the Cannabinoids Đ Dried or fresh plant and oil for administration by ingestion or other means Psychoactive agent. This document can be found at https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf