Tincture Many patients who utilize and benefit from medical cannabis do not wish to smoke due to the perceived health hazards of smoking or for other personal reasons. These patients are in something of a bind. Smoking cannabis delivers the active cannabinoids within seconds. Medicine is absorbed in the lungs and goes directly to the brain and general circulation. The same effect can be achieved with a vaporizer, which is safer than smoking burning vegetable matter. Since the effects of inhaled cannabis are so quick, it is easy for patients to titrate their dose by simply waiting a minute or two in between puffs. Oral cannabis, such as Black Out Bud Butter, is absorbed in a very different fashion from smoking or inhalation. The GI tract gradually absorbs Cannabinoids over the course of one to two hours. Medicine is processed first by the liver, which converts some cannabinoids such as delta nine to delta 11version of THC. Orally delivered cannabis requires four to ten times the amount of the smoked version in order to achieve the same effect. Orally delivered cannabis can present a problem in achieving the required or desired dose level in any consistent fashion. Tincture is designed to address the problems of rapid medicine delivery and consistent dosing. Most tinctures are made to be used under the tongue or sublingually. English pharmaceutical companies are presently working on a cannabis extract "spray" that can be used under the tongue in a similar fashion. These sprays are not expected to be approved for use in the United States for years and will be very expensive. Absorption by the arterial blood supply under the tongue is completed in seconds. One trick is to not swallow the dose as, if swallowed, absorption will be in the GI tract. Many patients, though, add their tincture to a cup of tea or cranberry juice for easy delivery. When tincture is used in a beverage, absorption will be slower than if absorbed under the tongue. While tincture absorbed in an empty stomach is accomplished in minutes, conversion in the liver remains, as does the difficulty in titrating dose. Usually, a tincture dose is delivered by means of a medicine dropper or a teaspoon. A rule of thumb on dose is that patients receive benefit from 3-4 drops to a couple of full droppers depending upon the potency of the tincture and the patients own unique requirements among other factors. The methods listed below will detail two major methods of preparing tincture. While the methods are optimized for purity and potency, ultimately these will largely be determined by the purity and potency of the cannabis from which the tincture is made. Another item of note in regard to starting material for tincture is the patient or caregiver selection of strain. A rough rule of thumb is to select Indica dominant strains for cramping and muscle spasticity and Sativa dominant strains for pain relief. The reality, though, is often that the strain is unknown or not well characterized. Trial and error is usually required to acquire the appropriate strain and the proper dose level. General Rules: Tincture is an extraction of active cannabinoids from plant material. Cannabis contains many chemicals that can either upset the stomach or taste nasty. One of the goals of extraction is to secure the cannabinoids while leaving out as many of the terpenes and chlorophylls as possible. Both heat and light adversely effect cannabinoids and should be avoided or minimized. Tincture should be stored in airtight dark glass containers kept at room temperature or below. Avoid plastic containers. The ethanol in the tincture may solubilize some of the free vinyls in the plastic. Cold Method with Ethanol Making tincture cold preserves the integrity of cannabinoids. To be potent, this method requires starting material high in cannabinoid content such as flowers or kief made from trim and leaf. The material must be mold free and dry. Drying can be accomplished in the freezer (-4-10 degrees Celsius) or better yet by placing in a liquid proof bag into a dry ice/ethanol ice bath (-70 degrees Celsius). Once water has been removed then the surface area of the starting material requires expansion. This can be accomplished a number of ways but two ways stand out: Using flowers (bud)- Place dried buds in a coffee grinder and pulse until thoroughly ground but not powdered. Making kief- Rub dry trim and leaves over a silk screen. Collect the powder the comes through the screen. It should be a very pale green. "Kiefing" is an age old way of extracting trichomes from plant material. Whether kief or ground bud is used both should kept ice cold for this preparation. Similarly, the ethanol to be used should also be ice cold throughout the process. Selection of alcohol- ethanol or ethyl alcohol is the form of alcohol that can be used by humans. The proof listed on commercial alcohol refers to the percentage of ethanol that the beverage contains. The proof is twice the percentage, so 80 "proof" means that the mixture contains 40% ethanol. The higher the alcohol content used, the better the extraction will work. Ideally, 200 proof ethanol would be best except that ethanol cannot be distilled to this proof so benzene is used to remove the last vestiges of water. This makes "pure" ethanol poisonous. Many folks use "Everclear" which stands at 190 proof or 95% ethanol. Everclear has no taste. Apparently, Everclear is not available in all States. A close second choice is 151 proof rum. This is a light amber liquid that is 75% ethanol that has a sweet taste. One of our caregiver writers will use nothing but Korbel brandy because she likes the taste. Others use iced Russian vodka. These "normal" distilled spirits are 40% to 50% ethanol. Some patients find that the higher proofs ethanols like Everclear and 151 rum burn too much under the tongue. If burning is a concern consider a high quality 90-100 proof Vodka. Cold Extraction and purification- Use at least one ounce of starting material to each pint of ethanol. Place cold powdered kief or ground cannabis flowers together with ethanol in a glass quart-mixing jar. Close the jar tightly and vigorously shake for five minutes then return to the freezer. Continue to agitate the mixture every few hours with refreezing. Continue for a period of two to three days. Pour the cold mixture through a double thickness of sterile cheesecloth. Save the cheesecloth "ball" for topical uses or use the material to make bud butter once dried. The liquid collected through the cheesecloth should then be filtered twice through a paper coffee filter. Use gloves throughout the process, as it is necessary to squeeze the cheesecloth and coffee filters to facilitate the extraction. Without gloves some of the material will be absorbed on the skin. If Everclear is used the tincture will be pale green to golden. If 151 rum is used an amber tincture results. Dark green tinctures mean that excess plant material is present. This does not mean that the tincture will not be potent, just taste nasty. When Everclear is used, various flavor extracts may be added (vanilla, raspberry, etc.). Be careful to use only a few drop of flavor extract. Traditional or Warm Method The old fashioned (and effective) way to make tincture from trim, leaf or "shake" is to grind the plant material to expose surface area. A fine grind is not needed and will just make the tincture cloudy. A rough chop will do. Most folks cant afford to use kief or bud for tincture but may have leaf handy. If so, this is the way to go. Use ethanol as described above in the same proportions. The key difference is that in this preparation the materials are kept warm (not hot). Light must be avoided. Place the ethanol and chopped cannabis in a large glass Mason jar. Shake at least once a day. Place the jar in a brown paper bag or otherwise shield the jar from light. Leave in a warm spot (near a window) for 30-60 days. The mixture will turn a very dark green. Strain as previously described through cheesecloth. Save the "shake ball" for topical applications. While this method produces a nasty tasting tincture, it is powerful. It may upset some fragile stomachs. It is recommended that Warm Tincture be used orally in cranberry juice or coffee with sugar. Keep the filtered tincture in light blocking glass jars or bottles in a cool dry place (refrigerator or freezer is fine). The shake ball should also be kept in the freezer. For topical applications, just take out the cold shake ball and apply a few drops of fresh tincture to the cloth then hold it on the affected area for a few minutes with gentle rubbing.