By Ruth Hill R.N.
Most people who do not use cannabis believe that everyone smokes and gets high. The methods of administration are the same as any pharmaceutical: inhalation, oral ingestion, sublingual, buccal, topical, transdermal, and suppositories (rectal & vaginal). Recent studies have highlighted the challenges associated with cannabinoid formulation, such as low solubility in water, rapid conversion in the digestive system, the actual utilization of the dose in the body, and the erratic activity of Δ9-tetrahydrocannabinol (THC) or cannabidiol (CBD) in the body over time. These challenges include how cannabinoids are absorbed, distributed in the body, localized in tissues, and excreted – all of which contribute to the limited efficacy of cannabinoids.
Unfortunately, smoking is the least efficient form of adult use and not the most appropriate for medicinal purposes. Let us explore the reasons why. When smoking a joint at high temperatures, much of the terpenes and 60% of the cannabinoids evaporate. However, it provides the most immediate response, which is why it is used medicinally for breakthrough pain, nausea, or anxiety. The effects can last one to two hours. A cleaner and more efficient way to inhale is with a vape pen (30% is lost) or through a volcano (54% is gained), similar to using an Albuterol (ProAir) as a bronchodilator. Currently, there is no way to measure the exact dose when inhaled.
The sublingual mode uses tinctures or sprays. Onset is quick and takes 15 minutes, like when a heart patient takes a nitroglycerin tablet for chest pain. Duration lasts 4-6 hours. Cannabis is lipophilic, meaning it needs fat to metabolize. If no relief in an hour, take a fat snack like cheese or avocado. If you do not like the taste, take it on a cracker. Tinctures are the best way to determine sensitivity to THC or CBD. Start low (2 mgs) and build up slowly (10 mgs), and space out the dosing.
The edible form is infused with CBD or THC. It can be pills, capsules, gummies, tea, coffee, water, soda, pops, or chocolate. The edible follows the same path of digestion as food, with the onset of 30-90 minutes, and the duration is up to 12 hours. Edibles can be cut into smaller squares to lower the dose ingested. Some cultivators fill the capsules with broad-spectrum oil instead of just the infused molecules.
Individual genetic differences result in the dose taking 2 to 3 hours. This is because THC is converted into a metabolite by the liver that is stronger than THC (11-Hydroxy-Δ9-tetrahydrocannabinol). For this reason, tinctures are the recommended mode of administration for individuals using marijuana for the first time.
FECO (full extract cannabis oil) and RSO (Rick Simpson Oil) are highly concentrated forms of cannabis in which the whole plant is extracted and ingested orally. This process offers a broad spectrum or full-spectrum representation of the full cannabinoid and terpene profile found in that cannabis strain or cultivar. These products are usually used for cancer patients or children with seizures.
Topicals are CBD or THC-rich in creams, balms, or liquids. Apply after a shower and 2- 3 times/day, depending on the intensity of the pain. Onset is in minutes, with a duration of up to four hours. Most topicals do not enter the bloodstream. Transdermal patches penetrate the bloodstream for a slow-paced relief of up to 48 hours. Individuals with sensitive skin may get a rash when the patch is removed. It is not marijuana that is the culprit, but the adhesive used to adhere to the skin. Patches are expensive because one is needed every 48 hours. Some users cut the patch into 2s or 4s.
Suppositories vaginally or rectally are used for severe pain with menses or cancer. Dabs—also referred to as wax, shatter, amber, honeycomb, or budder—are concentrated versions of butane hash oil (BHO), which contains highly concentrated levels of THC. These can irritate the throat and are not suggested for medical use.
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