Methods of Administration
One of the most unique and exciting aspects of cannabis is the large number of administration methods available to a patient. No other medication, that we know of, has this many options for introducing it in one’s body. By manipulating the different delivery methods, doses, and ratios of cannabinoids, a patient can feel empowered and find relief from the symptoms of their qualifying condition.
In pharmacology, bioavailability is a subcategory of absorption and is the fraction of an administered dose of a medication that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. This refers to how much of the medication you put in your body and how much your body is able to absorb and utilize.
Extended Release vs Fast Acting (PRN) Medications:
An important concept of medication use is how to administer the medication so one gets the best coverage and control of the symptoms they want to diminish. Ideally, we would like to control any symptomatology with just ingestion. A patient would take capsules twice or three times a day. Ingestion is an extended release method which allows the patient to find relief and coverage at all times. However, this option is not always possible for all patients. For this reason, we can add a fast acting medication, as needed, for relief. PRN, “pro re nata,” which means “as needed” is a complementary administration so the patient can control break through symptoms.
The Importance of Layering the Methods of Administration:
Layering the methods of administration is a one of the most important concepts for patients to understand. Everything we have at our facility is a tool for each patient’s tool box. Depending on what symptoms the patient may be experiencing, they can manipulate the dose, the timing of the effect experienced, and the ratios of the cannabinoids for best results.
Titration – Finding the Patient’s Baseline Dose:
Titration is the process of determining the proper dose that reduces symptoms to the greatest possible degree while avoiding possible side effects.
Slow and methodical, backed by the scientific method.
Before a patient can effectively use our meds, it is recommended to find the patient’s baseline dose (or minimum amount of cannabis to achieve the best result).
To titrate, the patient will start with a particular dose. Our suggested initial doses can be found on the Dosing Schedules for cannabis conditions document. The patient might want to start with a lower or higher dose, which is also okay. The key to titration is to use the initial dose in a consistent and systematic way. The patient will have to pay attention to their bodies and ideally have a log. They should pay attention to the change in symptoms the day they are administering their medication and at the end of a predetermined interval (2 or 4 weeks). We advise patients to take notes on what their pain level is just prior to administration, and their pain level 30 minutes after they use a tincture or inhalation or 2-3 hours later after ingesting a capsule/edible. After a four week period, the patient will reassess their dosing schedule by looking at their log. For example, if in the four week period, their overall pain went from an 8 to a 6 on a pain scale, they are under dosing and should titrate their dose up. It is good to note that this process is not done in absolutes, it is a guide for patients.
Due to the safety of cannabis, if they want to increase their dose after 3 days for example, they can do that. However, it is important to remember that even though cannabis is very safe, with high doses, patients may experience uncomfortable side effects.
For a lot of patients, it is important to them to eliminate other medications. We do not suggest for patients to stop taking any of their other medications. Ideally, the patient should include the prescribing physician in the process of medication tapering.
Regardless of how a drug effect occurs—through binding or chemical interaction—the concentration of the drug at the site of action in the body controls the effect. Response to concentration may be complex and is often nonlinear. The relationship between the drug dose, regardless of route used, and the drug concentration at the cellular level is even more complex.