Delivery of medicinal cannabis

Abstract

Cannabis can be administered via inhalation, oral, buccal, sublingual, rectal, topical, ophthalmic and systemic route. Taking preferences of patients into consideration is essential in improving the quality of life of patients. The aims of this study were (i) to evaluate delivery systems used for medicinal cannabis and patient preferences for delivery approaches (ii) to review studies focusing on medicinal cannabis dosage forms. Two self-administered questionnaires were developed, one for users and another one for potential users of medicinal cannabis, to evaluate the onset and duration of effect and side effects experienced with medicinal cannabis. Reasons why potential users would consider starting using medicinal cannabis were also assessed. Both questionnaires evaluated the preferred methods of medicinal cannabis administration. The questionnaires were developed in English and Maltese and were validated using the Delphi method. Questionnaires were disseminated at two different clinics and online, following ethics approval. Two systematic reviews were conducted to identify studies published between 2010 and 2020, about medicinal cannabis dosage forms and opinions of medicinal cannabis users about cannabis dosage forms. HyDi, a tool offered by the University of Malta which provides access to different databases, was used for the search. Eighty-seven users (mean 39 years; SD ±1.08 years) and 100 potential users (mean 41 years; SD ±1.20 years) of medicinal cannabis completed the questionnaires. The desired effect is perceived within few seconds when taking Pedanios 22/1 (41%, n=11), Pedanios 20/1 (29%, n=8), Bedrocan 22 (35%, n=13) and CBD oil (21%, n=7) and within 1 to 15 minutes for Pedanios 22/1 (44%, n=12), Pedanios 20/1 (54%, n=15), Bedrocan 22 (49%, n=18), Bediol 6/8 (86%, n=6) and CBD oil (41%, n=13). The effect of medicinal cannabis perceived to remain for 1 to 2 hours (41%, n=32) and 2 to 3 hours (26%, n=20). The main side effects of medicinal cannabinoids were feeling hungry (56%, n=44), energised (51%, n=40) and sleepy (44%, n=34). Potential users would consider using medicinal cannabis because they heard of others benefitting from the treatment (58%, n=50), they read a lot about it (49%, n=42) and mainstream medication is not enough to treat their condition (28%, n=24). Main reasons for not wanting to start using medicinal cannabis were the fear about health consequences (38%, n=13) and social implications (29%, n=10) and complexity of the process to obtain medicinal cannabis (27%, n=9). Medicinal cannabis users rated cookies or other food items (n=66), tea (n=65) and drinking oil (n=72) and potential users rated water (n=79), vegetarian capsule (n=79) and tea (n=83) as the most preferred method of administering cannabis orally. Users prefer cannabis in the form of cigarettes (n=71) and tincture (n=67) while potential users prefer as patch (n=78), tincture (n=83) and ointment (n=74). The systematic reviews identified 89 articles about medicinal cannabis dosage forms related to pharmacodynamics (n=41), pharmacokinetics (n=32) and types of dosage form used (n=12) and 10 articles assessed opinions of medicinal cannabis users about cannabis dosage forms. Sixty-two studies focused on one administration form, mainly smoked form (n=32), followed by the oral form (n=15) of cannabis. Twenty-five studies compared two forms such as smoked versus oral (n=9) and oral versus oro-mucosal (n=5). Twelve studies involved multiple dosage forms including smoked, vaped, edible, oral, oro-mucosal and topical forms. This study contributes to the knowledge about perception of patient-centred cannabis delivery systems. The availability of different dosage forms preferred by patients, other than cannabis flowers, ensures a patient-centred medicinal cannabis delivery system.