Routes of administration
A route of administration is the method in which a psychoactive substance is delivered into the body.
The route through which a substance is administered can greatly impact its potency, duration, and subjective effects. For example, many substances are more effective when consumed using particular routes of administration, while some substances are completely inactive with certain routes.
Determining an optimal route of administration is highly dependent on the substance consumed, its desired duration and potency and side effects, and one's personal comfort level.
It is worth noting that most substances are reported to be strongly bitter and unpleasant to administer via sublingual or buccal routes.
Oral administration is the most common route of administration for most substance classes. This route allows a substance to be absorbed through blood vessels lining the stomach and intestines. The onset is generally slower than other methods of ingestion as it must undergo first-pass metabolism through the liver (may vary greatly between individual substances). Additionally, the absorption and overall duration are generally longer as well.
This route causes the substance to be absorbed through the large lingual artery present underneath the tongue, generally resulting in a faster absorption than oral administration.
Caustic compounds, such as the freebase form of amine-containing substance, should not be used sublingually because they can severely burn the inside of one's mouth.
Buccal administration refers to absorption through the cheek and gum.
This route is commonly employed when ingesting potent psychedelics such as 25I-NBOMe, DOM, LSD, and other substances distributed on blotter paper. Potent clandestine manufactured benzodiazepines like alprazolam and etizolam are also sometimes distributed on blotters.
Like sublingual absorption, the substance is largely absorbed through the lingual artery, but is also absorbed through the gum lining. This method is used when chewing plant leaves such as khat, kratom, salvia divinorum, and sometimes tobacco (snus).
Avoid sharing drug paraphernalina for insufflation (straws, bank notes, ‘Kuripe’, etc).
Insufflation (also called "inhalation" and "snorting") refers to the introduction of a substance into the sinus via the nostrils, circumventing first pass metabolism.
It is a very common method of use for substances in powder form, specifically so-called "street drugs" like cocaine, heroin, and methamphetamine. Some users find this route to be painful and uncomfortable, although certain substances are easier to insufflate than others.
This method is capable of rapid absorption through mucous membranes and blood vessels in the sinus. Absorption and onset is generally much more rapid than oral and, as a result, a substance feels much more intense and is often shorter acting than if taken orally.
Insufflation is common with substances such as cocaine and ketamine. It is also utilized in yopo rituals, the self-applicator pipe is known as ‘Kuripe’, and the blow pipe is known as a ‘Tepi’ in the Brazilian tradition. Insufflating tobacco in snuff form was a common practice until the early 20th century.
Short-term side effects of insufflation includes nasal congestion, which may last for 24 hours.
Frequent insufflation of some substances can damage one's mucous membranes, induce bleeding, damage the nostril's cartilage and lining, burn the throat, and cause other trauma to the nasal passage and sinus area. To reduce damage, it is recommended to grind the substance completely before use and alternate nostrils.
Also, sharing snorting equipment (straws, banknotes, bullets, etc) has been linked to the transmission of hepatitis C. In one study, the University of Tennessee Medical Center researches warned that other blood-borne diseases such as HIV, the AIDS-causing virus, could be transmitted as well.
Avoid sharing drug paraphernalina for inhalation (vapes, joints, pipes, etc).
Inhalants do not require an external heat source to produce psychoactive vapors that can then be inhaled through various methods depending on the substance used. Inhaled substances are absorbed very rapidly and lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.
It is substantially easier to overdose on alcohol inhalation than drinking alcohol.
Many substances can be inhaled to achieve an altered state of consciousness, however, some substances used for this purpose produce highly negative physical and neurotoxic effects including solvents like toluene (see toluene toxicity) often found in glue, acetone often found in nail polish, and gasoline., and number of gases intended for household or industrial use including butane gas sold as lighter gas refill.
To smoke a substance a direct heat source, most often a flame, is applied directly to the substance with no barrier between the heat source and the substance. The smoking of substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.
When a substance is smoked, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption. Smoking a substance also bypasses the GI tract's tendency to break certain substances down, such as DMT.
Cannabis is commonly consumed via the respiratory tract. The average THC transfer rate for joints, bongs, and vaporizers, is 20-26%, 40%, and 55-83%, respectively. For a proper gas or smoke deposition, one are advised to take a deep initial breath, and then hold it for 10 seconds to allow for the gas or smoke to get fully absorbed in the lungs. Subjects are frequently instructed to follow the "10 seconds rule" in studies. Prolonged breath holding does not substantially enhance the effects of inhaled marijuana smoke.
Vaporizing substances is a common method of consumption with the most common examples including cannabis and nicotine, but also heroin and crack-cocaine. Vaporizing a substance, especially with a digital temperature controlled device, allows for more temperature control because the flame or heat source does not come into direct contact with the substance.
Even though many drugs, like heroin and oxycodone pills are colloquially referred to as "smoked" the process used to consume them is vaporization. Vaporizing substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.
When a substance is vaporized, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption. Vaporizing a substance also bypasses the GI tract's tendency to break certain substances down, such as DMT.
Vaporization is commonly associated with the vaporizer pens that have become popular within the past decade, but it is not limited to ingesting the vapors from an electronic heat source.
Smoking a substance that should be vaporized leads to a blast of heat that may burn off the active ingredient or ignite the substance itself, both of which are wasteful and incorrect, which may cause judgement impairment of the dosage.
Ethnobotanist Daniel Siebert cautions that inhaling hot air can be irritating and potentially damaging to the lungs. Vapor produced by a heat gun needs to be cooled by running it through a water pipe or cooling chamber before inhalation.
Chasing the dragon
Heroin is colloquially referred to as "smoked" but is really vaporized, often using tinfoil as a barrier between the substance and the flame source. The heat source can be held at different distances as temperature control.
However, a vaporizer is a safer drug paraphernalia than aluminum foil.
An overdose caused by chasing the dragon is hard to predict because this technique doesn't deliver a standardized dosage. It's virtually impossible even for skilled users to know how much of the substance that has been evaporated, burned, and inhaled.
These combined factors may create a false sense of security when a given dose seem safe to repeat, but may cause an overdose when all the factors are randomly excluded.
About 0.1 mL of the solution is lost in conventional syringes through the luer lock tip and the luer lock adapter of the hypodermic needle. That can be compensated by either adding extra 10% or 5% substance in 1 mL or 2 mL syringes respectively, or by using low dead space syringes.
Intravenous administration refers to a drug being directly introduced into the bloodstream using a hypodermic needle. This method has the benefit of a very short onset and eliminates absorption by directly entering the bloodstream. However, much greater care must be taken when compared to other methods of administration.
Sterilized, unused needles and a high purity substance with little to no adulterant are required to avoid damage to the circulatory system.
Making sure no air bubbles are present in the reservoir before the plunger is released is also of frequently practiced to avoid air embolism. However, this expectation is a bit unrealistic: a large volume of 50 ml or greater infused at a rapid rate is potentially fatal.
Intramuscular administration refers to a drug being injected into the muscle tissue using a hypodermic needle. This method is very similar to the intravenous route, but is often more painful with a decreased onset and absorption. Some drugs (such as ketamine that has low oral bioavailability, and is dangerous to take intravenously rapidly) are commonly administered via this route. Like intravenous administration, intramuscular injection must be taken with precaution, using sterilized unused needles.
Subcutaneous administration (also known as skin popping) refers to a drug being injected into the subcutis, the layer of skin directly below the dermis and epidermis. Subcutaneous administration is relatively uncommon among psychonautics, as many people are not trained how to do it or would rather use a different route of administration which they are more familiar with.
Rectal administration, also commonly referred to as boofing or plugging, is one of the most effective methods of administration for many substances. The absorption rate is very high compared to other methods and the onset is usually very short, generally with a higher intensity and shorter duration.
This is due to a large amount of arteries located in the rectum; thus rectal administration is often superior to other methods despite social stigma.
Rectal administration can involve either the insertion of a low-volume solution into the rectum, using a syringe or pipette, or by placing a pill or gelatin capsule containing the active substance. The latter form is known as a suppository, and is common in medicine when the gastrointestinal tract cannot support oral medicine.
Transdermal is a route of administration where active ingredients are delivered across the skin for systemic distribution. Examples include transdermal patches used for medicine delivery for opioids such as fentanyl  and transdermal implants used for medical or anesthetic purposes. This route is typically not observed in non-medical or recreational contexts due to the manufacturing requirements.
- Ohlsson, A., Lindgren, J.-E., Wahlen, A., Agurell, S., Hollister, L. E., Gillespie, H. K. (September 1980). "Plasma delta-9-tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking". Clinical Pharmacology and Therapeutics. 28 (3): 409–416. doi:10.1038/clpt.1980.181. ISSN 0009-9236.
- Niv, D., Davidovich, S., Geller, E., Urca, G. (December 1988). "Analgesic and hyperalgesic effects of midazolam: dependence on route of administration". Anesthesia and Analgesia. 67 (12): 1169–1173. ISSN 0003-2999.
- Porter, W. R., Intraoral methods of using benzodiazepines
- De Boer, A. G., De Leede, L. G. J., Breimer, D. D. (January 1984). "DRUG ABSORPTION BY SUBLINGUAL AND RECTAL ROUTES". British Journal of Anaesthesia. 56 (1): 69–82. doi:10.1093/bja/56.1.69. ISSN 0007-0912.
- Ask Erowid : ID 41 : Is snorting MDMA worse for you than taking it orally?
- Research chemicals (MyCrew) http://www.mycrew.org.uk/drugs-information/research-chemicals
- Sharing Drug “Snorting Straws” Spreads Hepatitis C, 2016
- Burbacher, T. M. (December 1993). "Neurotoxic effects of gasoline and gasoline constituents". Environmental Health Perspectives. 101 (Suppl 6): 133–141. ISSN 0091-6765.
- Lanz, C., Mattsson, J., Soydaner, U., Brenneisen, R. (19 January 2016). "Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis". PLoS ONE. 11 (1): e0147286. doi:10.1371/journal.pone.0147286. ISSN 1932-6203.
- Wallace, M. S., Marcotte, T. D., Umlauf, A., Gouaux, B., Atkinson, J. H. (July 2015). "Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy". The journal of pain : official journal of the American Pain Society. 16 (7): 616–627. doi:10.1016/j.jpain.2015.03.008. ISSN 1526-5900.
- Wilsey, B., Marcotte, T., Tsodikov, A., Millman, J., Bentley, H., Gouaux, B., Fishman, S. (June 2008). "A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain". The journal of pain : official journal of the American Pain Society. 9 (6): 506–521. doi:10.1016/j.jpain.2007.12.010. ISSN 1526-5900.
- Zacny, J. P., Chait, L. D. (1991). "Response to marijuana as a function of potency and breathhold duration". Psychopharmacology. 103 (2): 223–226. doi:10.1007/BF02244207. ISSN 0033-3158.
- Zacny, J. P., Chait, L. D. (June 1989). "Breathhold duration and response to marijuana smoke". Pharmacology, Biochemistry, and Behavior. 33 (2): 481–484. doi:10.1016/0091-3057(89)90534-0. ISSN 0091-3057.
- Can You Get Sick From Dirty Bong Water?
- The Dangers of a Dirty Bong, 2018
- Ask Erowid : ID 3139 : Do vaporizers work with Salvia divinorum?
- Evans, S. M., Cone, E. J., Henningfield, J. E. (1 December 1996). "Arterial and venous cocaine plasma concentrations in humans: relationship to route of administration, cardiovascular effects and subjective effects". Journal of Pharmacology and Experimental Therapeutics. 279 (3): 1345–1356. ISSN 0022-3565.
- Craven, R. (December 2007). "Ketamine". Anaesthesia. 62 (s1): 48–53. doi:10.1111/j.1365-2044.2007.05298.x. ISSN 0003-2409.
- Aungst, B. J., Rogers, N. J., Shefter, E. (1 January 1988). "Comparison of nasal, rectal, buccal, sublingual and intramuscular insulin efficacy and the effects of a bile salt absorption promoter". Journal of Pharmacology and Experimental Therapeutics. 244 (1): 23–27. ISSN 0022-3565.
- Fentanyl Transdermal Patch: MedlinePlus Drug Information