The Rectal administration of cannabis has many advantages
We have listed the many medical properties of Cannabis oil, for it’s well researched and becoming far more accepted knowledge that medical marijuana has many healing properties.
Here we address the delicate subject of how to administer medical marijuana rectally, for the best results. Administering medical cannabis (full spectrum) oil rectally is the most appropriate route for most patients. Cultural sensitivities, as well as misinformation regarding insertion methods, may be barriers to the practice.
The reason that rectal administration is best for cannabis oils, is the rectal mucosa has a blood and lymph supply that is capable of effective systemic absorption.
The rectum is relatively underused in some societies as a route for safe administration of medicines, arguably due to the intimacy of the site compared with more socially accepted and visible routes, such as oral, or topical administration, or injection.
Better than oral application
In addition to being a viable option for patients who can’t ingest cannabis, the advantages to applying it rectally, rather than orally are:
- It starts to work quicker, at around 10–15 minutes, compared to orally where it might not be felt for 30–90 minutes, as it has to travel through the intestine and liver
- It lasts for a longer period of time (4 to 8 hours)
- It’s 50-70 percent more efficient, whilst digesting cannabis oil by mouth is only around 20 percent efficient and therefore has a “superior bio-availability”
Reduces side effects
As well as being a more effective route of delivery, rectal administration also reduces some side effects that the oral administration may induce such as gastric irritation, nausea and vomiting (Tortora and Derrickson, 2008). Euphoric effect.
You will feel less of the THC effect than by mouth, which will have a greater impact on your day and improve your quality of life.
The rectum constitutes the final 20cm or so of the terminal gastrointestinal tract; approximately 2-3cms of this is the anal canal. Absorption from within the anal canal is via its highly vascular mucous membrane that is divided into folds or pillars, known as anal columns (Tortora and Derrickson, 2008).
Once carefully inserted into the rectum and inserted far enough inside the medication (see instructions below) should not cause pain. The anal canal is divided into areas above and below the Pectinate line ; the area below (distal) is sensitive to pain, touch and temperature, whereas the area above (proximal) is only sensitive to stretch.
Within the anal canal are two areas to control the opening of the anus – the internal and external sphincters. The internal sphincter functions involuntarily, whereas the external sphincter is under the control of the individual. This is why the patient receiving the oil need to be sufficiently relaxed and cooperative, to enable both insertion and retention of the drug.
Who Should Use Cannabis Rectally?
- Chemotherapy patients: who experience severe nausea and can’t keep oral cannabis down
- Elderly patients: and babies who find it harder to swallow
- Surgery patients: who are not allowed to ingest anything immediately before or after a procedure,
- People with severe pain or distress: , as cannabis is also a great natural pain relief
- We have found that the anal application is much preferred for all
- Haemorrhoids Cannabis oil is ideal in the relief and treatment of haemorrhoids
- anal pruritus (itching) – Cannabis oil can soothe the mucosa and relieve symptoms of common anal disorders.
- Beginners: with a low tolerance to cannabis and are maybe taking it for the first time, as the high is lower.
- There are also some people who just have sensitive stomachs that are irritated by ingesting cannabis and so rectal administration negates the gastric effects.
For cancer and other life threatening conditions (other ailments may require lower doses) it is recommended (for adults) to start with 1ml a day – 0.5ml in the morning and 0.5ml in the evening.
Increase the amount of cannabis oil every 3-4 days as your body adapts to it. The recommended amount is 2ml/cc a day – 1ml/cc in the morning and 1ml/cc in the evening before sleep.
What Should You Expect from Cannabis Anal application?
You will likely feel a warm, relaxing sensation wash over your body starting from the pelvic region. You may feel pain relief almost immediately, without anxiety or a “head high”.
Psychotropic Side effects
Some people may experience psychotropic side effects when using cannabis oil that has a high THC component. The THC has many advantages, but initial reactions can vary and this includes administering it rectally. There are 3 likely explanations:
1. They may be starting off at a higher amount of THC than the body can handle, adults should not start at a higher than 0.5ml/gm dose in one application. Over time the bodies tolerance to THC will increase and as such you can increase the dosage (as stated above).
- They have inserted it too far
For most adult anatomy about one inch in is ideal. The reason being is that there are 2 separate blood circulation subsystems in the anal and rectal anatomy.
Go in too deep and the oil will be absorbed in the rectal venous circulatory supply which actually sends blood back through the liver.
The liver processes THC and related cannabis components in ways that will significantly accentuate the psychotropic effects.
Whereas going only one inch in means that oil is absorbed by the mucous membrane of the anal tissue which is serviced by a different venous circulatory system that does not route back through the liver and the resulting psychotropic effects are not increased.
The bottom line (no pun intended) is do not insert the syringe too far.
3 Used too much
The person may be simply taking more than is needed for the healing process alone. So they are getting too much THC no matter how it is administered and hence the psychotropic effect (all be it is less than any other way of administering the oil).
So just check you are taking the right amounts. Up to 2ml a day is recommended for Cancer and serious illness (as stated above).
For most health conditions (with exception of end stage cancers) a single administration in a 24-hour period is sufficient and appropriate. So, for those wishing to avoid any psychotropic effects, administer it at bedtime, just before sleep. That way you minimize the psychotropic effect and get the peak or high during sleep when it is less noticeable.
INSTRUCTIONS FOR APPLICATION
Preparing the patient
If you are administering this for someone else, then here is a step by step guide
It is essential to obtain the patient’s consent to carry out this procedure
and to check the patient’s allergy status
Explain the procedure in terms the patient will understand. Ask the patient to repeat what to expect from the procedure to ensure comprehension. When you are satisfied the patient understands, gain declared spoken consent, as appropriate.
Ensure privacy by drawing curtains around the bed space. Retain the patient’s dignity by minimising exposure and checking their comfort – for example, absence of pain, agreeable temperature.
Empty the bowels first Where possible the bowels should be opened before administration.
Best position Help the patient to lie on their left side with the right knee raised towards the chest, if possible. This enables eventual gravity-assisted flow into the rectum and ideally towards the sigmoid colon, which deviates to the patient’s left-hand side.
The right knee may be supported by a pillow.
- A rectal examination to assess whether faecal matter is present may be performed before administering the suppository, or syringe
- Place an absorbent pad under the patient’s hips and buttocks.
- Ensure the patient remains comfortable and ready for the procedure.
- Wash your hands thoroughly to remove any potential bacteria that could contaminate the patient.
- Wear non-sterile gloves and apron while at the bedside.
- Lubricant like coconut oil may be required for either a suppository or syringe insertion tube
- Small clinical waste bag
- Clinical gloves
- Absorbent pad in case of discharge
- Gauze swabs or tissues
- Bedpan, commode and toilet paper, or ready access to a toilet if required.
- Store the oil in a cupboard and do not refrigerate
The best form of rectal administration is either; suppository or syringe.
Suppositories – Small, torpedo-shaped pellets that melt at body temperature. Suppositories and enemas are administered for a number of reasons as alteration on route.
Syringe direct with a 1ml insulin syringe ensures least amount of discomfort for the patient.
- Remove all packaging from the suppository and place the equipment onto a clean dressing trolley or similar.
- Squeeze sufficient lubrication onto a piece of gauze and lubricate the apex (pointed end) of the suppository.
- Ask the patient to relax, perhaps by concentrating on their breathing or controlling their breaths.
Part the buttocks and gently insert the suppository (Manufacturers, recommend inserting the pointed end first)* into the anal canal to around 2-4cm, using a gloved index finger will help with the insertion.
- Repeat the process if more than one suppository has been prescribed;
- Wipe away any excess from the anal area
- The patient should be asked to retain the suppository for 20 minutes or longer, providing this is comfortable, in order for the drug to be absorbed.
- Leave the patient in a comfortable position, preferably still lying on the left side, with a call bell so you or a staff member can be called for assistance if necessary.
- Document the administration procedure.
- Document the effectiveness of the suppository, as appropriate
- Wash your hands thoroughly and make sure your nails are trimmed
- Place the excess oil in a small cup (egg cup or similar)
- Remove 1ml insulin syringe from its packaging and place the equipment onto a clean dressing trolley or similar.
- Remove the cover from the nozzle and draw in the correct amount of oil from the small cup, ensuring there are no bubbles. Check above for dosing advice.
- lubricate the tip of the nozzle with coconut oil, and along the top of the syringe covering just over one inch in length. Also apply the lubricant to the inside of the the patient’s sphincter muscle
- Ask the patient to relax, perhaps by concentrating on their breathing or controlling their breaths.
- Part the buttocks and holding the nozzle, gently insert the lubricated syringe no more than 1½ inches into the inner sphincter. Using a gloved index finger will help with the insertion.
- Push the syringe plunger in until all the contents have been deposited
- Continue lying on your side and hold your buttocks together and squeeze your sphincter muscles tightly for a few seconds.
- Stay lying on your side for at least a few minutes.
- When you feel ready get up
- For hygiene purposes make sure you discard the syringe and do not use it again
- Dispose of the gloves and wash your hands thoroughly
- Be aware, there’s a small risk of some leaking for the next 30 minutes, so plan your activities accordingly.
- Try not to break wind 15 minutes after taking the oil, as this will also cause leakage.
- Store the oil in a cupboard (do not refrigerate)
Colon Tube syringes
If you have problems with the syringe, please also see that there are Syringes available that come with a colon tube and so you may also find this useful:
Another option is to fill empty capsules with oil and insert them using a sterile Rectal suppository applicator.
We recommend Organic Full spectrum oil
The best blend derives from cannabis plants that have had the full spectrum of natural light (NOT grown under artificial lights) and is shade dried, as you lose less of the medicinal effects, from plants that have been grown organically and not cultivated using ANY chemicals and pesticides.
The best balance being: 35% THC, 35% CBD and 30%
Where to purchase quality oil
We have trusted suppliers and distribution agents worldwide we are therefore now able to offer medical grade RSO/ full spectrum organic cannabis oil.
International Price List
- USA 30USD per ml/gram/cc
- UK 30GBP per ml/cc
- Europe 30 Euros per ml
- Worldwide 50 Euros
For further details, please email [email protected]
There have been a number of conflicting reports about which end of a suppository should be inserted first. Most of the confusion stems from an article published in The Lancet (Abd-el-Maeboud et al, 1991), which suggested that suppositories should be inserted blunt-end first.
Bradshaw and Price (2007) identified a lack of evidence for the claims made by Abd-el-Maeboud et al. Unfortunately subsequent adoption of their advice is uncritically applied, to the extent that their “findings” have entered common clinical practice, as evidenced by Kyle (2009) and Dougherty et al (2015).
The Royal Marsden Manual (Dougherty et al, 2015) continues to refer to Abd-el-Maeboud et al’s (1991) study, but there is now a caveat to say that a common-sense approach should be adopted when deciding which end of a suppository should be inserted first.
Love and light
Amanda Mary Jewell and The Healing Oracle team
Love and Light
The Healing Oracle Team
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