Science and Medical
Jay R. Cavanaugh, Ph.D.
AAMC, National Director
Many patients who utilize and benefit from medical cannabis do not wish to smoke due to the perceived health hazards of smoking or for other personal reasons. These patients are in something of a bind. Smoking cannabis delivers the active cannabinoids within seconds. Medicine is absorbed in the lungs and goes directly to the brain and general circulation. The same effect can be achieved with a vaporizer, which is safer than smoking burning vegetable matter. Since the effects of inhaled cannabis are so quick, it is easy for patients to titrate their dose by simply waiting a minute or two in between puffs.
Oral cannabis, such as our Better Bud Butter, is absorbed in a very different fashion from smoking or inhalation. The GI tract gradually absorbs Cannabinoids over the course of one to two hours. Medicine is processed first by the liver, which converts some cannabinoids such as delta nine to delta 11 version of THC. Orally delivered cannabis requires four to ten times the amount of the smoked version in order to achieve the same effect. Orally delivered cannabis can present a problem in achieving the required or desired dose level in any consistent fashion.
Tincture is designed to address the problems of rapid medicine delivery and consistent dosing. Most tinctures are made to be used under the tongue or sublingually. English pharmaceutical companies are presently working on a cannabis extract "spray" that can be used under the tongue in a similar fashion. These sprays are not expected to be approved for use in the United States for years and will be very expensive. Absorption by the arterial blood supply under the tongue is completed in seconds. One trick is to not swallow the dose as, if swallowed, absorption will be in the GI tract. Many patients, though, add their tincture to a cup of tea or cranberry juice for easy delivery. When tincture is used in a beverage, absorption will be slower than if absorbed under the tongue. While tincture absorbed in an empty stomach is accomplished in minutes, conversion in the liver remains, as does the difficulty in titrating dose. Usually, a tincture dose is delivered by means of a medicine dropper or a teaspoon. A rule of thumb on dose is that patients receive benefit from 3-4 drops to a couple of full droppers depending upon the potency of the tincture and the patient’s own unique requirements among other factors.
The methods listed below will detail two major methods of preparing tincture. While the methods are optimized for purity and potency, ultimately these will largely be determined by the purity and potency of the cannabis from which the tincture is made. Another item of note in regard to starting material for tincture is the patient or caregiver selection of strain. A rough rule of thumb is to select Indica dominant strains for cramping and muscle spasticity and Sativa dominant strains for pain relief. The reality, though, is often that the strain is unknown or not well characterized. Trial and error is usually required to acquire the appropriate strain and the proper dose level.
Tincture is an extraction of active cannabinoids from plant material. Cannabis contains many chemicals that can either upset the stomach or taste nasty. One of the goals of extraction is to secure the cannabinoids while leaving out as many of the terpenes and chlorophylls as possible. Both heat and light adversely effect cannabinoids and should be avoided or minimized. Tincture should be stored in airtight dark glass containers kept at room temperature or below. Avoid plastic containers. The ethanol in the tincture may solubilize some of the free vinyls in the plastic.