By Nicholas Fraleigh
This is a common reaction to the suggestion that cannabis can be used as a suppository. Rectal administrations (suppositories) have an unfairly bad reputation in North America, despite the diverse benefits they offer. 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.
Fig. 1 – Comparative bioavailability of different administration routes
Inhalation : 10 – 25% efficiency, highly variable, depends largely on the individual’s level of experience
Oral : around 20% efficiency, highly variable, even between doses within a single individual
Rectal : around 50% – 70% efficiency, with predictable effects even between different individuals
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.
It is important to wash your hands thoroughly before insertion of a suppository, as germs and bacteria can enter the body through the rectum.
Disposable medical gloves or a finger cot can be used for this purpose.
Ensure that fingernails are trimmed and have no sharp edges.
Ensure the suppository is firm enough to insert.
If it is too soft, harden it in the package by placing it in either the fridge or freezer.
Suppositories can also be quickly hardened in the package by running cold water over them.
If only half of a suppository is being used, cut it lengthwise to make insertion easier.
When cutting, make sure to use a sterile knife or scissors.
Avoid sharp edges! Suppositories can be gently smoothed by hand.
Lie on your preferred side with your top leg pulled up towards your chest.
Lift your upper butt-cheek to expose your rectum.
Insert the suppository lengthwise, with the pointed tip first, using your index finger to push the suppository in.
Ensure the suppository has been inserted past the anal sphincter. If not inserted fully past the sphincter, some or all of the suppository may be expelled without the active ingredients reaching the rectal wall and being absorbed into the blood stream.
It is important to not place the suppository too high up in the rectum.
If placed too high, the active constituents will enter the Superior (upper) hemorrhoidal artery, which leads to the liver. This presents the same problem as oral application, as the liver will metabolize a significant proportion of the active ingredients.
The suppository should ideally be placed around 2 to 4 centimetres (1 to 1.5 inches) into the rectum, just past the anal sphincter.
Hold your buttocks together and tightly squeeze the muscles in your sphincter for a few seconds after insertion to help keep the suppository from sliding out.
Remain lying on your side for several minutes after insertion to allow the suppository to fully diffuse through the rectum. This will also help to prevent the unintended expulsion of the suppository.
Dispose of the glove or finger cot sanitarily and wash your hands thoroughly using soap and hot water, paying extra attention to cleaning under the nails and between the fingers.
Be very aware of the possibility of unintended expulsion of melted suppository residue during flatulence over the next few hours after insertion. If you have ANY doubts, use a toilet.
The unique properties provided by the rectal administration of cannabis have the potential to empower many individuals. Suppositories can be used to refine existing therapeutic regimens to greater effect. Individuals who have been prevented from using cannabis due to an inability to administer via either inhalation or ingestion can potentially derive benefit from this wonderful plant for the first time. At the V-CBC, we believe strongly in the philosophy of empowering our members with the education and resources to heal themselves. We hope that these new products will help to do just that.