ABSTRACT
SUMMARY. Inhalation of carcinogenic combustion products associated with smoking is generally regarded as the major health hazard in connection with the medical use of cannabis products. Strategies to reduce respiratory and other adverse events resulting from this common practice include relinquishment of inhalation and replacement by other routes of administration, the use of plants with a high THC content allowing reduction of the amount of smoked plant material, usage of inhalation devices that improve the ratio of THC and tar, and avoidance of the Valsalva maneuver that may cause spontaneous pneumothorax. The major risk associated with oral cannabis use is accidental overdosage, especially in inexperienced users that can be avoided by appropriate dosing procedures. A combination of oral use and inhalation may be meaningful in several indications, decreasing the specific risks of both routes. Preliminary studies using rectal, sublingual and transdermal routes indicate that these alternatives to the two most common forms of ingestion may be utilized medicinally in the future, further reducing the possible risks associated with the administration of cannabis or single cannabinoids. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: <getinfo@haworthpressinc.com> Website: <https://www.HaworthPress.com>; © 2001 by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Cannabis, marijuana, THC, cannabinoids, smoking, inhalation, oral use, rectal use, sublingual use, transdermal use, therapeutic use, side effects, health risk, harm reduction, cancer, spontaneous pneumothorax, dosing, overdose, opium, opiates, pharmacokinetics
INTRODUCTION
Major objections to the use of crude cannabis products medicinally are often based not on properties of the natural herb itself, but on the possible adverse health effects resulting from the most prevalent form of application in recreational use: smoking a marijuana cigarette or pipe (Joy et al. 1999; Tashkin 2001). The major advantages of inhalation of cannabis or THC are rapid onset of action and flexible dose titration, making this route of administration very attractive to medical users. Dronabinol is a synonym for the natural ()-trans isomer of delta-9-THC (the pharmacological most active isomer of delta-9-THC that is present in the cannabis plant) when synthesized and manufactured as Marinol®. The oral route is more prone to improper dosing, resulting in unwanted side effects due to overdosage. However, this route may be advantageous if a long duration of drug action is desired. Harm reduction techniques are intended to minimize the health risks associated with different routes of application while maintaining the specific pharmacokinetic advantages.
