The cannabis movement is subject to a lot of stigma in the world today and one of the biggest hurdles we have to overcome to gain acceptance is the idea that medical marijuana must be smoked to be effective. This is simply untrue.
While smoking cannabis is useful for reasons we will explain later, there are several other methods of use, each with their own positive and negative qualities. Vaporizers for wax and oil, edibles, tinctures to go under the tongue, topicals to put on your aches and bruises, gel capsules to be swallowed like a pill, suppositories?? Yes, that's right folks, cannabis suppositories, hashes, waxes, flowers.
With all these options how does one know where to begin when visiting their local dispensary?
Factors to consider when helping patients choose their best method of use are:
1. Desired onset of effect
2. Desired duration of effect
3. Ease of titration
4. Patient demographic and current health conditions/treatments
Lets start with onset of effect. When smoked or vaporized the effects of cannabis come on very quickly, say in less than a minute, finding their way to the blood stream through the lungs. This contrasts with the slow onset of effects when cannabis edible products are used. In the edible form onset of the effect is delayed 40 minutes to an hour because the medicine must be processed by the liver before crossing the blood-brain barrier.
Now, these two methods also have very different duration of effect. The smoked or vaporized form that came on very quickly also dissipates quickly, with the effect fading in less than an hour, while the effect of edibles can last six to eight hours.
Topical use: (applied to the skin in the form of a cream, balm, or lotion)
The topical form will begin to take effect 15 to 20 minutes after application and have a duration of effect of two or three hours. This form is not intoxicating — that is, you won't feel "high", and it will also not cause you to show up dirty on a drug screen if that is a concern.
Sublingual use: (a tincture form given under the tongue) Because some of the active cannabinoids and terpenoids make their way to the blood stream under the tongue and some are swallowed and go across the liver like an edible the effect can vary greatly. Typically this is an excellent method of use for those who do not wish to smoke because it provides a happy medium to the onset/duration of effects.
Specific health and demographic factors to consider are age and specific conditions. For example, an elderly patient who has never used cannabis before or a young child are not people that I want to see smoking cannabis, so we would use the other options available, perhaps edibles or tinctures, but one size doesn't fit all in today's world so we run into roadblocks. Some older people and people with liver dysfunction are not able to process edibles like we expect. They see little to no effect from edibles and must seek other methods of use. In regards to kids, some have used edibles, topicals, tinctures, and vaporizers to treat youngsters. One baby girl took her dose via a candy dissolved into liquid suspension thru her feeding tube. One favorite story about MMJ use by children is about a mom who was frequently asked if her 6-year-old smoked his MMJ. She would sarcastically reply, "Oh yes, we got him a little Elmo bong."
Earlier I said that there were reasons smoking, vaporizing and other inhaled methods of use were useful. The reasons are ease of titration and rapid onset of symptom relief. When inhaled the desired effect comes on very quickly so measuring the amount needed is easy. One can take a few small puffs, wait a short time and decide if more medicine is needed at the moment.
Another time inhaled method of use is more useful is in situations where a patient has severe nausea from their health conditions or their medical treatments. It does no good to give a cancer patient cannabis in an edible form if they can't keep it down long enough to process their medicine.
In the end it comes down to freedom of choice, a bit of trial and error, and seeing what works for each individual patient.