Are cannabis suppositories safe, and will they get me high?

Q:

I’m considering using a cannabis suppository but have read a lot of contradictory information online. Is this a safe method? Will I get high? Thank you for any information you can provide!

A:

Suppositories are a popular method of cannabis administration and can be effective at treating some conditions and disease. However, information available on healthcare forums, blogs, and social media posts includes prevalent misconceptions about the efficacy of suppositories and erroneous interpretations of the existing research. The following information should enable you and others to make more informed decisions about which delivery method is best to treat their condition.

During rectal administration, fluids are absorbed by the rectum’s blood vessels and are mostly directed into the body’s circulatory system, which distributes the fluid to the organs and bodily systems. Typically, a drug that is administered rectally has a faster onset, a higher bioavailability, a shorter peak, and a shorter duration than when the same drug is administered orally.

Multiple factors affect the absorption rate of rectal medications, including molecular size, water-solubility, depth of insertion, dehydration, low surface area, and the base of a suppository preparation. Additionally, absorption rates of suppositories are slower than that of other delivery methods and the rate at which suppositories absorb is largely dependent on chemical additives in the suppository.

Currently, there is some debate about whether rectally administered cannabis can effectively treat conditions affecting the entire body.

Commonly-referenced research states that rectal absorption rates of cannabis are as high as 50-70 percent. In these studies, however, delta-9-THC was coupled with an ester hemisuccinate, which is an additive designed to increase absorbency by breaking down fat-soluble compounds into water-soluble compounds. Other studies designed to test rectal absorption of cannabis demonstrated that, without hemisuccinate, rectal absorbency was three percent or less. In fact, there exists some general agreement that fats and oils are poorly absorbed from the rectum. Cannabinoids are lipids (fats) and cannabis products are nearly always extracted into an oil or fat base, so it’s reasonable to assume that whole-plant cannabis oil products are poorly absorbed rectally. And, because most preparations of cannabis suppositories do not contain hemisuccinate, it is safe to assume most of these preparations are not being adequately absorbed. Clearly, more research is needed.

While Radicle Health occasionally recommends rectal administration for conditions that can benefit from a topical cannabis administration (such as fissures, hemorrhoids, and rectal cancer), this route can produce results that are incomplete, unpredictable, and erratic. Importantly, Radicle Health does not recommend rectal administration for patients undergoing chemotherapy because of the increased risk of infection and rectal bleeding. Patients should always consult with a healthcare professional before considering rectal administration.

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Written by Eloise Theisen

Eloise Theisen, AGPCNP-BC, is a dedicated and patient-focused nurse. For over 17 years, she has specialized in aging, cancer, chronic pain, dementia, Alzheimer’s, Parkinson’s, anxiety, depression, fibromyalgia, and various autoimmune and neurological diseases. The founder of Radicle Health, she started her career at John Muir Medical Center caring for patients suffering from cancer, terminal illnesses, respiratory failure/complaints, drug overdoses, acute alcohol ingestion, gastrointestinal bleeds, traumatic brain injury, and multiple traumas.

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