Sublingual tablets aren’t available in Canada yet, but they could provide faster relief for patients
Not everyone who wants the benefits of cannabinoids wants to light up, which is where alternative methods of taking cannabis come into play. Although not legal in Canada yet, sublingual cannabis tablets look to be safer than smoking and could offer quicker relief for patients.
As another alternative to smoking or vaping cannabis, users could take sublingual cannabis tablets containing THC or CBD by placing a dissolvable tablet under their tongue and absorbing the cannabinoids through their mucous membrane, explains Rosalia Yoon, PhD, a research scientist with Apollo Applied Research Inc., the medical research arm of Apollo Cannabis Clinics.
Direct to bloodstream allows for faster “onset of action”
Vikas Parihar, a clinical pharmacist and faculty associate with the Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster University in Hamilton, Ont., adds that because sublingual administration allows the active ingredients to go directly into the bloodstream and bypass the stomach and liver, as with orally administrated drugs such as pills, tablets or gel capsules, the “onset of action” is far quicker. “In the case of CBD, [it can take] five to 15 minutes for sublingual versus two hours for oral [administration],” Parihar reports.
There are other benefits to sublingual tablets—in addition to the speed of onset action, which Yoon says, “would be beneficial for patients who need quick relief.” Bypassing digestion results in more efficient absorption and higher concentrations of the active THC or CBD compounds at work.
“Sublingual tablets are just another route of administration for cannabinoids and, as such, they are used for the same common health reasons as the cannabis plant and oils,” says Yoon. “However, because sublingual tablets are orally administered, they are devoid of the toxic effects of the by-products of combustion in smoked cannabis.”
Taking it slow may be the better course
Despite the benefits of sublinguals, they are not always the best option for patients. “Sublingual tablets would be disadvantageous if a sustained, longer duration of action is desired,” says Yoon. Some examples of this would be if the patient was looking for long-lasting pain or anxiety relief, or help with sleeping. “In these cases, slow-release, extended-release formulations would be needed,” she says.
“Oral pills absorb slower, so how they distribute to different parts of the body is also slower and CBD’s clinical effects are prolonged,” explains Parihar.
Does faster speed equate to higher costs
As a result, the speed of sublingual tablets may, ultimately, make sublingual administration of cannabinoids a less cost-effective choice. “Because sublingual tablets last a shorter time, this means that patients may need to take more doses of a sublingual drug versus an oral drug, hence also driving up cost for a patient,” he adds.
Furthermore, for a sublingual cannabis tablet to work properly, Yoon says the tablet must meet certain requirements, such as actually having active forms of THC or CBD being able to dissolve quickly in saliva, and meet other formulation specifics.
Health Canada has yet to approve any sublingual cannabis tablets. Parihar attributes the lack of availability to the difficulties that come with creating sublingual tablets. There are cannabis licensing costs, as well as product research, development and formulation costs. “Ultimately, the research involved and technology used in the sublingual tablet drives up the cost of production. This makes it an unaffordable option compared to an oral tablet,” he says.
In other words, if sublingual tablets are legalized in Canada, users will want to make sure they get their tablets from verifiable sources. For now, Parihar says, “there are no head-to-head comparisons” on whether smoking, vaping or any form of sublingual administration of cannabis is more effective. “It’s a very patient-specific response,” he adds.
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