Administration

How medicinal cannabis is taken determines the onset, intensity and duration of any effects. Therefore, choosing the correct administration route, or dose form, is important. The correct route helps patients manage their total daily dosage, the timing and frequency of use. It also helps reduce the risk of side effects. A doctor advises which administration route best suits the treatment outcome and patient needs.

Below, you can find general information about the most common administration routes and dose forms for medicinal cannabis. You can also read about methods pharmacies use to prepare medicinal cannabis for patient use.

• Inhalation (by the lung)
• Oromucosal (inside the mouth/cheek)
• Oral (by mouth)
• Pharmacy compounding
• Cannabis oil

The effects of other administration routes, such as teas, are unpredictable and are not supported with clinical research. Smoking is also not considered a suitable administration route, as it is very harmful to health.

Administration via the lungs is a very common route. This is because of the rapid absorption of the cannabinoids by the lungs (i.e. THC and CBD). A medical device is necessary to ensure safer and consistent administration. Using a medical device, doctors can advise patients how to gradually reach an optimal dosage (dose titration). There are currently three registered medical devices that were developed specifically for the medicinal use of cannabis:

Volcano Medic® – a table top vaporizer device that produces a vapour of cannabinoids from dried cannabis flowers, and from liquid cannabinoids dissolved in alcohol.

Mighty® – a portable vaporizer device that produces a vapour of cannabinoids from dried cannabis flowers.

SyqeAir ™ –   an inhaler developed for professional healthcare use in hospitals or by licensed patients. It delivers metered and consistent doses of cannabinoids from full-spectrum cannabis in the form of aerosols. The device is currently only available in Israel and Australia.

With the oromucosal administration, the cannabinoids (THC and CBD) are absorbed through the mouth’s mucosa (the mucus membrane lining the inside of the mouth). The dose is usually administered sublingually (under the tongue) or buccally (inside the cheek) in the form of a solution, spray, or rapidly dissolving wafer. Among the products commonly administered via the oromucosal route are cannabis oil extract solutions.

Oral cannabis-based preparations are similar in form to other medicines patients may already take. Products for oral administration can come in the form of solutions, tablets, or capsules. However, oral dosing can result in very low absorption of TCH and CBD. It is estimated that up to 6% of the total taken, only, is absorbed. That is because cannabinoids undergo extensive first‐pass metabolism in the liver when swallowed. Lower blood concentrations and a delay to reach peak blood concentration (approx. 120 min) slow the onset of action and duration of effects.

Medicinal cannabis can be prepared in a specific formulation and dose form by a compounding pharmacy. This depends on the doctor’s prescription. Many compounding pharmacies can prepare products such as tablets, oils, capsules, sprays, or ointments. Compounded medicines are not pharmaceutically produced. Indeed, there is inconsistency in regulations and compounding methods, which means variability in cannabinoid content between different preparations and pharmacies.

CBD extracts and full-spectrum cannabis extracts (containing cannabinoids, terpenes and other plant components) are commonly referred to as cannabis oil. Cannabinoids are extracted from the flowers or leaves of the cannabis plant, often using a solvent extraction process (CO₂ or ethanol). The extracts are put into solution (formulation and dose) to be administered either sublingually or orally.

Cannabis oils in solution may be produced by pharmacy compounding as a magistral preparation. They are also produced by industry according to pharmaceutical standards.