cannabis edible
Inhaled versus oral cannabis – the two methods are not interchangeable.

One of the biggest misconceptions I encounter among my patients is the idea that if you don’t want to inhale cannabis, you should just take an edible.

I can see where they are coming from with this, but from a medical point of view, it’s the wrong way of thinking about cannabis as a treatment.

These two methods aren’t interchangeable, because inhaled and ingested cannabis behave differently in the body.

Both have different characteristics that need to be considered depending on a patient’s issue.

Benefits of Inhaled Cannabis

The biggest benefit to this method is that it’s quick-acting. Patients should feel the effects within 10-15 minutes.

However, “quick-acting” is different than “immediate,” which in my opinion is a phrase we should stop using.

As I point out to my patients, in the ten minutes you’re waiting to experience an “immediate” onset, you can take a whole lot of puffs off your vaporizer. That’s a really good way to overindulge and get “in the deep end of the pool,” which no one wants. 

Thus – keeping that 10-15 minute window in mind when dosing – inhaled cannabis is great for certain medical circumstances.

A migraine headache, for example, is a situation where you want quick relief. Taking an edible and then waiting an hour or two for the onset of effects just won’t cut it.

Another example is the nausea and appetite loss associated with chemotherapy.

Come mealtime, a patient with an already queasy stomach doesn’t want to ingest an edible and wait around to see if it’ll work (assuming they don’t throw it back up first).

Inhaling cannabis before the meal instead is a fast and easy way to settle your stomach and boost your appetite.

A third example would be difficulty getting to sleep. Insomnia is not helped by lying awake in bed for another hour or two, waiting for the edible to take effect, especially when a few inhalations from a vaporizer can offer a speedy solution.

Benefits of Ingesting Cannabis

cannabis edible
One disadvantage of oral cannabis is that many edibles are hard to dose and contain too much sugar.

Generally, edibles are the most preferable for conditions that need prolonged coverage, as oral cannabis provides a stable level of control over health issues. 

The effects of edibles usually last for around 6-8 hours or more, which is great for a patient who’s troubled by health issues 24/7.

Instead of taking edibles as needed and waiting for relief, patients can take them at regularly scheduled intervals to maintain best control of ongoing symptoms.

Patients with any kind of chronic pain, whether in their joints, their back, neuropathic issues, or otherwise will benefit greatly from this method.

However, there are several variables to consider with oral cannabis that are not encountered with inhaled cannabis:

1) The Delayed Onset of Effects Takes Some Getting Used to

With edibles, the delay in onset can lead new patients to take more, then get caught by surprise when it all kicks in, and they find themselves over-intoxicated.

As the old adage says, “You can always take more, you can never take less.”

To prevent this with my patients, we always start at a lower dose and work our way up slowly towards what will eventually be their regular dose.  

This method gets them used to what it feels like to consume oral cannabis and gives their bodies a chance to adjust. What a dose of cannabis feels like on Day 1 vs Day 30 can be radically different.

Easing patients into oral cannabis treatment until they get the benefit they need requires attention and care.

2) When It Comes to Edibles, Calories Count

Another issue with edibles is that they often come with a lot of extra calories.

To me, it doesn’t make sense to advise patients with additional health issues such as diabetes to be eating an extra two brownies a day.

Even without a glucose issue, it’s generally not recommended to be adding extra sugar to anyone’s diet.

While an infused pastry is fine for the occasional recreational indulgence, there’s a wide gap between that and products that are appropriate for regular medical use.

Patients need to consider the caloric footprint of their oral cannabis and make healthy choices.

In my opinion, the best medical cannabis option for patients is a small gummy or hard candy as opposed to an entire brownie or cookie.

3) Could Capsules Replace Edibles?

While capsules are another oral cannabis option to consider, they, unfortunately, come with far more drawbacks.

The consumer demand for capsules isn’t strong, which means that the price is generally higher than other edibles. $15 for two capsules gets prohibitively expensive quickly, and most dispensaries aren’t carrying them in any kind of reasonably-priced bulk form that would allow for a month’s supply.

Another issue with capsules is that, biochemically, the cannabinoid absorption efficiency of the gut is pretty lousy to begin with.

Edibles are absorbed much more efficiently than oils found in capsules or tinctures, which means a patient would have to take twice as many capsules for the same effect. This just increases the price of capsules even more.

So, as far as edible options go, gummies or hard candy remain the best choice.

4) Finding the Right Medical Dosage with Edibles

The final complication with edibles is their dosing on the medical end.

Simply put, they can be insanely potent, which is problematic for patients.

At some dispensaries, a patient cannot find an edible lower than 50mg! With an edible the size of an Oreo, there’s no way to slice it in any way that gets you to an accurate, beneficial 5-10 mg dose.

Unfortunately, these dispensaries have not accounted for the mixture of patients and recreational users when they’ve done their market research and believe that high-potency edibles are what sells.

For those just beginning cannabis as a treatment, the intoxication resulting from consuming such large amounts of THC can be incredibly unpleasant.

Ultimately, building up a tolerance to cannabis, as many consumers and even some patients have done, is not necessary for treatment and is likely harmful as it causes dysregulation of the endocannabinoid system.

The patients that I advise who are new to cannabis need 5-10 mg products, which can be hard to find at a medical dispensary. On average, I’ve found the most beneficial dose to be 10 mg.

Inhaled vs. Oral Cannabis: Finding the Right Method

If you’re wondering whether inhaled vs oral cannabis will be the best method for you, a quick rule of thumb is:

  • Quick Relief: Inhalable
  • Extended relief: Oral

However, you also don’t have to pick only one or the other.

While there are basic guidelines for using oral vs inhalable cannabis as a treatment, each situation is different.

It takes a little time and guidance to figure out what works and occasionally, we need a little of both inhaled and oral.

What’s important in the end is to find the best and most effective relief for your condition.

Dr. Tishler is a Cannabis Specialist. Through his training in Internal Medicine and years of practice as an Emergency Physician, Dr. Tishler brings his knowledge, reason, and caring to patients at inhaleMD, and through his advocacy work at the local and national levels.

Dr. Tishler graduated from both Harvard College and Harvard Medical School, trained at the Brigham and Women’s Hospital, and is faculty at both the Brigham and Women’s Hospital and Harvard Medical School. He has spent many years working with the underserved, particularly providing care for Veterans. Having treated countless patients harmed by alcohol and drugs, his observation that he had never seen a cannabis overdose lead Dr. Tishler to delve deeply into the science of cannabis safety and treatment.

Dr. Tishler is also a parallel entrepreneur working for patients’ wellbeing in the corporate space, helping to elevate dosing and safety profiles of medication, and helping to establish best practice for bringing new Cannabis products to market.

Dr. Tishler is a frequent speaker and author on a variety of topics related to the medical applications of cannabis. He is the President of the Association of Cannabis Specialists which aims to educate clinicians, lawmakers, and the industry about best practices and needed tools for proper patient care.


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