By MICHAEL PATTERSON

Currently, the Florida Department of Health Office of Medical Marijuana Use (OMMU) does not allow for smokable marijuana flower (buds) to be used legally. However, with the state of Florida losing the legal challenge to smokable flower in 2018, Governor DeSantis has demanded rules and regulations on smokable flower passed through the Florida legislature during the 2019 Legislative session which began March 5, 2019. Therefore, we will most likely see legal marijuana flower for medical marijuana (MMJ) patients later in 2019.

With marijuana flower becoming a reality and rules for implementing marijuana edibles coming any day, it will give MMJ patients more choice in the route of administration of the cannabis plant. As more patients begin asking physicians about these new routes of administration (regardless if the MD writes MMJ recommendations), it is beneficial to know the different effects each administration route has on the human body.

• Vapor- This is the most common method of ingestion of MMJ currently in Florida. Cannabis oil or flower is heated to a vapor, via a portable battery or stand-alone device, and inhaled. According to Researcher Dr. Kari Franson at the University of Colorado Skaggs School of Pharmacy, the bioavailability of vaporizing cannabis is between 5-20 percent with peak concentrations affecting the patient within minutes. These effects last 1-3 hours depending on the patient and tolerance to cannabis. Vapor allows patients to inhale cannabis without combusting the medicine.

• Smoking- Has a bioavailability of 10-25 percent with peak effects occurring within minutes and lasting 1-3 hours depending on the patient and tolerance to cannabis.

• Oil/Tinctures- Has a bioavailability of 50-75 percent which requires less product to get the desired effect. Oils and Tinctures offer a more reliable dose of cannabis, without the need to smoke or inhale the medicine. Oils and tinctures have a delayed effect compared to smoking or vaping. Peak effects can take up to one hour to appear and can last up to 5 hours.

• Edibles- Edibles are any food product that contains cannabis (cookies, gummies, brownies, pretzels, chocolate products, drinks, coffee, etc.) The regulation will only allow the maximum dose of 10 mg of THC per each item. For example, if you buy a package of 10 MMJ cookies which contain 100mg of THC, each cookie would have 10mg of THC. This standardization of dosing for edible products at 10mg per item will decrease the risk of ingesting too many cannabis products.

With the bioavailability between 50-75 percent, edibles allow users to experience the desired effect with MMJ from less product compared to smoking or vaping. However, edibles have even a more delayed effect (peak effects can take 30 min-2 hours to appear), which can lead to patients taking too many edibles due to lack of education of the delayed effect of ingestion.

• Transdermal Patches- Since cannabis transdermal patches are relatively new, there is little research on bioavailability. Transdermal patches have been known to provide a steady dose of cannabis medicine up to 48 hours while applied. However, it is not well known how much of the medicine penetrates the dermal layer of skin and provides adequate amounts of medicine to the body to get the desired effect.

Other delivery methods that are developing, but still not widespread are:

1. Inhalers with Medical Cannabis (similar to an asthma inhaler)
2. Water Soluble cannabis- This will be added to all types of drinks (including water) to deliver cannabis without any odor of a typical marijuana plant.
3. Powdered Cannabis- Imagine taking a small individual pack of powdered cannabis (similar to Sugar, Equal, or Stevia) and mixing it into any beverage. Powdered cannabis will provide convenience, discretion, and proper dosing of the medicine.

Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally.