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Tush Kush: What You Need to Know About Suppositories

Christine Kielhorn PHD
cannabis, suppositories, medical cannabis, recreational cannabis, cannabinoids, endocannabinoid system, CBD, THC, terpenes

Rectal suppositories could be the very best way to get the most out of your cannabis medicine. 

Smoking, vaping, and medibles are the most common methods for patients to get their medicine. Cannabinoids, such as delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) can also be extracted and consumed as an oil or oromucosal spray. The least common method, and perhaps the most intimidating, is via rectal suppositories. Yet, for some patients, a rectal suppository could be the most effective way to obtain the appropriate therapeutic dose of THC without the effects of smoking or the need for injections.

Physicians often weigh the pros and cons of each route when considering how to prescribe a medicine. The pharmacokinetics are important; pharmacokinetics describe the mechanism and rate at which the drug enters the blood stream and the target tissues take it up; including how long the concentration of the drug stays at therapeutic levels in the blood stream. Studies also consider the Bioavailability of the drug. This means the percentage of the drug the blood stream actually absorbs, as opposed that which the body eliminates.

cannabis bud

Cannabis, for example, has low bioavailability when consumed orally. The liver will break down some of the active ingredients and dispose of them as waste before they ever have a chance to get into the blood stream. Scientists  is often call this the “first-pass effect” of the liver. The pharmacokinetics of orally consumed cannabis are also highly variable among individuals and the uptake of active ingredients is relatively slow.

Oral Doses Might Not Work For You

Therefore, prescribing THC or other cannabinoid medicines as an oral dose may not always be the optimal solution. Unfortunately, its impossible to self-administer injections. Still, they allow more control dosage control and much greater bioavailability. Smoking and oromucosal sprays are easy to self-administer, but some patients may object to smoking and may have difficulty with the sprays. For these patients, a rectal suppository is a good alternative.

Box of cannabis seedlings

One small clinical study (just two patients) found that bioavailability of THC administered in a rectal suppository was twice that of THC taken orally. Studies performed in monkeys found that not only were rectal suppositories superior to oral dosage, but even to injections. The amount of time that the rectally administered THC stays in the bodies of the monkeys (or mean residence time) was longer than intravenous injection by about two and a half hours. A rectal suppository delivers the drug directly to the blood stream and avoids the first-pass effect of the liver.

Note: A Different Form of THC

However, studies have found that pure THC cannot be absorbed rectally, but it must be administered in a pro-drug form called THC-hemisuccinate. This pro-drug easily absorbs into the blood stream through the rectum. Soon afterwards our body converts it to THC in the blood. However, so far, we do not have enough clinical data on rectal suppositories. A handful of very small studies are all we have so far. Further, the data obtained was from monkeys. As a result, doctors do not yet commonly prescribe cannabis as a suppository, yet.

For patients who do not wish to smoke cannabis, a rectal suppository is a good alternative to taking cannabinoids orally. A higher therapeutic dose can be administered, and the effects can be felt more quickly than consuming orally. It is also a better option for those patients who have difficulty swallowing or using a spray.

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Christine Kielhorn
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