Combining ingestion and inhalation may be the best option for cannabis patients.
There are a variety of ways to treat pain with cannabis. Whether a patient has most success treating breakthrough pain with THC or CBD depends on the root of the problem. For instance, someone dealing with nerve pain may derive most benefit from cannabis that is high in THC. For inflammation-based pain, however, chemovars rich in CBD may potentially provide more relief.
Another important consideration is the most effective method for consumption. Edibles? Vaping? Tinctures? Or would a combination of consumption methods be the best path?
What We Know About Cannabis, Pain, and Bioavailability
Bioavailability, the rate of absorption into the body, changes with each consumption method. And this deeply impacts the level of relief a patient gets for breakthrough pain.
In a study published in Molecules (2018), researchers sought to expand our knowledge on these different routes of cannabis administration. They did this by exploring how each method managed inflammatory pain. When seeking pain relief, the key component is the rate of absorption of the medicine. Affecting this rate is the fact that cannabis is fat-soluble and the organs through which it must pass will vary. Add to this the variable contributions of individual genetics and the health status of the patient, and you can quickly see why personalized medicine is the way of the future.
There are things a patient can do to improve absorption. For instance, eating a meal high in fat can increase the absorption rate of CBD if consumed just prior to the cannabis. When vaping or smoking, the depth of inhalation and how long the breath is held can also influence rate of absorption.
Bioavailability and Breakthrough Pain
Consumption method will determine the level and speed of pain relief.
Oil or Edibles for Pain Relief
In the study, researchers found that the absorption rate following oral administration of cannabis is “slow, erratic and variable.” In addition, orally consuming cannabis requires a first-pass through the digestive system, which reduces bioavailability as many of the cannabinoids are chemically changed by the digestive process.
Interestingly, as shown in the same study, oral delivery systems was found to be most effective in treating gastro-intestinal conditions, like Crohn’s disease and inflammatory bowel disease. This paradox is but one indication that investment in research for cannabis medicine is greatly needed.
Oromucosal Route of Administration
For patients who still want oral delivery without that first-pass through the liver and gut, there are options. Oromucosal methods, such as sprays, oils, and tinctures, offer an alternative. The study found that transmucosal systems offer a higher rate of absorption than swallowing cannabis medicine.
So this method of consumption can be helpful to patients that need fast but long lasting relief of chronic pain, like cancer or Multiple Sclerosis (MS).
Transdermal Administration of Cannabis
Topical and transdermal routes also avoid that first-pass through the digestive system and potentially offer better absorption. Cannabinoids, however, require a good carrier to get across the skin barrier. The reason for this is that cannabis is not water soluble. Emu oil is one of the best transdermal carriers.
This method is most beneficial for conditions like arthritis and dermatitis that benefit from a localized form of treatment that can’t be achieved with ingesting or inhaling cannabis.
Inhalation of Cannabis
Ultimately, the study pointed out that the fastest onset of action and highest bioavailability came from inhalation. However, due to the possible irritation of the lungs, inhaling cannabis via smoking, vaping isn’t necessarily ideal for most patients. There are alternatives, such as the cannabis inhaler, but these are only just coming onto the market and can be very expensive.
What About Mixing Methods of Consumption for Pain Relief?
When dealing with pain, it’s important to get relief as quickly as possible. And what works for all-day relief may not be suitable for breakthrough pain. Sometimes the pain is severe and patients can’t wait the one to two hours for relief to kick in?
This is where a mixed method approach could be beneficial. However, we have yet to see peer-reviewed research that explores a combined approach to pain treatment with cannabis. However, through this study, we can extrapolate a few ideas.
The study points to oromucosal delivery systems for treatment of chronic pain conditions, such as MS and Crohn’s. But, patients could also try novel methods like cannabis powder (that kicks in after fifteen minutes) or cannabis spray, when they experience breakthrough pain. Vaping dry herb is also a safe option for manage pain that flares up outside of normal treatment.
Is it Safe to Mix Cannabis Consumption Methods?
This question is a difficult one to answer, since there doesn’t appear to be too much in the way of research regarding mixed consumption. While there is a wealth of information about the dangers of mixing cannabis and alcohol, as well as mixing cannabis and tobacco, research has yet to delve into the topic of essentially ‘double dosing’ with cannabis.
From what we know about cannabis, it’s important to be aware of the level of potency in each method of administration. And when it comes to edibles, it is also crucial to have an acute understanding of its effect on the individual in question. Not only that, but it also makes a difference whether the medicine contains CBD, and in which ratio. CBD can mitigate the effects of THC and lower the overall effects of potency.
Until further research is done on the matter, when mixing methods of cannabis consumption, it makes sense to follow common guidelines for any route of administration — either alone or together with another technique.
Generally, doctors recommend that patients start off low and titrate up slowly. When mixing methods to manage breakthrough pain, be aware of the rate of absorption and potency. One additional, overlooked consideration is that some pharmaceuticals, such as certain psych meds, can have reduced effect in the presence of cannabinoids.
Like many cannabis treatments, experimentation may be necessary until science catches up with full dosage recommendations with the best way to manage pain using cannabis medicine.