Medical cannabis is a complex organic substance that can come in many forms, from whole flower to oil capsules. This diverse product range means that taking medical cannabis is not a one-size-fits-all approach. Different products and different methods of administration need to be considered depending on the condition being treated, the ratios of active cannabis compounds needed, and the individual patient. [1]
Cannabis flower
The most common medical cannabis product is whole flower. This refers to the natural leaves and buds of the cannabis plant which has been cultivated specifically for medical purposes. Unlike cannabis that is grown for recreational use, medical cannabis flower must be produced to Good Manufacturing Practices (GMP) standards. Medical-grade cannabis flower is therefore cultivated to high standards to ensure quality and consistency.
Cannabis flower prescribed for medical purposes is vaporised and inhaled. This involves heating the flower until the cannabinoids and other active ingredients are released. These compounds are then inhaled into the bloodstream via the lungs. Vaporising cannabis offers high bioavailability and a rapid onset. [2]
Cannabis oils
Cannabis oils contain cannabis extracts with specific levels of cannabinoids and other active compounds. If in capsule form to allow ingestion, cannabis oils are administered with a carrier oil such as MCT, or other more common fatty oils, that improve the bioavailability of ingested cannabinoids.
However, these oils are often administered as drops sublingually (under the tongue) where it is to be held for one to two minutes to ensure absorption. While onset time for sublingual cannabis oils is longer (maybe 60-120 minutes), effects last longer (up to 6 hours or so) than inhaled vapour. This makes oils ideal for background relief.
The thin skin barrier under the tongue allows cannabinoids to be absorbed more efficiently than through other areas of the skin. Furthermore, this route of administration allows cannabinoids to avoid the stomach and liver where a lot of the active ingredients can be filtered out before reaching the bloodstream.
Oromucosal Spray
Another method for administration is the use of an oral spray. These products work in much the same way as cannabis oils in that they are absorbed through the tissue in the mouth. The most well-known medical cannabis oral spray is Sativex – a combination of CBD and THC which is licensed in the UK for the treatment of spasticity related to multiple sclerosis. However, this product can also be prescribed for other conditions through private medical cannabis clinics. [3]
Topicals
A topical is a product that is applied directly to the skin as a localised treatment. These medical cannabis products are usually prescribed for skin conditions or to provide pain relief in specific areas of the body. For example, medical cannabis topicals may be prescribed to tackle pain linked to arthritis or musculoskeletal pain. [4]
Dosing
The accurate dosing of your medical cannabis product will vary from case to case, depending on factors such as patient experience/tolerability, the product being used, and the condition being treated. As a general rule, clinicians will recommend that you ‘start low, go slow’. Usually, prescribers will initially consider products with lower or no levels of the psychoactive compound THC. This is to avoid unnecessary side effects; however, the ratios of the product used may be introduced and titrated upwards until patients achieve their treatment goals.
As part of an average treatment plan, it is unlikely that a patient will require more than 1-grams of cannabis flower, or more than 150 mgs CBD or 20mgs THC in cannabis oil treatment per day.
References
- [1] MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-19.
- [2] MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-19.
- [3] MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-19.
- [4] MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-19.
