10 Cannabis Questions for Primary Care

From high-potency cannabis for smoking to a remarkable array of “edibles,” your patients can choose from hundreds of cannabis options based on need, desire, lifestyle, etc. They can also choose cannabis products based on the concentration of the active ingredient -- tetrahydrocannabinol (THC) or cannabidiol (CBD). As this marketplace gets more complex, clinicians need to be well versed in types of products, how they compare in potency, pharmacokinetics, how to estimate a patient’s use, and more.

Take this short quiz to see what you already know and what you might want to know more about.
 

1. While cannabis is a federally prohibited drug, it is legal in its medical and recreational forms, respectively, in how many states?

A. 30 and 8

B. 35 and 8

C. 25 and 10

D. 20 and 10

Please click below for answer and next question.

Answer: A. 30 (states that have legalized medical cannabis) and 8 (states that have legalized recreational use of cannabis)

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2. CBD has been shown to induce transient symptoms of psychosis among healthy volunteers and is thought to be a risk factor in developing psychosis; conversely, THC is theorized to have antipsychotic and anxiolytic properties.

A. True

B. False

Please click below for answer and next question.

Answer: B. False (The reverse is true; THC has been associated with symptoms of psychosis and CBD may have antipsychotic/anxiolytic properties) 

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3. Compared to the cannabis of the 1960s, which was typically about 1% to 5% THC by weight, selective breeding of high-THC content cannabis has produced some strains that reach as high as:  

A. 15% to 25% THC by weight

B. ≥ 30% THC by weight

C. ≥ 40% THC by weight

Please click below for answer and next question.

Answer: B. ≥ 30% THC by weight (THC content of some current strains of cannabis)

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4. Five hundred (500) mg of an herbal cannabis product that is 20% THC by weight has ~100 mg of THC in it. After loss of THC to combustion, side stream, and exhalation when smoked, the inhaled dose of THC from the 500 mg sample would be between: 

A. 10 mg and 20 mg

B. 15 and 30 mg

C. 20 and 30 mg

D. 25 and 35 mg

Please click below for answer and next question.

Answer: D. between 25 and 35 mg (dose of THC would be inhaled from a 500 mg herbal cannabis sample when smoked)

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5. If the product being smoked was 500 mg of a concentrated cannabis extract that is 70% TCH by weight (vs the herbal product in question 3), the net dose to which the person would be exposed would be between (approximately):

A. 65 mg and 95 mg

B. 75 mg and 105 mg

C. 85 mg and 125 mg

D. 95 mg and 135 mg

Please click below for answer and next question.

Answer: C. Between approximately 85 mg and 125 mg (dose of THC would be inhaled from 500 mg of a concentrated cannabis extract when smoked)

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6. Cannabis intoxication via smoking occurs as soon as 2 minutes after the first inhalation. When does peak drug effect occur and for how long will a user remain intoxicated?

A. 15 minutes; 2 to 4 hours

B. 30 minutes; 2 to 4 hours

C. 45 minutes; 3 to 5 hours

D. 60 minutes; 4 to 6 hours

Please click below for answer and next question.

Answer: B. 30 minutes (peak drug effect occurs); 2 to 4 hours (duration of intoxication)

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7. When inhaling cannabis via vaporizer, approximately what percentage of the total cannabinoids present in the herbal cannabis is absorbed by the user?

A. 25%

B. 33%

C. 50%

D. 66%

Please click below for answer and next question.

Answer: B. 33% (of total cannabinoids are absorbed via vaping herbal cannabis)

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8. Dab, wax, and butane honey oil are colloquial names for which of the following:

A. Compacted resin glands from cannabis plant

B. Traditional hashish

C. Highly concentrated, relatively pure hashish extracts

D. Highly concentrated, relatively pure THC cannabis extracts

Please click below for answer and next question.

Answer: D. Highly concentrated, relatively pure THC cannabis extracts (dab, wax, honey butane oil)

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9. Orally ingested cannabis products, or edibles, often produce a more intense, longer-lasting effect than cannabis that is smoked or vaped. Studies have shown, however, that for every 1 mg of THC consumed via smoking or vaping, a user must ingest approximately how much by mouth to achieve the same effect?

A. 1.5 mg

B. 2.0 mg

C. 2.5 mg

D. 3.0 mg

Please click below for answer and next question.

Answer: C. 2.5 mg (of THC must be orally ingested to achieve the same effect produced by inhaling 1 mg of THC)

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10. The more intense experience produced by oral ingestion of THC vs smoking likely occurs because THC is hydroxylated in a higher amount to the highly active metabolite 11-OH-THC by the cytochrome P450 enzyme.

A. True

B. False

Please click below for answer and Extra Credit Question.

Answer A. True (greater intensity of experience with edible cannabis is likely related to hydroxylation of THC into a highly active metabolite by the CYP450)

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Extra Credit Question: A recreational cannabis user who refers to smoking spliffs is talking about which of the following:

A. A cannabis cigarette

B. A cannabis cigar

C. A cone-shaped joint with a filter

D. Cannabis mixed with tobacco

Please click below for answer.

Answer: B and C (the term spliff can refer to either a cone-shaped joint with a filter or cannabis mixed with tobacco)

How did you do?

For anyone interested in brushing up on their differential cannabis knowledge, the editors recommend taking a look at the reference list available at the end of the source article for this quiz; link provided below.

Source: Peters J, Chien J. Contemporary routes of cannabis consumption: a primer for clinicians.J Am Osteopath Assoc. 2018;118:67-70.