By Troy Ivan
Using cannabis to treat medical conditions is gaining in popularity and acceptance every day. While smoking, vaping, edibles, and topical applications are very familiar the use of suppositories is still in the shadows and a relatively unknown alternative. After learning about the success many people claim to have with suppositories I decided to bring this helpful information to the masses. I quickly learned, and was shocked to find, that the effectiveness of cannabis oil (CO) suppositories was a topic of heated debate! Suddenly, my idea of a quick and easy informational post ballooned into an amateur research exercise and science project to identify points in the debate I could confirm, dispel points that didn’t checkout, and develop a better understanding of the topic in general. This post I endeavors to explain many things about CO suppositories; what the debate over effectiveness is about, possible benefits, physiology involved, personal testing experience, what my experience proved to me, and what a blood test showed about absorption.
WHAT’S THE DEBATE ALL ABOUT?
Medication administered rectally in the form of suppositories is used in general medicine to provide a rapid, very efficient uptake and absorption into the circulatory system. CO suppository advocates propose that the same applies to the efficiency of THC uptake and it can reach up to 70% with suppositories while oral ingestion and smoking top out at around 20%. The other side of the argument contends that the high uptake efficiency attributed to suppository medication only occurs when the delivery medium is water soluble or is aided by an additive to increase absorption, and accordingly oil based material alone can’t be absorbed through the thick mucus and wall of the lower rectum. Therefore, the naysayers say homemade CO and coconut oil suppositories can’t be absorbed in any meaningful concentrations and maybe not at all. Whether or not oil-based compounds like CO alone can be efficiently absorbed through the lower rectum is the crux of the entire debate.
WHAT WOULD BE THE BENEFITS OF CO SUPPORITORIES?
There are two key attractive benefits of suppository use. One benefit is the high efficiency and bioavailability of rectally administered meds. If the absorption efficiency can reach 50%-70% the cost effectiveness per volume of CO used is very desirable and would provide substantially more medicine for the same money. Moreover, the ability to deliver a higher dosage of CO to the blood and areas requiring treatment would be greatly enhanced.
Second, and more complex, is the benefit of avoiding most, or all, psychoactive effects of THC. The psychoactive effects from smoking or orally ingesting CO can be so devastating for some users that they’d rather forgo using CO despite any potential it may have in their treatment. If large amounts of THC were able to be absorbed without psychoactive effects many people who currently can’t medicate with CO could enjoy its healing powers.
The lack of psychoactive effects of THC is interpreted very differently by the proponents and the doubters in this debate. Proponents say if a suppository is administered properly, in the lower section of the rectum, the THC is absorbed in a way that avoids psychoactive effects. The other side of the debate points to the lack of psychoactive effect as proof that the CO is simply not being absorbed and distributed through the circulatory system. I needed a lot more information because I had zero knowledge concerning the physiology of the rectum or how it functions within the circulatory system so I started searching for answers and asking lots of questions.
RECTAL PHYSIOLOGY, BLOOD FLOW, AND DRAINAGE WITH RESPECT TO SUPPOSITORY ABSORBTION, METABOLISM AND THC INDUCED PSYCHOACTIVITY?
The physiology, drainage and blood flow away from the rectum differs between the upper and lower sections. Understanding the differences between the upper 1/3rd and lower 2/3rds of the rectum gives clarity to why a CO suppository in the lower rectum could circumvent the onset of psychoactive effects brought on by THC absorption.
The upper 1/3rd of the rectum is part of the hepatic portal system where nutrients are absorbed, drainage occurs through the portal vein, the blood is transported to the liver and metabolized by the liver, then onto the heart for general distribution to the body. When delta-9-tetrahydrocannabinol (THC) passes through the liver some is metabolized into the stronger and more psychoactive 11-hydroxy-THC. Oral consumption of CO essentially follows this same flow through the liver, referred to as first pass metabolism. Higher pressure in the upper region of the rectum more readily facilitates oil based medicine absorption and can be tested by putting some CO way up there and letting the psychoactive circus begin.
The lower 2/3rds functions much differently. This section drains to the internal iliac vein which bypasses the liver and is delivered to the right atrium of the heart, to join the systemic circulation, and off to the body. Advocates of the CO suppositories say that by missing the liver this way the lack of THC metabolites greatly limits or eliminates psychoactive effects of THC. Contrarily, the naysayers argue that the pressure in this area is too low, the mucus wall too dense for oil based medication to be absorbed, and therefore the lack of psychoactive effect is due to the medicine not being absorbed in any meaningful amount, if at all.
BOTH SIDES MAKING SENSE?
I was conflicted because I really wanted suppositories to be the missing link to healthy consumption of CO, however, both sides of the argument seemed to be making sense and I needed to find more reliable information to base a conclusion and then share with those who may be as confused as me. In searching for information and guidance I found plenty of anecdotal third party stories, testimonials, and a few often referenced studies that were either flawed or introduced elements that made them incompatible with analysis of the use of suppositories made with only CO and coconut oil. I was so deep in hearsay and tainted information the only way to form an opinion about this subject was to test it on myself.
WHAT I WANTED TO LEARN BY TESTING
First, I wanted to determine what kind of physical or psychoactive effects I would experience by using CO suppositories. Second, I wanted to find a definitive way to establish if THC was absorbed into the bloodstream and if it was absorbed what was the concentration and constituent make up?
PLAN FOR TESTING
The goal for pre-test preparation was to cleanse my blood of any residual THC. THC for a single use is estimated to stay in the blood for 12-24 hours while those who use cannabis on a regular basis can expect TCH to remain in the blood for nearly a week. To ensure there would be no trace of THC in my blood prior to the experiment I abstained from anything cannabis for 2-weeks. Clean blood was crucial for the accuracy of the cannabinoids blood screen (test code 8421) to evaluate THC absorption and shed light on any other useful information that might indicate CO efficiency. Abstaining ahead of the testing would also increase sensitivity to any physical or psychoactive effects brought on by the suppository testing.
The execution stage of the experiment would include taking one 2ml 20mg THC suppository the evening prior to the blood test to evaluate any physical and psychoactive effects. At 8 a.m. the next morning I planned to take a second 2ml 20mg suppository to reevaluate and compare the effects to the night before. Finally, I would conclude the experiment with a blood test 4 hours later in hopes of catching any current THC absorbed near its peak and any residual THC metabolites from the night before.
Before I could start testing on myself I had to learn to make suppositories. In preparation I ordered 2ml disposable suppository molds from Amazon. Once the molds arrived, I made 0.8g of CO using the Source (making FECO with the Source by ExtractCraft), combined it with 50g of coconut oil (the type that returns to solid form at room temperature), filled 28 disposable suppository molds, then put the molds in the freezer to solidify and store. Assuming the CO I made was approximately 70% THC the suppositories were 20mg each. For clarity, as in the linked FECO making instructions, I used decarboxylated material to increase the bioavailability of THC. I was happy to find that making the suppositories myself was pleasantly simple and rewarding.
(Side note: suppository molds are awesome for storage! You can make a bunch of frozen, premeasured doses for oral consumption or for cooking. The frozen coconut oil and CO in that shape are very easy to handle and use.)
EXECUTION OF THE TESTING
With cleansed, THC-free blood it was time for truth, an unbridled search for scientific knowledge, and putting something where nothing has ever been put before. At 6 p.m. I put on the recommended latex glove, inserted the suppository just inside the sphincter, no more than 1 ½ inches inside, making sure it stayed in the lower area of the rectum, laid on the bed for a few minutes hoping I did it correctly and very thankful the kids didn’t come barging in at the most inopportune time. The process was very simple and much less stressful than I anticipated. After a few minutes I stood up, half expecting something to come shooting out, but much to my relief everything seemed very normal.
After 10-minutes the effects undoubtedly showed the first signs of effectiveness with an almost imperceptible body calming sensation. By the 30-minute mark a full body calming was in full effect. It wasn’t a strong, stony body high, but more like the comforting feeling of being tension free and wrapped in a warm blanket. I also recognized a sensation in my mouth and jaw that I often identify with cannabis consumption. There was an interesting, very slight feeling creeping up the back of my neck that felt like the CO was flirting with imposing a head-high but it held short and left me clear headed the entire time. My body was high, my psyche was soothed, and my ability to reason untouched. Finally, when I turned in for the evening I was well relaxed and had a solid, serene night sleep. I woke up with ease the next morning and felt great with none of the hangover effects often associated with edibles. After getting around and completing my morning duties it was time for the 8 a.m. dose. I followed the same procedure as the previous night and was once again surprised by how easy the process was. The effects of the morning dose were an exact repeat of the night before. It made for a very pleasant, relaxed, clear headed, and pain free morning. At around noon (4-hours later) I had my blood drawn for the cannabinoids blood screening. A little later, in the early afternoon I became tired and at 2 p.m. I took one of the best naps of my life. I woke up from the nap feeling great, perfectly clear headed, with all discernable sensations of the CO gone. From the feedback my body provided there was no doubt in my mind the CO had been absorbed and had worked its magic on me. With the blood test finished, the experiment was complete and the only thing left to do was to wait 7-10 days for the results.
I was very excited anticipating the results of the blood test because regardless of what the results indicated it was going to be very interesting. If the test showed significant uptake and absorption of THC it meant many people could feel confident that CO suppositories did in fact deliver the medicine in an effective way. On the other hand, if the results indicated negligible or no absorption at all we would have a mystery on our hands to explain what was responsible for the physical effects experienced during testing?
Seven days after having my blood drawn for the test I received the results:
DELTA 9 THC………………………NONE DETECTED < 1.0 MCG/L
11 HYDROXY DELTA 9 THC……NONE DETECTED < 1.0 MCG/L
11 NOR 9 CARBOXY THC………6.38 MCG/L
First, I was able to identify definite physical effects of the CO suppositories but no psychoactive effects at all. The physical effects I identified left little doubt that absorption of the CO defiantly took place. How much absorption took place was hard to judge because I’ve never before experienced a body-high in the absence of a head-high. My experience with the disjointed body-high supports the idea that when administered in the lower area of the rectum any THC absorbed bypasses the first pass metabolism, misses the liver, and therefore has little to no psychoactive effect. My unscientific support of this idea comes from the imbalance of what my body and head experienced, therefore, I reasoned if the distribution of THC was in balance, like with smoked or orally ingested CO, I believe I would’ve had a strong head-high to match what was going on with my body.
Second, I needed to establish if THC was actually absorbed into the bloodstream, and if it was what was the concentration and constituent make up. Unfortunately, the blood test results were in direct conflict with my unscientific conclusions based on physical experience alone. The blood test clearly showed that 4-hours after the use of the 20mg CO suppository made with coconut oil there was no detectable THC or its first metabolite 11-hydroxy-THC. There was a low level of 11-nor-9-carboxy-THC, the second metabolite, which could be minor evidence of absorption or simply residual THC remaining from more than 2-weeks prior to the testing. Due to the fact that both delta-9 THC and 11-hydroxy-delta-9 were not detected at all, the origin of the low level presence of 11-nor-9 carboxy THC can be debated and is definitely worthy of some follow-up research. Next time a blood test should be added to the experiment before using any CO to establish a reliable benchmark against the post consumption results to be compared for absolute certainty of the metabolite origin.
Unfortunately, my conclusion is almost as confused as my understanding of the topic was when I began this project. I think it’s clear that for people with medical conditions requiring treatment in the pelvic area where the suppository can deliver the CO directly into contact with the needed treatment area it would be advantageous to use CO suppositories. For those treating pain, stress, depression, general well being and would like to forego the head-high associated with THC I would highly recommend giving CO suppositories a try and judge the effectiveness for yourself. For severe illnesses like cancer, where high levels of THC penetration is absolutely required I can’t ignore the blood test results. At best I would say its worth using in combination with other modes of CO ingestion but the results clearly demonstrated that the necessary delivery of THC is not occurring.
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STAY SAFE, HEALTHY, FREE AND LIFTED
NOTES: I highly encourage everyone to give suppositories a try and let me know about your experiences. Everything in this blog is simply my opinion and based on my personal experimentation and not as a medical professional. Any recommendations I make should not be taken as medical advice and before following any recommendations in this blog you must consult with your doctor. Don’t consume anything you are not familiar with and hasn’t been cleared with your doctor. It’s imperative that you know and abide by the laws governing your area concerning cannabis and any processing of cannabis.