Medical Cannabis: A Patient Dosage Guide

Traditional drugs that have been approved by the Federal Drug Administration (FDA) come with precise dosing that is based on both the age and weight of the individual as well as the pharmacokinetics of the drugs (how the drug is metabolized in the body). Consequently, you will come across dosages that specify the quantity of the drug to be administered and how many times a day.

Dosages for children (pediatric dosages) are usually very sensitive and hence will always specify the age and weight of the child. Different formulas can be used to calculate pediatric dosages such as the Young’s Rule or Clark’s Formula.

For example, the recommended pediatric dosage for Tylenol is as below:

Child’s weight 6 – 11 lbs 12 – 17 lbs 18 – 23 lbs 24 – 3…
Syrup (Oral Suspension): 160 mg/5 milliliters (ml) 1.25 2.5 3.75 5
Chewable 80 mg tablets 2
Chewable 160 mg tablets 1

Adapted from USHospitals.org [2]

How To Get Started with THC Dosing

THC dosing follows similar principles based on the weight of the individual and the pharmacokinetics of the THC. To simplify this. It means that a person with more weight will need a higher dose of THC for it to be effective. The exact dosage and frequency of use will also be affected by the potency of the THC product and how it is broken down in the body. But unlike FDA approved drugs, THC dosing is not standardized.

Cannabis dosage is affected by different factors including a person’s unique physiology. Therefore, it is advisable not to copy paste anyone’s ideal dosage but rather to observe your response and find what works for you. Remember, cannabis is not a one size fits all type of medicine.

Here are some tips to help you find your effective dosage for THC.

Start With a Low Dose

Tetrahydrocannabinol (THC) is a major component of medical cannabis. Unlike other cannabinoids, THC is psychoactive and when taken in higher doses it will trigger a euphoric state. New patients may not tolerate higher levels of THC and can easily get overwhelmed by the euphoria. In addition, at higher doses THC will cause adverse effects. This makes it very important for patients to always start with the lowest possible dose as you look for the minimum effective dose. This means finding the lowest dose that produces sufficient therapeutic benefits without causing adverse effects.

Find The Minimum Effective Dose

The “Minimum Effective Dose,” or M.E.D., is the smallest amount of cannabinoid (THC) a person can ingest that will have the intended result of calming symptoms such as nausea, pain, cognitive/mood disorders, and others.

Your M.E.D. is actually fairly easy to assess. An easy yet effective way to determine it is:

  1. Evaluate your particular symptom on a scale of 1-10 before taking any cannabidiol or THC product.
  2. Start out with a small amount of cannabidiol or THC. For moderate symptoms, 1 mg of THC is good or 5 mg per day. For severe symptoms, such as severe pain, you may want to try 5 mg to 10 mg and work your way from there.
  3. Monitor the level of your symptom every fifteen minutes or so to determine if the symptom has lessened with the amount you ingested. A good way to track your observations is to write them down in a journal or notepad.
  4. After an hour or so, determine if your symptom severity has gone down by at least two points on your 1-10 scale. That is how you will know that your gummy, tincture, or capsule is doing its job at that particular dosage. You have just discovered your M.E.D.

If you are still experiencing symptoms that are too severe for your comfort, then you may have to up your dose. Take a small amount more (5-10 mg) and repeat the same procedure. Be sure to recheck your M.E.D. periodically (every few months or so) as your body changes with age, disease development or healing, and in response to other factors.

Using your M.E.D. As your guidance for THC or cannabidiol consumption is a good overall strategy and helps you to save money too!

Tolerance to THC

A patient may build tolerance to THC after consuming it over an extended duration. This means that over time, a patient will not be able to achieve the same therapeutic benefits from THC that they have achieved in the past. They get to a maximum effect and consequently the patient will need to increase their dosage over time.

Here are a few things that can be done to prevent building tolerance to THC:

Take occasional breaks: If you notice that you are building tolerance to THC it will be advisable to take a break for 3-7 days to give your body ample time to recalibrate. During this period, the body will reduce THC that is stored up in the fat and the ECS will reset, bringing tolerance down.

Taper down your dose: Instead of increasing your THC levels as the body is demanding, you can taper it down gradually. You might stop feeling the therapeutic effects for a while as your system recalibrates. But over time your body will readjust to gaining benefits from lower THC doses.

THC Biphasic Effects

Biphasic effect refers to the property of THC of behaving in two phases. As you increase THC consumption, the therapeutic benefit will also increase but only up to a certain level. Beyond this level, increasing the THC will not produce greater therapeutic benefits. If anything, greater doses may produce the opposite effect as in declining benefits.

Terpenes and Cannabis Dosing

Cannabis products may contain pure cannabinoids or they may contain additional bioactive molecules that are known as terpenes. Common terpenes in cannabis include myrcene, limonene, linalool, eucalyptol, ocimene, and caryophyllene among others, which can also play a role in healing.

  • THC isolates contain pure THC
  • Full spectrum THC contains extra cannabinoids such as CBD and CBN. They also contain additional terpenes.>

Studies have shown that when terpenes and other cannabinoids are added to THC the healing effect that is produced is more powerful and lasts for a longer duration. [3] Terpenes may also help THC to overcome the biphasic effect, meaning that higher doses will produce an even greater healing effect. This mechanism is known as the entourage effect.

General THC Dosage Guidelines

Cannabinoids such as THC interact with the body through receptors of the endocannabinoid system (ECS). THC in particular has a strong affinity to CB1 receptors which are primarily located in the central nervous system (CNS).

How one person responds to 15 mg of THC will be different from how another person will react to the same concentration of THC. This difference arises due to several factors that influence THC dosing.

Here are the critical factors that determine THC dosing:

Frequency of use

Patients who have used THC products for longer durations may need higher concentrations to experience the effects. Newer patients, on the other hand, can easily get overwhelmed by lower doses of THC.

Type of THC product and ingestion method

THC comes in different formulations including the following:

  • THC flowers
  • THC tinctures
  • THC capsules and pills
  • THC joints and bongs
  • THC vapes
  • THC edibles
  • THC topicals
  • THC suppositorie

These products are consumed in different ways, some are ingested, and others are inhaled, while others are applied topically to the skin. This affects how much THC is absorbed into the system and consequently affects THC dosing. We shall have an in-depth look at how THC dosage changes depending on the consumption method.

Total body fat percentage

THC, as well other cannabinoids, are lipophilic aka fat loving. This means that they bind more readily to fat molecules. A person with a higher body fat percentage will “hold onto” more THC. Hence, less THC will be available in their system for use and they will be able to withstand higher levels of THC.

Activity level

Since THC is stored in fat cells, it is also released during exercise when fat is broken down to release energy. People who have higher activity levels will release THC more readily. In most cases, this means that they will need higher doses of THC in the long run.

Physiological factors

A person’s unique physiology will determine their personal response to THC. When medicating on THC, it is important to diarize how your body responds to different dosages of THC versus any adverse effects that you may experience. This will help you find that sweet spot where you achieve the maximum therapeutic benefits with minimal side effects. This sweet spot will be unique to you.

Use of nano-technology

Nano technology is used to break down cannabinoids such as THC into nano-sized particles that can easily mix with water. In short, nano technology makes it possible to transform THC into “water-soluble” molecules that are readily absorbed into the bloodstream. Research has shown that nano-emulsified cannabinoids have greater bioavailability. Consequently, a lower dose of THC will be required to provide a significant therapeutic benefit.

THC Dosage Guidelines For Sleep

Research has shown that THC in low doses is effective in promoting sleep. One study showed that 5 mg to 15 mg of THC taken before bedtime may have sedative effects. [4] Some studies have shown that higher doses may have the opposite effect. At the same time, consumption of THC over extended duration may disrupt sleep.

THC Dosage Guidelines For Pain

Medical marijuana can be used effectively to treat chronic pain. One study has shown that a starting dose of 5 mg of THC used in combination with 5 mg of CBD may be an effective way to treat chronic pain. [5] This dose can be titrated upwards aiming for a maximum dose of 40mg THC and 40mg CBD. While titrating, add 2.5 mg of THC after seven days as you observe how this can treat chronic pain. Research has shown that combining THC with CBD will boost the pain-relieving properties of THC (entourage benefits) and at the same time it will reduce the adverse effects that are associated with THC consumption, therefore improving the quality of life of the patient.

THC Dosage Guidelines For Anxiety

CBD is the cannabinoid that is mostly associated with anxiety-relief. However, low doses of THC such as 2.5 mg per day or twice daily may provide significant relief from anxiety. [6]

THC Dosage Guidelines For Multiple Sclerosis

Multiple sclerosis is one of the qualifying conditions for medical cannabis treatment. One study showed that 4mg of THC administered once daily in the evening reduced pain and spasticity in MS significantly. [7] A different guidance from Australia showed that a starting dose of 2.5 mg THC is ideal for MS treatment.[8]  There is a plant based pharmaceutical, not available in the U.S. called Sativex.  Sativex is produced by GW Pharmaceuticals based in the UK which was specifically designed for MS patients.  Its formulation, 2.75 mg of THC and 2.75 mg of CBD aka a 1:1 ratio. Please note, not all 1:1 ratios are 2.75 mg of each.  It could also be 5mg, 10mg, etc of each.

THC Dosage Guidelines For Nausea

Medical marijuana has potent anti-nausea effects. Dronabinol (Marinol) is a form of THC that is offered to patients with severe chemotherapy-induced nausea and vomiting. The recommended dosage (rapid protocol) for this drug is 5 mg every 1 to 3 hours aiming for a maximum of 30mg of THC per day.

What’s the Recommended Standard Dosage of THC?

Medical cannabis is yet to be standardized. There are several factors that have led to the lack of standardization such as the varying formulations of THC in the market and the gross mislabeling of THC products. However, efforts are being made to create standard units of THC. This will go a long way in streamlining medical cannabis and make it easier for doctors to prescribe this kind of treatment. It will also help researchers to interpret research results and draw objective conclusions with ease.

One review proposed 5mg as the standard unit of THC. Different research has shown that 5mg-10mg of THC is effective in relieving various medical conditions. Hence, 5mg of THC is slowly becoming an acceptable standard unit for quantifying THC dosage.

Can you Overdose on THC?

Given the negative publicity that has plagued the cannabis industry for decades, many patients often wonder if taking too much medical marijuana will result in a fatal outcome. To date there are no reported fatality cases that have been ascribed purely to THC consumption. Therefore, it can be concluded that it is not possible to overdose on THC. That said, taking higher doses of THC can result in adverse negative effects, some of which may land you in the ER.

Negative effects of THC include:

  • Extreme anxiety
  • Paranoia<
  • Increased blood pressure
  • Increased heart rate
  • Nausea and vomiting<
  • Psychotic symptoms like hallucinations and delusions

While the euphoria is temporary and not life threatening, the experience can be very scary for a new user. Therefore, new patients are advised to go real slow on THC and give their body ample time to adjust to the effects.

How THC Dosages is Affected by the Type of Product & Consumption Method

As mentioned earlier, THC comes in different formulations. Some products such as edibles and capsules are ingested, others such as joints and vapes are inhaled, while others such as lotions are applied to the skin. The different formulations of THC affect how much of the THC will get to the bloodstream to provide the desired therapeutic benefits and the onset of action. This of course affects THC dosing. Below is a breakdown of different marijuana products with notes on how they can be dosed.

Flower Dosage

Smoking is an ideal way to deliver marijuana directly to your bloodstream. When you smoke a high-THC strain, the THC is absorbed through the nasal mucosa and finds its ways through the lungs and to your brain via the bloodstream. In so doing, the THC escapes first pass metabolism where most of the THC would have been lost. Hence, a higher percentage of the THC gets to the bloodstream. In addition, this method ensures that the patient begins to experience the healing effects a few minutes after they take the first puff and the effects peak at 30 minutes. Lower doses of THC are required when the THC is inhaled.

Vape Dosage

Vaping is similar to smoking marijuana flower. However, there is no combustion involved. The THC can bepre-filled in a vape cartridge or used with actual cannabis bud/flower and inhaled using a vape pen. The THC immediately gets to the respiratory system and into the circulation and finds its way to the brain. Because hepatic metabolism (breakdown in the liver) is bypassed, higher concentrations of THC are available for use by the body. Consequently, low doses of marijuana are required.

Concentrate Dosages

Concentrates contain highly concentrated and pure forms of THC. The THC concentration in concentrates may be as high as 99%. Concentrates are usually inhaled through vaporizers or dabs. This ensures that the THC gets to the bloodstream immediately and hepatic metabolism is avoided. Having such high concentrations of THC, only minute quantities (such as a grain of rice) are required to deliver a powerful effect for severe pain. This consumption method is not recommended for new patients who are starting out with marijuana.

Edibles Dosing

THC edibles come in different forms, all of which have to be ingested through the mouth. Once ingested, the edible will have to go through the digestive system and undergo breakdown in the liver (hepatic metabolism) where a significant portion of the THC will be lost. Some studies have shown that only 4-20% of the THC in edibles is available for use by the body once the edible has been consumed. This means that higher doses of edibles will be required to produce significant therapeutic benefits. It is also important to mention that because the THC has to go through the digestive process before it gets to the bloodstream, the effects will take a much longer time before they kick in.  So please be sure to wait before eating/ingesting more.

Tinctures Dosage

Cannabis tinctures are taken sublingually (beneath the tongue). A few drops of the cannabinoid are placed beneath the tongue and the patient only swallows after 15 seconds have lapsed. This region has many blood vessels and the THC is taken up within a few minutes. This ensures that the THC bypasses hepatic metabolism and higher amounts are available for use by the body. The effects could be experienced within 15 minutes.

Cannabis Dosing: Patient Insights

“Start low and go slow”

This is a rule of thumb for cannabis dosing. It’s never possible to ascertain how your body will respond to THC. Therefore always start with a low dose such as 2.5mg of THC. You can increase gradually, like every seven days, as you observe and record how your body is responding. This will help your body adjust to the THC easily without having to experience extreme adverse effects.

Less is More

When it comes to dosing THC, less is always more. Higher doses of THC may elicit unwanted negative effects. Therefore, it is important to find the minimum effective dose that provides the greatest therapeutic benefits while eliciting minimal side effects.

Full spectrum tetrahydrocannabinol (THC) products will contain extra cannabinoids such as CBD as well as terpenes. This offers several benefits for dosing THC. A full spectrum THC product will enhance and prolong the therapeutic benefits of THC. At the same time, studies have shown that the CBD offsets some of the adverse effects of THC. This will make the THC CBD  product more tolerable to users.

Cannabis dosing may seem to be a complicated process, because there seems to be “no standard dose” per se. We hope that this detailed article has provided the much needed guidance on how to find an optimum dose that allows you to enjoy the numerous benefits of using cannabis without getting overwhelmed in the process.

References

  1. Freeman, T. P., & Lorenzetti, V. (2020). ‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration. Addiction (Abingdon, England), 115(7), 1207–1216. https://doi.org/10.1111/add.14842
  2. University Hospitals. Acetaminophen (Tylenol, etc.) Dosage Table. Retrieved from https://www.uhhospitals.org/rainbow/health-information/health-and-wellness-library/pediatric-drug-dosage-information/acetaminophen-tylenol-etc-dosage-table
  3. Nicholson, A. N., Turner, C., Stone, B. M., & Robson, P. J. (2004). Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. Journal of clinical psychopharmacology, 24(3), 305–313. https://doi.org/10.1097/01.jcp.0000125688.05091.8f
  4. Russo E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British journal of pharmacology, 163(7), 1344–1364. https://doi.org/10.1111/j.1476-5381.2011.01238.x
  5. Bhaskar, A., Bell, A., Boivin, M. et al. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 3, 22 (2021). https://doi.org/10.1186/s42238-021-00073-1
  6. Stoner SA. Effects of Marijuana on Mental Health: Anxiety Disorders. Alcohol & Drug Abuse Institute, University of Washington, June 2017. URL: http://adai.uw.edu/pubs/pdf/2017mjanxiety.pdf.
  7. S, G., Hb, S., K, L., R, T., Bs, R., Ps, S., F, S., & Ab, O. (2021). Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis. Multiple sclerosis and related disorders, 48, 102708. https://doi.org/10.1016/j.msard.2020.102708
  8. Australian Government Department of Health. Guidance for the use of medicinal cannabis in the treatment of multiple sclerosis in Australia. Version 1, Dec 2017. https://www.tga.gov.au/sites/default/files/guidance-use-medicinal-cannabis-treatment-multiple-sclerosis-australia.pdf

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