How is plant-based medicine administered?
As the ACT has made steps to decriminalise adult-use of cannabis for personal use in small amounts, there are once again discussions surrounding smoking and the associated harmful effects of ingesting it this way. Considering the long history of smoking in recreational settings, it is important to differentiate this from its medical and clinical applications.
Many international trials regarding cannabinoids have involved smoking or vaporising. This largely has to do with its history of inhalation as a means of ingestion. Yet, smoking even medicinal cannabinoids has well-known harms, reflective of those associated with smoking tobacco. Combustion of any kind presents damaging substances such as carbon monoxide and burnt particles that can be deleterious to health.
Vaporising is an alternative method that utilises ingesting the cannabinoids via the lungs. However comprehensive research of the safety of vaporising in the long term has yet to be elucidated. It’s always best to discuss the risk factors with your GP.
Cannabinoid smoking concerns
It is well-known that inhaling is the most common method of delivery for recreational users, so does that mean plant-based medicine in Australia is being legally prescribed to smoke? For the doctors that CA Clinics connects eligible patients to, the answer is no.
However, there may be instances where raw flower is prescribed for the purpose of inhalation, but this is via a vaporiser.
Media attention surrounding the harms of smoking also continue to feed into long-held stigmatisation of plant-based medicine, impeding cultural change and scientific research. However, now that research is setting roots globally, evolving regulations around the world are allowing for easier conduction of research into a wide range of novel and innovative delivery methods.
Alternative ways plant-based medicine is being prescribed around the world include the below, but not all methods are approved or registered for use in Australia:
- Buccal sprays
- Edible oil
- Sublingual wafers
- Tinctures
- Capsules
- Topical creams
- Transdermal patches
- Suppositories
- Pessaries
- Nebulisers
- Intranasal mists
Not a one-size-fits-all prescription for cannabinoid delivery mechanisms
Each of these methods above has benefits and drawbacks which can be dependent on the condition treated. In clinical practice, it is important to utilise delivery methods appropriate for the indication. Just as no two strains are the same, it is important to avoid a “one-size-fits-all” approach to the prescription of plant-based medicines.
Some indications may even require multiple methods of ingestion. For example, with regards to skin condition pain, oil dispensed under the tongue and topical applications may be a combined two-pronged delivery method that warrants further research.
Plant-based medicine treatment
When ingesting orally, most treatment protocols involve holding the oil or tincture under the tongue for a period of time. This allows for higher bioavailability when cannabinoids are absorbed via the oral mucosa. Although ingesting plant-based medicine via the digestive system may be prescribed as an adjunct therapy for a number of symptoms and for children or the elderly, a large amount of the active constituents are degraded in the acidic environment of the stomach or through liver processes. This is called ‘first pass metabolism’, in that edible or capsuled cannabinoids can have less bioavailability and therefore decreased medicinal action in the body.
The use of suppositories may be relevant for elderly patients or symptoms that affects the large bowel. In this form, cannabinoids might be able to be absorbed more, over a longer period of time. For some patients with swallowing difficulties, sublingual wafers, sprays or transdermal patches might be a more appropriate option considered by the medical professional, once again avoiding “first pass metabolism” and directing medications into the bloodstream. However, please check with your doctor as to what delivery methods are legal, registered and available in Australia. This is an evolving space.
More research will deliver more plant-based medicine delivery methods
For the future, as research expands, expect to see more novel delivery methods including nanotechnology and cutting-edge extraction techniques that offer a broader range of suitable treatment deliveries for varied demographics and ailments.
