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Finding your “just right” dose.

Optimal medical marijuana dosing practices will make your experience with the cannabis plant more enjoyable and help it work better for you, regardless of your condition. Medical marijuana is plant-based medicine at its most sophisticated. It is not like a typical prescription medication that is given to reverse a particular symptom or illness.

Medical marijuana dosing is unique. It’s not like regular prescription medication.

All good marijuana dosing starts with planning.

Marijuana, just like any strong medication, has risks. Just because your neighbor can take a 200mg THC edible does not mean you should, or that you could even handle that amount. Yet though no deaths have resulted from a marijuana overdose, it is still a very intoxicating substance at moderate to high doses and should be treated with respect.

The most common reported side effect of marijuana is “dizziness.” Other common side effects can include sleepiness, anxiousness (from too high a dose of THC), dry mouth, dry eyes, poor balance, and coordination, decreased short term memory function, and reduced motor skills.

Safe marijuana use starts with learning your tolerance to the plant, the method you are choosing to take it (oral, sublingual, or vaping), and the duration of its effect with that delivery method and dose. All of these things take some planning.

New patients will need to get used to medical marijuana at very low doses.

New marijuana users may get absolutely no effect from the first or first two times they use it. Recreational users know this fact well and will often site personal experience of not getting “high” the first time they smoked marijuana.

The Endocannabinoid system needs to be “primed” first to be able to react to the medication. Sometimes this takes one or two days of microdoses before trying to find a dose that will treat your condition.

To keep things simple, I usually recommend planning a three to five day sensitization period no matter the delivery method chosen. Typically the sublingual product will give you the ability to keep the dosing low and even take it drop by drop if needed.

To begin with, I always recommend taking a quality CBD product to be taken daily or twice daily. I recommend 10-25mg CBD in any form, such as capsule, liquid, or vape. A full-spectrum CBD product with 0.3% or less THC is preferred.

More information on the Utah Medical Marijuana Program

Plan to take a dose of 1-2.5 mg THC orally in the evening time when you are in a safe and comfortable location. Having someone you trust to be available is preferred. Keeping a mindful approach will make your relationship with marijuana all the better.

Write down your plan in a journal with the dose of CBD along with the planned dose and time for the THC.

Do: Find your therapeutic dose.

Finding a therapeutic dose of marijuana is next. The process follows a similar path to sensitization, but at higher and more regular times during the day or evening.

The delivery method starts to make a considerable difference depending on whether you vape flower, take a sublingual preparation, or take a capsule by mouth. The onset of action for vaping might be 2 minutes, while the capsule may take 2+ hours to take effect.

Also, the duration of the vape might be 1 hour, and the capsule may linger for the whole day (10+ hours). This article discusses a sublingual tincture, which typically has effects beginning as early as 45 minutes to one hour after ingestion.

I offer specific dosing protocols for each new patient individually because each person is different and has different goals and tolerances. Check with your provider or contact me for detailed information. Utahmarijuana.org is building comprehensive dosing protocols for all products based on my experience with patients, current research, and known best practices.

Patient Qualification Information

Start low and go slow; Do what works for you.

On the morning of day one of finding a therapeutic dose (day 1T), take your small dose 1-2.5 mg of THC when you are ready to begin. I suggest the afternoon or early evening allow for the onset of action and enough time before sleeping. For this example, let’s use 2 pm As our starting time.

At 5 pm, if you do not feel the effects of the marijuana plant in your body, take an additional dose of 1-2.5 mg of THC. This is it for today. Wait a few hours and take an inventory of how you feel. Awareness of the effects of marijuana is the key to establishing a good relationship with the plant as medicine.

If you found that by 7-8 pm you feel more relaxed and separated from your pain, then you are on your way to finding the right dose for yourself. If you found yourself feeling anxious or uncomfortable, you may have taken too much and need to find a “middle ground on day 2 (T2). If you felt nothing or sensed only mild effects, but did not feel improvement in your symptoms, move on to Day 2.

Day 2 (T2) of finding a therapeutic dose starts with the dose you left off from day 1. If you have already noticed that 2.5 mg of THC is allowing you to feel better and you are tolerating the side effects without any trouble, congratulations! You have found your dose.

If you are tolerating the side effects well and are not quite getting beneficial results, start with the dose you left off from day 1 (T1), 2-5mg of THC. Three hours later, take a mental inventory of how you feel. Are you starting to have relief from pain? Are you able to relax into your pain and notice that it is still there, but not as bothersome?

If the answer is no, and the side effects are not noticeable or are tolerable. Specifically, do you have trouble concentrating, or are you feeling a difference in coordination? Do you feel safe?

At this point, you can add 1-2.5mg of THC and record in your journal the effects. This will help you remember the dosing as well as the impact; list the side effects and pain level you are feeling.

Day 3 follows the same plan. Take the dose you did the day before to start, whether that was one, two, or three doses of 1-2.5mg. Remember to make each dose the same. Do not take 1mg doses, then if you don’t feel the effects after 3mg, jump to 6mg out of frustration.

Commit to finding the right dose for you. Trust me, it is worth building a solid knowledge of how this plant affects you, and the more care you take in this stage, the better your relationship with marijuana will be long-term.

Three hours after the initial dose, take another dose if you still feel that the side effects are small, and the therapy is not working. Continue this daily practice until you find that the pain is improved and the side effects are tolerable.

Check: Therapeutic dose vs. Uncomfortable side effects

Two things may happen when you follow this type of protocol. On the positive side, you will find a dose that helps your pain level decrease while you can tolerate the side effects. Alternatively, you may find that the side effects become the dominant force, making you uncomfortable.

If you find that the side effects are strong, but you are not getting much benefit from the medicine, you are not alone. Many of my patients report that the psychoactivity of the THC or other side effect bothers them during this first phase.

The human body develops a tolerance to the side effects of medical marijuana.

It is well known that humans develop tolerance to marijuana through studies of recreational users. Medical patients, mine included, typically report that the adverse side effects become lessened over time, but the therapeutic benefits remain. Even with the same dose of THC!

This is excellent news for medical marijuana patients. Simply lower the dose you are taking until you find the side effects are tolerable and maintain that dose for three-four days in a row, without change to build up a tolerance to some of the negative side effects. Then return to finding that dose that helps.

Remember the CBD you are taking daily? CBD acts as a buffer to some of the psychoactivity of THC and can lessen the adverse side effects at higher ratios. You may also increase the amount of CBD during this exploration phase of treatment to help blunt some of the side effects as well.

Overdosing on marijuana may not be deadly, but it can be costly.

Therapeutic dosing with marijuana follows a bell curve distribution, as shown in the picture. Too low a dose may not give the patient enough benefit to make sense. And too much will cause bothersome side effects along with negative impacts.

Consistently overdosing THC levels causes the need to keep increasing the dose of THC for the same effect.

If 10mg of THC is an ideal dose to help you decrease your other pain meds, or sleep better and avoid pain meds altogether, and you consistently take 20mg in order to get that “high” effect, you will eventually need to take 20 mg of THC in order to treat your condition. Your cost per month will continue to increase.

This can typically be avoided by using the correct dose that you found by following the above protocol. Evidence suggests that the Endocannabinoid system will maintain balance long term with optimal dosing strategies.

Sensitizing the body to marijuana and finding a truly optimal dosing strategy can be an exciting journey to find just the right balance. Check your mind and your body, keep a journal and talk to your medical provider with questions and concerns. Good advice from trusted sources is always helpful.

As always, if you have comments or questions about any of my articles, or want more information on individualized dosing strategies for any condition, reach out to me.

—Tim Pickett, PA-C

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-provider relationship, and should not be used as a substitute for professional diagnosis and treatment. Read the full disclaimer here.

Resources:

  • Whiting, Penny F., et al. “Cannabinoids for Medical Use: A Systematic Review and Meta-analysis.” JAMA 313.24 (2015): 2456-2473.
  • Russo, Ethan, and Geoffrey W. Guy. “A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol.” Medical hypotheses 66.2 (2006): 234-246.
  • The National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids; 2017. Available from: https://www.nap.edu/read/24625/chapter/5#76

4 responses to “Medical Marijuana Dosing Protocol”

    • Anne, I’m glad you found it helpful! While the pharmacists should be very thoroughly educated on dosage protocol, feel free to bring it to their attention if you feel they are not answering your questions adequately.

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