Delivery Methods for Medicinal Cannabis A Discussion Term Paper

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[. . .]   Medicating with edibles only lets you absorb around 20% of the cannabinoids, and these have to first be processed by the liver before they make it to the bloodstream (Smith, 2017). This is why edibles takes a significantly longer time to hit (30 to 60 minutes or more), which doesn’t make it ideal for patients who need fast-acting relief. However, in some cases patients medicate with edibles after sublingual application; doing so can provide a more holistic and longer-lasting therapeutic experience.

The sublingual application involves holding drops from a medical marijuana tincture under the tongue. It’s important to note that this sublingual tissue absorbs fats more readily than lipids, “as lipids do not hold an electrical charge-an optimal method for absorption at the surface of oral mucosa (under your tongue). Because of this, oil-based products are optimal for sublingual absorption, especially those that contain essential fatty acids such as Omega-3, 5, 6, 7 and 9” (Dope Magazine, 2017). Hence, these fats are better recognized by the body, a fact that helps with their own absorption into the bloodstream. As a result, many manufacturers of sublingual methods of cannabis rely on MCT, also known as Fractionated Coconut Oil, because MCT is made up of medium-chain triglycerides, such as Capric and Caprylic Triglycerides; neither of these substances have omega fatty acids (Dope Magazine, 2017). This is largely because, the more delicate the emulsification, the speedier and more efficiently the body will be able to take in and effectively use the medicinal substance (Dope Magazine, 2017). Some experts praise sunflower lecithin as being one of the more superior fats for the under-the-tongue method of absorption (Dope Magazine, 2017). Fats are so commonly used in this method that their use is known as liposomal delivery: “Our cells have a phospholipid outer layer, so when there is a lipid (or fat/oil) delivery, it aids dramatically in the body’s ability to absorb and utilize cannabis. Essentially, the lipids surround the medicinal molecules (such as CBD and THC) and the body recognizes it as a natural compound to uptake”(Dope Magazine, 2017).

Of course, the sublingual delivery method isn’t perfect. A study conducted to determine the use of cannabis to reduce intraocular pressure found that a 20mg does of CBD administered sublingually did not reduce this intraocular discomfort (Tomida, et al, 2006). However, this method is very notable and effective in numerous other studies in the art and science of removing pain. For example, in the study, “Short-Term Efficacy of CBD-Enriched Hemp Oil in Girls with Dysautonomic Syndrome after Human Papillomavirus Vaccination” the researchers found that the regular dosage of sublingual cannabis helped to improve the participants physical health, general vitality and ability to function socially with females afflicted with HPV (Palmiereri et al., 2017). The only arena where there was no improvement was in the participants emotional reactions. Largely this study is one of the many cases of evidence that show the overall promise of CBD-rich hemp oil in being both safe and well-tolerated in patients for a variety of pain and medical conditions.

In addition to being the answer to “first pass” metabolism that reduces the bioavailability of orally consumed cannabis, supports of the sublingual method of consumption praise not only the speed at which the cannabis is consumed but also the fact that there are literally no negative health effects. Smokers and vaporizers of cannabis simply cannot give that same assurance. Also the sublingual delivery method empowers physicians and other healthcare providers with a level of accuracy that oral consumption just doesn’t allow. Sublingual delivery also empowers the patient to keep a high level pharmaceutical grade solution at home through their own cannabis tincture or comparable solution. The dosing accuracy is nothing to underestimate. Being able to engage in accurate dosing means that patients have a much safer process when engaging in this form of medication. Furthermore, it’s a more discrete form of consumption, which can be beneficial for users who need frequent dosages.

Buccal Delivery Method

A delivery method of medical marijuana that is comparable to the sublingual method is known as the buccal method: this is where the dosage is placed between the gums and inner cheek for around three to ten minutes, allowing as much of the substance to absorb as humanly possible. In terms of comparison between the intraoral buccal versus the intraoral sublingual method, the buccal delivery method is considered somewhat inferior. “The buccal mucosa is considerably less permeable than the sublingual area, and does not provide the rapid absorption and superior bioavailability of sublingual administration. In several comparative studies, sublingual delivery was more effective than buccal delivery” (Kaufman, 2013). However, despite these drawbacks, experts still believe that when used in conjunction with sublingual methods, there’s still promise for the buccal delivery process. Furthermore, researchers think that even outside of CBD and THC consumption, more and more vaccines and antigens will be given via the sublingual and buccal (Senel et al., 2012). While buccal delivery methods might be less ideal at this time, there’s more talk in the field of science that CBD and THC will be better processed to work in a more superior way so that drug delivery is more effective by this particular means (Senel et al., 2012). There’s increasing talk about the best ways to process medical marijuana products to make them more suitable for buccal absorption. At this time, buccal absorption is a sound alternative for patients who cannot tolerate the sublingual delivery method.

Buccal mucosa has nevertheless received a host of attention over the last quarter of a century, and market demand has created many buccal delivery items. For example, “Nabiximols, an oral buccal spray, is a combination of THC and CBD. It was approved in Canada in 2005 for pain management in cancer patients and for multiple sclerosis–related pain and spasticity. It is not currently available in the US” (Cavalet, 2016). Buccal drug delivery still offers clear benefits and drawbacks, offering opportunities for the future for developmental substances in the cannabis and related health fields. Oral mucosa does offer pathways for increased drug absorption, though as already stated, the sublingual method is superior to buccal.

When it comes to dealing with the possibilities in connection with the oral mucosa, nanospheres are widely agreed upon to be where the future is headed.

“The solution for delivering nutritional supplements and nutraceuticals through the oral mucosa lies in encapsulating biological compounds into highly permeable lipid nanospheres. These are easy to administer to the mouth’s sublingual oral mucosa via an eyedropper for rapid uptake into the circulatory system” (Kaufman, 2013). These findings offer many implications for the future and for subsequent developments of cannabis related products for health and medicine.

Transdermal Delivery Method

Many consider the transdermal method to be the most innovate and unique form of marijuana consumption. The cannabis patch adheres to an area of the body near veins and this allows the marijuana to get to work immediately with access to the bloodstream. Transdermal patches have received a positive response because they are discrete and long lasting, and users can get an exact dose. Furthermore, patients can select a patch with various forms of isolated cannabinoids such as THC, CBD, CBN or in mixes of several (Llan,d 2017). This allows the user to select cannabis to address their specific condition. For some, transdermal patches are ideal because they can provide slow and steady relief over a period of time. This factor is another inherent element about them that makes them appealing to those in the health and medicine community: their slow and steady release of a cannabis means that they are less likely to be abused.

The transdermal method comes with numerous considerations: “Cannabinoids are highly hydrophobic, making transport across the aqueous layer of the skin the rate-limiting step in the diffusion process… In vitro diffusion studies may underestimate in vivo transdermal flux…After application of a dermal patch, mean steady-state plasma concentration of ?8-THC was 4.4 ng/ml within 1.4 h, and was maintained for at least 48 h. Permeabilities of CBD and CBN were found to be 10-fold higher than for ?8-THC. In vivo studies of transdermal drug delivery in guinea pigs noted the presence of significant amounts of plasma metabolites after topical application of THC” (Huestis, 2009). What this means is that there is still more research and experimentation that needs to occur in order to determine the overall viability of the transdermal method and to find the best solutions to many of the common problems that prevent transdermal patches from being more effective. For example, if transdermal patches were developed with more combinations of substances, it might increase the overall drug absorption.

Furthermore, the transdermal delivery of cannabinoids is viewed as something that should minimize the negative effects of other forms of consumption. A major benefit of this method is that the first pass metabolism from the liver is inconsequential. The implications of this method for patients who have serious afflictions, like cancer are immense. A patient could apply… [END OF PREVIEW]

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