As research and our understanding of cannabis advances, we see a wider variety of medical cannabis products available on dispensary shelves. From gels, capsules, inhalers, to powders that dissolve in water the options are seemingly endless. While these products help to improve access and break down barriers, they are also far different than the natural, whole plant, many of were first attracted to.
While I’m incredibly excited for the advances in cannabis medicine – I wish that a few factors were considered a bit further when putting these products in patients hands – primarily patient education, informed choice, and quality of ingredients. As someone who is keenly aware of the impact of foods and chemicals on my body (I have Celiac Disease – gluten is my kryptonite), I tend to take a second look at ingredients when new cannabis medicines are released. I wish I could say that every product I’ve looked into has been sneaky clean and health promoting, but that wouldn’t be truthful. In fact, I’ve developed a bit of a reputation for going hard on Florida MMTC’s for ingredients and labelling issues and it’s for good reason – patient’s every day lives are at stake. Sadly, I’ve seen too many patients lives affected by a combination of improper education, poor labeling, and a breakdown of information.
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Patient Education & Informed Choice
Medical cannabis is so different than any other medication. It’s recommended by a physician – not prescribed. These words are have weight. This difference means a doctor essentially authorizes a patient to access cannabis, but does not make the specific choices regarding delivery and dosing like we are typically used to when it comes to medicine. Here in Florida, doctors recommend different delivery routes and a max dose per day, but the medicine options under each of these routes are seemingly endless.
While during their appointment doctors might recommend a specific product to meet a patients need, ultimately when the patient gets to the dispensary the choice is their’s. This leaves patients to rely on accurate information from the “bud tender,” often an entry level retail position with minimal training. These dispensary retail staff are typically not medically trained. They don’t know or understand the patent’s medical history – such as someone who is in recovery from alcohol or someone with diabetes who cannot take things that can spike their blood sugar. Their recommendations may be well intentioned, but are often inappropriate. As a patient, it’s important to be mindful of these limitations and self advocate for your specific needs – whether that be asking the right questions at the dispensary, following up with your healthcare team, or doing independent research.
Unfortunately, often times as patient’s we don’t even realize there are questions to ask. I’ve worked with dozens of patients who are shocked to find out that a product they are taking contains a potential allergen, or a substance they rather avoid, like alcohol. When I first started doing this work I couldn’t tell you the difference between a cannabis and botanical terpene, now it’s one of the first things I look at when purchasing a vape or distillate oil. We are all learning as we go and we don’t know what we don’t know.
Fortunately, legal cannabis products include ingredient labels. If ingredients are a concern for you, be sure to ask to see these labels PRIOR to making a purchase. Don’t rely on retail staff to relay the information as ingredients often change and quality of continued training varies by company. While most companies also list ingredients online, it’s best to verify on the product itself to be safe. There’s been instances of products being mislabelled online or changes not reflected in a timely manner.
Quality of Ingredients
When we think about quality cannabis medicine, most of us tend to only think about the buds, or dried cannabis flower. We compare things like smell, appearance, potency, terpenes, moisture content, etc. There is also a wide variety of quality among other products and a lot of this comes down to the “inactive” ingredients, but nothing is really inactive. It’s all going into our bodies and will have some sort of impact – whether that be neutral, positive, or negative. Like anything we consume, the “cleaner” the cannabis medicine the better.
Quality of ingredients is so important as many cannabis patients suffer from autoimmune disease, chronic pain, and GI conditions that are all severely reactive to inflammatory ingredients – things like sugar, soy, corn, chemicals, preservatives, etc. Using a natural plant medicine with so many potential benefits and pairing it with a dose of inflammation promoting junk is quite counterintuitive. Cannabis edibles, oral powders, tablets, capsules, oils, and tinctures are all regularly paired with some of these substances, despite much healthier options out there. Unfortunately, many companies choose less expensive over healthy. If you are comparing cannabis products across companies and notice similar items at slightly different price points, there is a chance the higher prices item is because it contains cleaner ingredients. Look closer.
Ingredients to Be Aware Of
Every patient has to do a cost/benefit analysis and choose the cannabis medicines that meet their needs the best. Advocate for yourself at dispensaries, ask about ingredients, and make informed decisions so you can get the most out of your cannabis medicine. The below ingredients review isn’t meant to vilify any of these products – it’s only meant to inform you of ingredients so you can make decisions that best meet your needs. Knowledge is power (and the first step to thriving with chronic illness).
Many nanotechnology products – those advertised to work rapidly when applied under the tongue, sprayed into the sides of the mouth, or mixed into liquids use ethanol (alcohol) to assist with absorption. This can be a concern for patients in recovery or those avoiding alcohol due to contraindicated medications or certain health conditions.
Cannabis Products in Florida That May Contain Alcohol Include (not an exhaustive list):
Muv’s Metered Dose Inhaler
Trulieve TruNano Tinctures
Soy, Corn, and Potential Allergens
Ingredients like soy and corn are commonly used to create fillers, emulsifiers, and preservatives found in cannabis and pharmaceutical medicines a like. Aside from their allergenic potential, they can also be triggers of inflammation for those with certain conditions like autoimmune disease.
Sugar & High Glycemic Substances
Ingredients like maltodextrin are used to create cannabis powders. Maltodextrin is a highly processed ingredient, similar to corn syrup solids. It has a very high glycemic index and is processed in the body like sugar, resulting in blood sugar spikes that can be dangerous for patients with diabetes. Artificial sweeteners are also common in edibles, oral products, and tinctures. These sweeteners can contribute to the release of insulin (due to the anticipation of blood-sugar increase after tasting something sweet). Studies show these sweeteners can also alter appetite and glucose metabolism.
Sugar Alcohols, Preservatives, Unidentified Flavorings, and Other Food Additives
Crohn’s Disease (an inflammatory bowel disease) is a qualifying condition in Florida, opening up a host of similar GI conditions through Florida’s like kind or class qualification option. For patients with these conditions, avoiding potential gut irritants is essential to keeping flareups at bay. These irritants along with chemicals and preservatives can also be common symptom triggers for autoimmune, pain, and other inflammatory conditions.
Sugar alcohols and emulsifiers are found in cannabis edibles, tablets, powders, and tinctures. The majority of sugar alcohols are incompletely absorbed in the intestine and can feed gut bacteria, which can be problematic for some individuals. Symptoms may include watery stool, diarrhea, nausea, bloating, flatulence, and borborygmus (stomach rumbles).
Emulsifiers are used in cannabis products to blend the lipophilic (fat loving) cannabinoids with ingredients they normally couldn’t mix with (like blending oil with water). Many common emulsifiers have been linked with gut dysbiosis, irritation, and inflammation. Flavorings, preservatives, and chemicals used to stabilize cannabis medicines can also be problematic for some individuals. These ingredients are often sourced from things like corn, but are not required to be labelled as such.
Cannabis Products in Florida That May Contain Allergens, Sugars, or Other Additives (not an exhaustive list):
Trulieve TruNano Tinctures (multiple)
Trulieve TruPowder (multiple)
Trulieve Tincture Droplet Bottle (flavoring)
Surterra Tinctures (allergens)
Curaleaf Micro-Tablets (multiple)
Muv’s Metered Dose Inhaler (sorbitan trioleate)
Muv’s Spray (propyl glycol)
Like oral products, cannabis vapes are another cannabis medicine that should be looked at closer when it comes to ingredients. Covered further in my Things to Consider as a Florida Cannabis Patient Amidst Current Vaping Concerns post, being aware of differences in terpene sources, additional ingredients, and extraction source can help in avoiding unnecessary irritation and reactions. Ideally vapes should be strain specific with cannabis derived terpenes only and no other cutting agents.
Cannabis Product Types to Look Closer At
These categories of products are commonly made with ingredients other than just cannabis. It’s good practice to get in the habit of checking all ingredients, regardless of the company or product.
Tinctures (especially nanotech)
Drinks & Edibles