Table 2:

Cannabis Administration Methods and Their Effects

Product, Method of Use, and Bioavailability	Onset and Duration of Effect	Advantages	Disadvantages
Combustible flower: usually smoked rolled in paper or in a pipe. • Bioavailability: Varies between10–35% due to difference in number of breaths, duration of puff, breath holding, inhalation volume.26	• Onset: 3–10 minutes26 • Duration: ≤2 hours99	• Quick onset of action	Potential for adverse effects (short- and long-term): • Intoxication68 • Chronic bronchitis60
Vaped oil: Inhaled using a battery-operated portable pen-like device • Bioavailability: Varies between 2% to 56% due to difference in smoking dynamics (number of puffs, spacing of puffs, hold time, inhalation time, etc.) 99	• Peak: 9 minutes99 • Duration: ≤2 hours99	• Quick onset of action	Potential for adverse effects (short- and long-term): • Intoxication68 • Chronic bronchitis60 • Vaping lung injury (vitamin E acetate additive) 84
Vaped ground flower pods: Inhaled using a unique table-top device that creates vapor from plant material • Bioavailability: Varies between 2% to 56% due to difference in smoking dynamics (number of puffs, spacing of puffs, hold time, inhalation time, etc.) 99	• Peak: 9 minutes99 • Duration: ≤2 hours99	• Quick onset of action	Potential for adverse effects (short- and long-term): • Intoxication68 • Chronic bronchitis60
Capsule: Oral ingestion • Bioavailability: 4% to 25% depending upon the study. 63–67 Variable due to drug degradation in stomach, variable absorption in the stomach, and first-pass metabolism	• Peak: 1–5 hours63–67 • Duration: ≤25 hours63–67	• Slow onset of action, low bioavailability • Avoid adverse effects of smoking	• Risk of dose stacking—repeating doses before an effect is felt by the patient. Usually attributable to a long period before onset of effect. Results in unanticipated intoxication and adverse effects68,69
Tincture and spray: Sublingual/oral • Bioavailability: 87.5% to 90%100,101	• Onset: As early as 10 min100–102 • Duration: ≤10 hours100,101	• Fast onset of action • Avoid adverse effects of smoking	• Taste • Potential for user error
Suppository: Rectal • Bioavailability: 14% to 67% 22,103	• Onset: 1–2 hours104 • Duration: ≤8 hours104	• Avoid first-pass effect104 • Avoid adverse effects of smoking	• Undesirable dosing method • Very little supporting data for the use of suppositories
Lotions, gels: Transdermal • Bioavailability: Dependent upon how it is formulated, only studied in animal models22	• Onset: 2 hours105 • Duration: ≤48 hours105	• Avoid adverse effects of smoking • Helpful in patients unable to adhere to other formulations (terminal illness, etc.)	• Variability of bioavailability depending on how it is formulated105