The scientific and anecdotal reports on rectal cannabis use are somewhat conflicting.
Sometimes, the best way to research something is to do it yourself. For science, for Sensi Seeds, and for journalistic integrity, I tried a cannabis suppository and wrote about the results.
Recreational rectal use of cannabis is not a subject I’ve ever heard discussed. Vocal proponents of every other kind of cannabis ingestion can be found everywhere, from internet forums and international hemp fairs to coffeeshops and any given living room on a Friday night. The subject of savouring a potent high by inserting suppositories, however, has not been broached (at least with me). Is rectal cannabis the last taboo of recreational use? Does it even work? There was only one way to find out.
Step one: Get some suppositories for recreational rectal use
These are not a product that you can buy in a coffeeshop, nor a pharmacy, even in Amsterdam. Luckily I was able to obtain some (from a source who wishes to remain anonymous). They were made from butane extracted whole plant concentrate in a base of coconut oil, giving them a pleasant, almost chocolatey smell, rather like spacecakes. I had them tested and the results showed 16% THC and 1% CBD, which would definitely give a psychoactive effect if taken in any way that I was familiar with.
Having procured cannabis suppositories, our preparations were twofold: the classic ‘set and setting’. The former consisted of research. I found practical tips, including ‘lie on your side and bend one leg to make insertion easier’ and ‘don’t pass wind for at least 15 minutes afterwards’. I found anecdotal reports: “For me, music starts playing in my head about 1 minute after “dosing”,”; “Within minutes I could feel a warm, pleasant sensation washing over my entire pelvic region”. And I found science which said maybe it shouldn’t work at all.
What is the science behind rectal use of cannabis?
According to Allan Frankel, MD, who has researched and written about rectal absorption of cannabis, nothing was felt by his test patients when they tried cannabis oil in cocoa butter. Analysis of their plasma revealed negligible THC and CBD levels. According to Practical Pharmaceutics: An International Guideline for the Preparation, Care and Use of Medicinal Products, the rectum does not absorb fats efficiently. Any active substance in a suppository must first dissolve into the aqueous mucus that lines the rectum and then pass into the bloodstream; it cannot be absorbed directly by the membrane without traversing the aqueous mucus layer.
Therefore active substances that are themselves lipophilic (such as cannabinoids) should not be combined with a fatty or oily carrier, as this will reduce their overall absorption. Since virtually every cannabis suppository I found mentioned online was in a fatty base (as was mine), this should have impaired their efficacy.
Assuming that some of the cannabinoid content makes it through the mucus, it then circulates either via the inferior and middle rectal veins into the inferior vena cava, bypassing the liver; or via the superior rectal vein to the liver where it is ‘first pass’ metabolized. It was thought that the lack of psychoactivity resulted from THC missing the liver and therefore not metabolizing into 11 hydroxy delta-9 THC (11-OH-THC) which is more potent, and stays in the system for longer. (Interestingly, the effect of many drugs is reduced by first pass metabolism, but not THC!) Large amounts of 11-OH-THC are produced when cannabis is eaten, so this metabolic process determines much of the strength of the same dose when ingested in different ways.
The most recent scientific research on the rectal absorption of THC was published in 1991, and used crab-eating macaque monkeys. (People to whom I’ve told this have said “poor monkeys!”, to which the reply is, have you seen what else they do to monkeys? These monkeys are the lucky ones.) Results showed no rectal bioavailability of THC, but when the cannabinoid was processed to create a combination with the molecule ester hemisuccinate (THC-HS), the bioavailability shot up to 13.5% and the mean residence time of THC in the blood was 5.8 hours. THC-HS is water-soluble, which is why it dissolves into the aqueous mucus.
Back to my personal rectal cannabis experience
What all my theoretical research came down to was basically “anecdotes say something might happen, science says nothing should happen”. This being as far as I could get with ‘set’, I moved onto ‘setting’. We put mattresses on the living room floor and made sure there were enough drinks and munchies on hand. I had music, films, and interesting picture books to stimulate us if needed. I thought about lighting some candles, figuring I should make it as nice an experience as possible after subjecting my lab partner to descriptions of animal experiments and rectal aqueous mucus, but fire and altered states don’t mix so I just turned the lights down. To give an accurate report as possible, we had abstained from any other drugs (including the legal ones) and I set my phone to beep at half-hour intervals so I could chart the experience.
“For science!”. We toasted each other with the large, slippery, dark green bullets. First lesson: insert them as soon after removal from the fridge as possible, because fingertip heat alone is enough to start them melting. However, this means they are basically self-lubricating, which isn’t a bad thing. We lay down, me on my back and my lab partner on his side, and waited.
After half an hour, I felt quite giggly. This could have been the incongruity of live-tweeting rectal cannabis use as part of my job, though. In response to a tweet asking me how it was going, I attempted to analyse what I was experiencing. There was a mild tingling sensation, not unpleasant, around the ground zero area of application. I wasn’t able to say for sure if there was any psychoactive effect. My lab partner had fallen asleep, but he had travelled overnight from London to Amsterdam and arrived that morning. The data was inconclusive thus far.
One hour into the experiment: Getting high
My lab partner was still fast asleep and I was explaining to people on Twitter that I didn’t have IBS or IBD, this experiment was purely for research. A feeling of deep relaxation suffused me, especially my legs and pelvic area. I believe the use of suppositories to ease menstrual cramps could be very effective, based on this. I felt extremely tranquil, but not sleepy, and decided to finally get up and go to the kitchen for a change of scenery and to see if any psychoactive effects made themselves known.
They did. Once in the kitchen, the munchies kicked in with a vengeance and I noticed that colours and patterns were enhanced. I heated up some soup; flavours were enhanced too. I giggled to myself thinking about the great Dr Lester Grinspoon’s realisation that he was having his first cannabis experience when the pizza he was eating became the best he’d ever tasted.
Despite being a clearly recognisable cannabis high, what I was experiencing was unlike what I’ve felt when eating, smoking or vaporising it. My head felt clear and I felt peaceful yet alert; a sativa type of high without the soaring headrush or potential confusion. It was extremely enjoyable and not at all overpowering, yet I was definitely in an altered state. The dragon trees in my living room looked fascinating. Getting back under the duvet was lovely. I felt no need for additional entertainment. There was an opiate-like quality to the contentment and relaxation, but no nausea or feelings of disassociation.
An hour and a half in: Definitely high
I was still feeling the same effects, which seemed to have hit a plateau rather than fading or intensifying. My lab partner woke up and said he wasn’t sure if he was feeling anything apart from very relaxed, but he definitely felt like eating something. He just wasn’t sure what. (In retrospect, this was a total giveaway that he was experiencing the effects!) The following conversation took place:
“Is it chocolate?”
“Is it oatcakes with vegan cream cheese?”
“Is it… (I am having trouble remembering what else there is to eat) …is it tomatoes?”
“I don’t think so.”
“Ooh, is it pineapple soy yogurt?”
“YES. Yes, it is. Oh yes.”
“We are definitely high.”
We devoured a litre of said yogurt in under three minutes. It tasted fantastic. Then we lay back down and discussed the high. It was strong but not psychedelic, and deeply physically relaxing. The best analogy is that of lying in a warm bath that you don’t want to get out of. All muscle tension was dissolved, we felt warm and heavy but not sleepy, and the effect seemed to end at the upper neck – literally as though lying in a bath with only your head out of the water. However, it was not a ‘couchlock’ stone. We remained alert and talkative. Although the effect was powerful, it was not at all disorienting or overwhelming.
(There was one additional fact that I was not expecting. I hadn’t read about it anywhere during literally hours of research. So, dear reader, I will share it with you. After eating, the digestive system starts up. This can lead to passing wind. And if you’re experimenting with rectal use of cannabis, this causes your wind to smell like a growroom of strong sativas just before harvest. You’re welcome.)
The following day: Still high
It was also very, very long-lasting. Neither of us use cannabis regularly anymore and consequently we both have low tolerance; even so, I was not expecting to still be high the next morning. After I left for work, my lab partner had a large breakfast and went back to bed. By the time he texted me at 15:00 to say he had just woken up and could I get some more pineapple yogurt, I was pretty much back to normal. It took him several more hours to feel completely back to normal. This makes rectal use of cannabis by far the most economical method I’ve tried so far.
More research is needed on the rectal use of cannabis
Based on my research, what conclusions can be drawn? Firstly, there is no way that we were experiencing a placebo effect. I’ve used enough cannabis to know the difference. Secondly, although I had no way of measuring THC in our blood plasma, I can assure you that there was plenty sloshing around our endocannabinoid systems. So how did it get there? It’s fairly safe to assume that at least some THC entered the superior rectal vein and achieved first pass metabolism into 11-OH-THC. I was aiming for this to happen, so I literally aimed for it (unlike medicinal users who would presumably keep the suppository lower in the rectum to avoid it).
It might be possible that the effect was so long-lasting because any THC missing the first pass when it initially entered the bloodstream via the inferior and middle rectal veins would eventually reach the liver, so a second phase of metabolism into 11-OH-THC could take place long after the initial dose.
However, for the THC to get to any of the rectal veins, it still needs to traverse the aqueous mucus layer. As previously stated, this shouldn’t be possible without the presence of the hemisuccinate ester. Could it be that some part of the process of making the butane extracted concentrate causes the presence of THC-HS, or a similar enough ester to permit absorption to occur? The experiments on the macaque monkeys used THC only, not whole plant extract. Could the presence of other cannabinoids, the ‘entourage effect’, make the crucial difference? However, Dr Frankel’s studies used cannabis oil in cocoa butter, and that did not seem to work. The doctor himself concludes that more research is needed in order to take full advantage of this delivery method.
Benefits of rectal cannabis use
Having tried it, I can think of various benefits for both medicinal and recreational rectal cannabis use. There’s the long-lasting deep relaxation, which would definitely relieve pain and muscle tension. The extended ‘munchies’ effect would doubtless aid anyone who needed to gain weight, and the delivery method means that there is no risk of vomiting up oral appetite stimulants. The amount needed for an effective dose is small, and the dosage is easy to control. There is also the advantage over edibles, such as cake or sweets, of it being highly unlikely that someone will accidentally ingest a cannabis suppository thinking it is a harmless treat. There are numerous tales of people eating ‘medibles’ by accident, but I have never heard of anyone inserting a random suppository they found lying around.
Work the following day was a little more challenging than usual, but by no means impossible. I would not have wanted to drive or operate heavy machinery, but the clarity of the high was fine for writing, interacting with colleagues, going to the shops, and cooking dinner. For people who need effective pain relief without being incapacitated, this would be ideal.