Dr. Frankel's Journal

RECTAL ABSORPTION OF CANNABINOIDS.

6/14/2016: UPDATED INFORMATION AND MULTIPLE BLOGS I HAVE SINCE WRITTEN SHOW THAT WHOLE PLANT CANNABIS IS NOT RECTALLY ABSORBED. THC CAN BE RECTALLY ABSORBED BUT ONLY IF BONDED TO A SEPARATE MOLECULE, SUCH AS HEMI-SUCCINATE.

MANY PATIENTS USE HIGH DOSES OF THC BY THE RECTAL ROUTE TO AVOID PSYCHOACTIVITY. THE REASON THERE IS NO PSYCHOACTIVITY IS BECAUSE IT IS NOT ABSORBED.

There has been talk recently in some circles about the potential usefulness of rectal cannabis. For the first portion of this blog, I will deal with the substantial anecdotal information I am aware of and I will include a reference that truly settles the issue. In my experience with patients, there are a number of patients that use hash rectally. They clearly get VERY stoned, so it is being absorbed. I have many patients with Inflammatory Bowel Disease. If the disease is in the lower bowel, rectal administration often works better than oral absorption. There are a number of reasons why this might be the case for many patients as the cannabinoids are absorbed from two areas of the rectum.

It makes no sense at all to me that the overall cannabinoid effect is less than sublingual when placed in ANY area of the rectum. However, if portal circulation is what is desired, a soft tip syringe placed in 1.5 inches will be drained by the Superior Rectal Vein and mostly go through the liver.

 

The potential REASONS for using rectal absorption means are:

1. No other method practical.

2. The physician wants to help the cannabinoid medicine travel through the local rectal and pelvic veins and lymphatics. When a patient has a rectal or pelvic disease, it makes sense that this might be more effective….i.e. follow the Cancer. We have NO proof of this, but we are often making decisions with less than adequate information…..and not just in the field of Cannabis Medicine

3. Inflammatory Bowel Disease when oral is not working well

4. Some seizure kids during emergency rectal CBD administration. BTW, this seems to work clinically.

 

anus_veins_1

The rectum has two venous drainage sources. As you can see in the above diagram of the rectum, there are three veins that drain the rectum. They are the Inferior Rectal Vein, The Middle Rectal Vein and the Superior Rectal vein.

The inferior and middle rectal veins drain primarily into the Inferior Vena Cava and are absorbed into the blood stream avoiding the first pass effect through the liver.

The Superior Rectal Vein drains into the Portal system, goes through the liver and is first pass metabolized.

So, it depends WHERE in the rectum the suppository or “syringe” is placed. The “suppository” image represents the 3 cm of the Rectum. So, if a typical suppository is inserted fully, it will be absorbed by all the veins and there will always be a portion, probably significant, that goes through the Portal Vein System into the liver.

Oral absorption is a bit more erratic in large part due to stomach acid interfering with absorption, but still very effective especially if delivered with fat and little other food. In my experience with oral CBD capsules, it is extremely important to take it on an empty stomach.

I find that many patients with bowel disease do just fine with oral absorption, but it is not surprising that some with large bowel and or rectal/sigmoid disease, that regional absorption with regional venous and lymphatic drainage is very helpful.

So, now for the data. There are a number of studies showing both oral and rectal absorption of similar doses of cannabinoids. It seems pretty clear that the bioavailability through rectal absorption is about twice that of oral absorption. There are many variables and we have much to learn, but rectal delivery of cannabis is not new and it will become more common as better and more reliable preparations are made available.

 Check  Section 2.1.4 in this reference 

 

344 Comments. Leave new

Cannabis Suppositories: Why the Posterior Is Superior | UnitedPatientsGroup.com Blog
February 10, 2015 3:35 pm

[…] ARTICLE: Rectal Absorption of Cannabinoids by Dr. Allan Frankel of GreenBridge Medical […]

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Jackie Woerlee
October 22, 2015 6:44 am

Crohn’s has been with me for over 25 years ,with many surgical interventions that have led to short bowel syndrome,live with a malfunctioning malabsorbing bowel and severe cachexia. Cannabis has kept me alive. On the subject of rectal administration of cannabis oil I would like to say this, I take 1 an 1/3 gram of full spectrum cannabis oil mixed 50% with coconut oil I take this in 4 doses orally. The same mixture you can put in a baking silicone praline tray and freeze, this makes a perfect suppository . This for people that can’ take in orally{palliative] or people with active Crohns or cancer in the rectum. I do have to comment that if you are as compromised as me you more often than not end up. ejecting a lot of the time ,so timing is of the essence there. This is the reason I take my main dose orally. Also I have to remark to it is essential to make sure you re using unpolluted high quality full spectrum cannabis oil. that was made from old school plants grown to full maturity using no pollutants.

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Allan Frankel, MD
November 20, 2015 9:29 pm

Good points. In addition, I would advise using a plant extract, if possible, that is 50/50 CBD/thc

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Hi,

I am studying Cannabis Oil as effective use in treating cancer but I need to know more of course. Why Allen would you advise a ratio of 1:1 CBD:THC please ? I know they work together but it is really the THC that is the main killer no ??

Regards, Liam.

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Allan Frankel, MD
November 30, 2015 7:15 pm

Liam, I think you have enough good questions to schedule a phone or in person visit?

Lindsay. Milton
December 20, 2015 12:04 pm

Could I please ask advice on treating LMS cancer with full extract Cannabis oil I make from organic Cannabis, no fert’s no pesticides EVER.
My friend has 2 blood clots in her main bowel feeding artery and a tumour, very aggressive. I’m in desperate need to try and help the best way I can. I’m also in Australia so I face jail here if I’m caught but my friends life is worth more to me than jail.

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Hey Doc, since cannabis usage is a medical issue, not a criminal one, when will physicians in America step up and demand the government decriminalize self-medicating and addiction and allow you and yours to treat it?

If not now when…?

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Allan Frankel, MD
January 21, 2016 8:19 pm

I keep trying. Thanks.

Looking to acquire full spectrum oil. Please let me know if you have a source.

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Allan Frankel, MD
April 21, 2017 1:30 pm

I would suggest calling the office and setting up a phone call.

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I have high cancer in my right kidney. I do not have a left kidney. I plan on using cannabis oil. I will use 1/4 g at a time in suppository form adding up to one full gram in a day. Is there any danger?

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Allan Frankel, MD
January 14, 2016 2:17 am

I am not a fan of this high dose. You can find a lot of information on my website, and/or consider calling for an educational phone consult or come in?

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Hi.. I’ve been told to give my husband rectal cannabis….he has lewy body dementia!.. is this really necessary… all these threads are about cancer.. he takes coconut oil 3 table spoons daily…cannabis tincture….lypoic acid…slippery elm..pro biotic and more……..can it help him?.he’s to get stem cell treatment next month too

Jane kirk

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Allan Frankel, MD
July 30, 2016 5:05 pm

I would just use CBD and I would not use the oil rectally. It just is not absorbed. Also, since CBD for this situation is much more important than THC, he could easily be treated with CBD sublingual meds.

Marelyn Shapiro
March 17, 2016 6:11 pm

No one has ever died from taking cannabis. You should use rectally for greatest biavailability. Sometimes if ypu insert too far you hit the vein and ypu get high. When taken orally must work your dose up slowly because it’s extremely uncomfortable if you take too much. Best luck to you

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Bob, how are you? Were you able to stop your cancer?

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United Patients Group Introduces New Cannabis Suppositories from StateWide Collective – Press Release Rocket
March 28, 2015 7:18 am

[…] products are driven by the clinical care needs of patients, many of whom told us rectal administration of other medications they take are effective in treating their medical conditions,” says John […]

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John Chalmers
April 1, 2015 10:52 pm

What would the hemp oil be mixed with for best rectal absorption? Coconut oil? Propylene glycol?

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Allan Frankel, MD
April 13, 2015 7:16 pm

Coconut oil

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Allan Frankel, MD
April 14, 2015 4:39 pm

Not Propylene glycol. Any oil, but it might need to be frozen to remain “hard enough” for delivery.

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Mary K Bramble
October 14, 2015 4:09 pm

freezing does help, but you gotta work fast. I just discovered the convenience of using a mini-ice cube tray for this. I also make my “ice cubes” with cocoa butter. I still need to freeze because each one is at least 1 gram of CO and only about 1/2 gram of cocoa butter.

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PAMELA HAYMES
October 28, 2015 4:53 am

WITH SYRINGE ,YOU DONT NEED TO FREEZE FOR THE SYRINGE.. BUT FOR A REGULAR SUPPOSITORY,
COCOA BUTTER IS USED.. STAYS FIRM AT ROOM TEMPS. AND CAN TRAVEL EASILY WITH THEM.. I have seen people who put frozen suppositorys in the rectum can burn the delicate tissues..
also the cannabis oil with some strains ( lemon or citrus ) can be really spicy , so a carrier is really important..

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I have been diagnosed with stage 4 breast cancer triple negative. It has spread to my nodes, lungs and possibly my liver. How much should I take daily and what would be the best way to take it? Oral or rectal suppository? And what should the ratio be? 1:1?

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Allan Frankel, MD
April 26, 2016 4:20 pm

The one thing I can say for sure is that I would not take it rectally. It is just not absorbed rectally and there is good evidence for this. There are a lot of details for your therapy. I just can’t, for many reasons, outline a full treatment protocol by messaging. Feel free to contact my office.

Where do you get the syringe for this process?

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Allan Frankel, MD
April 21, 2017 1:30 pm

Any pharmacy will have it

Donna Jacobs
April 3, 2015 9:45 pm

For some reason, I cannot keep rectal suppositories in, even if I have just gone to the bathroom, as soon as I put it in, I have diarrhea. What is the secret?

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Allan Frankel, MD
April 13, 2015 7:15 pm

That is a tough one for folks with sensitive rectal reflexes. You might try something that is smaller in diameter? Perhaps the medicine in a small syringe?

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I wonder if it’s the oil you’re using. I had been using suppositories from a reputable dispensary with no problem. I switched to an oil that a friend recommended, and I couldn’t keep it inside for more than 10 minutes. It turns out that it was raw plant material, which contained THCa. It is so acidic that taking it rectally doesn’t work. Does this sound correct, Dr.?

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Allan Frankel, MD
August 28, 2015 2:01 pm

It is difficult for me to give advise without knowing a lot more about what is going on with you. I would think that suppositories made from raw cannabis would be a fairly poor product. Why are you taking the cannabis rectally?

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I’m taking suppositories so I don’t get high. I can get more product in that way, instead of tacking orally all day. Since the research is still going on, most of us have “educated” ourselves by following what Rick Simpson has suggested the best for ridding chronic disease. I’ve been hearing recently though that we don’t necessarily need one gram per day to heal cancer. I was diagnosed August 2014 a stage IV with 6 mets to the brain, originating from a May 2012 non-small cell lung cancer – adenocarcinoma with neuroendocrine features stage 1B. I have been taking in approximately 1/2 gram every night rectally, plus a 4:1 CBD to THC sublingual spray, and a few times per week vaporizing.

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Hi Michella,

What ratio were you using rectally please ?? And how are you doing ?!

Liam x

Where did you get suppositories from

Hi Michella, I am currently treating my husband with high THC oil for the same type of lung cancer you had. What have your experiences and successes been since you first wrote your comment?

Michella,

How are you doing? Do you see a difference since taking CBD:THC? I have a friend with stage IV small cell carcinoma.

Doctor, can you PLEASE explain this study?

http://europepmc.org/abstract/med/8897084

Multiple doses of delta 9-tetrahydrocannabinol (THC) capsules (Marinol) and THC hemisuccinate suppositories were administered in 24-hour intervals to 2 patients with organically caused spasticity. After oral doses of 10-15 mg THC, peak plasma levels from 2.1 to 16.9 ng/ml THC and 74.5 to 244.0 ng/ml 11-nor-9-carboxy-delta 9-tetrahydrocannabinol (THC-COOH, major THC metabolite) were measured by GC/MS within 1-8 h and 2-8 h, respectively. After rectal doses of 2.5-5 mg THC, peak plasma levels from 1.1 to 4.1 ng/ml THC and 6.1 to 42.0 ng/ml THC-COOH were measured within 2-8 h and 1-8 h, respectively. The bioavailability resulting from the oral formulation was 45-53% relative to the rectal route of administration, due to a lower absorption and higher first-pass metabolism. The effect of THC on spasticity, rigidity, and pain was estimated by objective neurological tests (Ashworth scale, walking ability) and patient self-rating protocols. Oral and rectal THC reduced at a progressive stage of illness the spasticity, rigidity, and pain, resulting in improved active and passive mobility. The relative effectiveness of the oral vs. the rectal formulation was 25-50%. Physiological and psychological parameters were used to monitor psychotropic and somatic side-effects of THC. No differences in the concentration ability, mood, and function of the cardiovascular system could be observed after administration of THC.

The way I read this rectal absorption is superior, no?

“The relative effectiveness of the oral vs. the rectal formulation was 25-50%”

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Allan Frankel, MD
March 16, 2017 9:04 pm

The reason the THC is absorbed in this situation is ENTIRELY because of the “esther” molecule with the Hemisuccinate. This requires very special processing and it is just for the THC molecule. This is run by a patent and there is no way you or I can or would ever make this product. Most folks in the cannabis field are using whole plant THC or CBD. Molecular THC bound to hemisuccinate is just not possible nor legal, due to patent.

Unless something is radically done to cannabis, it barely crosses into the bloodstream

Juenes Carter
April 19, 2016 4:07 pm

This cannot be correct. My partner who has has a rare stomach condition in which she was told she would not have any type of life unless she had her esophagus removed used high volume THCa with no problems. In fact she got miraculously better.

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Allan Frankel, MD
April 19, 2016 6:36 pm

Not sure who you are responding to?

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Marelyn Shapiro
November 22, 2015 3:54 pm

That happened for me. Now a half hour before dosing with my syringe with my CO I dose with 1 ml of coconut oil. That tricks things and generally will bring out anything (like the less expensive coconut oil!). Then when I dose usually it stays up there. However sonetimes the d comes only when I insert the CO. My thought is that the CO helped those toxins come out which may have stayed up there otherwise and needed to be eliminated…so perhaps its,working as it should.. I have heard that it is absorbed after 10 minutes. So if you can hold it up there for that length of time..There are some good articles on bioavailability and back door method. Just google.

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Try using it vaginally, just use a panty shield for leakage

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Allan Frankel, MD
February 3, 2017 2:55 pm

Vaginal absorption is very poor for any cannabis oil, or any oil for that matter

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Michael Eng
May 1, 2015 3:24 pm

Allan- I have recommended rectal delivery for several patients who desire as little psychoactivity as possible. Suppositories should minimize the first pass effect and thus reduce hepatic hydroxylation of the THC. As 11-OH-THC is a major liver metabolite and is supposed to be a more psychoactive cannabinoid than D9-THC, I anticipate that my patients should be less stoned this way. Has this born out in your patient experience?

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Allan Frankel, MD
June 3, 2015 6:11 pm

Yes. Absolutely.

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Hi Dr. Frankel.

I have liver mets from a primary neuroendocrine tumor that was surgically removed. I’m currently using rectal delivery of cannabis oil/coconut oil as there is no euphoria associated with this delivery method. Is that the best route for me? Please advise. Thanks.

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Allan Frankel, MD
June 2, 2015 5:00 pm

I believe this is very reasonable.

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HI Bonnie. I, too, have neuroendocrine with mets to my liver and have just been introduced to the possibility of rectal delivery of cannibis. I’d love to know more about if you think it’s working for you, etc. Is there a way on here that I can give you my email so you may write to me?
By the way, I am Bonnie, too!

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Hi Dr. Frenkel,
I got my oil from a reputable source and tried to ingest it and work up to a gram a day within a month. I got to 2/3 gram a day and it dropped my BP and heart rate like a stone. I have low BP. I have stage 4 breast cancer and despite ingesting oil it hasn’t helped…but I never got to the gram a day, either.

Now I am taking it rectally directly from a syringe with the oil blended with coconut oil, 1/2 gram a day with no psychoactive effects (unlike with ingesting which gave me issues most others don’t have like the low BP as well as anorexia).

In a couple days I am going up to 1 gram a day. I worry it’s not doing anything b/c I don’t get high. I’ve been told ingesting is better for BC but I can’t so I hope rectally is doing something. I’m not using conventional tx so far – too afraid of wicked side effects.

Do you think my way of dosing for my disease is valid, or do I need to struggle with ingesting? I wish there was a cannabis oil trial out there I could join for guidance.

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Allan Frankel, MD
July 10, 2015 5:30 pm

Patients have much less psychoactivity when using cannabis rectally. It does not mean it is less effective. I am not a big fan of these high doses, but there are numerous protocols that do work.

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Hello Dr. Frankel. Can you give rectal cbd suppositories in place of rectal Diastat for emergency seizure medication? Is it effective and quick ?

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richard iliffe
August 10, 2015 6:49 am

Concerning the rectal application of cannabis oil, i understand that, as it is not water soluble, it cannot be absorbed in this way. The version that IS absorbed is THC -Hemisuccinate (THC-HS), which is a prodrug of THC and, to my knowledge, is not readily available

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Allan Frankel, MD
August 12, 2015 2:35 pm

This is clearly not the case. Yes, cannabis is fat soluble but that does not block absorption, it just makes it a bit trickier with oral dosing. I don’t see why it would make any difference rectally. As patients have great relief rectally, it is not a placebo.

Most drugs, in fact, can be absorbed rectally. We are certain it is, as patients have good success with it. They “feel it” and their bowel issues get better.

You are correct that the only study out there was with the THC -Hemi-succinate, but it is just that other studies have not yet been done.

We finally have a lab that will be able to test patient serum levels of cannabinoids and their breakdown products. This will put this issue to rest.

I will publish all the results of serum levels here and we will know.

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Where will you publish these please ?

Liam.

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Dr. Frankel, have you gotten the results from serum level testing yet? If so, can you tell us where to find them, please?

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Allan Frankel, MD
April 4, 2016 7:02 pm

I only have the results personally, as the facility was not willing to print out results. This has been resolved and soon we will have a number of more patients tested with posted results

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Are these findings available yet?

Allan Frankel, MD
May 13, 2016 9:36 pm

Sorry, what findings?

Mr Right Reverend Gregory K Davis
January 6, 2017 4:41 am

the results must be in now. how can I access this information.

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Marelyn Shapiro
March 17, 2016 6:19 pm

Aren’t we all commenting on the,article above which definitively states the opposite?

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Do you mean on one hand it seems that the doctor supports rectal administration, but then doesn’t?

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Allan Frankel, MD
May 30, 2016 6:13 pm

If you are talking about me, I no longer support rectal administration, as it just does not get absorbed. I changed my mind as more data and serum levels study results came in

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Mr Right Reverend Gregory K Davis
January 6, 2017 4:42 am

oh my, I need to see the data. I must pass this along to our research team.

Allan Frankel, MD
January 11, 2017 12:05 am

What research team? There are a number of studies posted on National Library of Medicine. It is not just cannabis oil that is poorly absorbed rectally. Most oils are not rectally absorbed

paula dall stella, MD
August 21, 2015 12:35 am

Dear Frankel,

I m a medical doctor from Brazil and we are starting to use medical cannabis as a coadjuvant treatment to the existing ones. Do you have experience with brain cancer patients and cannabis using the anal route? If yes, what is the dose you consider effective?
Thank you very much.

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Allan Frankel, MD
August 26, 2015 5:41 pm

I see a lot of patients with Glioblastoma from regional hospitals. As you know, there is a study going on in Israel looking at similar issues. I use Whole Plant CBD with a full complement of terpenes, flavonoids and hundreds of minor cannabinoids. With Whole Plant CBD as opposed to molecular CBD or synthetic CBD, the dose is much, much lower. So, it depends upon what form of CBD you use. My experience is really only with plant derived whole plant CBD extracts and the dose is in the range of 60-70 mg of total cannabinoids. We TRY split the dose between CBD and THC.

If you are using molecular CBD, I would probably increase the dose to 600 mg daily. In my opinion, body mass does not effect dose.

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Dr. Frankel, I am helping a friend with Glioblastoma, after having been treating my husband for lung cancer with CO very successfully. I have used high THC oil, because it is all that is available. I also agree, that the 1 gram dosing often suggested, might not be needed, as we have never gotten to that dose and still had good results. My question is, have you noticed successful results when treating a Glioblastoma patient rectally? I have sort of gone along with the line of thought that the point of absorption should be as close to the location of the main tumor – in other words – brain cancer absorption should be oral, for example, along the interior gum line, sublingually, etc. Have you found that to be true at all? What is your view on this?

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Allan Frankel, MD
April 4, 2016 7:04 pm

In large part, I started using cannabis sublingually because I was treating mostly children. Now that I am treating adults and children, I have mostly stuck with sublingual use as it is easy, reliable and for sure with circulation in the skull and brain

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Dear Dr. Frankel,
I am using cannabis for prostate cancer treatment. Although I have not had a biopsy I have 3 sequential rising PSAs and a palpable prostate nodule that can be seen via color Doppler U/S. After using 3 treatment modalities for about 1 month treatment time (DC magnets, oral Capsol-T and oral cannabis), my PSA went from 1.9 down to 0.99.

I have coordinated this with my local urologist and have a biopsy scheduled for 1 Oct 2015, pending an office visit one week prior to the biopsy to get another PSA and for him to do a DRE to evaluate the nodule. If is PSA down, and/or nodule reduced or gone, then delay biopsy, if not go ahead with biopsy.

On the cannabis, I am currently taking a capsule orally with 30 mg THC & 15 mg CBD (per lab testing of product) cannabis oil at bedtime. Additionally, I am taking a cacao butter suppository with a total of 225mg THC and 75mg CBD derived from whole plant cannabis (hash oil). That total suppository dose is divided into 2 equal doses ( 9am and 3 pm). I find the cacao butter to be much easier to manage than coconut oil, and since it’s melting point is 97F it is easier to place before it melts than coconut oil.

Does this seem an appropriate dose for my circumstances?, and is a THC:CBD ratio of 1:1 the preferred ratio?

Your reply on this is sincerely appreciated,
Regards,
D Page

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Allan Frankel, MD
August 27, 2015 4:33 pm

I think you are on a pretty reasonable regimen. If I were to make any changes, it would be:
1. Take all the medicine rectally
2. Reduce your total cannabinoid dose per 24 hours to under 100 mg

Best Wishes. I think you are off to a great start and should do well.

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Hi, D Page,

Could you tell me please how you let your suppository set again after warming and mixing with Cannabis Oil ?

And how is it going ? Have you found differences between the ratios are working differently for you or can you not really make that out ?

Kind regards,

Liam.

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Dr. Frankel,
I am extremely thankful for you knowledge and time you take to answer these many questions (some of which are mine).

What a great service you are doing for the medical marijuana patients in need of guidance in a field that has such a diverse and unstudied amount of unknown and conflicting information– I commend you sir!

Finally, do you believe that a 1:1 THC/CBD ratio is the preferred mix of the two cannabinoids for my situation of is some other ratio preferred?

Kind Regards,
D Page

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Sally McDonald
August 29, 2015 1:44 am

Dear Dr. Frankel,

I have been told that Cannabis suppositories are the best medicine for COPD. I will be making a paste of powdered whole cannabis bud mixed with cocoa butter, heated to approx. 155 degrees and cooked for 12 hours. This makes a paste and about 7 ml of this equals 1 gram of cannabis. How much do you think I need to put in each suppository if I plan on 3 per day? Have you heard of anyone using the paste in this way? thank you so much, your input is vital to those of us suffering. I understand that people have been able to get off O2, steroids, puffers and the like once they start cannabis. I’ll let you know how is works for me once I figure out the dosing. thanks, Sally

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Dear Fr Frankel
Over the last yr I’ve been diagnosed with Hyperthyroidism. Graves disease. Lupus. Degenerative Disc disease. And now Biliary cirrhosis. A very good friend suggested I try cabanoid suppositories. I’ve been on 1/3 grm twice a day for a month.
I’m deffeniately not feeling as sick as I was a month ago. Even the inflammation of my joints seems less. I’m starting the second month soon. Should I stay at this dose or increase it?

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Allan Frankel, MD
August 30, 2015 8:46 pm

For SURE, I would not increase. I prefer lower doses as well as favor more CBD if possible where you live.

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I am looking for direction with a loved one with stage iv colon with mets to liver, lungs, and lymph. I was advised to mix 1/4 gram of oil with 3/4 gram organic virgin olive oil 3 times a day. plus equal amounts of both under the tongue three times a day. Does this sound like a good protocal? We haven’t started yet. Also, do you have any recommendations on the syringe for rectal admin? Should I just order oral syringes?

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Allan Frankel, MD
August 30, 2015 8:49 pm

I think it would well be worth your setting up a phone consultation or office visit with me. I think I can give you much better advise in that manner. This is way too serious and complex to do just by email. I hope you understand. If you do schedule some time, you will see what it is most likely worth while.

Best of wishes

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Dr Frankel.
My Friends 7 Year Old Son has been diagnosed with a Desmoplastic small-round-cell tumor, a really rare soft skin type sarcoma. He got a kind of “lump” removed from his abdomen and now he on his 3rd Chemo session, very weak I must say that poor Kid.
We wanted to know if you have some experience with someone taking Oil for this condition (DSRCT or similar soft tissue cancer), and if it was effective in some way.
While he is very young we are thinking about the suppository way to avoid a “high” discomfort. Does age affect the amount of dosage that has to be administered? (1Gr/day??)
One questions that boggles our mind is, How do you meassure eg: 750mg of THC and 350mg CBD? Is it 750mg oil extract from a THC Plant Strain?

Thanks in advance!
JL Vanta

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Allan Frankel, MD
September 8, 2015 2:01 pm

As I have stated many times in my journal, I am just not a fan of the “gram per day”. I have not seen a soft tissue sarcoma, but have seen similar types of tumors. My perspective is using a much lower dose, which I believe is at least as effective.

If you use a balanced CBD:THC extract, the psychoactivity will not be excessive.

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Hi Dr frankel, my husband has a glioblastoma brain tumour and have been giving him roughly 1.5 gram per day of cbd and thc rectally, but a lot of people have said that it needs to be giving orally when it comes to the brain, is this correct? Or can it still reach the brain via giving it rectally??? I give it to him orally once and he was totally powerless and slept the full day which scared me, so don’t want to do it that way again. Does rectally work???

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Allan Frankel, MD
September 8, 2015 1:57 pm

I treat GBM patients sublingually.

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Hello,
I’ve got a quick question about taking cannabis oil. Last year I was diagnosed with small intestine adenocarcinoma with mets to the Liver. I did not know about the oil at this time and took chemo. I was in remission until last month and the cancer came back in my scar and area on my right side of the abdominal wall. There are hard spots in my scar. My question is, should I take it orally or by suppositories and do you think it would help to apply some to my scar? If I do, do I need to mix it with anything?

Thank You

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Allan Frankel, MD
September 16, 2015 5:42 pm

I would take it by all three routes. We could discuss details in a phone or in-person consultation.

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Patrick Monk RN
September 9, 2015 7:39 pm

Excellent info. I’m recently retired after a 20+ year career as an RN Hospice Case Manager. Rectal administration of virtually all meds is a common practice. There are multiple reasons for use of this route. Rectal membranes are highly absorbent and generally equally effective at transportation and distribution, and far less potentially hazardous, than IV.
Patrick Monk. RN Hospice Case Manager. SF. Ca.
**Society of Cannabis Clinicians
**American Cannabis Nurses Association
**For Identification Only.

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Allan Frankel, MD
September 16, 2015 5:42 pm

Thank you. We are currently waiting for results of plasma levels of THC and CBD following rectal administration. We are working with NIDA!!

Would we have any work in common?

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Emphesema. Do you feel Dr. That cannabis oil could get one off oxygen , after 3 years? Taken orally

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Allan Frankel, MD
September 16, 2015 5:39 pm

I don’t know.
I do know that THC and CBD both help with broncho-constriction, so are useful aids in treating COPD

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Rich Williams
November 8, 2015 1:24 am

For COPD, I’ve seen suppositories are very effective.

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Hello Dr. Frankel. I have been applying CO topically since March on my nodular basal cell carcinoma arising from the scalp, while waiting for my Moh’s micrographic surgery schedule. I plan to avoid going under the knife. The nodule has tripled in size when I started to up the dosage starting May 21. They say its a regular reaction (herxing) and will kill the cancer cells, dry out and fall. However, when I’m not applying the oil, it bleeds, is painful and there’s an oozing white fluid which they say are the dying cancer cells. The other my surgeon called to say that surgery will be on Sept 16. I didn’t tell her that I’m using Cannabis oil. I refused to continue the Imiquimod cream she prescribed because the side effect was just too much. I’m planning to apply the CO continously after surgery. If they will recommend chemo/rad I won’t do it, just the oil. Do you think this is a good decision? thank you so much for your valuable advise.

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Allan Frankel, MD
September 14, 2015 11:36 pm

I think it is probably the dying cells. I would excise it and see what the pathology shows. If it shows that there were a lot of dying cells, I would just go back to using the oil.

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Hello, i would firstly like to say that finding this website and seeing all the great advice you give is truly brilliant.
I have stage 4 lung cancer and i am using 1 gram of cannabis oil with 1 gram of coconut oil administered into the rectum with a syringe. My question is how far should the tip of the syringe be inserted into the rectum so oil is absorbed by the blood rather than by the liver. Thank you in advance

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Allan Frankel, MD
September 16, 2015 5:35 pm

You ask a very good question. I would have thought after looking into the rectal vein drainage in our pelvis that we could select depth of rectal insertion and determine whether it goes through the portal/hepatic veins or systemic veins. It seems, however, that we almost never get much psychoactivity from rectal delivery regardless of whether it is deliver one inch or two inches in. I would go for one inch.

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I have question. Have friend mixes rso with coconut oil 1 gram inserted by rectum. When she did this 2 days ago with new patch of rso, she said she felt a burning sensation shoot through her arms &legs and now has hot & cold flashes and shaking. Does she have an infection from wrong insertion or from the rso she has lung cancer.

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Allan Frankel, MD
January 15, 2016 11:28 pm

I could not possibly speculate as to what happened. She needs to be examined by a physician.

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Dr Frankel-

Thanks for your thoughtful and detailed answers to the many questions posed here. Its escpecially valuable because of the difficulty in getting clear, informed answers to MM questions.

My wife was diagnosed with Stage 4 Anal Cancer in Sept 2014. She was successfully treated with chemo+radiation (per the normal standard of care) and she was disease free from January until July 2015, when 4 lesions were found in her liver. She is going to undergo Liver Directed Therapy to the lesions using Y90 pellets. And we are going to start a RSO regimen using 2:1 CBD:THC oil, but our Oncologist isn’t experienced with MM treatment, so we are flying a bit blind. She was planning to take the Oil rectally with suppositories. Would you recommend that approach vs. orally? Also would you recommend any other changes to dosage or anything else in our plan?

Thank you

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Allan Frankel, MD
September 23, 2015 5:24 pm

In general, I would advise taking 1/2 of the medicine orally and 1/2 rectally. In both cases it goes through the liver, which is what you want. I am not a big fan of the RSO oil’s concentration and dose.

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Dr Frankel,

Regarding dosing by way of Rectal administration & via vegan capsule. (due to shipping & melt concerns)
*What ration CO & CBD oil rectally admin would you recommend for a mid sixties gentleman with stage 4 Kidney Cancer? He declined chemo or radiation.
I understand a 1:1 ratio is best. *My question…Is this 1:1 in ml=g i.e. 1ml thc:1ml cbd
or is it in mg THCmg/ml:CBDmg/ml i.e. 400mg thc :400mg cbd.
Any suggestions or recommendation are greatly appreciated. *Do you take in out of state patients?

Dr. Frankel, thank you very much for your time and any advise you can offer!

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Allan Frankel, MD
October 9, 2015 1:45 am

This is something well worth discussing over a phone consultation. Just call the office.

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I forgot to mention Both thc & cbd are organic and made from
Whole plant cannabis 380mg thc/ml & Hemp CBD (Palmetto Harmony 20mg cbd/ml)

Thank you again!

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Thanks Dr. Frankel. I’ll call your office to get a phone consultation set up so we can get your help on dosage and concentration.

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I was diagnosed with colon cancer on June 12th and it was surgically removed June 15th. PET CT revealed mets of 2.5cm in each of the 2 lobes of the liver. Following RSO dosage I have been finally able to takie 500mg/day orally in capsules since. I don’t like the high so I’m taking it rectally using a syringe and orally at bedtime. I’m finding that the oil is so thick its difficult to get it out of the syringe even if I warm it. Should I mix it with coconut oil and then put back into the syringe or would you suggest I simply try suppositories? It is my understanding, please correct me if I’m wrong, that it should be administered one inch into the rectum.

Thank you so much for your anticipated reply.

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Allan Frankel, MD
October 9, 2015 1:44 am

There is much to talk about. Impossible for email. Please consider an educational phone consultation or visit. 🙂

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How wonderful to come across you …Firstly congratulations for being an educated source for people like us .
Dear Dr our son will go thorough BMT in 3-4 weeks which will involve reduced intensity chemo …Would you please advice me on the dose and its frequency .He is a 3 year old boy

Thanking you in advance

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Allan Frankel, MD
October 9, 2015 1:41 am

It is not quite that simple. However, you can setup a phone educational call and we can review options. There are a lot of issues involved.

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I have afib, but was told rectal suppositories can help with pain and exhaustion I feel from sotalol and elequis. I read smoking it cause rapid heartbeat.. my question is for rectal administration do the same, or is it ok.

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Allan Frankel, MD
October 9, 2015 4:57 pm

I think you are probably better off taking a 20:1 CBD:THC extract that you can take under your tongue. It MIGHT be worthwhile either seeing me or having a phone consultation

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Suppositories should always been made with cocoa butter because of the anandamide and CBD degrading inhibitors contained. Also hold their form better given the higher melting point over coconut. Suspect this will be the future of suppository administration with the potentiation effects of using cocoa butter.

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Hello Dr. Frankel,
My mother has stage 4 liver cancer and has struggled with the high from orally ingesting her 1:1 oil. Now she is taking it rectally 1/3 gram 3 times a day. My question is, since we are dealing with the liver, were is the best place in the rectum to place the suppository? Do we want it to go straight to the liver? Or in the blood stream?
Thank you so much.
Josh

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Allan Frankel, MD
November 4, 2015 7:17 pm

Hi Josh,

I would suggest going back to oral, but in a CBD:THC ratio that is not overly psychoactive. We have been checking serum levels after rectal administration and early tests show that it is very low. I would strongly consider a balanced dose that she can tolerate orally.

Dr. Frankel

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Marelyn Shapiro
March 17, 2016 6:36 pm

Hello, Are you suggesting that in general rectal administration is no longer recomended?

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Debbie Bradley
October 25, 2015 12:25 am

I get horrible nausea with migraine headaches, and the only medications available to me are phenergan suppositories. It’s a phenothyizine. I can get very bad side effects from more than 3 doses in 24 hrs. Cannabis suppositories would help with no problem. Too bad it’s not available in Texas..
#OneLove #OnePlanet

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Allan Frankel, MD
November 20, 2015 9:27 pm

CBD is great in low doses to prevent migraines. If you live in the LA area, you might consider setting up a consultation. If out of state, an educational consult may help you in a number of ways

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Any suggestions on best way to treatIng hogkins lymphoma?

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Allan Frankel, MD
August 9, 2016 5:22 pm

This is like asking an oncologist what dose of chemo and radiation therapy is needed. There are a lot of variables. I would suggest a phone consultation.

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Dr Frankel,

A friends 29 yr old daughter has PND primative neuroecto durmo . Do you believe that she is a candidate for RSO/cannabis oil?
We are also looking into essential oils.
Any advice would be appreciated.

Gary

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Allan Frankel, MD
November 4, 2015 7:16 pm

Hi Gary,

I presume you are referring to Primitive neuroectodermal tumor? In my opinion, I would for sure consider a balanced 1:1 CBD:THC dosed extract. There are a lot of details to consider. I am not a big fan of “RSO” or Rick Simpson dosing levels and find that a LOT lower levels seem to be pretty effective. Perhaps consider calling my office for a consultation or a visit if you are local?

Dr. Frankel

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Dr Frankel, I was diagnosed with Charcot Marie Tooth syndrome and also had a failed back surgery syndrome: discectomy, fusion of 3,4,5th vertebrae, laminectomy, disc decompression and awas pain free’after surgery. Then after 3 weeks of physical therapy it all changed back to same pain, I had various epidurals, facet injections, risotomi, and other injections, all with no relief after 2 days and sometimes got worse. I am looking for the most efficient way to produce the most effect on Body pain with the least psychoactive effect. So, in your experience, Is there any combinations, strains,,combined with any more efficient means of delivery (suppository? cream whatever) that has ability to help relieve affects of neuropathy pain in pelvic area, primarily perineal and coxxyxx pain. Curious if there is some dispensing method combined with increased body affect and minimal psychoactive affect.

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Allan Frankel, MD
November 4, 2015 7:14 pm

Hi Leo,

I think it would be well worth your while to either come by and see me or if you are not local, setup a phone consultation. There are many reasons to believe that a combination of CBD/THC AND THC-A might be quite helpful. Too many details to go into in a blog, but I would certainly pursue what you are thinking.

Dr. Frankel

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Hi Doctor Frankel , We have a couple questions regarding cannabis oil and rectal absorption . First we were wondering if you know about how long it takes the body to absorb rectally the full amount of cannabis oil mixed with coconut oil.
Also have you seen rectal cannabis oil cause constipation? If so would it be based on the amount of oil taken? Or if taken orally would constipation be less or more or the same?
Having some constipation issues since starting the oil. Was using a very high dose but have back off and are now aiming for 200 mg thc and 200 mg cbd treating melanoma. Any advice would be greatly appreciated thanks!

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Allan Frankel, MD
November 4, 2015 7:12 pm

Hi Stephen,

Thank you for reaching out. At this point, I am only suggesting rectal administration for localized prostate cancer, some rectal carcinomas and some patients with inflammatory bowel disease. We have begun studying plasma levels of CBD/THC after rectal administration and very early findings are showing very low systemic absorption. Very interesting and surprising. We need to study it a LOT more.

That said, I would in general prefer oral, but it depends upon the type of cancer and even more importantly, the location of masses.

Finally, although I know that many folk subscribe to the 60 grams in 90 days, I am a low dose guy. We give our patients generally 1:1, but at around 70 total mg. Best of luck.

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Thanks for your response Allan,

I have skin cancer and the tumor was in my lymph nodes on the left side of my neck. There is nothing anywhere else in my body right now so they are saying I’m stage 3 since they believe it came from a mole on the back of my neck.

The tumor was removed a week ago and they found cancer in 2 of the lymph nodes. The tumor was 2.8 cm in size. They are recommending 20 rounds of radiation over 4 weeks to kill any cancer that may still be in the neck area.

What do you think of the radiation (needed or not) and with this info do you recommend continuing the oil orally and at the dose you give your patients.

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Kerstin Staudinger
November 7, 2015 7:06 am

Hello Dr Frankel!

I have been treating my stage IV breastcancer with CO and CBD since July 2014. It helped in eradicating all mets in the liver. This was a tincture from Mediwiet in Holland. I thereafter couldn’t get this oil because of customs in Sweden where I live. I then had CO which was so difficult to dose. I only used CO and no CBD. I recently had mets in the skeleton coming back after they vanished after 9 sessions of chemo and drinking human breastmilk in 2010. I also have problems with the “high” and have know started using home made suppositories by mixing CO with coconut fat. After reading all posts here it seems that you recommend oral intake instead of rectal or am I wrong?

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Allan Frankel, MD
November 9, 2015 3:31 pm

Yes. I would do it orally for sure. Rectal administration seems best for local rectal/pelvic disease. It might be worth a phone consultation with me?

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Kerstin Staudinger
November 7, 2015 7:09 am

Hello again! I forgot to mention that I now combine with Golyoli a CBD oil together with rectal CO suppositories.

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peter rastall
November 7, 2015 2:13 pm

Dear Doctor. I have prostate cancer and I have been on active surveillance for 18 months. I have been on CO for 4 months and take it rectally because the high I get is very unpleasant. I don’t measure the oil I work on the grain of rice method but I have to make the oil myself with plants acquired from illegal sources and I use all of the plant so exact strengths cannot be calculated. I mix the oil with E,V,organic coconut oil in equal parts and fill up to 3/4 full a ’00’ vegetable capsule. These I use as a suppository and I have now upped the dose to 5 times a day. my latest PSA went from 5.6 to 6.5 and I am to undergo a template biopsy in 3 weeks time. Can you tell me if the dose I am taking is too much or not enough.

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Allan Frankel, MD
November 9, 2015 3:29 pm

Honestly, although I am a lower dose sort of guy and like 1:1 CBD:THC, I believe that your therapy is reasonable. I would continue with the treatment. Please write back to me and let me know how your scans and PSA are doing. BTW, I have seen a number of patients such as yourself, where there is a period of time where the PSA may go up, but the scans are better and you are feeling better. I believe that for some patients, as the tumor dies, it becomes necrotic and releases a lot of PSA.

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Kerstin Staudinger
November 12, 2015 10:34 am

Hello Dr Frankel!

I found this and can you explain why they seem to think that rectal administration seems to be good?

http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/infoprof-eng.php#chp2215

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Shilpa Proddutur
November 18, 2015 4:44 am

My friend is diagnosed with Glioblatoma stage 4.Taking Radiation and chemo currently.She is very weak right now ,i guess because of radiation.doing some reading about cannabis oil treatment.Talking with one of the support groups who also supply cannabis.They are recommending cbd to be taken sub lingual and THC as suppository.cbd is about 30 drops and THC about 60 – 75 drops.What is your input on THC taken as suppository.When you say orally in above posts – is it sub lingual or actual swallow the oil.My friend is not able to even swallow water.

Thanks a lot for all your help.
SHilpa

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Allan Frankel, MD
November 18, 2015 11:57 pm

I just responded to a comment about rectal THC. If you read the comment, you will find that I don’t believe in separating the CBD and THC. They should be given at the same time if we expect them to work together? Right? In addition, the reason THC is not felt as stony when taken rectally is because little is absorbed systemically when taken rectally. Some is absorbed, but mostly it seems to remain local.

I would take both CBD and THC together. I am available for phone or in person consultation if you might find that helpful

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Lady on youtube, Sharon Kelly, posted lung cancer tumors cleared in 7 months administering high thc oil really via syringe mix with coconut oil.

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Shilpa Proddutur
December 22, 2015 1:02 pm

Hello Dr. Frankel,
I had a phone consultation with you last month about my friend who was diagnosed with Glioblastoma. I had a chance to learn a little about CBD/THC and its potential benefits for autism. However, I am not clear on the precise benefits of this therapy for autism spectrum disorder (ASD). I would like to know if this might help my sonwhi is 8, preverbal with very few words (and apraxia) and I am not sure of his cognitive level. He does not have sleep or aggression issues which I hear are some of the major gains with CBD/THC therapy. Please let us know your thoughts on what could be other benefits that we could expect for kids with ASD as we would like to try this therapy for my son during this holiday time.

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Allan Frankel, MD
December 23, 2015 8:01 pm

We use CBD mostly for kids on the “Spectrum”. It is used at times for seizures, but mostly it is to help with behavior and developmental issues. We see these kids do very well over long periods with vocalization, motor and cognitive skills

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Shilpa Proddutur
December 28, 2015 1:04 pm

Dr. Frankel,

Thank you very much!

Shilpa Proddutur
December 28, 2015 3:46 pm

Thank you very much! With only CBD (i.e. your bottle #1), can you suggest what would be a typical dosing for a 8 yr old weighing about 50 lbs?

Thank you again,
Shilpa Proddutur

Allan Frankel, MD
December 28, 2015 7:24 pm

I just can’t give dosing information out this casually. There are nearly always circumstances that change the “usual dose” to something else. Feel free to call my office and see what forms of education are available.

I am such a fan of yours, Dr. Frankel! And thank you so much for such a great website! My mom has stage IV lung cancer (NSCLC, ROS-1 gene mutation) and we are doing suppositories to avoid the high (though still taking small amounts orally at night). We have been using a new syringe each time (currently 1 gram, 2 parts coconut oil and 1 part high THC cannabis, working our way up to 50% cannabis and 50% coconut oil) and it seemed to be working fine for the first few days, but now she is having lots of gas and has some leakage of clear fluid (maybe the coconut oil, but she isn’t sure). No one else seems to mention this at all. Is it because they are too sheepish or do we have an unusual problem? How do we know if suppositories are causing a problem or infection? Any insights you may have will be much appreciated. Thank you!

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Allan Frankel, MD
November 18, 2015 11:55 pm

For a lung cancer patient, I would not use suppositories. The rate of systemic absorption from cannabis rectally is actually pretty low. That is the reason folks do not feel “psychoactive” from suppositories. There is most likely good local effects for prostate cancer and inflammatory bowel disease, but otherwise, I prefer sublingually or orally.

For lung cancer patients I do a combination of vaping through a vape pen 1:1 CBD:THC oil. This way, a balanced anti-tumor effect goes right past the tumors in the lungs. Seems rational to me.
In addition, I would use either sublingual or oral 1:1 cbd:thc extracts.

Finally, the entire concept of using CBD and THC is that THC and CBD work TOGETHER in killing cancer cells. If the THC is all given at night, it is mostly gone by the AM. This is great for the “stony” issues, but it means we are not really using both molecules at the same time.

I know this gets complex. I do provide one hour phone consultations or of course in person visits if you are local.

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Shilpa Proddutur
November 19, 2015 2:33 am

Thank You Dr Frankel.I will talk to my friend’s family and try to schedule a consult with you.
Thanks a lot for all your suggestions.

Regards
Shilpa

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I have Stage IV melanoma in my lungs, stomach, adrenal gland & lymph nodes. Was given 5 infusions of Pembro, but caused ulcerative colitis. Infusions suspended (and probably will not be restarted). Have been taking two cannabis suppositories per day from my daughter in Washington. Tumors have decreased or disappeared depending on location. Could not tolerate subliminal cannabis (except for CBD oil). Totally knocked me out. Suppositories make me a bit lethargic, but otherwise no problems. Am I on the right track? How long should this continue?

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Allan Frankel, MD
November 23, 2015 8:26 pm

I think you are on the right track. I would also try take some of your CBD orally

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Hello,
Thank you in advance for your time, it is much appreciated. I have been making concentrated cannabis oil (Rick Simpson Oil) for breast cancer. It’s made from high quality marajuana supplied by MedReleaf here in Canada. Unfortunately, it really upsets my stomach and I’m experiencing nausea daily. If I stop taking it for a few days, the nausea goes away. I take a half gram of oil orally before bed each night.
I suspect the suppositories will eliminate the nausea? Thanks again for your time.
Stacy

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Allan Frankel, MD
November 30, 2015 7:18 pm

You were THC toxic. Taking concentrated THC causes nausea. I would take the medicine orally. Also, I would take a 1:1 CBD:THC mixture of oil. I just spoke with a patient in BC, Vancouver. They have 1:1 oils there. In my opinion, a gram should be plenty for two weeks of dosing and FOR SURE, I would use more CBD

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I can’t thank you enough for your time and direction. It is very much appreciated. I’m taking a week or so break from the oil then restarting very slowly and gradually based on your recommendations. I have also noticed a marked elevation in my resting heart rate, as well as shortness of breath. I hope these symptoms subside as the thc levels in my body start to drop. It’s been about 24 hours since I stopped the oil.
Thanks again for this wonderful site and for sharing your experience and knowledge of this medicine.
Much gratitude,
Stacy

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Can you tell me if using cannabis oil (THC & CBD) rectally reaches a brain tumor? I’ve been told conflicting information and need to know for sure.
Thank you

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Allan Frankel, MD
November 30, 2015 7:15 pm

I do not think rectal admin is good outside of the area of the rectum, prostate and perhaps local pelvic areas.

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Hello Dr Frankel,

I am trying to find out some information regarding a cancer in the jaw. Would administration via the rectum be best or orally, or both ? And also, if you feel that a ratio of 1:1 is best, how can I find someone with such a ratio please ? I can only find a high THC oil at the moment and I feel the high THC oil I have may not work as well as possible for people with cancers. Please advise.

Yours Sincerely,

Liam.

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Allan Frankel, MD
November 30, 2015 7:14 pm

I am a fan of 1:1 mixtures. I would use it orally and sublingually. Ideally, I would do a “swish and swallow”. If this does not make sense, perhaps it would be worthwhile to setup a phone consultation.

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Couldn’t handle much oral THC:CBD so started suppositories. First few days didn’t feel any effects with large doses(.5grams:.5grams). I now get quite high from this route, and have had to cut back my dosage(.2grams:.2grams), though still significantly more than oral threshold. Any thoughts on why I had delayed response?

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Allan Frankel, MD
November 30, 2015 7:12 pm

I really don’t know why you didn’t feel it at first. I am sure it must have something to do with local absorption. Perhaps you were administering it a bit different at the start? The dose you are using, I believe, is already plenty

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Dr Frankle,
What are your thoughts on the use of oil with regards to estrogen positive breast cancer? I have read many conflicting reports. Thank you!

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Allan Frankel, MD
November 30, 2015 7:10 pm

In general, I would use a 1:1 oil in doses of around 80 mg daily of both THC and CBD

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Dear Dr Frankel,
Please see the following interview with Dr Cristina Sanchez:

https://youtu.be/rnVisZVZfHc

In 9:52 minute of the video she elaborates about the per rectum method of administration being superior and explains why. Just thought it would be interesting to see your comment on this.

Why do you think Dr Sanchez is mistaken? Maybe your team or her team are doing something wrong/different when measuring? Possibly it would be beneficial to contact her and exchange opinions…

Thank you.

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Allan Frankel, MD
December 5, 2015 5:28 pm

Thank you

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Allan Frankel, MD
December 8, 2015 5:44 pm

What makes me concerned is that we have now performed THC and CBD serum levels after taking a 30 mg CBD suppository. The levels in the blood, drawn from the arm, was barely detectable. There was a little present, so it was probably not an error. We plan on doing more studies such as this.

However, at this point in time, I believe using suppositories for local prostate and rectal disease makes sense, but not for systemic disease

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Interesting to see serum levels in same patient(s) taking same dosage orally.

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Marelyn Shapiro
March 17, 2016 6:56 pm

I am curious to know serum levels after 1 gram of THC. Perhaps there is some threshold which one passes where more will go to the bloodstream? I have been following Dr Sanchez’s recommendation and passing that along to people who come to my informational page. I would really like to know if I should stop passing along the information that there is greater bioavailability when using rectally.

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My mother has stage 4 ovarian cancer which is found on the peritoneum, bowel, spleen, liver and has gone through 2 and a half chemotherapy courses. Since ending her chemotherapy she has been taking cannabis suppositories for 6 months now and the cancer is shrinking. She is however concerned that the chemo has left her with some nerve damage affecting her peristalsis and bladder control. She is experiencing some problems with administering the suppositories. Firstly She is having to take a laxative suppository initially to clear her bowel and often feels that she has some faecal matter still there – will this affect absorption? Secondly she takes her cannabis suppository at night but in the morning has a lot of leakage. Are the beneficial medicinal compounds still being absorbed? She is thrilled by the results and is determined to continue but feels she needs some guidance and reassurance. Thank you for your help.

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Allan Frankel, MD
December 14, 2015 6:12 pm

There are a number of issues to discuss here. I would suggest setting up a time for a phone consultation. I am not so certain that rectal administration is best for your mother

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Hello Ruth,

Wondering if the suppositories are still working Against your mother’s cancer? My mother also is going through chemo for ovarian cancer and have just started to take the oil orally but would like to take it rectally due to psychoactive issues.

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Allan Frankel, MD
January 3, 2016 11:55 pm

The reason, in my opinion, that there is less psychoactivity is because a LOT less is absorbed rectally.

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Lindsay. Milton
December 18, 2015 4:36 pm

Can I please get some advice. My friend is suffering from LOS cancer. She has 2 clots in her views feeding her bowel and a tumour. We have access to excellent full Cannabis plant extract but need help on administration. Oncologist’s have given up on her. They told her to get her affairs in order at palliative care then gave her a bottle of morphine to take home big enough to kill a horse. They gave her a checkout option which is just cruel. I’d love some input please. Thank you in advance.

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Allan Frankel, MD
December 19, 2015 7:54 pm

I would be happy to help. I do treat a lot of cancer patients both in and out of Hospice. I would suggest a one hour phone consultation to begin with.

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My wife was diagnosed with CLL and she is immune deficient. She was diagnosed three months ago stage one. Her white blood cell count varies from 15,500 to 17,600. Age 58, weight 120 lbs. We began cannabis oil treatment a month ago and when we reached a 1/2 g per day oral dose she was having difficulty, so we went to suppository vaginal with 1/2 gram day cannabis dose mixed with coco butter and coco oil, ratio is 1:1:1. She is better now without the psychoactive effects of the THC. However she does not feel that she can increase the dose to 1 g of cannabis oil per day as recommended by the dispensary where we purchased the oil in Denver. Our plan was 60 – 90 days of 60 gram of cannabis oil then move to 1 gram a month maintenance. Her main complaint remains lethargy. Her oncologist prescribed Vitamin B sublingual and that has helped some. She also has Bertolotti’s syndrome and that has been treated with Lyrica. She has reduced her Lyrica dosage from 225 mg/daily to 50 mg daily.
I am concerned about the method to determine the correct dosage for someone with this type of cancer. Is there anything we can change to increase her energy level?

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Allan Frankel, MD
December 19, 2015 7:53 pm

There is just no single cannabis regimen that is right for everyone. I think you are dosing on a high side. You might consider a phone consultation with me?

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I am 70 year old woman with multiple myeloma. Do you have any experience with this disease? What types cannabis, dosages and method of administration would you suggest?

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Allan Frankel, MD
December 21, 2015 5:22 pm

I do have some experience with MM. My mother had this, so I became very familiar with it. I am treating a handful of patients with MM. There is no “one dose fits all” to medical cannabis any more than there is for any other treatment for various diseases. I would be happy to see and evaluate you or perhaps a phone consult if you are not local.

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I’ve been using suppositories 1/4 gram mixed with coconut oil 3 times a day I noticed after I wake up and have a bowel movement I notice a oil slick of cocount oil mixed sometimes clear and sometimes mixed with the cannabis oil in the toilet and that’s after 10 hours since last use is this normal or am I having absorprion issues

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Abby Robertson
December 22, 2015 6:26 pm

Hello Dr. Frankel.

I was just diagnosed with Crohn’s Disease and I am in the early stages. I do not want to start the Budesonide or Prednisone which are the only options I was given. I was on the Budesonide for Colitis before and it did nothing. I basically cured all colitis flare up with going on a gluten free diet for two years. This one requires the big guns and that is why I am seeking some advise for a MM protocol. I make my own cannabis infused coconut oil and started with another 1 gm 3x/day rectally. I don’t like to take it by mouth as I get too high from it. I will if that what necessary to get remission but I just am not sure if the suppository method is the way to go or not or maybe I should be ingesting both ways. Secondly. I am getting 190 proof grain alcohol to make oil this week. Can you advise a protocol for that and should I continue with the cannabis infused coconut oil or just go with the oil once I make it. I am located in Massachusetts and do have a MM card.

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Allan Frankel, MD
December 23, 2015 7:59 pm

I really think it would be well worth your while to setup a phone educational consultation with me. There are a number of issues, particularly dosing and type of cannabinoids where I believe you can do much better

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ive been doing 1/4 gram twice a day suppositories mixed with coconut oil when I wake up and do a bowel movement after 8-10 hours since last dose I notice a oil slick in the toilet sometime clear sometimes mixed with cannabis oil is this normal or am I having absorption issues

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Allan Frankel, MD
December 23, 2015 7:58 pm

I only suggest using rectal cannabis to the extent it is being used to treat local rectal issues. The absorption appears to be extremely low and that is why people do not feel stoned. Clearly you are taking way, way too much volume. Ideally, you should be speaking with a physician such as myself and allow me to help guide you with dosing. ?

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Dr. Frankel hello. My wife has been diagnosed with stage 4 breast cancer. It is a return of her breast cancer from 2 years ago. We are considering the standard 90 day 1G treatment popular with RSO. From reading above I see you are not a fan of that approach. Due to time we will not be able to construct a 1 to 1 mix of THC and CBD. Can we be successful with a high THC treatment plan? Thank you.

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Allan Frankel, MD
January 3, 2016 11:57 pm

I think there are probably many different dosing regimens that kill cancer cells. I would always add CBD. I THINK you will find this pretty psychoactive

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With no standards in production of oil, be careful with rectal path. I’ve been using this avenue for prostate cancer and got a wicked intestinal infection.

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Dr. Frankel,
I know many who swear by rectal administration so am fascinated by your latest findings of low bioavailablity. With a lower than expected rectal absorption rate, do you have a theory about those that had success using the rectal route?

Also, have you posted or written (here or elsewhere) in more detail about your findings yet?
Thanks so much for your extremely informative posts, Cindy

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How do you assure quality of what you use to make suppositories (coconut oil, coconut butter, vegetarian capsules). I don’t want to introduce something that could cause infection or complications in the colon. I’m a nurse. I take another pharmaceutically-produced suppository for another condition. I feel like they are at least under some kind of scrutiny for quality.

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Allan Frankel, MD
January 14, 2016 2:16 am

At this point, my feelings and thoughts using rectal cannabis is going through a big change. Please see my response to another person today.

With regard to quality, I would have to write pages on this. If you feel it is important to administer rectally, perhaps setup a one hour educational consult with me over the phone. Of course if you live in S Cal, please feel free to call and schedule a visit

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Could you tell me the reason I’m having burning pain in my butt when I administer the oil by syringe? Should this be normal?

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Allan Frankel, MD
January 14, 2016 2:03 am

There is probably some rectal irritation from the syringe. I would be careful. Also, if you are taking large doses of THC just to avoid psychoactivity, you may not be achieving the results you are seeking. Systemic absorption of Cannabis from the rectum is very, very erratic

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My patient has inoperable pancreatic cancer. She has started on RSO, mixed with coconut oil and frankincense, orally. Can you advise on best protocol please?

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Allan Frankel, MD
January 15, 2016 11:26 pm

There is no “single” protocol. Also, I am not a high dose fan. I would probably try go orally. For more specific dosing information, perhaps call my office to setup educational consult?

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Hello Dr Frankel,

A friend of mine has DLBCL with a localization in the central nerve system (CNS). Would you recommended sublingual instead of rectalin his case?

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Allan Frankel, MD
January 15, 2016 11:24 pm

For sure I would not use rectal. Sublingual or oral

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Hello Dr Frankel,
I am wondering if stool would prevent the oil from absorbing as a suppository?
Thank you

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Allan Frankel, MD
January 18, 2016 3:58 pm

A lot of things interfere with rectal absorption. I would encourage alternative methods of delivery

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Hi,I Am using cannabis oil that I made and put it into capsules I am inserting them anally,would it still be effective even tho I haven’t used coconut oil etc…

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Allan Frankel, MD
January 20, 2016 6:22 pm

Honestly, it is not clear to me how much cannabis is actually absorbed body wide. We have not seen much in the way of blood levels after rectal absorption. We clearly need to do MUCH more testing, but it is at best, confusing

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Hello, I am new to ths forum so if this has been answered please forgive. I am a 42 yr. old female that was diagnosed with SLE Lupus in ’92, renal failure ’95, cadaver kidney transplant ’97. Because of immunosuppressive meds for transplant have been battling cervical in situ and recently diagnosed with vaginal cancer tumor on anterior wall. Docs want me to begin 5 weeks M-F external radiation and then 1 week M-F internal radiation. I am absolutely against it. I want to begin with CO taken anally, and possibly vaginally and orally. What are your thoughts? Having the transplant so long I do not see this issue going away any time soon. Any info is welcomed.
Thank you in advance!!

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Allan Frankel, MD
January 25, 2016 5:50 pm

I think it might be worthwhile scheduling a phone or in person consult? 310-393-0640

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Hello Dr. Frankel,
my mother has stage three pancreatic cancer, 1.9 cm tumor which has begun to invade the portal vein. The Dr’s want to shrink it with chemo first and then operate to remove. We have started her on cannabis oil orally at a rate of 4 drops three times a day (approximately the size of a grain of rice) , and with the current suggested dosage this will be increased to 24 drops then to 45 drops per day broken up into three doses. At her current dose, she is already feeling strong psychoactive effects, and sleeps a lot. The thought of more than tripling the current dose for her is a bit worrisome, as she may not be able to function at such a high dose. She has minimal symptoms from the disease, and we are not sure if they would be more pronounced if she were not taking the oil as they weren’t very severe to start with when the tumor was found two months ago.
Your last comment describes perfectly how I am feeling about trying to figure out what the best dose and route is!
When taking the oil orally, mom has been swallowing it on a little bit of softened host wafer.
Do you recomment sublingual? We found that the oil travelled in her mouth and stuck to her teeth, so thought that swallowing it was better, but I read that it is better absorbed through the oral mucosa than through the digestive tract and stomach. We had also thought of trying suppositories, but having read your replies here are rethinking that idea.
With kind regards and hoping you may be able to give some recommendations, Pilinka
Any comments or

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Allan Frankel, MD
January 25, 2016 5:49 pm

I am not a big fan of this dose. Also, it negates all the benefits of CBD. Perhaps give my office a call and setup an in person or phone educational consult. 310-393-0640

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Geoff Holland
January 26, 2016 4:46 pm

Like you mention in your article I get a stoned effect from rectal absorbtion of cannabis. Does this show that in my case rectal absorption is working?

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Allan Frankel, MD
January 26, 2016 9:56 pm

It is very highly variable but clearly you are getting high from “something”….it has to be from THC

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Geoff Holland
January 26, 2016 4:48 pm

When you tested rectal absorption of cannabis, how many subjects were in your study?

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Allan Frankel, MD
January 26, 2016 9:55 pm

Just two. We are setting up much higher doses of suppositories and will try again

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Hi Dr. Frankel, I have stage 4 rectal cancer with mets to the liver (removed surgically) and recently discovered nodules on the lungs. The rectal tumor was radiated and largely eliminated in 2013 and I barely avoided invasive surgery, but there is tissue damage from the radiation as well the possibility of lingering cancer cells in the rectal area. I am interested in a suppository of THC and CBD oil suspended in coconut oil. I have been taking THC oil orally and sublingually for awhile now. As the cancer has metastizised to the lung, my idea is to take the THC/CBD/coconut oil as a suppository administered to the lower rectal area, bringing targeted treatment to the damaged tissues as well as any lingering cancer cells, and also work up the vena cava portal vein (bypassing the liver) to the lung area as well. I am working towards making my own suppository, can you suggest a dosage that would be safe and effective? Many thanks and best wishes

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Allan Frankel, MD
January 28, 2016 12:43 am

It is difficult giving a full treatment protocol by blog. However a few general notes. I would use a vape pen to deliver CBD/THC to the lungs. In addition, although in your case rectal therapy makes sense, it also makes sense to use it systemically or orally, as rectal absorption is fairly poor.

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Geoff Holland
January 28, 2016 6:48 pm

Thanks for your reply Dr Frankel. I have found that rectal application can be quite variable in the level of ‘high’ I get. I had assumed that the less psychoactive occasions were ok because the liver was bypassed but the medicine still got absorbed by the rectal blood vessels, travelling to the tumors Do you think it would be fair to say that the ‘higher’ experiences where thc is so obviously in my bloodstream are probably as effective as orally taken CO when a similar high is obtained? I suspect that there are various extenuating factors with rectal application giving different results on different occasions.

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Allan Frankel, MD
January 29, 2016 5:17 pm

Of course I can only speculate, but I think you bring up a very interesting point. There is no question that the serum level, for any given patient, is related to the “high” that is felt.

Thanks for the interesting comment.

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Geoff Holland
February 5, 2016 6:19 pm

I believe all this suggests that rectal administration with no high may be a waste of time and oil. I know you have done tests on two subjects, but is there anything else that makes you certain that this is so?

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Allan Frankel, MD
February 5, 2016 7:51 pm

I just don’t know yet for sure. However, if a few more tests come back at near zero, I will have to make that conclusion.

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Carly Stephens
February 7, 2016 4:29 am

Dr, Frankel.
Thank you for so much wonderful information. My husband has Stage IV Colon Cancer that metastasized to his liver. It developed very quickly and within a weeks, his liver was covered with over three dozen tumors. August 1, 2015, he began taking Cannabis Oil (from initially a grain of sand-sized dose to quickly moving to a gram and a half a day, taken orally, After twenty four days on the treatment, his doctors were stunned. His liver showed unbelievable regression. He was left with fewer than one dozen, and over the next few months, the tumors continued to regress. His January scan showed just a couple of “micronodules of metastasis”

Unfortunately. not all the news was good. His pelvic and abdominal lymph nodes continued to grow, so chemo was added. Then after two months of this treatment, my husband’s lymph node growth had become a cancer mass the size of a deflated football. Chemo was stopped right immediately. During all of this, we have continued with the oral cannabis oil, both THC and CBD, which is likely why the continued possitive liver results, and but obviously a more effective delivery method was in order. So, of course, we are now using the suppository method and the oral method. I am mixing the THC and CBD Oil with coconut oil to create the suppositories.

Doctor, I am really interested in the reasoning behind your idea that one gram per day of the oil is not optimal. Is this something that applies to patient currently battling active growing cancer. So much of what I have read makes the argument that the gram a day protocol is best for cancer fighting and that seems to be even more true for patients with Stage IV,

We are looking for a method about that will provide our best hope for beating this which they say cannot be beaten. I want to make sure that we are selecting the optimal dosage and delivery method. Using your recommendation, how does this change long term maintenance plan. We have planned that in order to keep Scott’s cancer in control he would probably need to remain on some oil regimen forever.

What is your recommendation for use of the oil, once it’s knocked out the cancer. Can you tell me what are the reasons for keeping to half a gram, rather than a full? Dangers, negatives, whatever might be important to know.

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Allan Frankel, MD
February 15, 2016 3:25 pm

I believe a gram per day is a LOT of medicine and I don’t understand why it is so popular. I think it is just the lack of data. I would consider setting up an educational phone call with me? We can review a LOT of issues in an hour phone call

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Carly Stephens
February 9, 2016 1:09 am

I had posted a rather long message with several questions and now it is not here. Was the post somehow too complex, since I asked so much? I am looking for some guidance regarding the use of THC+CBD/coconut oil suppositories.

I would like to know what is the ideal dose of THC when fighting actively growing cancer in the lymph nodes and retroperitonium.

The oral THC OIL seemed to almost beat the liver metastasis, so I have high hopes for the suppositories and this mass. Will doing radiation negatively effect the ability of the suppositories to work.

Also, can you talk about the reason for a lower amount of THC oil versus the one gram a day we hear about constantly

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Allan Frankel, MD
February 15, 2016 3:21 pm

Please call my office for an educational consultation. As you say, this is a bit too much for a blog response and I have to be careful on many levels

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Susan Rutherford
February 17, 2016 11:45 pm

What are your thoughts on adding one drop of wildcrafted or organic pure frankincense essential oil, to a 25 mg dose of 1:1 ratio THC to CBD cannabis oil taken orally 3X a day, so, 75 mg a day total, for treating cancer? Also, what are your thoughts on doing the above and taking it for 90 days, as a preventative measure to “nip it in the bud” for any cancer or disease process that has not manifested yet, but could possibly be brewing?

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Allan Frankel, MD
March 1, 2016 12:36 am

Everything that I have read on Frankincense has been positive. I would encourage pursuing this. I need to learn more, so if you read some great source, please copy me?

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Susan Rutherford
February 17, 2016 11:49 pm

I have also heard that it is not so much the amount of cannabis oil taken, but the frequency that it is taken is more important, to keep a constant amount in the bloodstream. In other words it is more effective to take 25 mg of cannabis oil 3X a day than 800 mg taken 1X a day, say before bed. Your thoughts on that?

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Allan Frankel, MD
March 1, 2016 12:36 am

As with any medication of any kind, both dose and frequency are critical. I would never take 800 mg!! that is a crazy dose of either CBD or THC. The general effective doses of CBD/THC per day range from as little as 20 mg daily to 75 mg per day…a far cry from 800.

Also, it depends how the cannabis is administered. If it is oral, twice daily or every 12 hours is generally just fine. If it is a sublingual dose, it needs to be taken eery 3-4 hours. Smoked or vaped every 90 min to 2 hour. So, there are a lot of variables

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Can you please settle this debate for once and for all? Does rectal dosing of cannabis help brain tumors?

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Allan Frankel, MD
March 1, 2016 4:56 pm

I do not think so. None of the information I talk about is “final”. It is a process, but my personal thoughts are if no cannabis goes to the brain, how can it be effective. I believe the correct way to deal with cancer and thc psychoactivity is to add a lot of CBD…better than rectal administration

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Allan Frankel, MD
March 2, 2016 7:10 pm

I don’t think it does

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Hi Dr. Frankel. This blog is amazing. I’m learning so much. My husband was just diagnosed with Non-Hodgkins Lymphoma. We are waiting for a referral to find out how advanced but he’s had a biopsy to remove two lymph nodes in the groin and armpit. This is all quite recent but he’s started taking CO both orally and rectally. And is smoking it, as well. He eats far less than he’s taking rectally (as the high is too much). I’m making the suppositories smaller than I was (was making them with coconut oil & 1/3 gram CO x2 a day. Now I’ve decreased that to less CO x3 a day.) Would you suggest anything different at this point. We don’t know any details yet other than it’s NHL. Thank you for any information.

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Allan Frankel, MD
March 11, 2016 5:22 pm

We should talk either in person with your husband or if you are not local to LA, perhaps a phone consult. Rectal cannabis just does not seem to work

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Terra Moravcik
March 12, 2016 4:42 pm

Heli Dr. Frankel,
How do I go about booking time to speak with you ?
My mom is currently taking 1 to 1 for triple negative breast cancer. I was recently told by our oncology nurse that the back door method is found to no longer be effective for breast cancer.

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Allan Frankel, MD
March 12, 2016 5:42 pm

Just call my office at 310-393-0640. I am curious about your oncology nurse and how she learned about the issues with rectal absorption. Does she know me?

BTW, we have had a lot of good results/outcomes treating triple negative Breast Ca.

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Hugo Andres Gutierrez Martinez
March 13, 2016 3:13 pm

Hi, Dr. Frankel. My name is Hugo Andres, i’m from Colombia. My mother was diagnosed with IV stage breast cancer, multiple lung metastasis. She is in chemio since jan-2015, and refused surgery after we removed this big tumor with a homemade black salve, no lymph nodes involved. Now, we are focused on the lung nodules, using cannabis oil, RSO recipe. Marihuana is ilegal in my country, but is very cheap, maybe USD$40 per pound. So, now we have 150 cc of pure oil. In second week of the therapy, she could resist this dosage: 3cc pure oil, rectal administration once per day, no oral ingestion. She is not feeling high or stoned. What do you think we can achive with this very high dose?

Colombian regular marihuana is 3-4% THC or CBD, and a 1:1 proportion. Our extraction yield was 10% w/w. So, we think each mililiter may have 250-300 mg of THC and CBD. That is way we opted for a high dosage, no thing else. Thank you so much.

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Allan Frankel, MD
March 15, 2016 11:58 pm

I truly doubt that much if any cannabis is rectally absorbed. I realize you avoid the stoniness, but this is because it is not absorbed.

I would give her total cannabinoids in the range of 100 mg and split them between T and C.

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Hugo Andres Gutierrez Martinez
March 13, 2016 3:32 pm

Excuse me. I forgor to tell you we used pure DMSO as solvent, equal parts. Maybe we are wrong with de THC and CBD quantity in each milimeter.

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Allan Frankel, MD
March 15, 2016 11:56 pm

Not sure and I have no experience with DMSO

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Marelyn Shapiro
March 17, 2016 7:15 pm

Demo burned my skin.

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Is Marijuana Safe During Pregnancy? – Medical Marijuana
March 17, 2016 2:20 pm

[…] the conventional medical community will suggest this because the effects of a cannabis suppository, even rectally, might risk the baby getting high and affecting the heart rate. Another question is whether […]

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Mmj activist
March 18, 2016 4:22 pm

I see you do not like dosing cannabis at a gram plus a day. This is the opposite of advice normally given by cannabis activists when treating and killing cancer. Have you ever successfully curd anyone with these low dose protocols? And I do mean cancer patients no other disorders.

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Allan Frankel, MD
March 23, 2016 10:04 pm

I don’t use the “cure” word. There are many patients on various doses and ratios of cannabis for cancer and sadly, many of them die; more die than don’t die. I have seen many patients where their tumor burden has reduced or is gone. I.e., we have many patients whom we are following for years.

In addition I just don’t buy a dose of cannabis that makes people so ill. It does not make sense. In addition, the old adage “the more the better” is just not true for cannabis. It is clearly a “bi-modal” medication and high doses often have entirely opposite effects of low dosing. For example with pain, studies at UC San Diego have shown more benefit from low doses. In addition, high doses of THC generally suppress appetite and low doses stimulate it. Ultimately, with high enough of a dose, people not only don’t eat, they are nauseated.

Perhaps give my office a call?

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The general idea is to start low with dilutions as high as 120:1 carrier oil to cannabis oil and work up to a gram a day. Slowly deceasing dilution and increasing cannabis frequency as is comfortable. It’s crazy to start right off at a gram a day.

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Claudia Davis
March 18, 2016 7:21 pm

Where can I find cannabis oil ..husband diagnosed with pancreatic cancer – chemo is so harsh on his body Please help me….Keep hearing about suppositories well

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Allan Frankel, MD
March 23, 2016 9:56 pm

Rectal cannabis sadly does not work well at all. very minimal absorption. Perhaps a phone or in person consult would help you with dosing as well as using a reasonable oil that will help your husband feel better and also kill cancer cells

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Can one take ginseng with RSO? My mom is tired all day even after taking the beginner dose orally. We are trying to work her up to 1gm a day but not sure she will be able to.

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Allan Frankel, MD
March 23, 2016 9:54 pm

The Ginseng is not a problem. I am not in favor of the dosing with RSO. I think it is way, way too much THC. You might contact my office?

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My mam was diagnosed 1 year ago with stage 4 secondary lung cancer (given 5-7 months to live) and cancer has now spread to lymphs & stomach.She started cannabis oil sopositaries today. Do you think this oil (from Amsterdam) will help at all?

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Allan Frankel, MD
March 23, 2016 9:46 pm

It is pretty clear now that cannabis is not well absorbed rectally. There are some alternative delivery means both orally and by inhalation. I would suggest an office consult to discuss details……there are alternatives.

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Thank you Doctor for your wonderful and care giving nature.
I am considering oil after herceptin for stage2, grade 3, HER2 breast cancer…cancer (Breast) all removed, no lymph cancers found. CHemo stopped since I could not tolerate. Herceptin only now. I am stopping herceptin at 6 months instead of recommended 12 months due to heart risk and limited efficacy gain. I am considering 1:1 oral. Is 2 grams per month total correct for no active cancers known at this time? Thank you very much Doctor.

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Allan Frankel, MD
March 29, 2016 4:14 pm

A 1:1 with approximately 100 mg of total CBD and THC per day is reasonable. I would take orally in capsules

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Thank you very much

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Dear Dr. Frankel,

About 2 months ago I started a 5:1 CBD:THC cannabis oil for asthma. I was having daily symptoms so I began taking about 1/2 rice grain size dose in a suppository 3 times a day so as to get as little psychoactivity as possible. The first month I felt incredible, my asthma symptoms went away, my mild anxiety disappeared, my moods felt balanced, my energy was great and I felt more loving and patient with my family than ever before. After the first month my asthma symptoms started coming back and my moods and energy did not feel quite as good as before. I also started getting constipated even though no changes had been made to my diet. My asthma is still much more mild than before starting CO but I’m confused as to why my symptoms came back and why CO would make me constipated. I tried a 31:1 recently but that did not help the asthma. I am wondering if I should try switching to sublingually? Any suggestions would be greatly appreciated. Thank you so much for your time.

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Allan Frankel, MD
March 29, 2016 4:26 pm

I think this is a bit too much for an email response. You might consider calling my office and setting up a time to talk?

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Thank you for all of the wonderful information on this site. I have been battling a rare cancer (carcinoid and adenocarcinoma in the same cell) since age 24. I am now 37. The primary origin site I known but my first metastasis was to the liver in 03′ and all off my other metastasis have been to my lungs over the years. I’ve had liver surgery and 5 lung surgeries and tries numerous chemos. I am now at a point (due to the fact that this new tumor in my lung is aggressive and is surrounding my pulmonary artery) that I am trying numerous alternative treatments and now getting ready to try cannabis oil. My question is: if I want to take it rectally to avoid the psychoactive effects and try to take in more, can I do it just with a syringe without using coconut oil or suppository? It just seems like that would easier. If so, it seems that knowing how far to insert the syringe is very important to have it bypass the liver? Also if I have a 1 gram syringe and am just starting out, what is the best way to get the cannabis out and in a new syringe to use?

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Allan Frankel, MD
April 18, 2016 8:40 pm

There are MANY issues to discuss. As this is a serious issue, I would certainly take the dosing seriously. Rectal administration avoids psychoactivity because virtually none is absorbed. If you can, I would advise calling my office and setting up a consultation?

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Dr. Frankel, my husband is taking Rick Simpson oil for an aggressive prostate cancer (Gleason 8.) He can’t get enough orally to be effective, it is just too much high. He wants to try rectal dosing. We have 80% THC oil to use. Will any of this reach his prostate or is it a waste?

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Allan Frankel, MD
May 11, 2016 6:16 pm

It is a waste. I would way prefer seeing him use a MUCH lower dose and a combination of CBD and THC. I am not a big fan of the huge dose of THC in the RSO. Just don’t see a reason for it and we see patients do very well on much lower doses. Sadly, rectal absorption just does not work. Period.

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Janet Johannsen
May 18, 2016 12:13 am

Hi Dr. Frankel,
I have seen some opinions online that say to take curcumin supplements (turmeric) apart from cannabis by about 6 hours. Do you have any information on this?
Thank you.

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Allan Frankel, MD
May 24, 2016 4:24 pm

No I don’t. I have some sources to check it out, but my initial gut reaction is that it does not make sense. If someone uses a cannabis edible or capsule, the effects can last for 10-12 hours. Would this mean that if you use oral cannabis you need to separate the tumreric by 12 hours. Frankly, it makes little sense to me

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Can you also use this way of consuming with weed/ the dried flower somehow ? 🙂

thank you for your advice 🙂

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Allan Frankel, MD
May 24, 2016 4:37 pm

If there are NO OPTIONS, that is always worth a try. The real issues with smoking are not the health issues of smoke, although this may be a minor issue. the issues are:
1. You don’t know what you are smoking
2. You don’t know how much you are taking; every breath is different and is not a dose
3. You may only get effects for a very short time as smoking is rapid onset and rapid out.

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Douglas Griesenauer
May 25, 2016 9:25 pm

My wife has breast cancer that has metasteses to the liver. She has had a mesectemy . Her breast cancer is Erpr + Her2-
Would you recommend she take orally or suppository. What dosage and mix.
Thank you Doug

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Allan Frankel, MD
May 27, 2016 4:29 pm

I don’t think that taking cannabis rectally works at all. Oils in general are just not absorbed rectally. I would suggest oral for most patients, but there are other options as well, for example, if there are lung metastases.

Consider calling my office at 310-393-0640

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Really? I was under the impression that rectal administration was much more bioavailable. This goes against everything that I have read.

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Allan Frankel, MD
May 30, 2016 5:53 pm

Nope. The ONLY study out there is quoted in my first “rectal administration” blog, that molecular THC when bonded chemically with Hemi-Succinate does get absorbed. Other than that, there is no article that shows whole plant cannabis is rectally absorbed. If you know of a good study, please, please send it to me. However, it just can’t be someone’s experience; Needs to be more.

Don’t you find it strange that we expect full absorption and yet do not feel the effects of the THC? Serum levels or blood levels of THC are directly related to how “stoned” someone is. The higher in the serum, the higher in the brain. There is no question of this.

Why would it get absorbed and not cause psychoactivity?? Every other way we use cannabis, it is clearly absorbed, there are documented serum levels and patients feel the effect. This is true even topically.

If in fact, the cannabis were absorbed rectally, it would go through both the portal/hepatic venous system as well as the systemic venous circulation. For the portion that in theory would be portal, we would expect a delay and a very stony effect. For the part that is absorbed into the venous circulation, it should be a fast response.

In fact, we see none of this. One caveat, the old stories where hash was hidden rectally when the bags broke and patients got stoned, clearly shows that at SOME level it is absorbed, but this is with many grams.

Finally, any evidence you have, I would love to read. I wish it worked better.

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My GF is dealing with stage 4 breast cancer. Our MMJ consultant has her doing 3 doses of RSO sublingually per day (approx. 10 ml. each). She hasn’t been able to increase the dose.

The consultant also assembled a 4-week supply of suppositories mixed with black seed oil. They double every week. Now, in week 3, she is at 55 mg. CBD, 21 mg of CBN, and 84 mg of THC.

Lat night after an hour she had to use the bathroom and lost some of the oil. Is it possible that it had all been absorbed by then? Any thoughts? Thanks!

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Allan Frankel, MD
May 30, 2016 5:56 pm

Rectal cannabis is used all the time to avoid psychoactivity. However, the REASON for no “stoniness” is that it is not absorbed. I am sorry to say it is a waste, regardless of how popular it is.

At this point, I am not a big fan of CBN, although I will await more information.

Is there lung involvement? Liver involvement? Brain involvement? All of these will often change how we deliver the cannabis.

Consider calling my office for a phone or in person visit?

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My husband has stage 3 pancreatic cancer. His on 1:1 CBD: THC 1 gm suppoisitories a day. Because he couldn’t tolerate oral dose. Do you think he need go back by mouth instead suppositories?

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Allan Frankel, MD
May 30, 2016 5:44 pm

Rectal is sadly not effective. However, a gram a day is a ridiculously high dose and not needed. I realize this is popular due to the “RSO” deal, but we have been working with MUCH lower dosing for a number of years and all is going pretty well. Most docs around the world do not suggest dosing of a gram per day.

Consider calling my office for a phone or in person consult to work out a rational plan

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Hi,
My mom has Stage 4 – Inflammatory Breast Cancer HER2 positive. She has been taking THC/CBD suppositories(1:1 ratio) twice a day (300 mg each) for about 4 months, and I don’t think it’s working, because the cancer has now spread to the mediastinum (middle of chest) and right lung, causing water to build up(pleural effusion). I’ve read that you suggest 80 to 100 mg CO orally a day for breast cancer, instead of rectal administration, do you think this amount can help decrease the amount of water that is forming in the lung? You also talked about vaping. Would you recommend vaping, if she has water in the lung? (The doctor put in a catheter in the right lung area, so we drain the catheter every few days.)
Thanks for your time.

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Allan Frankel, MD
June 1, 2016 2:42 pm

I would consider calling my office for a consult in person, if you are local, or by phone. There is a LOT to discuss

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Dear dr. Frankel,
Finally we are clear about the fact that thc is not rectally absorbed (except for thc-hemisuccinate, which historically may have caused the misconception).
Unfortunately most people only read/skim the beginning of this webpage and some conclude that rectal CO can be used (without reading all the replies). Why isn’t your conclusion from your labtests about bioavailability of thc after rectal administration posted clearly in the Beginning of this webpage? There is so much wrong information about this everywhere online. I personally know someone who has consumed massive amounts of CO rectally 3x/day for over 2 years in the hope to cure his cancer and now he is going to die. He didn’t know he has just been wasting effort money and precious time by doing this, only because too many irresponsible articles online state that rectal is even the preferred method of administration.

For the people who still think rectal is the way, already in 1985 there has been a study which showed that the bioavailability of rectal thc is Zero:
http://onlinelibrary.wiley.com/doi/10.1002/jps.2600740213/abstract

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Allan Frankel, MD
June 1, 2016 2:40 pm

Thank you so much for the reference. If you don’t mind I will post it. May I quote you as a “blog reader”

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Vincent van Maanen
June 7, 2016 4:27 pm

Sure you can.
I’d like to add to my previous argument another relevant studie. It seems clear that the non-polar form of thc won’t be absorbed rectally, but also various polar esthers of thc have been studied and it appeared pretty difficult to make it bio-available using suppositories. http://www.sciencedirect.com/science/article/pii/0091305791903534

Also I hope you will address the issue that many people who read this webpage (beginning @ feb 2015), still read that you say that thc is being absorbed rectally.
This misconception is being repeated again and again everywhere (without any scientific backing), and people believe it because of all cannabis advocates repeat it.

I understand from your posts that you have done thc bloodlevel readings from patients after rectal administration. Maybe your own research is pretty unique and deserves to be outlined more clearly to the general public, so that maybe more and more people can hear the scientific truth. How you have done your research and why the unpopular conclusion is inevitable. To measure is to know!

For me personally, now it is finally explained clearly why people experience no psychoactive effect after rectal administration.

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Allan Frankel, MD
June 7, 2016 6:34 pm

Thanks again. I have posted on this a number of times, but more good data is great.You are correct, people don’t seem to pay attention or perhaps I need more blog readers?

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Margaret Reid
June 11, 2016 5:18 pm

Dear Dr Frankel:
Do you have any articles on treatment of liver cancer with cannabis? Also could cannabis cause alt and ast levels to go from normal to very high when using? Thank you dr.

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Allan Frankel, MD
June 13, 2016 6:34 pm

It depends upon what you mean by liver cancer. Are you referring to primary liver cancer or another cancer with metastases to the liver?

Cannabis does NOT increase the alt and ast

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Margaret Reid
June 14, 2016 3:19 pm

Thank you dr. I meant primary liver cancer. After about one month on rso the alt went to 200 and ast 87. Then at next blood work it went down to normal. And he had been off the oils about two weeks. Also has prostrate cancer . I appreciate any idea you may have on that.
Margaret

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Allan Frankel, MD
June 14, 2016 7:52 pm

There are so many things to consider. I would suggest an educational phone consult or come in for a visit. Call 310-393-0640

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What’s another way you can take the oil orally? On top or under tongue? I have COPD, is orally or rectally recommended?

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Allan Frankel, MD
June 25, 2016 4:51 pm

With COPD, I would vape a 50-50 CBD/THC oil

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Natalia P H
July 4, 2016 10:08 am

Hi Dr Frankel.
I have read your article and all of the comments and and now a little worried as I have been giving my father cannabis oil suppositories for 4 months now having been told this is the best method to treat his cancer given a) its placing it near to the affected area of his body – prostate, soft tissue surrounding his testicals and pelvic lymph nodes and b) more is absorbed compared to taking orally as it doesn’t get broken down by stomach acid. It now appears this is not true?? He does take some orally also but only 2 -3 portions the size of rice grains spread out throughout the day. Surely then this isn’t enough to have any effect other than some pain relief? He spends a lot of time sleeping and has zero energy. He has also lost all the strength in his left leg due to a tumour in his pelvic lymph node pressing on his sciatic nerve and causing him great pain! He also has some tumours between his legs and so he cannot sit down. Are you able to offer any advice please? Thank you

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Allan Frankel, MD
July 7, 2016 5:35 pm

I would encourage setting up a phone consultation. I treat a lot of GBM patients, mostly referred from UCLA. I think a good educational phone visit would be worthwhile. If you are local, of course you can visit the office.

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Kacee Hopper
July 7, 2016 6:40 am

Very informative, thank you! My father was just diagnosed with a single 11.5cm HCC tumor in his liver. They have him scheduled for surgery in two weeks. The oncologist feels that it is encapsulated and should be removed. He has been doing the rectal application for about a week now as the majority of everything I read suggested this. It suggested that the veins in the area would carry it to the liver. Was this wrong? Would you suggest orally or sublingual for him? How much? He has no Mets that we know of and otherwise healthy. After surgery can you suggest a maintenance dose? I know that HCC has a very high recurrence rate and would like to try to prevent that via diet and CO if possible. He is 58 years old and other than the cancer his only issue is High Blood PressurE which he is on meds for. Any advice would be greatly appreciated. While CO seems to have a multitude of benefits it is complicated by a variety of competing opinions.

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Allan Frankel, MD
July 7, 2016 5:30 pm

In general I would favor oral. Perhaps setup a phone consultation to discuss details?

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Great to see that you have made it more clear that THC is not absorbed rectally at the beginning of this page.
Table 1 in this research http://jpet.aspetjournals.org/content/318/3/1375.full shows that there are non psychoactive cannabinoids that have a stronger anti-cancer effect that THC. Do you know why these substances are hardly studied? Almost all research focuses on THC, sometimes some CBD is added in a ratio like 6:1, but in the end, the anti-cancer formula carries a strong psychoactive component, especially when one would try to reach blood-concentrations similar to what is used in scientific research. Using the practically most effective method of adsorption (oro-mucosal), it is estimated that people need 1700mg of 100% THC to reach a 6hour long sustained blood-concentration of 1uMol/L (from figure 4 in Kerri Alexandra Schoedel et al. 2011 A study of the abuse potential of nabiximols). So I am largely underestimating to say this would be a a daily dose. Most good quality black oils contains 50% THC or less, so we are talking about 3400mg of such an oil to have this concentration for 6hours. Probably 7gram/day! However, hardly any study uses this concentration, 3-7 uMol is quite usual to gain elaborate effects (21-49 gram/day). In any case, people will need quantities of THC that are unbearable.
Why isn’t the non-psychoactive THC-acid (obtained by raw juicing the plant) used in such studies?
BTW to reach 1uMol/L CBD, about 5200mg CBD is needed with oro-mucosal Nabiximol/Sativex spray.

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Allan Frankel, MD
July 9, 2016 4:37 am

Thank you so much for your study and work. The only issue I have is that most of the studies showing grams of CBD being necessary are NOT whole plant. There is a HUGE (as trump would say) difference. There are articles showing that the dose of CBD IV needed for anxiety is 600 mg. Clearly, with whole plant CBD this is an over the top dose. I tried once to ingest 600 mg of whole plant CBD; I had an out of body experience.

The dose of Epidiolex for seizures is four times the dose I find needed and I have never seen any data nor seen any clinical evidence that dosing of CBD/THC is in any way related to body mass.

So, there is a lot to learn and we just must compare Apples to Apples

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Allan Frankel, MD
July 9, 2016 4:42 am

PS

As there is reasonable In Vitro data that all major cannabinoids have anti-cancer effects. I have plans on using a 1:1 plant and decarb 1/2 of the oil by weight, thereby giving all four major cannabinoids along with, of course, any/all minor cannabinoids/terpenes that can be extracted without destruction….a big issue

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Wiliam Knapp
July 10, 2016 12:13 pm

I have early stages of prostate cancer. In my present position I am unable to function professionally while under the influence of cannabis. Just recently I started using Rick Simpson oil in a gelatin capsule rectally. In reading your recent blog I was unsure as to whether or not this was an effective method. Please advise.

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Hello Dr. Frankel,
I am a 52 yr old man who was diagnosed with HIV 2 yrs ago. I became undectable within one month of my diagnosis as my infectious disease doc. recommended meds before my t-cells went too low or my viral load went to high (I was 1000 viral & 800 t-cells when I started) and as mentioned within one month my viral load was undetectable and my t-cells went up above 1100. Now, I recently received notice that my last anal pap came back positive and my PCP wants me to have a biopsy which is scheduled for September 13th. 2016. After reading online I understand most anal cancer in people in my circumstances is much higher then in most and caused by HPV, which I expirience as anal warts in my 20’s. My question for you is, should I begin using cannabis suppositories prior to getting a biopsy. I am a firm believer in taking action as soon as I am aware of an illness, even if it’s precautionary. Please advise.

Thanks so much.
John C

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Allan Frankel, MD
July 18, 2016 4:57 pm

It seems that rectal therapy just does not get well absorbed. It certainly cannot hurt, but I am uncertain of the benefit

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Dr. S (email for contact details)
August 2, 2016 4:52 pm

Sir, I must disagree with your note stating that unmodified cannabinoids do not “get well absorbed” by the rectal ROA. It is true that the cognitive and behavioral side effects which can be a dose-limiting factor in oral or inhalation therapy are reduced – but they are still present. Conversely, the desired anti-inflammatory, anti-neoplastic, antidepressant / anxiolytic effects (… etc …) are magnified relative to oral ingestion. A patient who I am treating for IBS along with depression / anxiety experienced partial relief of symptoms, but could not tolerate the cognitive dulling caused by a custom-compounded oral formulation containing just 10mg of THC, 9mg CBD, and made with strains known to have minimal effects on cognition – not only was she “way too high” to focus effectively on her studies, she could not safely drive a car to get to her classes at the university.

An identical dose of the same formulation administered rectally provided the patient with PROFOUND subjective and objective relief of physical and emotional symptoms – with greatly attenuated side effects. Patient reported that she feels “a bit too happy” but is able to focus and work productively; I evaluated her driving skills in a safe location and we both agreed that she was driving safely and normally. Patient has continued on this regimen (10mg THC / 9mg CBD per rectum TID) which has remained effective and well-tolerated for over 30 days.

Dear Dr. Frankel, you got it right the first time! Give yourself a little credit 🙂

Respectfully Yours,

Dr. S – Toronto, Canada

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Dr. S (email for contact details)
August 2, 2016 4:59 pm

PS. It may be that the extraction and decarboxylation procedure used and/or the composition of the carrier oil makes a difference to pharmacokinetics with rectal admin. This particular formulation involved simple dry-heat decarboxylation at 235f for 30 minutes followed by extraction into organic coconut oil (2 hours at 210f, double boiler / water bath setup). An additional benefit of this method is that it can be performed by the patient in their own home after minimal training and does not present a fire hazard.

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Allan Frankel, MD
August 3, 2016 9:00 pm

Well, we have done some very simple studies giving 100 mg of thc rectally or orally. The serum levels after rectal administration were 2 ng/ml, or less than the legal level in several states.

In addition, multiple studies duplicate these findings. Another way to study this, but not pleasant, is to send stool samples for THC/CBD levels.

Time will tell. I am not closed to this route and do sometimes use it, but we are also doing very, very well with extracts and/or capsules.

With regard to homemade oil, I have a different approach which works out great. Many, many patients cannot afford “dosed” co2 extracted cannabis medicine. Our seizure kids, for example, mostly cannot afford the medicine. We introduced a “one plant….one child” program four years ago. The collective gives the patient six Wide Ratio CBD plants, whose genetics is well known to us. They receive them as teens, stick out in their yard and finish a nine week flowering cycle. The patients then return the plants and depending upon weight of the plants and the needs of the patients, they are just taken care of.

Of course, this was the original plan for medical cannabis, but American retail/wholesale took over.

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Allan Frankel, MD
August 3, 2016 9:02 pm

I always appreciate various angles. I don’t entirely avoid rectal administration, but in the end, so to speak, we find oral buccal and oral and soon, topical, to take care of most needs. Psychoactivity is dealt with by starting with a wide ratio CBD:THC if patient is THC sensitive. Then every two weeks, go to 4:1, 2:1 and finally 1:1. Patients tolerate it very well and clinical responses seem reasonable and at times exciting.

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Hello Dr Frankel
A dear friend has stage 3 or 4 collecteral cancer (7cm tumour) and has just finished oral chemo and 25 days of radiation. We have sourced some lab tested oil (ratio of 1:1 cbd & thc). We have got 60g. We were about to make it into suppositories using cacao butter and coconut oil but now I’ve read the latest comments, I’m stuck as to where to go from here. I’ve taken on board that these low serum levels mean it’s not doing its job. My friend has had an illeostomy. Can you please offer us some advice as to the method of taking it? Sublingual, orally or rectal?
Many thanks
Best regards
Adam

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Allan Frankel, MD
August 4, 2016 5:53 pm

It is a bit more complicated than taking a couple of aspirins. I would encourage you to call my office and setup an hour phone consult or setup an in person consultation if you are more local

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What about vaginally?? Will it work vaginally for tumors in the brain and on the ribs and breast?

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Allan Frankel, MD
August 18, 2016 4:16 pm

According to my contacts who have studied this particular issue, there is minimal vaginal absorption.

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Hi Dr. Allan Frankel
I am deciding the rout to take my RSO and need to ask if taking it up the bum will get to my cervix??? This is really getting confusing, i read the whole thread and been studing for days. It seems you do sometimes condone the back door if it is for localized threament, dose this include the cervix? Thank-you for all you do

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Allan Frankel, MD
August 25, 2016 4:07 pm

Cannabis oil as well as any other oil is not absorbed rectally. There MAY be some minimal absorption, but I would suggest using CBD:THC balanced capsules. Precisely which one, would depend upon a lot of factors, which if you are interested, we can decide together over a phone consultation. Hope to hear from you.

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Hello Dr Allan,

My mother has been using Co for Stage 4 Breast cancer (ER/PR+, Her-). She has been taking the oil orally and is currently at 11 rice grains of THC (80% potent) taken at night. She also takes CBD oil (30% potent) about 50 rice grains – 3 times a day.
Since her mets are in the ovaries, omentum and peritoneum, We are thinking of adding vaginal suppositories. Do you think she would benefit from the suppositories? What dose would you recommend?

Thanks,
Sowmya

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Allan Frankel, MD
September 12, 2016 5:43 pm

I don’t believe that vaginal nor rectal absorption is predictable. I would also strongly suggest adding CBD. You can reach my office at 310-393-0640

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Cannabutter made with organic butter (dairy cow source) – can it be used safely as a suppository? Or is there a reason no one seems to make suppositories from butter?

Also if delivered rectally what distance into the rectum will be the least psychoactive? Would have thought from the diagram that the further in its inserted the more psychoactive it would be due to being near the vein that goes to liver.

But if cannabutter thc is not being absorbed rectally in any case no matter what distance its inserted – what is its mode of action and how is it giving some people relief – for example is it other cannabinoids and terpenes that is causing whole body pain relief?

Appreciate your expertise and educating the community about these methods.

Luke

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Allan Frankel, MD
September 19, 2016 6:09 pm

I think that there is a very small amount absorbed which is often plenty to feel a modest effect, which is clinically good. However, nearly all of the suppository cannabis is NOT being absorbed and just wasted.

You might consider calling my office or setting up a visit, as the best way to do what you want is with a combination of cbd and thc in small doses

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Hi there! I have problems with spasms and stiffness in my back (lower and upper) and under arms and in upper arms. How should i take the oil? rectally or orally or both? Thank you so much! Geneve

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Allan Frankel, MD
October 4, 2016 4:34 pm

There are too many unknowns for me to be helpful. To begin with, do we even know what the oil is? CBD? THC? mixture?. If you read more of my blogs on rectal administration, you will find that I have ultimately found that rectal absorption is just not an efficient method of delivery. There is only trace amounts of absorption.

If you are local, I would advise an in person consultation. If you are remote, consider a phone consultation. Experimenting with oils that are unknowns is not the best way to medicate oneself

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Hi Dr Allan

My Dad has been diagnosed with terminal stage 3 liver cancer, there is nothing else the Drs can do as he also has sclerosis of the liver so they can’t operate on it. We have decided to get him some cannabis oil and the company we are purchasing from have advised that we get suppositories and do 1g per day. Apparently a lot of their patients /customers have tried to do 1g per day orally and give up because they can’t cope with the psychoactive effects so they now advise people to take suppositories. I noticed that you kept mentioning that suppositories are processed by the liver so for someone with liver cancer is it more beneficial to take via suppository or orally?

Really appreciate and help of guidance.

Thank you 🙂

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Allan Frankel, MD
October 4, 2016 4:42 pm

I would strongly suggest setting up an educational phone call. The high dose THC oil, whether used orally or rectally is just not a good idea. The rectal administration just does not work. I have written a lot on this and we have done studies measuring blood levels of thc and cbd after high dose suppositories.Patients do not get stoned because nearly none of the THC/CBD is rectally absorbed. I believe over the phone, or of course in person if you are local to LA, will help you obtain a more sane dose that will also help him feel better. Using such high THC doses, is tough to tolerate for nearly anyone and I believe that lower doses with more CBD than THC is a better regimen

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So I am confused, are you saying it is LESS effective to use the RSO rectally? We have been advised to do it that way because they said more is absorbed and you don’t get as high. But if I understand correctly, you are saying you don’t get high because it is not being absorbed? So it is a waste?

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Allan Frankel, MD
October 11, 2016 5:57 pm

Yes. I feel it is mostly a waste. Check out a number of my blogs on rectal absorption. If it were absorbed, we would see blood levels and patients would feel stoned. If it never makes it to the bloodstream, how can it work? It MIGHT work for local disease such as prostate or rectal cancer. However, even then I suggest patients take cbd/thc orally.

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Dr Frankel, firstly, thank you so very much for your research and this blog. You are providing a service which is nearly impossible to find elsewhere.

I was diagnosed with stage 2-3 rectal cancer in January of 2016. I had a 5cm x 4cm tumor approximately 1″ up inside my rectum and it had gone through the rectal wall and attached to the prostate. I went through 6 weeks of chemo, (5fu), and radiation in February. MRI in late May showed about a 40% reduction yet, tumor was still to big for resection. Honestly, I’m scared to death of the suggested surgery and the affect it will have on my quality of life….. In October I started chemo again with folfox (sp?) … half a day in a chair and 48 hours on a bag pump every two weeks.

Based on my previous research, I started cannabis and coconut oil suppositories two weeks ago. I suspect what I have is low quality as it was made with approximately 3 ounces of “trimmings” and one pound of coconut oil “simmered” for about 24 hours in a crockpot.

Sorry for the lengthy lead up….

My questions are these:

1) Since my tumor is right about where the suppositories are placed, am I getting in medical affect, ie – cancer cell death, with the suppositories, even without high absorbtion in the blood stream?

2) Should I be doing something else to cure myself without surgery? (There has been no spreading or growth of my cancer, based on an October MRI when compared to previous ones.)

Again, thanks for your time and helpful service.

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Allan Frankel, MD
January 11, 2017 12:18 am

If you are going to skip traditional therapy, which I often have some mixed feelings about, you should, as you are talking about, getting on a serious cannabis regimen. This will include CBD/THC and THC-Acid. Perhaps setup a time for a one hour consultation. I include a number of follow up messages for questions as they arise and are no charge. The consultation is one full hour and costs $300. The office phone is 310-393-0640

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Thank you for your response Dr. My husband will be thrilled!

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Hello,
I have ulcerative proctitis. I have just started to have a flair up. I have been taking THC rectally with coconut oil. I am reading here that this is not getting absorbed. Is this correct? I am also taking THC and CBD orally about 10mg each twice a day. CBD in a tincture and THC in a capsule. What would you recommend for me? How do I get THC-HS? Does it have to be and indica or sativa or does it matter?

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Allan Frankel, MD
November 4, 2016 9:14 pm

I would setup a phone or in person consultation. I do think it will be worth the effort

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Kathleen Brandenburg
November 7, 2016 10:17 pm

Hello, thank you for the information. I am dealing with anal issue. Pre possible cancer. I will find out in two weeks. I am doing my research now. If an anal problem I am thinking that suppositories may be a good way to go. I will use these even if I am diagnosed clean. Prevention. I have found that 1 on 1 cbd THC is a good ratio. Will I be able to find patches in that strength?

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Allan Frankel, MD
November 8, 2016 5:52 pm

Patches are not easy to find and are pretty expensive. Why not take a Capsule? There are several companies that make CBD capsules

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Wow what an interesting read!

My father in law has Ampulla of Vater tumour. Stent in place but tumour has grown and pushing stent causing a backup of bile now. Biliary drain put in to release bile flow. Also dealing with a sepsis infection that seems to now want to go away. He is 76 and in don’t think he can handle the physco high if he takes orally. I have the 50/50 Rick Simpson oil and wondering what is should start him on. Would he benefit from rectal syringe or are suppositories better. Don’t even know where to start with doing suppositories…do they sell empty ones? I’d much rather see him try syringes. He’s down to 120 lbs and we are so worried that the sepsis will take him before the cancer. I was going to start him tomorrow on a grain of rice size but I feel it needs to get into his system faster than that and at a higher dose?

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Allan Frankel, MD
November 21, 2016 7:34 pm

This is way too much for an email. I would be happy to discuss over the phone or in person. It is very difficult to dose the thick oil, so I would be very careful with that.

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I have been on cannabis oil for six months now. I have arthritis in my spine and knees plus I have severe fibromyalgia. I cannot take the oil orally because I get to high on it. Even the low THC strain of cannabis oil like Euforia which is about 19℅ the and 56℅ cbd gets me to high to take orally. The claim that taking oil anally does not get absorbed through the colon certainly does not apply in my case. I still get high from taking the oil in suppositories, just not as much as if I took it orally. But the pain relief is just as good as ingesting oil orally. When I first started putting oil in suppositories, I put to much oil I one of them and I couldn’t get off the couch for eight hours . So in .my case, my body is definitely absorbing the cannabis when used rectally

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Have you tried adding DMSO to the suppository to maximise the absorption? I have seen it mentioned in a few reports. My wife has stage 4 breast cancer with the main tumour in her sacrum. She has been taking 1:1 cannabis oil for several weeks now.. up to around a gram a day spread over 3 doses at this point. It is definitely making life as close to normal as you could wish for…. no pain, very minimal high, very easy all round compared with any oral dosing. But we are interested in just how much is getting absorbed in terms of reversing the cancer.. Occasionally see oil in the toilet next morning for example… We did try adding DMSO to the mix but have had some issues with irritation to the outside skin… hard to pin down where it has come from…. she has had antibiotics recently for some dental work which may have triggered a candida outbreak, but when she is over this we may try adding the DMSO again. It is remarkable stuff.

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Allan Frankel, MD
December 4, 2016 10:22 pm

You might consider setting up a phone consultation. There are a few things you probably should change. I would not use DMSO orally

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Just further to my last message…. My wife has been doing coffee enemas for the last few weeks and just this morning a whole bunch of what I strongly suspect is mucoid plaque has started to come out…. thick, sticky, mucousy film in clumps and “strings” that the enemas have dislodged… If this stuff has been coating the walls of the colon it would seem like a very strong contender for what might be limiting the absorption of CO…

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Allan Frankel, MD
December 4, 2016 10:23 pm

Sorry. Just have no idea. I hope she feels better

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Hi I have been taking 500 mg rectally with no add-on Like the coconut oil for example , I’m trying to kill the cancer I have I’ve been told I need to work up to 1 g a day which I have done for 500 mg twice a day for two days now however my butt is on fire… I have had no one to turn to in this because no US doctor will talk to me about this and don’t know what to do can you help….,

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Allan Frankel, MD
December 4, 2016 10:24 pm

A lot of patients from all over the world call me for dosing regimens. Just call the office. 310-393-0640

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Oh and by the way I have been doing the 500 mg for almost 2 months now

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Hi Doc,
Is vaginal delivery method just as good as rectal? I use cannabis oil to treat fibromyalgia.

Thank you!

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Allan Frankel, MD
December 4, 2016 10:25 pm

In theory, cannabis is not well absorbed vaginally nor rectally. You might want to setup a consultation? In person or phone. I see a lot of fibro and I believe you can probably have a simpler regimen

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Paul Martin Jr
December 19, 2016 6:54 pm

We would like to test my girlfriends serum levels for THC/ CBD after taking a suppository. How long after taking the suppository should blood be drawn for this test? Also, we have a large amount of RSO already mixed 50-50 with coconut oil. If these blood tests show that we need to switch to oral administration, can she use the 50-50 mix orally, using twice as much to accommodate for the dilution?

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Allan Frankel, MD
December 25, 2016 10:39 pm

I don’t know of any local labs that will test for thc and cbd. We do work with the University of Mississippi and can send lab tests directly to them. In order to get this handled, we would need to see you as a patient in order to get the lab to Mississippi. Also, there may be other treatment options.

If you find a local lab to test thc and cbd please let me know.

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Dr. Frankel, I am a 52 yr old female with peritoneal mesothelioma. For best treatment should I take cannabis oil sublingual or rectal? What should the ratio THC/THCa:CBD be? What can I do to avoid the high effect? Thank you for your time and I hope to hear from you soon.

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Allan Frankel, MD
January 11, 2017 12:20 am

I think this is a bit too much for a blog. 🙂 I do offer one hour phone consultations.

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Hi
Forgive my ignorance but if using oil via rectal route would it still reach the bladder?
i ask as i have bladder cancer and hate being stoned.

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Allan Frankel, MD
January 11, 2017 12:02 am

I seriously doubt any would reach the bladder from the rectum. I would go with oral meds and a combination of CBD and THC and THC-A. Consider a phone consult with me at 310-393-0640

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My husband suffers from severe ulcerative colitis… he has struggled with it for nearly 10 years and has done many forms of treatment. He was taking Humira and his body developed an antibody to it so it is no longer an affective form of treatment for him. Before they start him on something far more risky we were interested in trying Canabis oil…. for someone with UC is it recommended to use the oil orally or in the form of a suppository? Also what dosage is recomended?

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Allan Frankel, MD
January 10, 2017 11:57 pm

This is best handled over the phone or in person if you are local. There is never one size fits all. In addition, when we see or speak with a patient we include no charge messaging follow up which is very important and not generally available.
This would best be handled by a phone consultation. If you are interested, call our offices at 310-393-0640

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Is it the THC or the CBD that kills cancer. I have found marijuana plants that give very little THC but high in CBD. Is a plant with low THC and high CBD just as good as high THC?

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Allan Frankel, MD
January 24, 2017 3:30 pm

Both are effective as well as other cannabinoids such as THC-A or THC-Acid. I am most excited by cannabis regimens that use both as well as thc-acid. We offer educational phone consultations. They are one hour long and include follow up messages. Perhaps consider that? 310-393-0640

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THC acid (THCA, Δ9-THCA, 2-COOH-THC; conjugate base tetrahydrocannabinolate) is a biosynthetic precursor of tetrahydrocannabinol (THC), the active component of cannabis. THCA is found in variable quantities in fresh, undried cannabis, but is progressively decarboxylated to THC with drying, and especially under intense heating such as when cannabis is smoked or cooked into cannabis edibles.

11-Hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) is the main active metabolite of Tetrahydrocannabinol (THC) which is formed in the body after cannabis is consumed. The conversion from THC to 11-OH-THC is relatively high when cannabis is consumed in the form of cannabis edibles and, compared to oral consumption, lower when it is smoked or vaped. 11-OH-THC is more potent than THC and crosses the blood–brain barrier more easily. It has therefore an imporant role in the high effect.

Fresh cannabis contains Tetrahydrocannabinolic acid (THCA), which is converted into THC after heating and then metabolized by the body into 11-Hydroxy-THC. Peak THC concentrations are lower after eating/drinking cannabis than after administration by smoking or vaping, but conversely, 11-OH-THC/THC ratios are higher after eating/drinking than after smoking cannabis. After administration through eating or drinking, approximately equal quantities of THC and 11-OH-THC are formed, whereas 11-OH-THC is a minor constituent after administration by intravenous or smoking routes. Because edible doses are processed by the liver before entering the bloodstream, THC consumed as edibles produces high levels of 11-OH-THC, while smoked cannabis, which goes directly from the lungs to the brain via the bloodstream and does not enter the liver, produces lower levels.

Now, the question is whether rectal administration leads to greater bioavailability of THC AND lower high effect because there is a much lower conversion of THC in 11-OH-THC and not because it is not absorbed.

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Allan Frankel, MD
January 24, 2017 3:08 pm

Interesting thoughts. However, when we smoke/vape cannabis there is also no first pass through the liver, yet we can get quite “high” when taking it through the lungs. Ultimately THC is hydroxylated regardless whether it is the first pass through the liver or second pass. The main difference is the length of activity. When THC is hydroxylated on the first pass it becomes seven times more “sticky” to the CB1 receptor. We can smoke or vape or “dab” and get very, very “high” but the length of time is 1/7 that of taking cannabis orally.

When taken rectally, there is SOME absorption, but just not very much at all so most is wasted.

So, the level of the high is not effected much but the duration is.

Finally, when we have done this with real live patients, the level of thc or 11 hydroxy THC in the serum are both very, very low

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Hi I live in England I’ve had rectal cancer twice now and just started on the oil ,
I’m taking 05,ml at the moment is that ok or should I take more at a time \
Tumar is 3cm inside me , thank ,

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Allan Frankel, MD
February 7, 2017 9:31 pm

Cannabis is very, very poorly absorbed by the rectum. If you tumor is present in the rectal area, some absorption into the tumor is most likely of significance. I can’t tell you the dose, as I don’t know how many mg is in your oil. Also, I don’t understand your statement saying “05,ml at the moment

Not sure what that means?

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Hello Dr Frankel
I suffer from an extreme case of tinnitus (24 hrs a day), daily headaches, diziness, facial numbness. Very anxious with frequent panick attacks. Please advise if and what sort/combination ratio of cannabis oil would help. As I live in Australia and here is illegal and not available where can I obtain it. Thank you so much

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Allan Frankel, MD
February 11, 2017 2:23 pm

The last patient I JUST responded to I wrote:
Personally, at age 66, I have had the onset of some high frequency hearing loss and some tinnitus, or ringing in my ears. I went to my ENT buddy and was told to come back in one year and see when I need hearing supplements.

My tinnitus is entire gone, except if I take too much THC. I find this last part of great interest, because it is POSSIBLE that THC increases tinnitus

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Dr. Frankel,

What would be the best way to initiate cannabis/RSO treatment for someone newly diagnosed with throat cancer? Is it better to use it as a suppository, place the RSO in the feeding tube, vaporize, or use it sublinguall?y I thought the latter two ways would be contraindicated due to this type of cancer.

Also, would you recommend a regimen similar to the original RSO, i.e. high TCH/low CBD? Thank you!

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Allan Frankel, MD
February 17, 2017 6:38 am

I would strongly suggest an office consult, or if you are out of town, perhaps a phone consult. I would not personally suggest using the RSO program. Consider an in person or phone consultation

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I have been fighting anal cancer since 2011. In 2015, the doctors told me it was inoperable and tumor was imbedded in my pelvic wall and deep muscle tissue as well as invading my bladder wall and utterer tubes. Last week I was sent home for Hospice care. I am 57 years old. I heard about Phoenix Tears and the benefit of fighting anal cancer. Living in Colorado I had no issues getting it. However my instructions to administer the drug was twice a day under my tounge the size of a grain of rice. My question is should I go the Anal route and what dose would prolong my life.

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Ps. I was also told to avoid taking steroids and hormones while taking Phoenix Tears. Hospice gave me 6 mg of steroids to take each day to help with inflammation. My marijuana source had been a woman who showed great success using Phoenix Tears this way. She was given four weeks to live four years ago.

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Allan Frankel, MD
February 17, 2017 6:32 am

I am not fond of the RSO or phoenix tears type of medication nor the dosing. I can’t give advise on something I don’t believe in

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Allan Frankel, MD
February 17, 2017 6:33 am

I am not at all a fan of RSO type oil/dosing.

Rectally administered cannabis is not stony, because it is NOT ABSORBED. Just not a way to go in my opinion

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Carla Bloomfield
March 6, 2017 8:46 pm

My doctor just prescribed me a thc suppository for my chronic endometriosis and interstitial cystitis but marijuana (If smoked) makes me paranoid. I do not like the high from pot. This suppository has 207 milligrams of thc in it and I’m afraid to try it. Any advice?

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Allan Frankel, MD
March 7, 2017 3:34 pm

Cannabis is not absorbed rectally. This has been studied for many years. Initially I thought it would work and wrote a long article on my blog. However, since then, so much more information is available. Check out my blog; just type in rectal.

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MUCH LOVE, to all of you! I hope you or your loved ones conditions improve.
Also going through these topics I read somewhere that cacao butter is less likely then coconut oil to cause diarrhea if that’s a problem. However I would need someone to confirm the effectiveness of this as I am not a doctor.

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Allan Frankel, MD
March 13, 2017 2:33 pm

Coconut or MCT oil does tend to cause some GI upset in some patients. generally it always goes away. cacao butter or even olive oil can help in these situations. At the same time, the GI upset tends to go away

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I was recently diagnosed with rectal cancer. After reading several blogs/articles I am encouraged about the use of cbd oil suppositories. But I would appreciate clear instructions on doseage and insertion for the best result.

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Allan Frankel, MD
March 27, 2017 2:36 pm

Except under special circumstances, I do not believe that rectal cannabis is absorbed thru the rectum and into the gut. I realize there is a lot of talk with regard to rectal cannabis, but we have not seen that it crosses the rectal mucosa and gets into the bloodstream. Search my website for rectal administration and take a look at the articles as well as the references.

There are a number of studies reported showing the lack of absorption. In addition, we have done some simple studies administering rectal cannabis and checking blood levels for CBD or THC. There was essentially no absorption.

That said, there are times when rectal administration can be part of a treatment plan for rectal cancer. Although there is minimal blood stream absorption, but there may be some absorption into a LOCAL tumor. I.e. If there is tumor locally, it can make sense.

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Elizabeth Turney
April 6, 2017 11:20 pm

Does anyone have PROOF that high THC is no good for estrogen driven cancers?

Thank you

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Allan Frankel, MD
April 13, 2017 6:56 pm

I doubt this proof exists. I always include THC in any anti-tumor treatment plan.

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Hi Dr. Frankel

My father was diagnosed with Prostate Cancer last year which has spread to the bones, Gleason 10. He’s been recieving Hormone Therapy for approximately 10 months now and has had 6 sessions of chemo (Docetaxyl, administered every 3 weeks).

He’s still responding to the Hormone Therapy. His last consultation revealed that his PSA is still <0 and his ALP is basically normal (although it will never go to 0).

I've recently acquired some cannabis oil caps, 100 to be precise. As I'm told, these caps are made using hash and mixed with coconut oil, no solvent has been used in their creation as it's understood it's quite harmful. My source says these particular caps are 10mg in strength, he intends to send me some 30mg strength as well sometime soon.

I'd like to get him started on these caps asap. Preferrably, I'd like him to take them rectally so as to bypass any psychoactive effect of having a large dose of cannabis. Would you reccomend this? The amount of stuff I've read on the efficacy of cannabis oil in treating cancer is encouraging. I just to make sure now we're delivering it to him in the best possible way.

Thanks very much for any advice you might be able to offer.

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Allan Frankel, MD
April 21, 2017 1:25 pm

Rectal absorption just does not work systemically. It MAY give some local therapy, but with bone mets, he needs systemic therapy. We use combinations of CBD, THC and THC-Acid.

In addition, as he is taking Docetaxol, it is likely that he could develop neuropathy from this drug and generally CBD can prevent it.

I would consider a phone consultation as I don’t treat everybody with the same dosing program.

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