There are multiple methods, or delivery methods, for consuming medical cannabis. In Florida, these are broken down into 6 categories in the State Medical Marijuana Use Registry - Inhalation, Sublingual, Oral, Topical, Edibles, and Suppository. Within each of these categories are multiple different cannabis product types and varieties. This can be confusing to new and established patients a like. This post breaks down each of the 6 categories, how they are different, their benefits, and how this relates to what you will find in your medication orders in the State Medical Marijuana Use Registry (MMUR).
Florida Cannabis Delivery Methods
Inhalation
Onset: Immediate, within 1-5 minutes
Duration: 1 to 3 hours
Inhalation is the most common delivery method for cannabis consumers. It includes both smoking (combustion) and vaporizing methods. Inhalation allows for rapid onset, quick titration, shorter duration, and more control over effects when proper care is exercised.
There are a plethora of devices and vehicles for smoking, including the most common joints, blunts, pipes, and bongs/water pipes. An entire subculture exists for cannabis glassware, with artists creating everything from the very expensive, complicated, & intricate designs to the most basic and plain pieces. The same variety is available with vaporizers - available in both portable and desktop versions with an array of price points and features.
Vaporizing allows for better control of effects by targeting temperature. It also conserves medicine, and eliminates negative side effects associated with smoking as temperature do not reach that of combustion. When consuming cannabis oils via vaporization, patients should check for added ingredients.
Florida MMUR Notes:
Inhalation products include vaporizer cups (flower in sealed containers meant for vaporization), vape cartridges & disposable pens, and concentrates such as wax, shatter, and rosin. Cannabis distillates can also be purchased for inhalation (filling own cartridges or dabbing). Flower meant for smoking is not dispensed under the inhalation category and instead dispensed in it’s own medication type.
Sublingual
Onset: Within 15 Minutes
Duration: 2 to 6 hours
Sublingual delivery is the process of administering cannabis medicine under the tongue or to the other mucous membranes in the mouth, usually via a tincture, oral solution, or a dissolvable compound. Tinctures are typically produced with alcohol or glycerin, adding in sublingual absorption. Many cannabis markets sell oil based products labelled as tinctures, confusing patients and consumers. These products typically do not work well sublingually and instead are primarily swallowed, acting more like an oral delivery method. Benefits of sublingual delivery include rapid onset, easy titration, and moderation duration. Patients in recovery or otherwise sensitive to alcohol should be aware of sublingual products as it’s a common ingredient. If the alcohol causes burning or irritation dilute with water and swish around the mouth.
Florida/MMUR Notes:
Muv and Surterra have alcohol based tinctures. We do not typically provide patients with orders for sublingual as all sublingual products are approved for oral consumption and can be dispensed under that order type.
Oral and Edibles
Onset: 30 minutes to 2+ hours (highly variable)
Duration: 6 to 8 hours (highly variable)
The oral delivery method includes any cannabis products that are swallowed and ingested via the stomach. This may include oils, capsules, powders, and cannabis infused foods called edibles. Oral cannabis is a powerful medication option with long lasting and full bodied effects. While low and slow is the rule for all cannabis dosing, it’s extra important when dosing orally. The onset can be delayed and highly variable, causing patients to consume more too quickly. Over medicating orally can result in high levels of anxiety, paranoia, and nausea, often lasting multiple hours. Patients brand new to medical cannabis should typically begin with sublingual tinctures or inhalation before experimenting with oral cannabis. Patients with GI absorption issues or those without a gallbladder may find difficulty with the variability of oral cannabis.
Florida/MMUR Notes:
The oral category includes sublingual products in addition to capsules and other oral only medicines. Edibles were released in Florida as their own registry category on August 27, 2020, but function in the same manner as oral products. Edibles can also be made from oral oils or cannabis flower.
Topical
Onset: Varies, typically within 20 minutes
Duration: Varies; Up to 4 hours (topical) to multiple days (transdermal)
Topical delivery includes any cannabis product applied to the skin. Topical products do not break the blood brain barrier and are instead absorbed locally into endocannabinoid receptors present in the skin. This means there is no psychoactive effect with topical products. Topical products include creams, balms, gels that are used primarily to reduce localized pain (muscle, nerve, inflammatory) or reduce skin irritation from conditions like eczema or psoriasis. Topical products can be reapplied as needed and are a great option for patients new to cannabis and those wishing to avoid psychoactivity and/or smoking.
While technically a different delivery method, the topical category in Florida also encompasses transdermal administration. Transdermal products include compounds used to assist cannabinoids in gaining entry into the bloodstream, allowing for a systemic effect. While able to provide full body effect, transdermal products typically have less psychoactivity than other counterparts. Transdermal products include creams, gels, lotions, and patches. When applied to a vein they will work systemically allowing for full bodied relief. Transdermal products can also be applied locally, acting more like an extended topical. Many patients find transdermal products extremely effective for migraines and headaches, applied to the temples and base of the neck. Some transdermal products work for up to 72 hours allowing consistent and long lasting dosing.
Suppository
Onset: 30 minutes or less
Duration: Varies; 30 minutes up to 12 hours
Suppository is probably one of the least understood and least common forms of cannabis delivery methods, yet can provide a profound impact for those in need. Suppositories are oil capsules that can be administered vaginally or rectally, with different benefits of each. Some research has demonstrated suppository absorbability up to 80% (far beyond other methods). When placed correctly (deep enough), suppositories act quickly and bypass the liver, resulting in an efficient dose with no psychoactivity. Suppositories may be beneficial for menstrual pain, pelvic disorders & pain, cancers of the pelvic floor, and GI conditions. They can also be useful for patients who cannot swallow or take cannabis in other forms.
Florida/MMUR Notes: We (along with the majority of FL cannabis physicians) do not include suppository on patient recommendations unless specifically discussed with the patient as it’s a very uncommon choice. Suppositories often need to be special ordered by the MMTC as they are not regularly in stock. They are currently available through Fluent and Columbia Care dispensaries. Cannabis suppositories can also be easily made yourself with a suppository mold, cannabis concentrate like distillate or RSO, and a base oil.
Example Florida Registry Order Showing Different Delivery Methods
Other Florida Registry (MMUR) Notes
Smokable Cannabis
When most people think of cannabis, they think of the raw flower or buds; and for good reason - cannabis flower is by far the most popular cannabis product on the market. It can be used in a variety of ways. For patients who like to do things themselves, making other products (like edibles and topicals) from cannabis flower can be a cost saving and gratifying experience. Here in Florida, the State separated cannabis flower into it’s own category - ‘Smokable Cannabis,’ instead of dispensing it under the delivery method in which it’s intended for. Patients can purchase up to 2.5 ounces (or the limit set by their physician) every 35 days and possess up to 4 ounces of cannabis flower at any time.
Low THC, Medical Cannabis, & Delivery Methods
In addition to the smokable cannabis category, patients must have orders for both low THC and medical cannabis in each of these delivery types to purchase the full array of cannabis products available on the market. The exception is sublingual, as these products are also authorized for oral use so the category does not need to be repeated.
Post Written By: Kristina Risola, MA, CRC, NBC-HWC
Cannabis Health Coach
