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Carl’s Jr. offered this cannabis-infused hamburger at one of its Denver restaurants last Saturday. Getty Images

Marijuana users with a case of the munchies celebrated 4/20, the annual marijuana holiday, by ordering a burger infused with cannabidiol oil at a Carl’s Jr. restaurant in Denver last Saturday.

The Rocky Mountain High Cheese Burger Delight represented the first time a major fast-food chain has incorporated the cannabis extract — derived from hemp — into a food item.

But while the Carl’s Jr. burger was a one-day promotion, there are a wide variety of foods being made with cannabidiol (CBD) as well as marijuana, including at least one restaurant franchise with dreams of opening cannabis pizza joints from coast to coast.

Marijuana has long been used as an ingredient in food for users who wanted to get high but didn’t want to smoke.

In addition to the classic “pot brownies,” the mainstreaming of medical marijuana — now legal in 33 states and Washington, D.C. — has given rise to a cottage industry of producing marijuana edibles.

Cookies, gummies, and hard candies infused with THC can be found for sale right alongside loose marijuana at dispensaries where the drug is legal for medical use.

Cannabis-based compounds have been touted for health benefits from pain relief to acne prevention, but some experts caution there hasn’t been enough research done to know the short-term and long-term health benefits of regularly ingesting these compounds, either by smoking them or eating them.

And a recent study catalogued how many emergency room visits in one city were related to eating cannabis-infused foods and what health problems the edibles caused.

There are dozens of professional chefs who are incorporating cannabis into the dishes they serve, including multicourse, fine-dining experiences.

Mindy Segal, who won the James Beard Foundation’s Outstanding Pastry Chef Award in 2012, makes sophisticated cannabis candies.

Michael Magallanes, who worked in Michelin-starred restaurants in the San Francisco area, cooks with hashish and sprinkles powdered cannabis on dishes during private gourmet dinners.

The fortuitously named Stoner’s Pizza Joint, a small pizza chain based in South Carolina, hopes to incorporate CBD and eventually THC into its recipes as it rapidly expands in the next few years.

The chain’s plans are due in part to the growing interest in cannabis cooking and financial backing from Sol Global, a Canadian cannabis investment firm.

“I’ve been cooking with cannabis for more than 20 years, but the bottom line is it hasn’t been acceptable until now,” Glenn Cybulski, the company’s president and chief culinary officer, told Healthline.

He adds that Stoner’s Pizza wants to become the leader in exploring the savory side of edible cannabis, including infusions of salad dressings, sauces, and even pizza crust.

The 2018 Farm Bill passed by Congress removed hemp containing only trace amounts of THC — tetrahydrocannabinol, the psychoactive ingredient in cannabis — from the Controlled Substances Act.

That, in turn, has opened up a broad, legal market for products containing CBD extracts from hemp.

While THC remains illegal under federal law, CBD is now legal in all 50 U.S. states.

Proponents say there are a wide variety of health benefits for THC and CBD, from pain reduction to acne prevention.

Thus far, however, the Food and Drug Administration has only approved a few cannabis-based drugs. These include a synthetic THC to fight nausea and a CBD-based drug for the treatment of seizures associated with two rare forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.

In Europe, a drug called Sativex that contains both THC and CBD is used to treat spasticity and pain associated with multiple sclerosis.

Nonetheless, cooking with cannabis has been creeping toward the mainstream as chefs work to educate consumers that infused dishes can be both safe and healthy.

Controlling dosage can be a challenge when cooking with CBD or THC, especially for home chefs like Christine Manente, a Connecticut resident who holds a state-issued medical marijuana card and used cannabis to blunt the pain from a work-related injury.

“I have a brownie pan that splits into 18 equal size pieces,” she told Healthline. “I’m a lightweight, so I can handle half of a brownie to help with the relief of pain without being wasted. I don’t love that feeling.”

“Smoking does not translate to ingestion of edibles,” Daniel Winer, director of marketing for the Canada-based cannabis retailer Starbuds, told Healthline.

“When absorbed through the lungs, THC is absorbed immediately and then dissipates. With edibles, THC-9 is turned to THC-11 when it is being broken down,” he said.

“This is why edibles experiences not only last longer but are often more intense. If you are new to edibles, start with 5 milligrams. Wait an hour after consumption to see how you feel and go from there,” Winer added.

For commercial use, there can’t be guesswork about how much THC or CBD is in a bite of food, or where the cannabis comes from, says Cybulski.

“Our guests need to know that we have gone to a level of making sure the purity is there,” he said.

He notes that Stoner’s intends to track every step of cannabis production from farm to table.

“Consumers want to ingest cannabis how they eat,” Andrea Drummer, food editor for cannabisMD, told Healthline. “They want to eat a full, complete meal.”

That means dishing out THC in small doses rather than one big hit that leaves diners stoned before they get to the second or third course.

Top cannabis chefs are highly educated about the various strains and potencies of the plants they use, says Drummer.

“Sourcing plants is as important as sourcing a great piece of fish or an organic turnip,” she said.

That goes for flavor as well as strength, especially when using the plant in recipes, she says.

California Blue Dream cannabis tends to have sweeter flavor notes that work well in a creme brûlée, for example, while OG Kush is more pungent and can be added to robust sauces like mole.

Chefs or anyone else who wants to cook with cannabis must first convert the raw THC-A in the cannabis plant into the psychoactive THC.

Heat is the key, which isn’t a problem when cannabis is smoked. For edibles, however, the cannabis must first be decarboxylated, which means baking it in an oven.

“Once this is done, you can do anything you want with your cannabis,” said Winer. “It can be eaten right there. However, we advise infusing an oil or butter with it. This will help stretch your cannabis and make it way more delicious.”

“The key is to not let your oil or butter get too hot,” cautioned Winer. “Doing so will turn your THC/CBD to CBN, which has a more sedative effect.”

One of the quirks about cooking with cannabis is that, unlike other food ingredients, the goal sometimes is to minimize the flavor of the plant, not enhance it.

“I was cooking with cannabis/coconut oil,” Kay Pointing, a former pharmaceutical company employee who learned to cook with cannabis while living in the Caribbean, told Healthline. “It’s a very heavy oil but vegan and pleasant to cook with, and it helps to mask the cannabis flavor which can taint food flavors.”

Like many DIY cannabis chefs, Pointing began making jellies and hard candies for medical users, not recreational users.

“My friend’s father had terminal prostate cancer, so I produced tempting edibles to encourage him to eat,” she said. “It increased his appetite and relieved pain. The potheads want strength, but most people using for medical reasons need smaller amounts in manageable doses.”

Drinks as well as food are being infused with cannabis.

Warren Bobrow, author of the book “Cannabis Cocktails, Mocktails, and Tonics,” is a skeptic about CBD oil. He calls it “snake oil” whose effects — if any — are negated by alcohol. But he’s a big believer in infusing drinks with THC.

“I have glaucoma. I can medicate in a Negroni — a stoney Negroni,” he told Healthline.

A master mixologist, Bobrow says the strength of a THC drink can be manipulated, just like one containing only alcohol.

“It’s up to the drinker,” he said. “From mild to wild.”

Experts do issue some cautions on regular cannabis use.

A study published last week analyzed emergency room visits between January 2012 and December 2016 at a large urban hospital in Colorado.

The researchers reported 9,973 emergency room visits that showed signs of cannabis use.

Of those, 2,567 visits were determined to be at least partially attributable to cannabis.

Of those, 238 patients had eaten a cannabis product as opposed to smoking or otherwise ingesting the compound.

The researchers reported that the edible cannabis patients were more likely to be suffering from psychiatric symptoms, intoxication, and cardiovascular issues than the other cannabis-related patients.

“Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more [emergency room] visits than expected,” the researchers wrote.

The National Institute on Drug Abuse (NIDA) does highlight some of the benefits of cannabis products for conditions such as epilepsy and post-traumatic stress order.

In her testimony before Congress in 2016, Susan R.B. Weiss, Ph.D., the director of the NIDA’s Division of Extramural Research, said it’s essential that more research needs to be done on the effects of marijuana-related treatments.

“In general, adequate and well-controlled studies are lacking, which means that patients across the country are using marijuana strains and extracts that have not undergone rigorous clinical trials, are not regulated for consistency or quality, and are used for medical conditions with an insufficient evidence base supporting their effectiveness,” she said.

On its Drugs Facts web page, the NIDA notes that when a person eats or drinks cannabis-related compounds, the effects from THC ingredients take longer to show up in the brain and other organs than when they smoke the compounds.

The organization states that THC can cause the brain to “overactivate” and produce short-term symptoms such as altered senses, mood swings, impaired body movement, and impaired cognitive functions.

The organization added that long-term use of marijuana can affect brain development.

“When people begin using marijuana as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. Researchers are still studying how long marijuana’s effects last and whether some changes may be permanent,” the web page states.