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Dosage & Routes Of Cannabis And Cannabinoid Administration

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It was the smoking of cannabis as an intoxicant by black jazz musicians and Mexicans that marked the beginning of the "reefer madness" campaign against marijuana in the 1930s. Prior to the Marijuana Tax Act of 1937 which ultimately resulted in the removal of cannabis from the US Pharmacopoeia by 1941, there were numerous cannabis preparations available for medical use. Throughout the world many cultures used cannabis as medicine in a variety of preparations such as teas, tinctures, extracts, and salves. Today many patients smoke cannabis because they learned that it could provide relief for a variety of symptoms and conditions almost immediately. The federal government and anti-marijuana groups repeatedly dismiss the use of cannabis as medicine because smoking is the most popular method of delivery. Although today's healthcare professionals are uncomfortable with the idea of prescribing a medicine that may be burned like a cigarette, cannabis cigarette preparations were available prior to the prohibition. It is important for both health care professionals and patients to understand that there are ways to reduce the potential harm from smoking cannabis and that there are other routes of administration that may be safer and more effective.

Dosage

Dosage is the most complex and important factor in using a medication and is the most frequent cause of serious injury or death from medications. Correct dosage includes the correct amount of the drug as well as the route and frequency of administration. Natural Cannabis has a remarkably wide margin of safety and it is virtually impossible to overdose on it. It has been reported that the LD50 (lethal dose of a drug of 50% of the animals tested) of cannabis is 20,000 to 40,000 : 1 or as stated by Arthur McBay, Chief Toxicologist for the State of NC in 1997 - a person would have to consume 1500 pounds in 15 minutes to get a lethal dose. Clinical research and anecdotal reports have found that dosage can vary greatly from person to person. The key to the proper dosage for cannabis is to find the lowest dose that yields the intended benefit with the fewest side effects.

Smoking remains a popular route of administration for patients using cannabis primarily because that is how they learned to use it. Risks related to smoking cannabis are presented more thoroughly in the Science section under Safety Profile. The primary benefit to smoking cannabis is that the effects are experienced almost immediately and this allows patients to easily self-titrate their dose. For patients using it to stop nausea and vomiting, smoking cannabis can be effective when they would not be able to hold down an oral preparation.

However, to eliminate any potential harm from inhaling smoke, patients can be taught to use a vaporizer. A vaporizer is designed to heat the plant material to a temperature that will release the essential components in a vapor that can be inhaled, but not to the point of combustion that would create smoke. This route of administration allows for rapid onset of action and easy titration without the contaminants found in smoke.

The oral route of administration has been widely used in other cultures and in early American history. As a fat soluble substance the cannabis plant material is soaked in alcohol to create a tincture that is usually very concentrated. Medicinal edibles include various baked products, cannabis butter and even cannabis ice cream. Steeping the leaf material in water can make a relaxing cannabis tea. Along with medicinal cannabis preparations made from the leaves or flowers of the female cannabis plant, another ingested cannabis product that offers great nutritional value comes from the hemp seed and can be consumed as roasted seeds, a cold-pressed oil, or a hemp seed flour.

Plasters containing cannabis were very popular in the treatment of painful corns in early American medicine. Poultices and salves made with cannabis (and other herbal ingredients) have been useful for wound care or skin problems. Just like other medications delivered by patch (nicotine patch, long-acting opiate patches), research has been conducted to create a cannabis or cannabinoid patch. This method of delivery is designed to provide long term action through gradual absorption of the medicine through the skin

This section includes a variety of preparations that may be especially useful for specific conditions. GW Pharmaceuticals has developed an oromucosal cannabis extract spray (sprayed into the mouth and absorbed through the mucosal lining of the mouth), which has the advantage of getting into the blood system fairly rapidly resulting in a fairly quick onset of action. Cannabis suppositories can be helpful for sedated patients or those with difficulty swallowing. For glaucoma patients it seems very appropriate to use an ophthalmic preparation that can be given as eye drops. Two such cannabis preparations have been developed in Jamaica where the incidence of glaucoma is higher among the black population.

Source: Dosage & Administration | Dosage and Administration
 
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