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Introduction
01
The two possible application methods of medical cannabis are: inhalation or ingestion
There are two options for the medical use of cannabis: either Cannabis or cannabinoid-containing medications are inhaled or orally applied. The pharmacological properties of medical cannabis vary depending on the form of application. This applies both to the absorption and distribution of the active ingredients in the body as well as to their metabolism and excretion.
When prescribing, physicians must therefore consider which form of intake is best suited for the patients and the individual symptoms. The dosage form, i.e. cannabis flowers, full-spectrum extracts, dronabinol and cannabidiol formulas or finished dosage, also plays a role. A combination therapy consisting of inhalation and oral intake is also possible.1
Medical cannabis for inhalation
02
Medical cannabis for inhalation: rapid onset of action in case of acute need
Inhalation is a fast-acting form of application of medicinal cannabis, because the inhaled vapours are quickly absorbed by the lungs. Consequently, the effect also sets in quickly. Many patients prefer this form of application because the symptoms are relieved in a short time.
The inhalation by vaporizer does not use tobacco. Crushed, dried cannabis flowers are suitable for inhalation. To ensure a high bioavailability And a rapid onset of action, it is recommended – also for better dosage of the medical cannabis – to use a medical vaporizer (vaporizing inhaler).2 However, for people with lung or respiratory diseases, inhalation is only suitable with limitations.
On the other hand, since toxic substances such as carbon monoxide, ammonia and polycyclic aromatic hydrocarbons enter the body when mixed with tobacco (joint), this form of inhalation is not recommended due to the increased health risk.
The advantage of inhalation by vaporizer: rapid onset of action within a few minutes. The maximum concentration of active ingredients in the blood can be as much as 300 nanograms per milliliter after about three to eight minutes. After about 20 minutes, a subjectively perceptible maximum effect occurs; the effect lasts for two to four hours (see Figure 1).1-3
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Time course of the subjectively perceived effect when using medical cannabis as inhalation1
Time course of the subjectively perceived effect when using oral medical cannabis.1
Medical cannabis for oral use
03
Medical cannabis for oral use: longer duration of action – beneficial in chronic diseases
Taking cannabis extracts dissolved in oil is a reliable medical form of application.1 After oral application, the extracts are absorbed via the oral mucosa. The precisely defined content of the cannabinoids in drops (or sprays) ensures a constant, individualized dosage option at all times. Although bioavailability and onset of action vary with oral administration, the dosage is accurate and simple. Additionally, drops can be used everywhere in daily life, independently of aids1.
The advantage of oral use: If medical cannabis is used orally, the effect usually only becomes apparent after 30 to 90 minutes. Although the maximum active substance concentrations in the blood only reach a value of up to 15 nanograms per milliliter after two to four hours, they remain at this level much longer and the effect lasts up to eight hours (see Figure 2).1
Inhaling cannabis or using it orally – or as a combination therapy of both forms of application
In individual cases, the treating physicians decide which form of application of medical cannabis is most suitable for the respective patient based on the different properties such as onset of action, metabolism and duration of action. To this purpose, the physician considers the specific situation of the patients: diagnosis, comorbidities, contraindications and individual criteria. In individual cases, a combination of inhalation and oral application may also make sense.1
References
Status: 2021
Cannabis: Verordnungshilfe für Ärzte von Franjo Grotenhermen; Klaus Häußermann 2017; Verlag. Wissenschaftliche Verlagsgesellschaft Stuttgart – ISBN 10: 3804737595 – ISBN 13: 9783804737594
Hazekamp A et al. Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol. J Pharm Sci. 2006;95(6):1308–1317. doi:10.1002/jps.20574.
Earleywine M, Barnwell SS. Decreased respiratory symptoms in cannabis users who vaporize. Harm Reduct J. 2007;4:11. Published 2007 Apr 16. doi:10.1186/1477-7517-4-11.