How Cannabis Suppositories Can Save Lives

This article aims to educate about the advantages associated with the rectal application of cannabis and provide a simple set of guidelines for the effective use of suppositories.

There are many advantages to the rectal administration of cannabis not afforded by other routes. Medicine may still be administered even if the oral route is impaired (e.g., due to vomiting, an injured jaw or throat, or gastrointestinal difficulties) or disallowed due to the oral intake restrictions that are frequently required both before and after surgery. Avoiding the gastrointestinal tract also prevents first-pass metabolism by the stomach and liver, which break down many different molecules into their constituent parts (including Δ9-tetrahydrocannabinol, otherwise known as THC), and allows the active constituents to reach the blood in much higher concentrations.

In the case of THC, the liver transforms around half of what is ingested into the significantly more psychoactive metabolite 11-Hydroxy-Δ9-tetrahydrocannabinol. While not harmful in and of itself and potentially of therapeutic benefit, this molecule causes much more intense cognitive effects than THC. Rectal administration not only avoids these effects, but also allows a much greater proportion of THC to eventually reach the blood stream. This increase in overall efficiency is also shown in the different levels of bioavailability that different administration routes afford, as seen in Fig. 1. Rectal administration also allows for medicine to exert effects over localized ailments (e.g., hemorrhoidal tissue, inflammation of the rectum, or tumours in the rectal cavity). This form of use also has a much faster uptake than oral administration (around 10 minutes, on average) and leads to more consistent blood concentrations of the active constituents. The speed and reliability of their uptake combined with their circumvention of many of the issues surrounding both ingestion and inhalation make rectal applications an excellent addition to both new and pre-existing therapeutic regimens.

When designing a personalized medication regimen, it is important to know the various timings involved with a given administration route. With suppositories, most people will begin to notice initial effects within the first 10 – 15 minutes after insertion. These effects usually last for between 4 – 8 hours, depending on the individual’s physiology and tolerance to cannabis. This swift increase in effect allows for acute dosing in many cases, although this depends both on the situation and on specific individual needs. There are several issues that can slow absorption from the rectum to the blood stream. Diarrhea and fecal matter can slow or prevent the active ingredients from reaching the rectal wall and being absorbed. Tumours or cysts on the rectal wall can also slow or prevent absorption. In this case, less medicine would reach the blood, but as the tumours are likely the intended target(s) of the suppository, the direct delivery of the active constituents may help prevent an overall reduction in efficacy. Finally, rectal dehydration can drastically reduce the effectiveness of suppositories. Staying well hydrated by maintaining a healthy consumption of both water and electrolytes should prevent this in most cases, but specific medical conditions may cause it as well, in which case the solution may not be as simple. As always, if there are concerns, a medical professional should be consulted.

Anyone who decides to take advantage of the benefits provided by suppositories should do so with a good understanding of the process involved. Although not overly complex, the few simple instructions outlined below will enable their effective use.