About Cannabis-Infused Suppositories

January 10, 2024

By Genester Wilson-King, MD FACOG 

Cannabis-infused suppositories have gained attention for their potential therapeutic effects, especially for female health and oncological/palliative care. A suppository is a small, cylindrical, or round-shaped object that contains medicine. It is inserted into a body orifice, most commonly the rectum or vagina, and sometimes in the urethra. This method allows for more efficient absorption of most cannabinoids, particularly when oral consumption is contraindicated or inappropriate.

Clinical research on the pharmacodynamics or pharmacokinetics of cannabis-infused suppositories is limited, which means not very much is known. Most of the data is preclinical (meaning done on animals or in petri dishes). Suppositories can dispense medication systemically and can be easily inserted into the rectum and the vagina. This article will briefly examine the differences between vaginal and rectal suppositories and highlight their effects and uses.

Rectal vs Vaginal Suppositories

Suppositories are designed to be inserted into the vagina or rectum, where they are absorbed directly into the bloodstream. The effects are then delivered systemically. There may be an interesting dichotomy regarding vaginal vs. rectal suppositories.

Rectal suppositories do not yield the effects of THC. In the 1980s, scientists observed the absence of detectable THC levels in blood plasma following rectal administration.1 In a 1991 preclinical study using monkeys, Delta-9 THC was connected to various ester groups, hemisuccinate, N-formyl alaninate, N-methyl carbamate, and methoxy acetate. Each suppository contained a 10 mg dose of delta-9 THC. Blood samples were analyzed for both THC and its carboxylic acid metabolite (ll-nor-Ag-THC-9-COOH). The data showed that no THC or THC metabolites were detected in the blood samples, except for hemisuccinate-THC.2

THC requires an attached hemisuccinate ester to be absorbed via suppositories. But I haven’t found a study that examined what happens with vaginal suppositories. A hemisuccinate ester group is a chemical structure attached to a THC molecule that makes it water-soluble. THC with the ester group attached is converted to THC inside the body.3

In my clinical experience, patients using THC-based vaginal suppositories (without hemisuccinate) report they experience its effects, which can include impairment. THC vaginal suppositories can be made with or without hemisuccinate ester.4 As more people make their own products, we will have more data on suppository use which will expand our knowledge base. These individual reports are known as anecdotal information, which can inspire more research that is greatly needed.

Absorption

  • The vaginal mucosa has a rich blood supply, allowing cannabis components to be absorbed directly into the bloodstream. It is important to note that comprehensive pharmacodynamic and pharmacokinetic studies of cannabis-infused suppositories have not yet been done.5,6
  • Cannabinoids, such as THC, CBD, etc are lipophilic (soluble in fat). They can readily pass through the lipid-rich cell membranes of the vagina.6
  • In my clinical practice, patients may experience the effects of THC (i.e. impairment) with cannabis-infused suppositories. Making hemisuccinate suppositories involves a complex chemical procedure that is beyond the capabilities of the average home kitchen.6 To date, I haven’t come across any peer-reviewed research that demonstrates the presence of THC in the bloodstream after the application of non-hemisuccinate suppositories.

Potential Benefits

  • Pain relief: In my clinical experience, people using cannabis-infused vaginal suppositories report relief from menstrual cramps, pelvic pain, or conditions like endometriosis and dyspareunia.7,8,9
  • Muscle relaxation/spasm relief: Cannabis contains compounds with muscle-relaxant properties that may benefit individuals experiencing tension or spasms, including menstrual cramps. CBD and CBG are two (but not necessarily the only) phytocannabinoids that yield these benefits.10
  • Anti-inflammatory: Cannabinoids such as CBD and CBG have anti-inflammatory properties. This could benefit inflammation-related conditions like arthritic pain, low back pain, and endometriosis.11,12
  • Avoids first-pass effects meaning the substance bypasses the liver (or another metabolizing organ), thereby avoiding metabolism before it reaches its intended targets. The “First Pass Effect” reduces the concentration of the active ingredient that reaches circulation and its intended targets. Drugs that are absorbed via the gastrointestinal tract (swallowed and reach the stomach) will pass through the liver first. The liver then acts as a filter, and only part of the drug or substance is circulated systemically. This is known as the “First Pass Effect.”13
  • Does not cause nausea or vomiting due to gastric irritation. Suppositories can be a good remedy for vomiting since it is given via a non-oral route.
  • Can be given to unconscious patients, for example during end-of-life or post-op care.
  • Offers a direct method of administration affecting the vagina or rectum, such as menstrual difficulties, digestive issues, or tumors in these areas.6

Types of Suppositories

  • CBD-Dominant: These contain primarily cannabidiol (CBD), or other non-impairing cannabinoids with little to no tetrahydrocannabinol (THC).
  • THC-Dominant: These contain higher levels of THC and may cause impairment.
  • Combination: Some suppositories combine different cannabinoids and may include other botanical cannabinoids such as CBD/CBG, CBD/THC, CBD/CBG/CBC, etc.14,15

Dosage and Potency

  • Dosage can vary.
  • Start with a lower dose. The “right amount” depends on the individual. What is a high dose for Patient A can be a low dose for Patient B, or vice versa. Monitor how your body responds before considering higher doses. Again, there aren’t yet good pharmacodynamic/pharmacokinetic studies on cannabis-infused vaginal suppositories.
  • The ideal dose is found by starting low and going slow, as is the case with any cannabis product. This means starting with a low-dose vaginal suppository and increasing if needed. You can do this by making your own suppositories, or if there are varying doses available of the product you have. If you are making your own suppositories, 5-10 mg is a good starting point. If you do not get relief, increase your dose by 5-10 mg.
  • Suppositories may be difficult to obtain or be prohibitively expensive in many areas. Many of my patients make their own suppositories.

Potential Side Effects

  • Cannabis has a good safety profile. The potential side effects associated with suppositories are those that could arise with any cannabis product. While many people tolerate cannabis well, side effects can include dizziness and fatigue. In the case of THC-containing products, impairment may be experienced with vaginal suppositories.
  • It’s advisable to consult with a cannabis clinician or healthcare professional before trying cannabis suppositories, or cannabis products in general, especially if you have pre-existing health conditions or are taking medications.
  • It’s important to consult with a healthcare professional before using cannabis suppositories, particularly if you have any existing health conditions or are taking medications. They can provide personalized advice based on your health history.

Product Quality

  • Ensure that you obtain products from reputable sources that adhere to quality and safety standards.
  • Do not use any cannabis products if you haven’t read the product’s certificate of analysis (COA) or if there isn’t one available. There should be a QR code on the product label or a link to the COA on the producer’s website.
  • The COA will tell you what is and isn’t in the product and the concentration of the ingredients. It is not advised to buy a cannabis product without seeing the COA.16

Final Note

Cannabis-infused suppositories offer a specific mode of administration for female health and palliative care. While clinical research remains limited, anecdotal evidence suggests advantages such as pain relief, muscle relaxation, and anti-inflammatory effects. Ensuring proper dosage, potency, and product quality, along with seeking healthcare guidance, is crucial for safety and effectiveness in the field of cannabis-based therapeutics. Please consult a cannabis clinician for support on your healthcare journey.

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Sources

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