Abstract
Inhalation of carcinogenic combustion products associated with smoking is generally regarded as the major health hazard in connection with the medical use of cannabis products. Strategies to reduce respiratory and other adverse events resulting from this common practice include relinquishment of inhalation and replacement by other routes of administration, the use of plants with a high THC content allowing reduction of the amount of smoked plant material, usage of inhalation devices that improve the ratio of THC and tar, and avoidance of the Valsalva maneuver that may cause spontaneous pneumothorax. The major risk associated with oral cannabis use is accidental overdosage, especially in inexperienced users that can be avoided by appropriate dosing procedures. A combination of oral use and inhalation may be meaningful in several indications, decreasing the specific risks of both routes. Preliminary studies using rectal, sublingual and transdermal routes indicate that these alternatives to the two most common forms of ingestion may be utilized medicinally in the future, further reducing the possible risks associated with the administration of cannabis or single cannabinoids.
