What forms of cannabis use are there, and which ones are suitable for medical use?

Flowers or extract? This question is on the minds of many patients—not only at the start of treatment, but also in light of the draft bill on the Statutory Health Insurance Contribution Rate Stabilization Act, which was approved by the Federal Cabinet on April 29, 2026. If the current draft bill from this spring goes into effect, cannabis flowers could no longer be prescribed at the expense of statutory health insurance providers. This makes the question of which forms of cannabis consumption are available—and how they differ—all the more important.

In medical care, two forms of administration have become particularly well-established: cannabis flowers, which are inhaled using a medical vaporizer, and standardized cannabis extracts for oral administration. Both contain the same therapeutically relevant cannabinoids but differ significantly in their route of administration. This affects the onset of action, the duration of effect, and the dosing options.

Which form of cannabis use is appropriate therefore does not depend on a general recommendation. The treatment goal, symptoms, and the desired course of action determine the approach. This article provides an overview of the most important forms of cannabis use, explains the differences between cannabis flowers and cannabis extracts, and classifies both forms of administration based on the current state of medical knowledge.

Why the Admission Process Influences the Course of Therapy

Whether cannabis is inhaled or taken orally affects far more than just the time it takes for the effects to set in. The method of administration determines how quickly cannabinoids enter the bloodstream, how long their effects last, and how precisely the dosage can be tailored to individual needs.

Medical cannabis therapy can therefore only be compared to recreational use to a limited extent.

When vaporized, THC and CBD are absorbed through the alveoli and enter the bloodstream within a few minutes. This rapid onset of action allows for flexible dosing and is particularly suitable when symptoms need to be relieved quickly.¹ Cannabis extracts take a different route. After oral ingestion, the active ingredients first pass through the gastrointestinal tract into the liver before entering the bloodstream. As a result, the effects set in later but, in many cases, last longer. The German Medical Association’s Drug Commission notes that orally ingested cannabinoids have a delayed onset of action compared to inhaled cannabis, as well as a longer duration of effect.²

The preferred dosage form is therefore not determined by a general recommendation, but by the therapeutic goal. While acute symptoms often require rapid relief, patients with chronic conditions frequently benefit from a longer-lasting release of the active ingredient.

How does the form of administration affect the effect?

Depending on the route of administration, cannabis flowers and cannabis extracts differ in several pharmacokinetic properties. These include, in particular:

• Onset of action
• Bioavailability
• Duration of action
• Option for gradual dose adjustment

These differences form the basis for selecting an appropriate dosage form.

Overview: A Comparison of Methods of Cannabis Use

Cannabis flowers and cannabis extracts are the main focus of medical cannabis therapy. In addition, there are other dosage forms, such as oral sprays and capsules, which are used for specific indications. Edibles and smoking cannabis are also frequently associated with this topic. However, they play only a minor role in medical applications. The following overview categorizes the most important dosage forms:

Dosage Form	Onset of action	Duration of action	Typical use	Medical Classification
Cannabis flowers (vaporizer)	5–10 minutes	2–4 hours	Acute symptoms, flexible dosing	Preferred inhalation route of administration
Cannabis extract (oral)	60–180 minutes	6–8 hours	Long-term symptom management	Standardized Oral Therapy
Cannabis oil (oral)	60–180 minutes	6–8 hours	Continuous treatment, easy to take	Standardized Oral Therapy
Mouth Spray (oral)	15–45 minutes	4–6 hours	Selected Indications	Absorption through the oral mucosa
Capsules (oral)	30–90 minutes	6–8 hours	Standardized Dosage	Alternative oral dosage form
Edibles (oral)	45–120 minutes	Up to 10 hours	Hardly relevant in everyday medical practice	Not a standard form of treatment
Smoking	A few minutes	2–3 hours	Not for medical use	Not medically recommended

This overview is intended to provide guidance. The treating physician always determines which dosage form is appropriate in each individual case, taking into account the clinical presentation, concomitant medications, and the treatment goal. Edibles and smoking are listed for the sake of completeness, but are not typically used in a medical context.

The Most Common Ways to Use Cannabis, in Detail

Good to know:
Cannabis flowers and cannabis extracts contain the same therapeutically relevant cannabinoids. The differences lie not in the active ingredient itself, but in the route of administration. This affects how quickly the effects set in, how long they last, and how flexibly the dosage can be adjusted.

Inhaling Cannabis Flowers with a Vaporizer

Inhaling cannabis flowers is one of the established forms of medical cannabis therapy. In this method, the flowers are not burned but are heated in a controlled manner in a vaporizer. The cannabinoids they contain vaporize and then enter the bloodstream directly via the alveoli. The major advantage of this method of administration is the rapid onset of action. The first effects can be felt within just a few minutes of inhalation. At the same time, the dosage can be adjusted gradually, as patients can individually control the number and volume of inhalations.

Depending on the device and the type of flower, medical vaporizers operate within a temperature range of approximately 180 to 210 °C. This process releases the cannabinoids without burning the plant material. Compared to smoking, this produces significantly fewer harmful combustion byproducts. The Federal Institute for Drugs and Medical Devices (BfArM) recommends using a suitable medical vaporizer for prescribed cannabis flowers and advises against smoking due to the resulting combustion byproducts.³

Advantages

• Onset of action within a few minutes
• Flexible and gradual dosage adjustment
• No burning of plant material
• Particularly suitable for acute symptoms or breakthrough symptoms

Possible restrictions

• Shorter duration of action than with oral formulations
• Use requires a suitable medical vaporizer
• Regular cleaning of the device is required

Cannabis extracts for oral use

In addition to cannabis flowers, standardized cannabis extracts are among the most important forms of medical cannabis therapy. They contain defined amounts of THC, CBD, or a combination of both cannabinoids, thereby enabling consistent dosing. Unlike homemade cannabis oils, medical cannabis extracts are manufactured under controlled pharmaceutical conditions. Their standardized composition facilitates both dose adjustment and long-term monitoring of treatment.

After ingestion, the active ingredients first enter the body via the gastrointestinal tract and are then metabolized in the liver. This so-called first-pass effect delays the onset of action but often results in a longer-lasting and more consistent effect. This continuous release of active ingredients can be particularly beneficial for chronic conditions or long-term treatment.⁴ Taking the medication can be easily integrated into existing treatment plans and does not require an inhaler. The Federal Ministry of Health lists cannabis extracts, in addition to flowers, as a key dosage form for medical cannabis therapy.⁵

Advantages

• Standardized concentrations of active ingredients
• Reproducible dosing
• Long-lasting effect
• Well-suited for continuous treatment
• Easy to Use in Everyday Life

Possible restrictions

• The onset of action is delayed
• Changes in dosage become apparent only after some time
• Food intake can affect the rate of absorption

Other Dosage Forms

In addition to cannabis flowers and cannabis extracts, other cannabis-based medications are available for specific indications. These include, among other things, oral sprays and capsules containing defined amounts of active ingredients. These preparations are primarily used for specific medical conditions or special therapeutic needs.

In everyday clinical practice, however, cannabis flowers and standardized cannabis extracts play a significantly greater role.

Why Smoking Is Not a Recommended Method of Use

Although smoking is the best-known and most widespread form of recreational cannabis use, it is also used by some patients who have been prescribed medical cannabis. From a medical standpoint, however, this form of use is not recommended. When cannabis flowers are burned, in addition to the desired cannabinoids, numerous substances are produced that have no therapeutic benefit and can place additional strain on the respiratory tract. These include carbon monoxide, fine particulate matter, and various combustion byproducts.

For this reason, medical professional associations and the Federal Institute for Drugs and Medical Devices recommend inhalation using a medical inhaler. This method releases the cannabinoids without combustion, thereby avoiding most of the harmful substances produced by smoking. Even though the onset of effects after smoking is similarly rapid to that of vaporization, the disadvantages outweigh the benefits from a medical perspective. Smoking cannabis is therefore not a recommended method of administration and is practically never used in guideline-based cannabis therapy.

Planned Changes to the Reimbursement of Cannabis Flowers

As part of the Statutory Health Insurance Premium Rate Stabilization Act, the federal government plans to restrict the eligibility for reimbursement of cannabis flowers under statutory health insurance. According to the current draft bill (2026), primarily standardized cannabis extracts and approved finished pharmaceutical products will remain eligible for reimbursement in the future. Cannabis flowers, on the other hand, would generally no longer be eligible for reimbursement by statutory health insurance plans.

The planned new regulations are driven by rising expenditures in the statutory health insurance system. According to the federal government, eliminating reimbursement for cannabis flowers is expected to result in savings of approximately 130 million euros in 2027.

This change would have significant consequences for patients. Those who continue to rely on cannabis flowers and do not receive alternative treatment would likely have to pay for their treatment themselves in the future. At the same time, cannabis extracts and medications containing the active ingredients dronabinol or nabilone are to remain eligible for reimbursement under the existing conditions. The requirements for prescribing medical cannabis medications have also been clarified recently. According to the Federal Ministry of Health , medical treatment—including telemedicine services— must comply with generally accepted professional standards. For many initial prescriptions, in-person contact between doctor and patient is also considered a medical standard.

The plans have elicited mixed reactions. While the federal government emphasizes, above all, a more cost-effective supply system, patient advocacy groups, pharmacies, and some professional associations warn of supply shortages for seriously ill patients who are already being successfully treated with cannabis flowers. Discussions regarding the medical and health policy implications are therefore continuing in the parliamentary process.

“Compared to cannabis flowers, standardized cannabis-based finished pharmaceutical products and extracts are supported by significantly more robust data regarding dosing, reproducibility, and standardization under pharmaceutical regulations.” – Statement by the German Medical Association during the hearing of the German Bundestag’s Health Committee on January 14, 2026.

Conclusion

The various methods of cannabis use differ less in terms of their active ingredients than in the way they enter the body. This route of administration influences the onset of effects, the duration of action, and the options for adjusting the dosage. Cannabis flowers inhaled using a medical vaporizer are particularly suitable when symptoms need to be relieved quickly or when flexible dosing is required. Standardized cannabis extracts take longer to take effect but often provide a more consistent release of active ingredients over several hours.

There is therefore no one-size-fits-all answer as to which dosage form is appropriate. Only by considering the combination of diagnosis, symptoms, treatment goals, and medical expertise can a treatment be tailored to the patient’s individual needs. According to the Federal Ministry of Health, the planned regulation regarding the reimbursement of cannabis flowers aims to align the supply of medications more closely with standardized dosage forms and to limit expenditures by statutory health insurance. The draft bill is the subject of heated debate.

FAQ

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1. Häuser W, Finn DP, Kalso E et al. European Pain Federation (EFIC) position paper on the appropriate use of cannabis-based medicines and medical cannabis for chronic pain management. European Journal of Pain. 2021. ↩︎
2. German Medical Association’s Drug Commission (AkdÄ): Active Ingredients Today – Cannabis, Issue 3/2023. ↩︎
3. Federal Institute for Drugs and Medical Devices (BfArM): Information for Patients – Medical Cannabis, as of 2024. ↩︎
4. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: National Academies Press; 2017. ↩︎
5. Federal Ministry of Health (BMG): Cannabis as Medicine – Questions and Answers. ↩︎