Medical Cannabis Delivery Routes

One of my favorite things about medical cannabis is the variety of ways to consume the medication, also known as the delivery route. 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. 

When choosing a method it’s important to consider the nature of the symptom, time of day, overall goals, and any patient specific concerns. The onset time, overall duration, and potential psychoactivity of the medication should also be considered. This 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. 

INHALATION/VAPORIZING

Vaporizing cannabis heats the active ingredients called cannabinoids and converts them into a vapor which is then inhaled. Vaporizers remain under the temperature at which the ingredients combust, or turn to smoke. This allows patients to avoid the consumption of toxic compounds such as benzene and carbon monoxide. 

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 4 hours depending on patient tolerance. Vaporizing does not produce the same smell as smoke, allowing for quick, efficient, and discreet medicating. 

Due to the quick onset, many patients prefer vaporizing for managing breakthrough symptoms like pain, anxiety, and nausea. In Florida, both cannabis flower and oil based medical cannabis vape products are available. 

SUBLINGUAL TINCTURE, OILS, AND SPRAYS

Sublingual tinctures and sprays are usually oil or alcohol based liquids 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. Sublingual consumption allows for specific dosing. Patients should start with 1-2.5 mg of medicine and slowly increase the amount as needed. Products will be labelled with a milligram per milliliter (mg/mL)/ designation.

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. 

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. 

ORAL OILS & CONCENTRATES

Oral medications are the same oils that can be used sublingually, but they are immediately swallowed or eaten in food. 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 5 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. Many patients find maximum benefit by mixing oral concentrates into food or baked goods and consuming as a “medible.”

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. 

TOPICAL & TRANSDERMAL

Topical applications of medicinal cannabis are growing in popularity, especially for elderly users. In Florida you can purchase creams infused with cannabinoids, 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. 

Article also published in the NUSASun.