At the Village Bloomery cannabis dispensary in Vancouver, Andrea Dobbs sometimes meets clients in search of a heavy dose of THC to ease the strain of cancer treatments or the pain of endometriosis.

If the client is new to cannabis, or physically frail, Dobbs might suggest cannabis suppositories, inserted directly into the rectum or vagina.

Village Bloomery co-founders Jeremy Jacob and Andrea Dobbs at their Vancouver cannabis dispensary.

"A lot of people don't know about them, so it's usually us broaching the subject," said Dobbs, co-founder of the dispensary.

"And yes, it can be a moment where people are very uncomfortable," she said with a laugh.

The Village Bloomery sells suppositories produced by B.C.-based BioMed Botanicals, in strengths ranging from 25 to 200 milligrams of THC. 

"You're able to get higher amounts of THC into your system without navigating euphoria. You don't feel the high," said Dobbs.

At very high doses, she said, some suppository users "have reported feeling a little bit woozy or a little bit extra sleepy."

"It wouldn't be like, 'Yahoo, this is so fun,' but it's very, very nice for menstrual cramps — endometriosis, in particular."

Medical mystery

The therapeutic use of vaginal cannabis suppositories could date back as far as ancient Egypt, says neurologist and medical cannabis expert Dr. Ethan Russo.

"It seemed to be an aid to childbirth, which is a known usage of cannabis extending into the 19th and 20th centuries, even in the U.S.," he told the Leaf News.

Anecdotally, Russo said he's heard of "a lot of people that are using cannabis suppositories because they can't swallow or they're nauseated — particularly in treating cancer we've heard a lot about this."

Neurologist and cannabis researcher Dr. Ethan Russo.

"But what's interesting is, even though reportedly some of these (suppositories) have high doses, people are not observing psychoactive effects."

Among Russo and many of his medical colleagues, the consensus view is the THC in cannabis suppositories doesn't get circulated through the rest of the body, raising doubts about their systemic effects.

"But again, I'd emphasize that there's no reason to think that it isn't having local effects," he said.

"So if someone were treating hemorrhoids, or there was rectal pain, or with a vaginal issue, any of those could be treated in this way, with a suppository preparation. But for a systemic condition, I have real doubts about it."

Russo said "we clearly need more studies" to determine how rectally and vaginally absorbed cannabinoids act within the human body.

"I know that phrase gets thrown around too much, but this is absolutely one of the cases where it should apply."

Strict potency limits on suppositories

Health Canada's medical cannabis regulations permit the legal production of cannabis suppositories, but cannabis industry consultant Deepak Anand said he isn't aware of any government-licensed cannabis company that makes them.

"I think it's a matter of just the stigma," said Anand, vice-president of government relations with Cannabis Compliance Inc.

Cannabis suppositories produced by BioMed Botanicals are available in strengths ranging from 25 to 200 mg THC.

"I think there may be a concern that this is not readily going to be adopted" by North American cannabis users, he said.

"But I could see, in places like Europe, this would be hugely successful, because there's just such a push towards using suppositories for so many different conditions in Europe."

Anand said he expects to see a Canadian licensed cannabis producer release a regulation-compliant suppository within the next year, and said they might be a good candidate for export to the European medical cannabis market.

Those government-approved suppositories will be much less potent than those currently available on the illicit market. Health Canada's new regulations for the cannabis industry will limit rectal and vaginal suppositories — along with orally administered cannabis capsules — to yielding no more than 10 mg of THC per unit.

In a statement, a Health Canada spokeswoman said those limits are meant "to protect the health and safety of consumers by ensuring that they know how much THC they are consuming per dose, and help reduce the risk of accidental overconsumption."

Health Canada's new limits on THC in cannabis suppositories are "unfortunate," said Dobbs.

In order to continue operating after legalization, her dispensary is applying for a new retail cannabis store licence from British Columbia — and under the new legal regime, licensed dispensaries will only be allowed to sell government-regulated products from licensed producers. That might mean high-THC suppositories could be unavailable to Village Bloomery clients.

"It's that whole potency thing that (the government) haven't really gotten their minds around," she said.

"It's just going to take time. At least we're all coming to a place where we can talk about it openly, and where doctors can engage without fear of repercussion, and where nurses can get involved."