Each day the science is advancing on how to treat painful conditions with medical marijuana. But what happens when some patients can’t smoke or ingest their medicine? Innovative companies have responded with a wide variety of forms of cannabis administrations for tough to treat conditions. 

Cannabis is probably most notable as a smoked substance, but there are dozens of other ways to administer a dose. Dispensary budtenders can help guide you through the various forms of cannabis administration available on their dispensary menu. 

Smoking vs. Vaporizing 

Smoking cannabis (via a joint, pipe, bong, etc.) is actually illegal in most states, even for valid medical marijuana patients. Some states cite the reason for this rule: scientific evidence that smoking cannabis is as harmful for your lungs as smoking cigarettes.  

In addition to being illegal, smoking cannabis also often induces coughing, which can exacerbate chronic pain. If smoking cannabis in the past produced a therapeutic effect, but caused excessive coughing, you might consider a vaporizer. Vaporizers can reduce coughing by producing a steady, controlled stream of smoke into the lungs. 

Vaporizers can also be an important tool for chronic pain patients. Within just a few minutes, a vaporizer can begin to relieve pain. (You may have heard this referred to as “bioavailability”.) 

While they work for some, vaporizers may not be right for many pain patients. They may also produce coughing to the point that it isn’t giving a true therapeutic benefit. Some patients prefer medical marijuana products they can take orally, sublingually, topically, or in other ways. New products are being introduced in cannabis dispensaries every day, with lots more in research and development. Here’s a few that you may not have heard of:

Cannabis Nasal Inhalers

Cannabis nasal inhalers look exactly like typical asthma inhalers. They are thought to provide a cleaner and more pure hit of cannabinoids. Nasal sprays could be particularly helpful for individuals with respiratory issues. Patients with conditions that affect the lungs should not smoke or vaporize cannabis, so a nasal spray could be an ideal form of administration. 

One particular nasal spray in the news recently is called Sativex. Sativex contains a whole plant medicinal extract of cannabis with a 1:1 ratio of tetrahydrocannabiol (THC) and cannabidiol (CBD). Sativex has been formulated for the relief of multiple sclerosis (MS) symptoms and the treatment of severe neuropathic-related cancer pain. While the U.S. FDA is still conducting trials on the drug, it’s received approval and is in use in other countries. 

Raw Cannabis Plant 

It has been hypothesized that the whole cannabis plant containing all of the available cannabinoid will have the most medicinal benefits. Though you can eat raw cannabis flower or mix it into a smoothie, it won’t have the same effect as consuming cannabis-based products. Researchers have now isolated more than 100 cannabinoids. THC, CBD, and CBG are three compounds that may produce the most significant therapeutic effects. These cannabinoids do not occur naturally in high concentrations in raw weed.

The cannabis flower purchased at a dispensary has to go through a process known as decarboxylation to become active. While eating raw cannabis isn’t going to hurt you, it likely won’t provide medicinal value. However, research continues into the possible medicinal benefits of THC-A, as it has demonstrated early evidence for neuroprotection, immunologic effects, and antinausea and anti-vomiting effects. 

Little research has been done into the effects CBD-A and CBG-A, although one very new and widely misunderstood study points to evidence that these cannabinoids could be effective in the fight against COVID-19. (The researchers additionally noted that THC-A showed similar promise, but federal research funding rules at their institutions prevented moving forward with testing actual THCA in cell assays.) The researchers found that these specific cannabinoids blocked the Covid-19 protein from penetrating human cells. At certain levels of potency, CBDA and CBGA were able to reduce viral infections—in a petri dish. The concentrations of CBDA or CBGA needed to block infection in actual humans by half “is high,” wrote the authors, “but might be clinically achievable.”

Whole Plant Extracts

A raw cannabis smoothie might not be the elixir you thought it could be, but you might consider a whole plant extract to get the most cannabinoid benefits. “Whole Plant Extract” means the product contains the wide range of cannabis compounds naturally offered in the cannabis sativa plant. These extracts are also commonly known as full spectrum extracts. They may contain any combination of CBD, CBD-A, THC, THC-A, CBG, etc.

Vast potential exists for cannabinoid extracts in the fight against cancer. Some anecdotal reports claim that the whole plant extract Rick Simpson Oil (RSO) can fight cancer. However, one of the world’s leading cannabinoid researchers, Dr. Donald Abrams, disagreed that cannabis cures cancer in this article in JAMA Oncology in 2020. Much more research is necessary to know whether whole plant extracts have any effect on cancer or any other medical condition. Still, the possibilities are intriguing. 

Topicals and Patches

Cannabis-infused lotions and balms applied topically get absorbed through the skin for localized pain relief and inflammation. Because they’re non-psychoactive, topicals are often a good option for patients who want the therapeutic benefits of marijuana without the “high”. Cannabinoids can’t breach the bloodstream but instead penetrate for localized relief. Along with THC, CBD, THCA, and other cannabinoids, topicals may also include natural therapeutic ingredients such as lemongrass and eucalyptus. Many patients report that a 50:50 THC-CBD lotion has provided great relief when treating chronic pain of the back and joints.

Topicals and patches work by binding to your cannabinoid receptors found throughout the body and activated either by the body’s naturally-occurring endocannabinoids or by the cannabinoids in the cannabis product. According to Leafly, topicals are most often chosen by patients for localized pain relief, muscle soreness, tension, and inflammation. Anecdotal evidence shows a widening spectrum of potential benefits of cannabis topicals for conditions like psoriasis, dermatitis, itching, and even headaches.

Suppositories

No thorough studies have been conducted to date of cannabis via rectal suppository. However, its use is spreading among patients; testimonies claim use of very high amounts of THC per day (more than 1 gram) without feeling any kind of psychotropic effect. This lack of effect is likely the result of the very low absorption of THC through the rectal mucosa. This tissue does not capture compounds well, making it an ineffective route for most. However, it may be worth thinking about for local treatments for digestive disorders in which the last sections of the gastrointestinal tract are affected, or in the case of patients who cannot use other routes of administration.

Capsules

Cannabis capsules contain many forms of cannabis, including an oil and decarboxylated flower. They can contain single cannabinoids or the full spectrum of compounds the source cannabis plant has to offer. Compared to vaping or smoking cannabis, many patients find capsules easier to dose and consume. Medical marijuana patients sometimes opt for capsules because they can provide a potent dose with long-lasting effects. Patients who benefit from edibles but struggle to eat due to digestive issues may find capsules to be easier to take. 

If you’ve considered getting a medical cannabis card for you or a loved one due to a difficult to treat condition, reach out to medicateOH@gmail.com to be matched with a medical marijuana physician in your area.

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Author

  • Medicate OH's Founder and Publisher is a native of Cincinnati, Ohio and holds an undergraduate degree in journalism and a master's degree in public administration, both from Northern Kentucky University. She has more than 20 years of experience writing and editing professionally for the medical and wellness industries, including positions with The Journal of Pediatrics, Livestrong, The Cincinnati Enquirer, and Patient Pop.