Dr Daniel’s Guide to Balanced Cannabis Dosing
The medical cannabis community is full of outstanding people. I owe a debt of gratitude to them for giving me a voice and platform that, ultimately, has led to my success. I’d like to share some of the knowledge I’ve gained as my clinical career in medicine has now morphed into a much more natural, functional approach to whole-body optimization. Cannabis medicine is in its early stages in Western Medicine, so establishing guidelines regarding whole-plant marijuana dosing and administration is also in its infancy. Due to this lack of awareness, I’m here to give a doctor’s opinion on marijuana to help those looking for guidance on marijuana dosing. When it comes to natural approaches to whole body optimization, there is a wealth of knowledge on cannabis’ role in potential wellness. As we continue to learn more about the medical benefits of cannabis with an increase of scientific research coming out each year, more people have become interested in learning for themselves. Everyone from cancer patients to war veterans have turned to cannabis as a solution to anxiety, inflammation, and more, but the lesser-known key to their success in the proper management of their dosing.
The History of CannabisA major hesitation in terms of choosing cannabis in addressing medical issues is the unawareness of marijuana dosing. This story begins in 2700 BCE when the Chinese Pharmacopeia was introduced. The early text indicates that high doses of marijuana seeds can cause a person to “see demons”, and moderate doses enable users to “communicate with spirits”. The modern adaptation of this text shows us that the threshold for medical benefits of THC is actually far lower than most would think, and having a sensitive endocannabinoid system is valuable for responding to illnesses. What we can take away from this is that people can achieve the potential benefits of cannabis without using high doses. There are many critical gaps in knowledge of marijuana dosing that we’ll explore. Transparency and cohesion are helpful in guiding patients and clinicians to better decisions regarding cannabis medicine dosing. Within this guide, you won’t just learn a doctor’s opinion on marijuana, but also how to dose cannabis products properly to reach the maximal benefit.
The Endocannabinoid System: Understanding the Science of CannabisThe Endocannabinoid System is a widespread neural network directed at maintaining equilibrium through neurotransmitter release. In times of stress or immune insult, when the body cannot adapt appropriately, we can be said to be in an endocannabinoid deficit. Understanding this aspect of natural balance is relevant to a practical guideline for marijuana dosing. The ECS is a system that has been around since long before cannabis (despite the name), and a healthy ECS can function well and achieve significant clinical benefit with only a small dose of cannabis supplementation.
How Do We Respond to Cannabinoids?The main constituents of the cannabis sativa plant are THC (tetrahydrocannabinol) and CBD (cannabidiol). Cannabinoids bind with their receptors to start a cascade of events in the cell that, ultimately, resets the biochemical thermostats to normal room temperature. As far as THC over toxicity from a larger than recommended dose, the body responds to a large concentration of THC molecules in the space outside the cell by withdrawing the cannabinoid binding receptors back into the cell so that THC can’t bind as avidly. This mitigates the effects of a biochemically unnatural dose by preventing the binding of THC to its receptor at the extracellular level. Cannabis interacts with cannabinoid receptors to create regulation throughout your nervous system. The body has adapted a workaround to short-circuit cannabinoid receptor overstimulation in the event of THC over-toxicity due to the breakdown of natural enzymes. Our metabolism doesn’t support a “high” marijuana dosage and can’t work through a large dosage any faster than a smaller one. Diet, exercise, day-to-day stress, and genetics all play a role in the way our endocannabinoid system processes cannabis, so those with healthier lifestyle habits generally have a stronger basal endocannabinoid tone.
Looking Through the Therapeutic WindowDetermining the therapeutic window where beneficial effects outweigh toxicity is key to dosing marijuana correctly. Overmedicating endocannabinoid receptors causes the receptors to retreat like a turtle head back into its shell so the THC molecule has no target to combine with. Small doses stimulate whilst larger doses sedate. After a certain point, high marijuana dosing can result in weaker therapeutic effects. This bell-shaped dose-response curve characteristic of cannabinoid pharmacology is unique. The linear dose-response curve of most Western methods reflects adding more of a drug to continue change without a maximum. Fatal overdose is impossible due to the scarcity of CB1 receptors in the respiratory center of the brainstem. Overdose of cannabis paradoxically leads to symptoms that cannabis would normally treat at lower physiologic doses. If patients run into this problem, a tolerance break of 48 hours is just the neural cleansing needed to upregulate the physiologic state.
Marijuana Dosing: How to Dose FlowerIndividualization of treatment is the answer here. This means finding the optimal product and route of administration for you. When selecting a product and method of consumption, patients should ask themselves three questions:
- How much cannabinoid is going to be incorporated into my body?
- How long before I feel the effects?
- How long are they going to last?
Prescription Cannabis ProductsBased on my experience as a doctor, my opinion on marijuana products of varying types is that patients should be more inclined to use preparations of dried cannabis flowers, extracts, oils, and tinctures. These prescription drugs are pure isolates of cannabis compounds and do not contain the full suite of chemicals as in whole-plant preparations.
- Dronabinol: an isolated THC molecule marketed in oral pill form as Marinol. Clinical trials of Marinol showed effective doses at 2.5 milligrams for children and elderly and allow for up to 10 mg per dose.
- Nabilone (Cesamet): a synthetic THC derivative that is 10 times more powerful than THC. It’s also a powerful antiemetic used to combat chemotherapy-associated nausea and vomiting.
- Sativex® (nabiximols): a sublingual spray. Each spray delivers a dose of 2.7 mg of THC with 2.5 mg of CBD into the oral mucous membrane. Their clinical trial on multiple sclerosis patients concluded eight sprays (puffs) per day (21.6 mg of THC and 20 mg of CBD per day) to be the optimal dosing regimen.
- Epidiolex® is a pure CBD hemp plant extract administered in the form of syrup. The pure isolate compounds are plagued by slow pharmacokinetics and a very narrow therapeutic index.
Inhaled Preparations for Dosing Marijuana
- Smoking: The principal route of cannabis administration, it provides a rapid and efficient method of drug delivery from the lungs to the brain. The smoking route is preferred by many cannabis users because of its rapid drug delivery and resultant fast onset of effects (peak concentration occurs at 9 min), but also for the ability to fine tune your dose to the desired degree of effect.
- The most useful method I have found for dosing inhaled marijuana is to take a single inhalation, breathe in deeply, and immediately exhale. Don’t resist the urge to cough and always keep hydration handy. New cannabis users should start with an even smaller dose at 2.5 mg THC before bedtime and carefully titrate up.
- Vaporisation: These vaporizers employ dry heat to cannabis products up to temperatures at which the cannabinoids decarboxylate, but without reaching the point of combustion in which the toxic by-products are generated.
Oral Administration for Dosing MarijuanaIn comparison with inhalation, oral administration features low rates of absorption and low THC concentrations. Orally administered THC or cannabis edibles can take 60-90 min to feel effects. The psychoactivity also lasts longer and is less intense at equal doses versus the inhaled method. These aspects are the reason why edible products are more difficult to control in terms of their intensity and the time they take to appear. This is what oftentimes causes overdosing on edibles. As a doctor, my opinion on marijuana edibles is that there do exist certain situations where they can be used to clinical advantage, despite the above-mentioned imperfections. I’m quite preferential to dosing marijuana within edibles for elderly patients for a number of reasons. Especially for patients with respiratory issues already, edibles simplify the process of getting THC into the body. Liquid oil and edible preparations are easily used on bread and muffins and the longer duration of action makes it ideal for a bedtime snack to get them some good rest. When taken carefully, these are some of the most convenient cannabis administration methods.
THC/CBD DosingSince marijuana prohibition, growers have been crossbreeding high-octane thoroughbred cannabis strains (type 1 THC heavy strains) to steadily drive up THC content while breeding out an essential cannabinoid in CBD. Type 2 strains with a more balanced THC:CBD profile are great for dosing marijuana so they’re prized in the medical world, but are much harder to find than their diesel fuel cousins. This aspect of the unavoidable commercial nature of marijuana is unfortunate because adding CBD to THC widens the therapeutic window. The therapeutic effects of THC-dominant cannabis can be achieved at dosages lower than those required to produce euphoria or impairment. A 2011 review from a trusted source on the safety and side effects of CBD found that continuous use of CBD, even in high doses like 1,500 mg a day, is tolerated well by humans.
Main Takeaways of Marijuana DosingThere are many things to consider in choosing cannabis products that are far beyond the scope of this blog. Generally, correct marijuana dosing should reflect the lowest dose that produces a therapeutic benefit without the associated adverse events. The main three points I advise you to take away from this guide would be:
- The sweet spot is a dose large enough to feel effects but small enough to not cause unwanted psychoactivity.
- Individualization of treatment is the key.
- Check the label to understand what level of THC and CBD is present to get desired effects.