Preparation and administration of cannabis

FM2 and FM1 were delivered to the hospital pharmacy as minced flowers. Thereafter, the doses of cannabis prescribed by the physician were prepared as sachets by the chemists. Bedrocan, Bediol, and Pedanios were delivered as whole flowers and finely minced for decoction (administered orally) or roughly minced for vaporization by the chemist. Oil was purchased from an outside private pharmacy (Farmacia Ternelli, Reggio Emilia) where it was prepared by the Romano-Hazekamp technique using funds provided by the hospital. The oil extract was supplied to the patient by the hospital pharmacy and was paid for by NHS. All MC products were accompanied by an analysis form upon purchase.

All cannabinoids in the plant were primarily present in their acidic form. Application of heat was required for the decarboxylation of the cannabinoid acids into their active forms (THC acid into THC; CBD acid into CBD) (ElSohly and Gul 2014).

For administration, the decoction was administered orally after preparation by boiling the contents of a sachet containing minced MC in 200 mL water and 30 mL of milk for 15–20 min (Hazekamp et al. 2007). Alternatively, the cannabis was administered by vaporization using a cannabis vaporizer at a temperature of 210°C (Gieringer et al. 2008). Finally, sublingual administration was performed using olive oil extract prepared by the Romano-Hazekamp technique (Romano and Hazekamp 2013).