What Are Suppositories?
Suppositories are a method of delivering a medication. They are bullet-shaped firm objects that can be inserted rectally or vaginally that then melt in the body heat releasing the medication to be absorbed.
The Value of Rectal Suppositories
Most people would go a long way out of their way to avoid sticking medication up their bum. Almost all the patients I cared for during my long career as an Emergency Physician would state emphatically that their anuses were “an out hole only”. So why the interest about cannabis suppositories specifically?
There are two reasons that I’ve encountered. The first is accurate – by absorbing cannabinoids rectally you bypass what’s called First Pass Metabolism, which is when medication is absorbed via the normal gut mechanisms it first goes to the liver which can modify the medication. We use this First Pass Metabolism to our advantage often in cannabis medicine when giving an edible containing delta-9 THC which is then converted by the liver into the longer-acting 11-hydroxy-THC version. This allows us to get longer benefit that is better for pain management, for example.
However, sometimes you don’t want or need that conversion. You want to use d9-THC as it is. In that case, taking cannabis orally will not work as intended. Taking cannabis rectally using a suppository will work.
The second reason that I’ve encountered, which is not accurate, is the notion that for some cancers like prostate or rectal you need to put the cannabis close to the problem area. However, this is a misunderstanding of the biology. No matter how “close” you put the suppository, the medicine is absorbed into the bloodstream and circulated all around the body, not just to the affected area nearby.
The Value of Vaginal Suppositories
Vaginal suppositories have been sold for the purposes of treating various sexual issues like pain or dryness, or to treat uterine issues like menstrual pain or endometriosis.
Clearly vaginal dryness may be addressed simply by the lubrication from the melted suppository itself, and this may even help with sexual pain. However, it’s important to understand that the benefit is from the vehicle (the goo, if you will) not from the cannabis. The vagina is designed to be a conduit – for semen, menstrual discharge, and babies. It is designed to NOT absorb things from the outside world that might otherwise make the vagina owner sick. Most medications are not well absorbed through the vagina and cannabinoids aren’t either.
Similarly, problems at the uterine level are not accessible by placing cannabis nearby. In order to affect the upper female reproductive tract, medicines must be systemically administered and circulated to those organs. As we’ve said, the vagina is not good at absorbing medications and cannabinoids, so treating menstrual pain or endometriosis intra-vaginally is not a winning strategy.
When Would You Recommend a Suppository?
I think you can hear that I don’t recommend suppositories very often. They’re not that useful nor that easy to use. In most instances, treatment with either inhalation or oral ingestion is easier and more effective. In those cases where they would be useful, they’re not readily available but can be made at home with some care and instruction.
My best advice is to not get ahead of yourself. Come see me in my practice so that we can discuss your care, your particular situation and illnesses, and come up with the best, safest, care plan for you. If that involves suppositories, I can get into the details of where to buy them or how to make them.
You see, it all depends on what’s going on for you, and tailoring your treatment to what you need is what I do.