03/24/2025
Always good information
Cannabis Dosage Forms
“Medical Cannabis” often brings to mind the thought of smoking cannabis flower for most people. Although it remains the most popular way to consume cannabis, the 2018 Farm Bill legalizing h**p, along with the legalization of medical (and adult-use) cannabis across the nation, has led to a tremendous amount of innovation in the cannabis industry. This has resulted in a wide variety of medical cannabis and h**p products being available.
The method of use is the easiest way to categorize cannabis and h**p products: edibles and beverages, elixirs and tinctures, topicals, v**e cartridges, concentrates, and flower. Each has characteristics with advantages and disadvantages for patients to consider when selecting therapy.
Inhalation Administration
Cannabis may be used by inhaling smoke from burning flower, dry herb v***rization of flower, v***rization of concentrates, or by using v***rization cartridges. This route of administration results in effects within minutes, making dose adjustment intuitive. A small dose of inhaled cannabis is used, the effects are assessed, and additional small doses can be administered as needed to treat symptoms.
Inhalation administration is most useful for becoming accustomed to the side effects of cannabis (feeling "high"), intermittent or short-duration symptoms such as muscle spasms and nausea, or as an additional medication for “breakthrough” symptoms in patients using longer-acting formulations for chronic symptoms.
Effects Felt: 1-10 minutes
Effect Duration: Euphoric effects last 30-60 minutes. Medical benefits last several hours.
Dosing: One or two inhalations, wait 10 minutes to determine effects before considering another dose.
Smoking: Inhalation of burning cannabis flower smoke is the most popular form of cannabis use.
Advantages: Simple administration – most people are familiar with the smoking technique, which only requires simple and low-cost apparatus, like a pipe or cigarette paper.
Disadvantages: Smoke can be irritating to the throat and lungs, and the smoke produced is not very discreet. Up to 70% of cannabinoids and terpenes can be lost to combustion.
Dry Herb V***rization: This involves the use of an electronic device (the dry herb v***rizer) that heats cannabis flower to a high enough temperature to “boil” the terpenes and cannabinoids, turning them into v***r for inhalation, but not high enough to cause combustion and smoke.
Advantages: The v***r produced causes less irritation than smoking cannabis or using a v**e cartridge, making it a good choice for patients with breathing issues. Dry herb v***rization results in a lower loss of cannabinoids and terpenes compared to combustion, and the lack of smoke makes it much more discreet.
Disadvantages: Quality dry herb v***rizers are relatively expensive compared to smoking, require regular cleaning and maintenance, and it takes some time and experience to learn how to use the device efficiently.
V**e Cartridges: These are small glass vessels filled with cannabis extracts. The cannabis concentrate is heated by applying an electric current to coils within the atomizer to produce a v***r rather than smoke. They are attached to a battery device that has a physical button or haptic switch to power the atomizer for use.
Advantages: V***r is only emitted when the device is activated, no environmental smoke is produced, very convenient, and discreet.
Disadvantages: Expensive, v***r can be irritating to the lungs, and some cartridges lack adequate concentrations of terpenes.
Topical Administration
The topical administration of medical cannabis products is useful for patients with arthritis pain, muscle spasms, and symptoms affecting the skin. Superficial joints such as the knee, shoulder, and hand typically respond well to topicals, while deeper joints like the hips and spine are less responsive due to limited pe*******on through deep tissues. Many conditions treated with topicals respond well to a whole-plant CBD topical alone; however, the addition of THC at a greater than 20:1 CBD:THC ratio will be more effective for most conditions.
Effects Felt: 5-30 minutes
Effect Duration: 2-8 hours
Dosing: Apply a small amount to the affected area.
Advantages: Focused delivery of medication, no systemic effects.
Disadvantages: Not practical for widespread symptoms, will not pe*****te deeply into tissues, requires repeated administration throughout the day.
Sublingual Administration
Elixirs and tinctures are liquid preparations of extracts from the cannabis plant. They are administered sublingually (under the tongue) and held for a minute or two before swallowing. Sublingual elixirs are rapidly and reliably absorbed into the circulatory system, providing consistent effects that last longer than inhaled cannabis, making this a preferred method of use for most patients with chronic, long-lasting symptoms.
Effects Felt: 15-60 minutes
Effect Duration: 4-12 hours
Dosing: CBD and CBG 12.5mg-16mg, THC 2.5mg-10mg
Advantages: Consistent absorption and effects, relatively fast-acting, longer-lasting effects than inhaled administration, no lung irritation, discreet to use, cost-effective.
Disadvantages: Some patients may have flavor issues with elixirs, and the MCT oil used in most elixirs can cause stomach discomfort or diarrhea in some individuals.
Oral Ingestion Administration
Edible cannabis preparations are food products infused with cannabis extracts, consumed by eating. They are available in a wide variety of products, from the familiar gummies and chocolates to beverages, and even products you can use to infuse your own cooking. Edibles can be more potent and longer-lasting than other routes of administration, but the effects can be difficult to predict. This is because cannabinoids are not water-soluble, making absorption from the gut more difficult. Consuming food with a high-fat content before using edibles will allow for better absorption of cannabinoids and more consistent results.
Effects Felt: 30 minutes – 2+ hours
Effect Duration: 4-24 hours
Dosing: CBD and CBG 12.5mg-16mg, THC 2.5mg-10mg
Advantages: Simple administration, long-lasting effects, no lung irritation, can be cost-effective for patients with high THC requirements.
Disadvantages: Variable GI absorption of cannabinoids can lead to inconsistent effects, relatively slow acting, difficult titration, easier to under- or over-treat symptoms, requires attention to time and type of food consumed to optimize absorption.
Choice of Product Form
The choice of which form of cannabis to use will determine how fast it will work, how long the effects last, and how you use it to determine the most effective dose. Most patients using medical cannabis are treating chronic, all-day symptoms, making elixirs and edibles a good choice for baseline symptom control. Inhaled cannabis is more useful for treating intermittent symptoms, when a shorter duration of effects is desired, and for treating symptoms that "breakthrough" the control provided by longer-lasting preparations.
