What can I take for pain between edible doses?

Q:

I’m using edibles to treat chronic pain, but sometimes my timing is off, or the products aren’t as strong as I expected. When this happens, I currently just deal with the pain until the next edible kicks in. If the pain is really bad, I sometimes take a prescription painkiller. Are these my only options, or is there a non-smoking cannabis choice I could use to bridge that gap between edibles? (I can’t smoke at work.) I’d really like to avoid using those painkillers.

A:

With cannabis edibles, there exist multiple factors that affect the onset of action and the potency of a dose, and these factors can create challenges for patients looking to minimize any gaps in relief between doses.

Of course, edible products differ in a number of ways:

  • Some edible products are better homogenized than others

  • Some edible products are available in small, discrete doses, while others require patients to break the product into smaller serving sizes, creating unequal pieces

  • In states where no labeling requirements exist, some edible products can fail to meet even the most meager labeling standards

In addition to product variability, other patient-specific factors can influence the effect. For example, the bioavailability of these products can range from four to 20 per cent, depending on a patient’s individual metabolism, whether they’re taking other medications, and whether they had a fatty meal at the same time that they ingested the edible.

What you should do for pain between edible doses

First, look for properly labeled products that list potency and select products that are available in small, discrete serving sizes. Some producers have developed edibles with as low as one mg of cannabinoids. Small, discrete serving sizes can help ensure consistency and provide you with more control.

Consider using sublingual products to provide relief between edible doses and when inhalation is not an option. But beware: there are few true sublingual products on the market. Most tinctures — while marketed as sublinguals — follow the pattern of ingestion. Patients often expect rapid onset when using tinctures, only to wait one to three hours for the dose to take effect. Cannabinoids are fat-soluble and do not absorb into the mucosa of the mouth in their natural state. A true sublingual (a product in which the cannabinoids are formulated to be more water-soluble) absorbs rapidly into the mouth and can take effect within 15 minutes.

If sublingual products are not available, consider a transdermal patch. A transdermal patch can provide eight to 12 hours of relief and are often more consistent and reliable than edible products.

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Written by Eloise Theisen

Eloise Theisen, AGPCNP-BC, is a dedicated and patient-focused nurse. For over 17 years, she has specialized in aging, cancer, chronic pain, dementia, Alzheimer’s, Parkinson’s, anxiety, depression, fibromyalgia, and various autoimmune and neurological diseases. The founder of Radicle Health, she started her career at John Muir Medical Center caring for patients suffering from cancer, terminal illnesses, respiratory failure/complaints, drug overdoses, acute alcohol ingestion, gastrointestinal bleeds, traumatic brain injury, and multiple traumas. Through her work with Aunt Zelda’s and the American Cannabis Nurses Association, Elosie has extensive knowledge of the endocannabinoid system and how cannabis and cannabinoids can be used successfully to treat patients.

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