Guest written by Eloise Theisen, AGPCNP-BC and Timothy Byars, CEO of Radicle Health.
There are a number of different delivery methods that Radicle Health patients use to consume cannabis and the benefits that they derive from cannabis are influenced by each method and by the site of absorption. Cannabinoids, terpenes, flavonoids, and other chemical compounds can be applied to a specific area on the body, they can be absorbed directly into the bloodstream, or they can be filtered through the digestive system before entering the bloodstream.
The delivery method (also referred to as the route of administration) and the site of absorption impacts how the body responds to the chemical compounds in cannabis—how the compounds are absorbed, distributed, and metabolized by the body, the duration of effects, as well as the patient’s overall experience.
Which route is best for me?
Topicals can provide local relief with few (if any) side effects. When applying a topical, patients can realize relief in minutes, and that relief can last several hours. Topicals can provide pain relief in the hands, neck, ankles, and feet (topical applications are more effective at treating painful joints that are closer to the skin surface). For example, many patients with arthritic pain and peripheral neuropathy should consider starting with a topical. Studies suggest that CBD penetrates the skin more effectively than THC, so Radicle Health recommends starting with a CBD-dominant topical for pain.
Topicals penetrate only the top layers of the skin, typically do not reach the bloodstream, and therefore will not provide systemic relief. For example, deep arthritic pain in the back, knees, or hips might not respond to topical applications and will likely require systemic treatments.
Products: salves, balms, creams, and long-acting patches
Ingesting cannabis can provide systemic relief for patients. The effects of ingested cannabis last longer and, over time, can reduce inflammation. Patients report that, when they use cannabis regularly and consistently, they can reduce the severity and intensity of their symptoms. Some patients are even able to decrease their overall cannabis intake over time without sacrificing the benefits.
Some edible products are better homogenized than others
Some edible products are available in small, discrete doses, while others require patients to break the product into smaller serving sizes, creating unequal pieces
With cannabis edibles there exist multiple factors that affect the onset of action and the potency of a dose, and these factors can create challenges for patients, especially those who are new to cannabis.
Products: low dose chocolates, mints, and other discretely-dosed foods
Patients can use sublingual products to provide relief between edible doses and when inhalation is not an option. That said, there are few true sublingual products on the market. Most tinctures—while marketed as sublinguals—follow the pattern of ingestion. Patients often expect rapid onset when using tinctures, only to wait 1-3 hours for the dose to take effect. Cannabinoids are fat-soluble and do not absorb into the mucosa of the mouth in their natural state. A true sublingual (a product in which the cannabinoids are formulated to be more water-soluble) absorbs rapidly into the mouth and can take effect within 15 minutes.
Products: Buccal strips, dissolvable tabs
Transdermal products are similar to topicals except that they have an added agent that helps the cannabinoids penetrate the skin and enter the bloodstream, mostly avoiding first-pass metabolism and potential unwanted side effects. A transdermal patch can provide 8-12 hours of relief (onset 30-60 minutes) and are often more consistent and reliable than edible products. Long-lasting, time-released patches can be a good choice for patients when medication compliance is a concern.
Products: transdermal patches
When inhaling cannabis, the bioavailability can range from 2-56%, depending on the depth of inhalation, the length it is held, and the genetic makeup of the patient. During inhalation, there is passive diffusion into the capillaries with onset in seconds to minutes, achieving maximal effect after 15 minutes, and lasting 2 to 4 hours.
Products: Cannabis flowers, pre-rolls, vape pen cartridges
Some medical practitioners and cannabis manufactures suggest that rectal administration is advantageous because patients can take larger doses while avoiding psychoactivity. However, cannabinoids absorbed through the rectum should flow into the circulatory system, there should be detectable levels of THC in the plasma, and those levels should correspond to a discernible psychoactivity. Patients who use high THC products through rectal administration and who fail to feel any psychoactive side effects are likely not improving any systemic issues—the reason no psychoactivity is reported is that the cannabinoids have not been adequately absorbed into the bloodstream. While Radicle Health rarely recommends rectal administration, patients might consider this route if they suffer from conditions that can benefit from a topical cannabis administration, such as fissures or hemorrhoids.
With a meal or on an empty stomach?
Make a plan
Of course, when treating any condition, working with a healthcare professional can be an effective way to save time and money. An experienced cannabis healthcare professional can get you started with a treatment plan that includes specific products, dosing, and frequency information, and can save you the heartache and expense of false starts and bad advice.
For over 17 years, Eloise Theisen has been a dedicated and patient-focused nurse specializing in aging, cancer, chronic pain, dementia, Alzheimers, Parkinsons, anxiety, depression, fibromyalgia, and various auto-immune and neurological diseases. The founder of Radicle Health (formerly Green Health Consultants), she started her career at John Muir Medical Center caring for patients suffering from cancer, terminal illnesses, respiratory failure/complaints, drug overdoses, acute alcohol ingestion, gastrointestinal bleeds, traumatic brain injury, and multiple traumas and from there worked her way up to management. Following that, her work with Aunt Zelda’s and the American Cannabis Nurses Association gained her an extensive knowledge of the Endocannabinoid system and how cannabis and cannabinoids can be used successfully to treat patients.
An East Bay, California native, Eloise is a passionate advocate for medical cannabis and cannabis oil alternatives after seeing the positive benefits it has had for patients. In partnership with Dr. R. David Ferrara MD, she started Radicle Health, a clinic dedicated to ensuring patients receive the qualified counseling they need to safely and effectively use cannabinoids to manage a health condition, cure an illness or reduce their intake of pharmaceuticals. She also provides education and training to other medical practitioners on the therapeutic potential of cannabis as a treatment option.
Eloise was a board director for the American Cannabis Nurses Association (ACNA) (2014-2016) where she helped develop the first on-line core curriculum program for nurses on cannabinoid therapeutics. She currently serves on the scope and standards committee for the ACNA. She is working to help further legalize and destigmatize therapeutic cannabis therapy. She’s a regular speaker at industry events and teaches classes at universities in the San Francisco Bay Area.
She has a Post Masters certification as an Adult-Geriatric nurse practitioner from University of Mass, Boston; an MSN in Nursing Administration from California State University; and a Bachelor of Science in Nursing from San Francisco State University.