However, using cannabis suppositories has been shown to be the most controversial with many claiming it to be ineffective.
According to Dr. Allan Frankel, MD, who has researched and written about rectal absorption of cannabis, nothing was felt by his test patients when they tried cannabis oil in cocoa butter.
Furthermore, analysis of their plasma revealed negligible THC and CBD levels.
However, Frankal acknowledges, “In spite of some of the medical findings, I do have several patients with positive results from using rectal administration of [ordinary] cannabis, so further research will certainly be beneficial.”
According to Practical Pharmaceutics: An International Guideline for the Preparation, Care and Use of Medicinal Products, the rectum does not absorb fats efficiently.
Any active substance in a suppository must first dissolve into the aqueous mucus that lines the rectum and then pass into the bloodstream; it cannot be absorbed directly by the membrane without traversing the aqueous mucus layer.
Therefore active substances that are themselves lipophilic (such as cannabinoids) should not be combined with a fatty or oily carrier, as this will reduce their overall absorption.
Rectal administration of cannabis suppositories and other methods
Rectal administration is one of the oldest pharmaceutical dosage forms. Hippocrates describes various compositions of acorns for rectal dosage and there is even mention of it in The Old Testament.
The first use of the word suppository goes back to 1763 in the Universal Pharmacopoeia of Lemery.
In Europe, particularly France, rectal administration of medicines is a very common and widespread practice due to the efficiency of delivery to the bloodstream and the fact that this form of administration bypasses the bodies vital organs such as the liver.
The main routes of administration of cannabis medications are well documented and include:
Patients can ingest their medication by making cannabis edibles which are easy to prepare but will take approximately one hour before there is a noticeable effect and for some patients the associated psychoactive high can be unpleasant. When taking edibles the patient has less control over the psychoactive effects and self-titration is a long process. There is the potential that your previous meal will effect the rate at which the medicine will take effect.
Inhalation of cannabis vapors using a vaporizer or utilizing a dabbing technique will deliver cannabinoids into the bloodstream fairly rapidly. This method is particularly suitable for patients who require faster relief from a variety of medical conditions such as acute pain, but also those suffering from neurological disorders and patients who experience difficulty swallowing their medications. As with ingestion there will be an associated psychoactive effect and this can be an unwanted side effect, particularly with patients who have no experience of cannabis use.
Cannabis can also be consumed as a liquid. Patients may wish to utilize their medicine as a form of tea or a milk based drink which works well. However, the most effective way to consume cannabis orally in liquid form is by making an alcohol tincture. This is more effective than teas or milk based infusions and provides a more concentrated dosage. Once again there will be a psychoactive effect which some patients may wish to avoid.
A topical cannabinoid medicine in the form of cannabis infused cream, or for serious conditions cannabis oil itself, is applied directly to the skin. This is particularly useful when treating skin cancers, burns, but also other less serious, yet irritating skin conditions. There is no associated psychoactive effect with topical applications of cannabis based medicines.
Ingesting cannabis in the form of edibles is estimated to be about 20 percent efficient and the user is likely to experience differing effects every time edibles are ingested.
The most recent scientific research on the rectal absorption of THC was published in 1991, and used crab-eating macaque monkeys.
Results showed no rectal bioavailability of THC, but when the cannabinoid was processed to create a combination with the molecule ester hemisuccinate (THC-HS), the bioavailability shot up to 13.5% and the mean residence time of THC in the blood was 5.8 hours.
What is THC-HS for suppository use
THC-HS is water-soluble, which is why it dissolves into the aqueous mucus. It is perhaps beyond the scope of most of us, however, the THC-HS is basically produced by a fairly simple chemical reaction. The most informative post we could source was found here and explains the process, but also the pitfalls and potential for abuse that may follow.
Suppositories avoid the gastro-intestinal system where metabolites separate and break down the compounds. One of these metabolites is 11-Hydroxy-Δ9-THC, which is a psychoactive compound similar to Δ9-THC.
This means there is little to no psychoactive effect on the patient. Basically you will not experience the associated high that cannabis consumed by other methods can produce.
Cannabis Suppositories: How Do They Work?
Despite these medical findings it seems that cannabis suppositories made from full spectrum cannabis oils still work for most patients.
A suppository is an ovular capsule that is inserted vaginally or rectally. In the case of rectal cannabis suppositories, the capsules are typically about an inch long and are generally made from cannabis infused cocoa butter or oil capsules can be used.
Once inside the body, the medicinal compounds in suppositories are quickly absorbed through the intestinal wall directly into the bloodstream, which results in superior bioavailability over other forms of administration.
This basically means you get more of the medicinal effects of the product using a suppository than if you smoked or ate the same amount. Similar to edible cannabis, the effects of a suppository are long lasting, often ranging between 4-8 hours depending on the individual’s physiology and tolerance to cannabis.
Who Should Use Cannabis Suppositories?
Also surgery patients who are not allowed to ingest anything immediately before or after a procedure, and patients in severe distress who can’t wait for oral cannabis to take effect.
There are also some people who simply have sensitive stomachs that are irritated by ingesting cannabis.
The rectal route is a good alternative to the oral route for pediatric treatments because these dosage forms obviously don’t need to be swallowed or be taste-masked.
Rectal forms can also be administered in an emergency to unconscious or vomiting children.
“I have patients with positive results from rectal administration of cannabis, so further research will be beneficial.”
Absorption can be slowed by fecal matter or if a patient is suffering from dehydration.
Cysts or tumors inside the rectal wall may also slow the compounds entering the bloodstream.
However the direct application of cannbinoids to these areas can help to activate local endocannabinoid receptors.
How Do You Use Cannabis Suppositories?
Suppositories are quick and easy to make. Utilizing the techniques for extraction that can be found on this website here, patients can perform an infusion of cannabis in coconut butter before mixing and portioning the infused butter into small torpedo like shapes.
These can be individually weighed to help ensure consistent doses; then wrapped in wax paper and refrigerated out of the reach of children and pets.
Alternatively oil capsules can be simply inserted into the anal cavity without the need for preparing coconut butter infusions, but this depends on the severity of the condition and the dosage required. Capsules inserted rectally are more efficient than oral administration and those treating themselves with cannabis oil capsules should consider trying this method of ingestion.
Before insertion, make sure the suppository is firm; if it’s not, put it in the refrigerator or freezer until it reaches the desired consistency.
Lie on your side and pull your upper leg towards your chest. Use your index finger to insert the suppository into your rectum, pointy end first. Place the suppository 1-1½ inches into the rectum, past the inner sphincter.
To prevent the suppository from sliding out, hold your buttocks together and squeeze your sphincter muscles tightly for a few seconds. Stay lying on your side for at least a few minutes.
Be aware that there’s a risk of slippage for the next few hours, so many patients administer suppositories at bedtime.
What To Expect from Cannabis Suppositories
You will experience what can best be described as a warm sensation starting from the pelvic region. Many patients report pain relief almost immediately, without any psychoactive effects. Suppositories allow patients to rapidly deliver the active ingredients in cannabis medicines. The rectum is rich in blood vessels.
Yes, some people find it bizarre. You’ll never convince them to put medicine up their butts. There are alternatives, but once patients become accustomed to the practice this is a valuable treatment method for medical cannabis patients.
If you need any advice or help please use the contact form provided. We try to answer all emails within 24 hours and are happy to help and advise on all aspects of medical marijuana treatments in complete confidence.