Using the products
How to use the product
Guide to application of medical cannabis products
Here, we list the general ways in which medical cannabis products can be administered. These instructions can be used as a reference after your medical consultation but do not replace your doctor's instructions, which should always be followed. Always contact your doctor if you experience severe side effects usually
Be aware that the effects of your medication may not be felt immediately but may develop over time or with dose adjustments in consultation with your doctor.
Handling and ingesting your medicinal cannabis product depends on the route of administration.
Oral ingestion of medicinal cannabis products
Medical cannabis extract for oral administration is available in the form of tincture (alcohol-based solution), oil or capsules.
Oils for oral use
Patients who use medical cannabis to treat chronic pain often prefer oral administration due to the long-lasting effect, so they don't have to take the medicine as often. However, the long action duration can mean it can take longer to find the correct dose. This should be taken into account when adjusting the amount [1].
Step-by-step guide*:
Shake the sealed bottle gently before use. Dosing the oil on a teaspoon is recommended by holding the pipette or dropper vertically over the spoon for accurate dosing. Please note that drop sizes may change when switching to a different type of pipette. The oil can be viscous, resulting in slow dripping.
After dosing, insert the spoon into your mouth and swallow the oil.
Tea for oral use
Cannabis tea is a way of administering cannabis flowers orally. Note that the solubility of cannabinoids, including THC and CBD, is low in water. Therefore, there is a risk that a large part of the cannabinoids are wasted as they are not released from the flowers. The risk of the potency of the tea varying and incomplete conversion of cannabinoids into neutral forms are other factors to be aware of when considering tea as a route of administration[2]. It is not recommended to use tea when administrating medicinal cannabis[3].
Step-by-step guide*:
Grind the flowers into a uniform powder and dose as your doctor recommends. This will help with consistent and accurate dosing.
Add boiling water and cover with a lid to prevent evaporation of the terpenes.
After 15 minutes of boiling, strain out the solid plant parts using a strainer or sieve.
Depending on the product used, the tea may taste slightly sharp. You can improve the flavour by adding honey, milk, or flavoured tea.
The shelf life and solubility of the cannabinoids increases when milk, cream or other fatty compounds are added.
Ingestion of medicinal cannabis flower
It is recommended to inhale medicinal cannabis flowers using a vaporiser.
Vaporiser for inhalation
A quick effect can be achieved by inhaling cannabis. Cannabis can be inhaled either by smoking or vaporising. Smoking cannabis involves burning the flowers (600-900°C) and inhaling the active components with the smoke. This is not recommended, as some combustion products are carcinogenic and can damage the lungs. Instead, vaporisation is the recommended route for inhalation as the plant material is not burned. Instead, it is heated at a lower temperature, releasing the plant’s active components as a vapour that the patient can inhale[3,4].
Medicinal cannabis products in 'flower' ('floss) form must be inhaled using a vaporiser approved as a medical device[1,3].
Step-by-step guide*:
We always recommend that you follow your doctor's instructions, which can be supported by the written instructions issued by the vaporiser manufacturer.
Unprocessed flowers should be crushed before use to improve dosing consistency. A grinder (herb mill) can be used for this purpose.
Store the products as recommended. If possible, storing the unprocessed flowers in the fridge or freezer can be helpful, as this makes it easier to grind them[1].
The shredded flower is placed in a chamber (the maximum capacity defined by the manufacturer) and inserted into the vaporiser.
The chamber is heated to 160-230°C (your doctor will advise you on the exact temperature) to decarboxylate and vaporise the cannabinoids[1]. The device can set the actual temperature.
Inhale the vapour and hold your breath for about 5 seconds for optimal absorption of the cannabinoids into the bloodstream through the pulmonary alveoli. Note that the vapour can irritate the airways and cause coughing.
When no vapour is visible on exhalation, the material in the chamber is considered exhausted.
The device must be cleaned and stored according to the manufacturer's instructions after each use.
Ingestion of oromucosal cannabis products
Cannabis can be administered as oromucosal products, such as oromucosal sprays and extracts. In these products, part of the cannabinoids are absorbed directly from the mouth into the bloodstream via the mucosal barrier. Another part of the cannabinoids are washed by the saliva stream into the gastrointestinal tract and absorbed there. Oromucosal administration can include sublingual (under the tongue) or buccal (between the cheek and gums) administration of drugs.
Use of sublingual extracts
Sublingual means "under the tongue". The product typically comes in a glass bottle with a drip device or a pipette/syringe for precise dosing.
Step-by-step guide*:
The oil is dripped onto a teaspoon as indicated above under the oral route of administration.
After dosing, insert the spoon into the mouth under the tongue and remove it slowly.
Waiting a few minutes before swallowing can increase the absorption of cannabinoids across the mucosal barrier.
Using oromucosal sprays
Oromucosal sprays allow for precise dosing and can be suitable for situations where an accurate dose is essential. Many patients find using oromucosal sprays more convenient than other medical application methods.
Step-by-step guide*:
It is recommended to hold the spray between your thumb and middle finger. Your index finger is placed on the nozzle.
The first time you use the spray, test the pump and check if it works. Hold the spray upright and spray onto a piece of paper a few times until a fine jet is formed.
The spray is ready to use and should be held upright when you point the nozzle under your tongue or against the inside of your cheek.
Press the nozzle down firmly to dispense accurately.
*Always consult your doctor, as the dosage and amounts can vary significantly from patient to patient!
References
MacCallum, C. A. & Russo, E. B. Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine vol. 49 12–19 (2018).
Hazekamp, A., Bastola, K., Rashidi, H., Bender, J. & Verpoorte, R. Cannabis tea revisited: A systematic evaluation of the cannabinoid composition of cannabis tea. Journal of Ethnopharmacology 113, 85–90 (2007).
DSKCan. Vejledning og anbefalinger til receptpligtig cannabismedicin – et minikompendium til læger. (2021).
Grotenhermen & Häußermann. Verordnungshilfe für Ärzte. (2017).