What is my proper CBD Dosage? A great article from projectcbd.org

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It can be relatively easy to experience medical benefits from cannabis. A puff or two of tetrahydrocannabinol (THC)-rich flower can do the trick for a lot of people.

Smoking marijuana, however, is not the be-all and end-all of cannabis therapeutics. There are many ways to experience the medical benefits of cannabis, and some of them are even non-intoxicating.

In recent years, the advent of potent cannabis oil concentrates, non-intoxicating cannabidiol (CBD) products, and innovative, smokeless delivery systems have transformed the therapeutic landscape and changed the national conversation about cannabis.

It’s no longer a question whether marijuana has medical value. Now it’s about figuring out how to optimize your therapeutic use of cannabis to suit your lifestyle and situation.

 

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DOCTORS AND CANNABIS DOSAGE

Optimizing therapeutic cannabis use can be a challenge – for doctors as well as patients. Most physicians never learned about cannabis in medical school and, according to a 2017 survey, few feel they are qualified to counsel patients about dosage, CBD:THC ratios, different modes of administration, and potential side effects.

“Dosing cannabis is unlike any therapeutic agent to which I was exposed in my medical training,” says Dustin Sulak, D.O., the director of Integr8 Health, which serves patients at offices in Maine and Massachusetts. “Some patients effectively use tiny amounts of cannabis, while others use incredibly high doses. I’ve seen adult patients achieve therapeutic effects at 1 mg of total cannabinoids daily, while others consume over 2000 mgs daily without adverse effects.”

Cannabis comes in many different forms with a wide range of potencies, and its production and distribution have yet to be standardized in states where cannabis is legal for therapeutic use. So what’s the best way to proceed when it seems like cannabis dosage is all over the map?

MICRODOSING FOR BEGINNERS

One of the common misconceptions about cannabis therapy is that you have to get high to attain symptom relief.

“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,” says Dr. Sulak, who asserts that “ultra-low doses can be extremely effective, sometimes even more so than the other [high-dose] extreme.”

Preclinical science lends credence to the notion that a small amount of THC can confer health benefits. 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), according to a 2005 report in Nature, which noted: “This effective dose is lower than the dose usually associated with psychotropic effects of THC.”

Because of federal cannabis prohibition and consequent research restrictions, clinical data is lacking to determine if low dose THC therapy can protect against atherosclerosis in humans. But this much is certain: The practice of micro-dosing – which entails the consumption of a sub-psychoactive or slightly psychoactive dose of cannabis – is gaining popularity among those who want the medical benefits of cannabis without the buzz.

Although banned by federal law, cannabis medicine is currently accessible in the form of concentrated oil extracts, infused sublingual sprays, tinctures, edibles, gel caps, topical salves and other products.

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MANAGING PSYCHOACTIVITY

The successful use of cannabis as a medicine largely depends on managing its intoxicating properties. Many people enjoy the cannabis high; for others it’s unpleasant. A person’s sensitivity to THC, the main intoxicating component of cannabis, is key to implementing an effective treatment regimen.

Cannabidiol (CBD) does not cause an intoxicating high like THC. CBD can actually lessen or neutralize the THC high, depending on how much of each compound is present in a particular product. A greater ratio of CBD-to-THC means less of high. Today cannabis patients have the option of healing without feeling high.

Broadly speaking, there are three types of resin-rich cannabis and cannabis products:

  • Type 1 (THC-dominant) – High THC, low CBD (famously intoxicating cannabis varietals)
  • Type 2 (THC & CBD) – Mixed THC and CBD cultivars (intoxicating, but not as edgy as THC-dominant varietals)
  • Type 3 (CBD-dominant) – High CBD, low THC (non-euphoric marijuana or hemp)

There’s also a fourth type – those rare cannabis cultivars that prominently express a so-called minor cannabinoid (like CBG or THCV). But in terms of what’s currently available for patients, the THC:CBD ratio is paramount and must be considered when formulating dosage strategies.

So, what’s the appropriate dosage for each of the three main types of cannabis?

“START LOW, GO SLOW”

The adage “start low and go slow” is apropos for cannabis therapy, in general, and THC titration in particular, as discussed by Caroline MacCallum and Ethan Russo in a January 2018 article in the European Journal of Internal Medicine. The authors, who are both physicians, provide sensible guidelines for health professionals and patients regarding the judicious administration of (Type 1) THC-dominant medicinal preparations.

If a new patient is going to smoke or vape THC-rich cannabis, Russo and MacCallum suggest they start with a single inhalation and wait 15 minutes before inhaling again. The effects of inhaled cannabis usually can be felt within a few minutes, thereby providing quick relief of acute distress. If need be, one can inhale an additional puff every 15 to 30 minutes “until desired symptom control is achieved.”

As for oral administration, one should keep in mind that it can take 60 to 90 minutes before the effects of a single dose are felt.

MacCallum and Russo suggest a carefully titrated regimen for consumption of ingestible THC-rich cannabis products. They recommend that patients with little or no experience using cannabis should start by ingesting the equivalent of 1.25 to 2.5 mg of THC shortly before bedtime for two days. If there are no unwanted side effects, increase the bedtime dose of THC by another 1.25 to 2.5 mg for the next two days. Continue to increase the dose of THC by an additional 1.25 to 2.5 mg every other day until the desired effects are achieved.

If there are adverse side effects, reduce the dose of THC to the prior amount that was well tolerated.

TYPE 3- FULL-SPECTRUM CBD-RICH EXTRACTS

Microdosing cannabis is a feasible option for those who prefer not to leap over the intoxicating threshold. High dose CBD therapy is another way of healing without the high.

As a general rule, Type 3 CBD-dominant cannabis (with little THC) won’t make a person feel stoned. Nor will a pure CBD isolate (with no THC). But CBD isolates lack critical aromatic terpenes and other cannabinoids, which interact synergistically to enhance CBD’s therapeutic benefits. Single molecule cannabinoids are simply not as versatile or as efficacious as whole plant formulations.

Preclinical research indicates that full spectrum CBD-rich cannabis oil is effective at much lower doses and has a wider therapeutic window than a CBD isolate. “The therapeutic synergy observed with plant extracts results in the requirement for a lower amount of active components, with consequent reduced adverse side effects,” a 2015 Israeli study concluded. In animal studies, CBD isolates require very high – and precise – doses to be effective. Problematic drug interactions are also more likely with a high-dose CBD isolate than with whole plant cannabis.

Hemp-derived CBD isolates and distillates are already available via numerous internet storefronts. If you’re shopping for hemp-derived products online, there can be some quality issues to address before purchasing. Drug companies are also eyeing single molecule CBD as a treatment for intractable epilepsy, psychosis, and other diseases.

In a 2012 clinical trial involving 39 schizophrenics at a German hospital, 800 mg of pure pharmaceutical-grade CBD proved to be as effective as standard pharmaceutical treatments without causing the harsh side effects typically associated with antipsychotic drugs. But a follow-up study at Yale University found little cognitive improvement in schizophrenics who were given a CBD isolate.

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PHARMACEUTICAL CBD

Bereft of the THC stigma (and its therapeutic moxy), single-molecule CBD recently became a FDA-approved pharmaceutical for pediatric seizure disorders. This is good news for families with epileptic children that have health insurance. Anyone without health insurance won’t be able to afford Epidiolex, a nearly pure CBD remedy developed by GW Pharmaceuticals as an anti-seizure medication.

Consider the dosage range utilized in clinical trials of epidiolex. Children with catastrophic seizure disorders were given up to 20 mg of epidiolex per kg of body weight. Such high doses caused interactions with other anticonvulsant medications, requiring adjustments of the latter to avoid a toxic overdose.

By comparison, Dr. Bonni Goldstein, author of Cannabis Revealed, typically starts with a much lower dose of full spectrum CBD-rich oil (1 mg CBD/kg of body weight) for epileptic children – with the understanding that the dose may have to be lowered or raised depending on the initial response. If necessary, Goldstein will increase the dose of CBD by increments of 0.5 mg/kg until a threshold of 5 mg/kg of body weight is reached. And that amount also may need to be adjusted.

Kids and adults metabolize drugs differently. It may seem counterintuitive, but young children can tolerate high doses of cannabis oil concentrates, including THC-rich formulations, which might be daunting for an adult. Thus, it’s not a good idea to calculate dosage for an adult based on what works for a child.

If 1 mg/kg of CBD is an appropriate starting dose for a child, and an adult weighs 15 times more than the child, one should not assume that the correct CBD starting dose for the grown-up is 15mg/kg of body weight. That could be way too high a dose. While CBD has no known adverse effects at any dose, an excessive amount of CBD may be less effective therapeutically than a moderate dose. 
Similarly, it’s not a good idea to devise a dosage regimen based on data from preclinical animal studies, which usually involve high doses of single-molecule cannabinoids. Human metabolism differs from mice and rats, and data from animal models doesn’t always translate to human experience.

PERSONALIZED MEDICINE

For people as well as pets, cannabis dosage must be individually determined. Several factors come into play, including one’s overall health and endocannabinoid tone, which are influenced by diet, exercise, sleep patterns, day-to-day stress, and genetics. Cannabis is best used as part of a healthy lifestyle.

Here are some dosage variables to consider:

  • Cannabis experience. Has the patient used cannabis before? Or are they a stoner who already uses cannabis every day but isn’t getting the best results? A veteran user may need a higher dose than a new user. Or a chronic user might need a break from getting high to reboot his or her sensitivity to cannabis (see Dr. Dustin Sulak’s cannabis “sensitization protocol” on Healer.com).

  • Time of day. Optimizing one’s therapeutic use of cannabis may entail using products with different CBD:THC ratios at different times of the day –  more CBD for daylight hours, more THC at night.

  • Preventive dosing. Prolonged low dose therapy may be advantageous for managing chronic symptoms or to prevent disease recurrence. Preclinical studies indicate that cannabinoids have neuroprotective and cardioprotective properties that could limit the damage of a traumatic brain injury or a heart attack.

  • Cannabinoid acids. Raw, unheated cannabis contains CBD and THC in their “acid” form, CBDA and THCA, which are not intoxicating. Consumed orally over several months, cannabinoid acids can be effective in very small amounts, but precise dosing is difficult when juicing raw cannabis. Other delivery systems are becoming available for CBDA-rich and THCA-rich products.


Cannabis is a safe and forgiving medicine. Figuring out how to make the most of its health-enhancing properties may involve some trial and error. No worries! At least cannabis isn’t harmful like so many FDA-approved pharmaceuticals.

So if you’re new to cannabis medicine or if you’re seeking to improve your therapeutic routine, remember this advice from Dr. Sulak: “Start low, go slow, and don’t be afraid to go all the way!”

So, the time has finally come when you want to see what CBD is all about, but you don’t know where to start. Tinctures are a great way to test your tolerance, whether you are going for something with a kick or you want to ease into things, our knowledgeable staff can guide you through the buying process. Our Delta 9 tinctures are just one reason that we are the best CBD dispensary in Indianapolis and Geist!

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