DOCTORS AND THE USE OF CANNABIS DOSE
Optimizing medicinal cannabis use can be a difficult task — both for doctors and for their patients alike. According to a 2017 survey, the majority of physicians never taught anything about cannabis during medical school, and only a minority believe they are equipped to counsel patients regarding dose, CBD:THC ratios, different means of administration, and potential negative effects of cannabis use.
Dr. Dustin Sulak, D.O., the director of Integr8 Health, which has offices in Maine and Massachusetts and treats patients, says that dosing cannabis is unlike any other therapeutic substance to which he has been exposed during his medical school training. “Some individuals are able to get by with very small amounts of cannabis, while others require quite high doses. I’ve seen adult patients obtain therapeutic results with as little as 1 mg of total cannabinoids per day, while others have consumed as much as 2000 mg per day without experiencing any negative side effects.”
There are many various types of cannabis available, each with a varying level of potency, and the manufacture and distribution of cannabis in jurisdictions where it is allowed for therapeutic purposes have not yet been standardized. In this situation, what is the best course of action when it appears that cannabis dosage is all over the place?
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When it comes to cannabis therapy, one of the most widespread myths is that you must be high in order to have symptom alleviation.
Doctor Sulak says that “most people are surprised to learn that the therapeutic effects of cannabis can be achieved at dosages lower than those required to produce euphoria or impairment,” and that “ultra-low doses can be extremely effective, sometimes even more effective than the other [high-dose] extreme.”
Preclinical research offers support to the hypothesis that a modest amount of THC can have beneficial effects on one’s health. According to a 2005 Nature report, oral administration of a low dose of THC (1 mg/day) resulted in “significant inhibition of disease progression” in an animal model of heart atherosclerosis (hardening of the arteries), with the following caveat: “This effective dose is lower than the dose usually associated with psychotropic effects of THC.”
Because of the federal prohibition of cannabis and the resulting study restrictions, there is a paucity of clinical data to evaluate if low-dose THC therapy can protect against atherosclerosis in humans. The practice of micro-dosing – which comprises the ingestion of a non-psychoactive or very mildly psychoactive dose of cannabis – is becoming increasingly popular among individuals who desire the medical advantages of cannabis without the psychoactive high.
Despite the fact that cannabis medication is now prohibited by federal law, it is nonetheless available in the form of concentrated oil extracts, infused sublingual sprays, tinctures, candies, gel caps, topical salves, and other items, among other things.
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MANAGING PSYCHOACTIVITY IS IMPORTANT.
The ability to control the intoxicating qualities of cannabis is critical to the successful use of cannabis as a treatment. Many people find the cannabis high to be enjoyable, while others find it to be unpleasant. The ability to detect a person’s sensitivity to THC, the primary psychoactive component of cannabis, is essential for developing a successful treatment plan.
Those seeking the medical benefits of cannabis without the psychoactive high are increasingly turning to micro-dosing, which involves ingesting a sub-psychoactive or mildly psychoactive dose of the plant.
Cannabidiol (CBD) does not provide an intoxication high in the same way that marijuana does. Depending on how much of each ingredient is present in a particular product, CBD can actually diminish or neutralize the psychoactive effects of THC. A higher CBD-to-THC ratio indicates a lower risk of getting high. Patients who use cannabis for healing now have the option of not getting high while doing so.
According to a general classification, there are three types of resin-rich cannabis and cannabis-derived products:
Type 1 (THC-dominant) – Contains a high concentration of THC and a low concentration of CBD (famously intoxicating cannabis varietals)
Type 2 (THC & CBD) — Cultivars that contain both THC and CBD (intoxicating, but not as edgy as THC-dominant varietals)
Type 3 (CBD-dominant) – Contains a high concentration of CBD and a low concentration of THC (non-euphoric marijuana or hemp)
There’s also a fourth sort of cannabis cultivar: those rare cannabis cultivars that are very high in a cannabinoid known as a minor cannabinoid (like CBG or THCV). However, when it comes to what is currently available for patients, the THC:CBD ratio is critical and must be taken into consideration when developing dosing plans.
As a result, what is the recommended dosage for each of the three primary forms of cannabis?
“START LOW, GO SLOW” is a phrase that means “start slowly, go slowly.”
According to Caroline MacCallum and Ethan Russo in a January 2018 study published in the European Journal of Internal Medicine, the adage “start low and go gradually” is appropriate for cannabis therapy in general and THC titration in particular, as they detail in their article. The authors, who are both physicians, present practical recommendations for health-care professionals and patients on how to administer (Type 1) THC-dominant therapeutic formulations safely and effectively.