When patients choose clinically formulated medical cannabis topicals and suppositories, they can rely on consistency between batches, no risk of contaminants, and an even distribution of cannabinoids with each application. What’s more, the research and technology that goes into topicals and suppositories is continuously evolving, meaning new formulations and new ways to intake medical cannabis are often around the corner.

Topical products today include creams, gels, transdermal patches, and even solid sticks for easy application. New to the medical cannabis market, suppositories make it easy for patients to self-administer medical cannabis for managing conditions in the pelvic region, or as a means to deliver cannabinoids that doesn’t involve inhalation or ingestion.

Medical cannabis topicals are cannabinoid-rich products (CBD, THC, CBN, etc.) made expressly for application on the skin’s surface. Topicals can be a great option for medical cannabis patients needing targeted cannabinoid therapy, e.g., arthritis pain. Or, with transdermal topicals, a means to get medical cannabis into the bloodstream without inhaling or ingesting. They’re also generally an easy entry-level format for those new to cannabis as there’s minimal risk for overmedicating.

Even if a topical contains THC, it won’t generally cause intoxication or a “head high.” Absorption through the skin avoids first-pass metabolism by the liver where most THC in the body is converted to its more intoxicating form, 11-hydroxy-THC. That being said, medical oversight is still recommended for topical medical cannabis patients as everyone’s system reacts differently to cannabis. It’s also possible that topical medical cannabis applied to broken or thin skin could result in higher concentrations of THC entering the bloodstream than unbroken or average skin, causing some intoxication.

Here’s a closer look at medical cannabis topicals available to patients today:

This subcategory of medical cannabis topicals is the most robust, and for good reason—these products look, smell, and feel like common creams or lotions already in your home (i.e., they smell nothing like cannabis!) There’s typically no learning curve to use them; simply apply to the skin as directed. Plus, they can feel great: many medical topicals contain active ingredients for a cooling effect to help ease pain, or rich moisturising agents that help leave dry or irritated skin feeling supple and healthy.

How topicals work: Creams, lotions and gels are used on a specific area of the body, with onset generally within minutes and lasting about three hours. These products are most commonly used to help manage:

• Joint and muscle pain

• Eczema and psoriasis

• Chronic neuropathic pain or itch

• Acne

• Dry skin

• Lesions, including pre-cancerous lesions

What to look for in creams, lotions, gels: Medical cannabis topicals are optimized for skin penetration, meaning they’ve undergone testing to help the medicine surpass the skin’s upper layers. The tricky part is these epidermal layers are mostly made up of water, and cannabinoids are hydrophobic, meaning they do not mix with water. Some ingredients that help cannabinoids surpass the skin’s surface include:

Terpenes: Including Bisabolol, Menthol, Terpineol (also present in peppermint and eucalyptus) which help break up cannabinoid bonds

Emollients (fats): For even distribution and to help stabilize cannabinoids

What to avoid: Some ingredients commonly found in body lotions may add moisture to the skin, but can lock out cannabinoids in the process, namely mineral oil and petrolatum. And while parabens do easily penetrate the skin, they’re also a known hormone disruptor and many consumers generally try to avoid them. Patients with sensitivities or allergies should also avoid chemical fragrances or perfumes (parfum) that could irritate the skin.

THC, CBD or a 1:1 formula? While a healthcare provider can guide medical cannabis patients on what topical formula is best for a particular condition, it’s generally advisable to start with a CBD formula. To date there is more published literature on CBD-based topicals, meaning medical professionals have a better sense of how they work and what they could help with versus THC-based topicals. CBD topicals like the Wildflower CBD Cool Stick offer patients a convenient method of application

However, moving to a balanced CBD and THC product may help to achieve a desired outcome. As with all medical cannabis, start low and go slow, meaning start with a small amount and gradually increase once you know the effects.

How potent are topicals? With cannabinoids listed in the hundreds of milligrams per package, decoding a topical label can be confusing. As a general rule, the higher the milligrams of cannabinoids per gram of product, the more potent it is. For example, 500 mg of CBD per 50 g of cream has greater potency than 250 mg CBD per 50 g of cream. The Beacon Medical Extra Strength CBD Cream contains 1000mg of CBD per 50 gram jar, making it a potent option backed by an antioxidant-rich formulation.

Follow a healthcare provider’s instructions on how often to apply your topical as there are no validated dosage recommendations.

Just like a nicotine patch or estrogen patch, a medical cannabis transdermal patch is a medicated adhesive strip that stays on the skin, delivering a steady release of medicine over the course of a full day or longer.

Transdermal patches can help ease a localized health condition, such as sore muscles, plus they're a means to get medical cannabis into the bloodstream for more widespread circulation. In terms of THC intoxication, bypassing first-pass metabolism by the liver means a transdermal patch containing THC won’t have the same intoxicating effect as an edible or from inhaling cannabis. However, low-level intoxication could still occur as the effects of medical cannabis vary with each person—patients should begin using a transdermal patch responsibly (e.g., avoid driving), even with strictly CBD products for the first few days until they know how their body reacts.

How transdermal patches work: These adhesive topicals can be used to help manage a range of health conditions that may benefit from medical cannabis, both short-term or chronic. A transdermal patch is typically placed in an inconspicuous spot, such as the upper arm, chest or abdomen, or any place with minimal body hair. Patients should wash and thoroughly dry the area first, then apply the adhesive (sticky) side of the patch to the skin.

Onset can be relatively fast—less than 30 minutes—and can last 24 hours or more, depending on the product. Once a patch is removed, for whatever reason, cannabinoid delivery will stop and effects can dissipate in under 30 minutes, depending on the product. The advantage of a patch is that it offers a slow and steady release of medicine that is neither inhaled nor ingested, which can be helpful for patients uncomfortable with inhalation or with digestive issues, for instance. The Atlas Thrive CBD Transdermal Patch is a high CBD format that may be suitable for patients who are newer to medical cannabis or are seeking a discrete method of application.

What to look for in a transdermal patch: It’s important that the adhesive and non-medical ingredients do not irritate your skin. When first using a transdermal patch, medical cananbis patients should check the skin site after a few hours and secure again with medical tape, if needed. Patients can also move the patch around to find a place that isn’t quite as sensitive as another skin site may be.

It’s not unusual to feel squeamish about suppositories, which are medicines in solid form intended for use either vaginally or rectally.

Suppositories have a long history in human medicine, documented as far back as ancient Egypt where physicians used ingredients such as honey, oils, and even wine. Through the ages, suppositories have remained an effective and important medical format that generally acts quickly, avoids the digestive system, and can uniquely address a localised medical issue, i.e., rectum, uterus, pelvic floor, or anywhere in the lower abdomen. Suppositories are mostly relegated to the realm of last resort, but this doesn’t make them any less effective or helpful for patients. The Current x Prairie Grass line of medical cannabis suppositories offers patients multiple options, including the Relief Pods, which contain THC derived from whole cannabis flower.

How medical cannabis suppositories work: There is a rich supply of blood vessels in both the rectum and uterus. When suppositories are used, cannabis medicine can directly enter the bloodstream through cell walls where it then quickly circulates throughout the body. Suppositories also avoid first-pass metabolism by the liver, meaning the risk of intoxication by THC is typically minimal, although still possible for some people. Onset for suppositories is generally 15 minutes or less, with a duration of about 12 hours.

A big advantage suppositories can offer patients is in cannabinoid absorption: about 80 percent of the medicine is typically absorbed into the body. By comparison, ingesting cannabis typically delivers about 35 percent of cannabinoids to the body; inhalation around 15 percent.

Suppositories may be used to help manage:

• Inflammatory bowel disease (IBD)

• Hemorrhoids

• Menstrual pain

• Endometriosis

• Dyspareunia (painful intercourse)

• Vulvodynia (chronic pain or discomfort of the vulva)

• Vaginal dryness

Suppositories can also be a resource for patients who cannot swallow, as well as for patients undergoing cancer treatments or in palliative care.

What to look for in a suppository: Carrier ingredients in suppositories—i.e., oils or other ingredients that hold the cannabis—could potentially affect the pH and bacterial flora of the vagina. Clinically formulated suppositories are mandated by Health Canada to have microbial limits in order to avoid impacting vaginal pH. Patients should monitor the health of their vagina in addition to other medical symptoms, or look for carrier ingredients that will not alter vaginal chemistry.

How to use a suppository: There will be directions on the package specific to each product. In general, start by thoroughly washing hands and emptying bowels if using rectally. Start either standing with one foot on an elevated surface, such as a chair or the side of the bathtub, or lay on your side with one leg slightly bent against your abdomen. Using your finger, insert vaginal suppositories about three to four inches inside the vaginal canal—about the end of your finger. For rectal insertion, gently push the suppository in about one inch, just past the inner sphincter muscle. It may help to moisten suppositories with water before insertion. Follow all directions applicable to the specific suppository product.

Image courtesy of Prairie Grass Inc.

If you think medical cannabis topicals and suppositories could help manage your symptoms, we’re here to help. There’s no cost to becoming a Medical Cannabis by Shoppers patient, which gives you access to our Shoppers® Cannabis Care Team pharmacists who can provide counseling on dosing, titration, potential drug interactions, management of side effects, appropriate use of medical cannabis and any other questions or concerns.