Written by Lindsey Marshall, PharmD

Introduction

Patient demographic
40 y/o female

Case Presentation

PMH and allergies: sensitivity to gluten

Medications: none

Illicit substances or alcohol use: drinks alcohol on rare occasions

History of Cannabis use: Long-time recreational cannabis user that typically prefers flower but has also used oral products with no issues. She also consumes full-spectrum hemp products, purchased over-the-counter, for keeping pain and inflammation at bay (daily supplementation)

Chief complaint(s): anxiety, depressed mood, and lack of motivation. Has a passion for creating art and music in her spare time and wants to lift mood, decrease stress and increase creativity and productivity. Wants a THC-only product since she is already using CBD-dominant products at home successfully for pain and/ or inflammation. The flower that she has been using thus far has not given her the effect she desires. She also wishes to try a longer-acting consumption method, in addition to flower.

Restrictions of use (personal and DOH): no true restrictions, but THC-dominant products with a stimulating effect are preferred

Management

Formulation (s):

1. GLeaf Sativa Extra-Strength tincture (guava flavored) – 37.6mg THC per ml
2. Vireo “Chocolope” sativa flower prn low mood/creativity

Dose:

1. Tincture: 6-7 drops daily in the morning; a dose which yields roughly 4.7mg of THC in this dose
2. Flower: Inhale as needed in the daytime

Frequency:

1. Tincture: up to 3x daily, last dose before 5pm (to avoid stimulating effects from late afternoon/evening usage)
2. Flower: As needed in the daytime, last dose before 5pm for reasons stated above

Other comments:

1. Tincture: can increase by 6-7 gradually every 3-5 days if needed. Must space from ETOH by at least 4 hours to avoid over-sedation

Outcome

The patient reports that the desired effects on cc are achieved by using only the starting dose, which is 7 drops of tincture (approx. 4.7mg THC); the effects last roughly 3-4 hours, per patient report. She uses this dose in the morning and noticed the effects upon initial administration. She has yet to express the need to increase her tincture dose and is content with her current regimen of 7-drops in the morning, along with as-needed daytime use of Chocolope flower, which she is also very pleased with.

Discussion

We have come to find that Sativa-dominant strains/formulations with stimulating terpene profiles work best for this patient’s chief complaint. Sativas in general are considered best for daytime use due to their stimulating effects. The batch of Chocolope flower that the patient was recommended that day contained a relatively high amount of limonene. From what we know about terpene effects, limonene is stimulating and can help depressed mood and lack of motivation, along with aiding anxiousness. The Gleaf Sativa tincture was recommended due to its Sativa lineage as well and provides a longer duration of action due to its sublingual administration. The combination of both intermediate (tincture) and short-acting (flower) formulations proved to best serve the patient’s needs in this case.

This patient presented with a long history of cannabis use and seemed to be very comfortable using concentrated MMJ products orally. Had this not been the case, I would have suggested a less potent oral formulation, to help limit the chance of her over-medicating. Sublingual administration (versus swallowed) was chosen due to the patient’s preference for a tincture, the current menu’s availability, and the comparative cost-effectiveness of the oral products available. Many patients find that liquid oral preparations allow for more dosing flexibility and cost-effectiveness, particularly when starting a titration schedule for a new oral product. It is critically important to consider patient lifestyle, cannabis history, perceived THC tolerances, and budget when making product recommendations.

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