How medicinal cannabis can be consumed

Medicinal cannabis (historically also known as ‘marijuana’) can be delivered to the body in a number of ways, depending on your individual needs as a patient. 

When consuming cannabis, different methods and the site of absorption will impact how the cannabis compounds are absorbed, distributed, and metabolised by the body, altering your body’s response to them. This means that the cannabis format selected will have varying effects on the duration, strength and quality of your experience. 

Let’s look at five different ways to consume medical cannabis:

1. Inhalation (including vaping and smoking methods)
2. Ingestion
3. Sublingual
4. Topical
5. Suppositories

‍Inhalation

There are two different ways to consume cannabis via inhalation — smoking and vaporising — both of which produce rapid onset and similar effects. 

In medicinal contexts, vaping is preferable to smoking cannabis because it reduces the amount of undesired hydrocarbons being absorbed into the body while also alleviating the need for tobacco, which can lead to addiction and other serious health issues. Vaping is considered the healthier alternative to smoking for medical patients as it also allows for a more precise dose to meet the therapeutic needs of a patient, given that less of the THC dose is lost in side stream/combustion.

Vaping

Vaping is the process of heating the cannabis plant or cannabis extracts at high heat without burning it, allowing cannabinoids and terpenes to be released in the form of a vapour, which is then inhaled. Inhalation delivery methods, like vaping, allow cannabinoids to be absorbed directly into the bloodstream through the lungs, making this the preferred method for patients who require rapid relief of symptoms.

Pros of vaping cannabis

Some of the benefits of vaping instead of smoking flower, include:

• Rapid onset and fast relief – first effects occur within 90 seconds and reach a maximum after 15 to 30 minutes before wearing off after 2–3 hours. Useful for symptoms and conditions where immediate relief is required.¹
• Higher concentrations of active ingredients – vaporising heats the cannabis without burning it², which maintains the concentrations and quality of the active ingredients like cannabinoids and terpenes³. This allows you to better absorb cannabinoids and other active ingredients.
• Temperature control – patients can control the temperature of their vaporiser to achieve desired benefits based on the boiling points of their cannabis medicine’s ingredients, including cannabinoids and terpenes.
• Potential reduction in overall consumption – enhanced cannabinoid and terpene uptake, reduced cravings due to no tobacco, and the ability to easily pick up and put down the vaporiser as needed allows patients to use less cannabis flower than they would need to use when smoking. This reduces the amount of medication needed and saves the patient money over time.
• Less carcinogens and safer than smoking flower
• Decreased respiratory symptoms compared with smoking⁴
• Drastic reduction in pyrolytic smoke compounds compared with smoking⁵
• Legal in public smoking areas with a prescription
• The only inhalation method approved for medicinal cannabis consumption by the TGA
• More discreet than smoking – vaping is easier to conceal than smoking and does not release as strong a smell due to the cannabis being safely heated rather than burnt.

Cons of vaping cannabis

Although vaping cannabis – particularly with a TGA approved dry-herb vaporiser – is known to be safer than smoking, it can still come with health risks.

The negative health risks associated with vaping are often related to the use of illegally manufactured vape products⁶ and vape products with chemical profiles that are closer to that of e-liquids. Some of these health risks include:

• EVALI: Potentially Fatal Lung Injury, as well as other health issues. The risk of damage increases significantly if your vape product contains a chemical called vitamin E acetate, which is not present in medically approved vaporisers.
• Ingestion of harmful by-products, including microbial contaminants, toxic chemicals, carcinogens, and addictive substances like dextromethorphan which are often found in black market cannabis oils, unapproved vape pens, cartridges and e-liquids. 
• Vaporiser injuries from unapproved vapes can also range from burns to accidental liquid ingestion and a lung disease known as 'popcorn lung.' 
• Lung injuries
• Heart issues

Patients who have an underlying condition which affects the lungs or airways, such as asthma or chronic obstructive pulmonary disease, may be advised against using a vaporiser to consume medicinal cannabis. In these cases, the doctor may prescribe a treatment to be taken sublingually or orally.

To be safe and effective, prescribed cannabis flower should be vaporised using a TGA-approved dry-herb vaporiser within the correct temperature range as advised by your prescribing doctor. While these vaporisers can be more expensive than non-medical-grade vaporisers, they are known to have significantly less health risks.

Learn more about vaping by heading to our Ultimate Guide to Vaping Medicinal Cannabis article or browse TGA-approved medical cannabis vaporisers at Shop Polln.

Talk to your doctor before using a vaporiser with your prescribed cannabis treatments and only use your treatments and vaporiser as advised.

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Smoking

Although smoking is the oldest and most common way to consume for non-medical cannabis users, it is not recommended for medical cannabis patients due to the health risks and the variability and unpredictability of each individual’s response. Some common smoking methods include use of rolling paper or smoking devices such as pipes or bongs. Other consumption methods are recommended and considered healthier alternatives for medical patients such as ingestion, sublingual or vaping methods. In fact, prescribed medicinal cannabis is consumed predominantly via oral routes, with an estimated 71% of patients opting for this method in Australia.⁷

Here are some things to consider when it comes to smoking methods:

• At least 40% of the THC dose in cannabis is lost in side stream/combustion when smoking, making it difficult to estimate the amount of THC content a patient is receiving.⁸
• Cannabis smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes⁹. It can also inflame and irritate your respiratory system due to exposure to heat, burned organic matter and carbon monoxide.
• If you smoke cannabis in combination with tobacco, you are increasing your risk of many health conditions and diseases including cancer, heart disease and chronic respiratory conditions¹⁰.
• Smoking cannabis is not supported by the TGA.
• Smoking cannabis is less discreet than vaping as cannabis smoke has a distinct smell. It's also not an approved way to consume cannabis in public smoking areas – even with a valid prescription.
• Smoking cannabis with tobacco is more likely to lead to addiction and dependence, which can cause patients to use more cannabis than required. This is primarily due to nicotine – the addictive substance found in tobacco – and not the cannabis itself. 
• You may need to use more of your cannabis treatment to achieve the same results as you would with vaporising, due to cannabinoids and active ingredients being lost in combustion. This increases the costs of your medication over time. 

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Ingestion

Ingestion methods of cannabis consumption include any cannabis treatment that is consumed orally – such as cannabis edibles, tinctures, oils, capsules and extracts. While the effects of cannabinoid medicines will take longer to kick in when taken orally, they will also last longer¹. This makes them ideal for medical conditions or symptoms where control over longer periods of time is required, similar to other types of slow release medication. In a 2022 study of 1600 participants, oral consumption was the most common method for medicinal cannabis use (72%) in Australia⁷.

When ingesting cannabis, cannabinoids are absorbed through your digestive system and gastrointestinal tract before metabolising in the liver, resulting in slightly varying medicinal properties and both stronger and longer lasting effects than other methods. Oral medicinal cannabis treatments can come in the form of tinctures, oils, capsules, lozenges or sprays. Cannabis-infused edibles – such as gummies, cookies, candies, drinks and more – are another popular ingestion method for cannabis, however there are currently no edibles available for medicinal purposes in Australia.

Pros of ingestion

• No risk to lung health
• Ability to manage dose in exact measurements
• Can be consumed discreetly 
• Effects last longer than other methods (4 to 12 hours)

Cons of ingestion

• It may take 30 minutes to two hours¹ to feel the full effects from ingested cannabis, however some patients may find this to be an advantage due to convenience and longer duration of effects.
• When ingesting a treatment that contains THC, there is a potential for a second spike of psychoactive effects when the THC is metabolised in the liver after initial effects, which may be unwanted or unexpected. 

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Sublingual

The sublingual method of cannabis involves placing the treatment under the tongue, a consumption method which allows active ingredients to be absorbed directly into the blood vessels of your tongue, bypassing the digestive system. Treatments taken sublingually can come in the form of cannabis oil, tinctures, lozenges, tablets, sprays, wafers and more.

Patients who use this delivery method will place their sublingual cannabis treatment under their tongue so that the mouth's mucus membranes – similar to those in the lungs – absorb the consumed cannabis into the bloodstream. 

Because this method allows the active ingredients in cannabis to bypass the digestive system, its bioavailability is higher than that of edibles and other ingestible cannabis treatments, allowing for faster onset and higher concentrations of cannabinoids. 

Pros of sublingual

• Faster onset of effects than ingestion methods (typically 15 to 40 minutes)¹¹
• No risk to lung health
• Ability to manage dose in exact measurements
• Can be consumed discreetly 
• Sublingual oils and tinctures have a longer shelf life and are easier to store than cannabis flower, edibles and other treatments (low risk of degradation of cannabinoids and other compounds when stored in correct temperature)

Cons of sublingual

• Some patients may find sublingual administration slightly more inconvenient than ingestion or inhalation methods, due to having to hold the treatment under the tongue for approximately 1 minute or more
• Depending on your treatment, you may not enjoy the taste of the treatment under your tongue

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Topical

In this method, the cannabis products are applied directly to the skin, penetrating only the top layers of skin and providing localised relief from inflammation, pain, skin irritations and more. This is one of the most discreet ways of consuming cannabis.   

Cannabis topicals come in a variety of forms, including cannabis balms, lotions, creams, salves and transdermal patches.Topical CBD skin creams in particular have shown promise in treating symptoms of skin conditions like acne, psoriasis and eczema¹², arthritis¹³, neuropathy pain¹⁴ and jaw pain¹⁵.

For most topical application, cannabinoids react with receptors under the skin but do not reach the bloodstream. Transdermal patches however, are one method designed to slowly release cannabinoids into the bloodstream over a longer period of time, usually producing effects within 15 minutes.

There is substantial clinical evidence suggesting the beneficial effects of topical cannabinoids (especially CBD) in treating a range of skin conditions¹⁶. However much more research is needed in this area.

Pros of topicals

• Ideal for localised relief
• Non-impairing – even when a topical treatment contains THC, the THC does not penetrate blood vessels meaning topical treatments are unlikely to be psychoactive (won’t get you high)
• Minimal side effects
• No dose limitations (can be applied multiple times a day)
• Easy to use
• Very discreet

Cons of topicals

• Effects are localised to specific area
• May require continued application if symptoms persist (more than once a day)
• The transdermal patch may be visible depending on the area that requires treatment

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Cannabis suppositories

Suppositories offer a targeted dose of cannabinoids to a localised area that can help facilitate higher absorption rates in the body. Suppositories are particularly useful for those suffering from ailments related to the mid-lower region of the body, including pelvic inflammatory diseases, inflammatory bowel syndrome, Crohn’s disease, endometriosis and more. In this method, medicinal cannabis is provided in a solid form to be inserted into the rectum or vagina. Cannabis oil suppositories have one of the greatest absorption rates of all delivery methods, producing effects within 10 to 15 minutes for rectal administration. Unfortunately, medical cannabis suppositories are currently not available in Australia, but we hope that in the near future, more and more novel cannabis products with therapeutic benefits such as this are made available to Australian patients.

Pros of cannabis suppositories

• Provides localised relief from symptoms
• Great alternative for those who cannot or prefer not to take ingestible, sublingual or inhaled cannabis-based medications, due to age, medical condition, chemotherapy-induced nausea and vomiting, difficulty swallowing or personal preference
• Fast onset of effects
• Long duration of effects (peak effects felt within 2–8 hours with overall duration of about 8 hours)¹⁸
• Generally safe and well tolerated
• Unlikely to produce a ‘high’ sensation

Cons of cannabis suppositories

• Some patients may find this delivery method uncomfortable or invasive
• Mainly provides relief to a certain area, may not be suitable for relieving generalised symptoms like anxiety
• Patients need to be mindful of the ingredients in the solid, oil-based holder used to contain the cannabis medicine incase of allergy or sensitivity
• Patients also need to be mindful of hygiene and sensitivity in areas where the suppository is inserted to avoid health issues like yeast infections

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Medically approved ways to take cannabis in Australia

Consuming cannabis via vaporisation (with a TGA approved vaporiser), ingestion, sublingual methods and suppositories are all approved methods for consumption in Australia with a valid prescription. Always follow the advice of your prescribing doctor when selecting the way you wish to consume cannabis - as well as the dosing and administration instructions provided in your prescription or on your treatment packaging.

What is the best way for me to consume cannabis?

While there are many different ways to consume cannabis, it’s important to note that not everyone experiences these medicines in the same way. What works best for one patient may not necessarily be the ideal method for you. Individual endocannabinoid systems, tolerance levels and other biological factors vary from person to person, so it’s important to try and find out which consumption methods work best for you with the support of your doctor.

To talk to a doctor about medicinal cannabis and different delivery methods, sign up as a Polln patient today. Or take our free eligibility quiz to find out if medicinal cannabis might be right for you.

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