One of my favorite things about medical cannabis is the variety of ways to consume the medication. As a patient, I love having the ability to choose how I take my medication based upon my specific need. This gives me a sense of control and relief that I’ve never been able to achieve with other treatments. We call the different ways to consume medical cannabis delivery routes, or delivery methods.
Choosing a Cannabis Delivery Method
When choosing the right cannabis delivery method for you, it’s important to consider the nature of your symptoms, the time of day, your overall goals, and any other specific concerns you have. The onset time, overall duration, and potential psychoactivity of the medication should also be considered. Figuring out the right method(s) requires some experimentation, but with a little trial and error most patients are able to find the method, or combination of methods, that works best for their symptoms. When deciding on your personal delivery method, it may be helpful to identify at least 2 options – one for overall symptom management (long term relief) and one for breakthrough symptom management (acute relief).
Delivery Method Types
Onset: Immediate, within 1-5 minutes
Duration: 1 to 3 hours, varies
Cannabis can be inhaled via smoking or vaporization. While smoking is the most common method, vaporizing cannabis – either the flower or oil, allows patients to avoid the consumption of toxic compounds such as benzene and carbon monoxide found in smoke. Vaporizing heats the active ingredients called cannabinoids and converts them into a vapor which is then inhaled, while remaining under the temperature at which the ingredients combust, or turn to smoke.
With all forms of inhalation patients can expect to feel the medication within 1 to 5 minutes. This quick onset makes it easy to increase the dose as needed. Effects will last 1 to 3 hours depending on patient tolerance and the product/strain used. Vaporizing does not produce the same smell as smoke, allowing for quick, efficient, and discreet medicating.
Due to the quick onset, many patients prefer inhalation for managing breakthrough symptoms like pain, anxiety, and nausea.
Onset: 15minutes +-
Duration: 2 to 6 hours
Sublingual tinctures and sprays are alcohol based cannabis extractions that are applied under the tongue and to the mucous membranes of the mouth. Left to absorb for 1-2 minutes, the cannabinoids are delivered to the bloodstream and begin to take effect with 15 minutes. Most patients reach peak intensity within 45 minutes with total effects lasting approximately 4 hours, sometimes longer. Sublingual consumption allows for very specific dosing, typically allowing patients to dose down to the milligram.
Many patients find optimal relief by using sublingual preparations 2-3 times per day, adding inhalation methods as an adjunct therapy for breakthrough symptoms on an as needed basis.
Confusing to patients, many cannabis products are labelled tincture when they are actually an oral oil. Oils are not absorbed efficiently into the bloodstream through the mucous membranes and are better swallowed. Be sure to check ingredients of all oils and tinctures before purchasing.
Tinctures are typically labelled and sold by mg/mL. For example, a 1mg starting dose of medication in a product that is 10mg/mL would be .10 mL of medication. In a 20mg/mL preparation the same dose would be .05mL.
Includes: Tinctures, sprays, lozenges, powders
Onset: 30 minutes – 2+ hours, highly variable
Duration: 6 to 8 hours
The oral delivery method includes cannabis edibles (foods), capsules, powders, and oils that are swallowed and digested through the stomach. Oral cannabis has the benefit of a much longer duration than any other administration method, but it can also be the most difficult to dose. Onset is anywhere between 30 minutes to 2+ hours with effects lasting 6 to 8 hours. Onset and duration can vary wildly by patient due to differences in absorption, metabolism, and stomach content.
Effects are more intense and body dominant than other delivery methods, making it a good choice for severe and persistent chronic pain. Patients with sleep difficulties, especially middle of the night awakening, also respond favorably to oral dosing.
While low and slow is the rule for all medicinal cannabis dosing, it’s extra important when consuming oral medication. Too high of a dose can result in intoxication, anxiety, paranoia, and nausea. Patients new to cannabis should start with doses under 5mg. Those with cannabis experience may start with10mg and slowly titrate dose up as needed, being sure to allow ample time for medication onset. Dosages can vary wildly by experience and tolerance, with some cannabis users requiring 200+ mg. Patients with no gallbladder and/or GI absorption issues may find difficulty with oral dosing. Consuming oral doses with additional fat can help.
TOPICAL & TRANSDERMAL
ONSET: Varies, typically within 20 minutes
DURATION: varies, 4 hours – 72 hours, dependent on product
Topical applications of medicinal cannabis are growing in popularity, especially for elderly users. You can purchase or make your own creams infused with cannabis, which are used to relieve pain, neuropathy, muscle spasms, and skin conditions such as psoriasis and eczema. Topicals do not produce a high or psychoactive effect, making them a great choice for pain relief when working or on the go. Onset is usually felt within 20 minutes with relief lasting 3-4 hours. Patients can also purchase transdermal patches, which provide a steady low dose of medication for up to 12 hours at a time. Onset is typically felt within 45-90 minutes and may have some minor psychoactivity depending on where it is placed (vein vs local pain area).
Includes: Creams, salves, lotions, patches, gels
Onset: 30 minutes or less
Duration: Varies, 30 minutes up to 12 hours
The least common of all delivery methods, cannabis infused suppositories, can be used rectally or vaginally to provide both localized pain relief and a systemic response. Suppositories can be a helpful option for individuals with severe pelvic pain or those too ill to consume cannabis via other methods. While research is limited, bioavailability upwards of 80% has been demonstrated when cannabis suppositories are used properly (deep enough). They also bipass the liver, removing any potential for psychoactivity. I make my own and use them for my endometriosis related symptoms.
If you are a Florida patient wanting to learn more about how these delivery routes relate to your Certification Orders and the State Registry, please check out this post.
Post originally published on July 24, 2018 and in the NUSASun.
Post updated September 12, 2020
Not a Florida Medical Cannabis Patient? Check out www.flmedcannabis.org to get certified and obtain your card.