One of the major criticisms of cannabis as medicine is the idea that it must be smoked. The vast majority of physicians and health care workers have been trained to discourage smoking wherever possible as part of the campaign against tobacco.
While smoked cannabis is not nearly as harmful as smoked tobacco it is important to recognize that there are both benefits and risks to smoking as a route of administration. The primary risk is respiratory inflammation including bronchitis. Much of the cannabis currently available is rather crude and produces a hot smoke that can irritate delicate lung tissues and aggravate existing respiratory problems. These problems alone are enough for the majority of physicians to refrain from recommending cannabis as medicine. Arguments detailing the expectorant, anti respiratory pathogen effect, and anti neoplasm effects of cannabis are insufficient for physicians and many patients to feel comfortable with smoking medicine.
The benefit from smoking as a route of administration is instant action and the ability of the patient to self titrate the dose needed for relief. Here we describe how patients can achieve similar quick acting relief and the ability to control dose without smoking. It is important that the medical community understand that whole cannabis products are available today that provide significant relief without smoking. We don’t have to wait for a pharmaceutical pill to be developed years in the future in order to have the benefits of cannabis. The present pill (Marinol) has proven very unsatisfactory due to a long delay of action time, poor absorption in the GI tract, and its failure to include many of the antioxidant and anti-inflammatory cannabinoids present in whole cannabis and its extracts. In addition, future pharmaceuticals will be wildly expensive.
There are two major and one minor method of achieving the aims of quick action and dose control. The first is the use of cannabis tinctures. Tinctures are not new. Until cannabis was banned in 1937, tinctures were the primary type of cannabis medicines. Tinctures are essentially alcohol extractions of whole cannabis (usually the flowers and trim leaves). Tinctures are easy to make and very inexpensive (see: http://www.letfreedomgrow.com/recipes/tincture.htm). Tinctures contain all 60 of the essential cannabinoids instead of only one with Marinol. Some of the cannabinoids such as cannibidiol (CBD) actually reduce the psychoactive effects of THC while increasing the overall efficacy of the preparation.
The best way to use tinctures is sublingually (under the tongue). Titration or dose control is easily achieved by the number of drops a patient places under the tongue where the medicine is rapidly absorbed into the arterial system and is quickly transported to the brain and body. All a patient need do with tincture is use a few drops, wait for the desired medical effects, and either use more or stop as the situation indicates. Tinctures can be flavored for better taste. They are best stored in dark bottles in the refrigerator. Since tinctures average some 75% ethanol there is little worry of bacterial or other biological contamination. Those who wish to avoid alcohol can instead use their tincture as a base for making a concentrated elixir (see:http://www.letfreedomgrow.com/recipes/elixir.htm). While elixir is absorbed into the venous system via the GI tract it is still reasonably quick acting if used on an empty stomach. Elixir is usually made with honey and tastes good. It can be used by the teaspoon either alone or in a beverage of choice like tea.
The second (and newer) major method of non smoking cannabis delivery are vaporizers. All vaporizers essentially use a controlled heating element that raises the temperature of whole cannabis samples (flowers) just to the point where the cannabinoids vaporize. There is no combustion with vaporization and no chemical conversion from heat. There is no hot smoke to irritate the lungs and no annoying combustion byproducts. Vaporizing is far more efficient in delivering medicine than smoking so in the long run "vaping" is far cheaper than smoking as well as much healthier. Just as with smoking, a patient inhales a dose of vapor and waits one or two minutes to evaluate the effect. Patients can use only that amount that is necessary for the relief of symptoms. An added benefit of vaporizing is that there is little cannabis odor when vaping which can be important for both security reasons and general decorum. There are a wide variety of vaporizer systems that vary greatly in ease of use and cost.
The third method of delivering smokeless medicine is through food products. The downside of oral delivery is the same as with pills like Marinol. Absorption in the GI tract is slow and variable. It is much more difficult to achieve quick action but the plus side is that while the onset is far slower than tincture or vaping (20-60 minutes versus 1-2 minutes) the effects are more long lasting (4-12 hours versus 1-4 hours). Oral cannabis is an excellent way to maintain consistent cannabinoid levels. These levels can be therapeutic without being psychotropic although eating too much in the way of cannabis based food products can produce long lasting and rather intense "highs" unless one understands the potency of the food products. The best way to deliver whole cannabis orally is for patients and/or caregivers to first make "cannabutter" (see: http://www.letfreedomgrow.com/recipes/better_bud_butter.htm) or "canny" oil (see: http://www.letfreedomgrow.com/recipes/oils_well_that_ends_well.htm) which is then used in baked products or other food dishes.
Many of today’s medical cannabis patients utilize vaporizers, tinctures, and oral cannabis food products. Some patients have never smoked (either cannabis or cigarettes) and don’t have to in order to obtain the full benefit of cannabis medicine. Other patients maintain basic cannabinoid levels with tincture or food products and then only smoke when they experience acute distress from their illness. These patients could just as easily vaporize for these acute episodes.
Thus, inexpensive, healthy, and effective methods of cannabis drug delivery exist today. Patients and physicians do not have to wait for "better" delivery systems. Patients and caregivers are very adept at producing standardized and consistent products with known effects. While progress can and should be made in characterizing and researching cannabis medicines, they are available today for the relief of a wide range of illnesses and disorders.
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