Healthy cannabis dosing? (Doctor advises)

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• You have certainly often wondered how much cannabis is actually optimal. In this article, Dr. Dustin Sulak will give some advice to answer this question.

DR. Dustin Sulak:

"If we want to avoid side effects and make optimal use of cannabis consumption, dosage is the key factor. After following hundreds of patients who used medical cannabis for eight years, I found that cannabis dosing is not comparable to understanding the main principles. Proper dosing helps you get the most out of this incredibly versatile, safe, and effective herb.

Some patients effectively consume only a small amount of cannabis, while others consume an incredibly large amount. I have seen patients achieve therapeutic effects with just 1 mg of cannabis per day, while others have taken more than 2000 mg per day without side effects. Although this amount is unusual in treatment, researchers did not kill the monkeys in tests even at doses up to 300 times higher than the highest amount used by physicians. [i]

Multiphasic Dose-Response Relationship

As evident from this broad dosage range, cannabis exhibits an atypical relationship between the dose and the expected response. With most drugs, a higher dose leads to stronger therapeutic effects and a higher likelihood of side effects. This process is described as a monophasic dose-response relationship. Cannabis, however, does not follow this process.

For most consumers, a gradual increase in the amount of cannabis produces stronger effects, but at some point they will break. This moment occurs differently for each person, and the result is a gradual reduction in therapeutic effects and an increase in side effects.

Consumers who nevertheless continue to increase their cannabis dosage will often notice a recurrence of some therapeutic effects or even the discovery of new effects that did not occur at lower doses. Of course, higher dosages are much more expensive and usually lead to many more unwanted side effects. Most patients do better when they stick to a lower dose.

Less is more for them! One study focused on 263 cancer patients who were divided into several groups. The group that consumed 21 mg of THC and CBD daily showed much greater pain relief than the other group that received 52 mg daily. In the third group, which consumed 83 mg of cannabis daily, there was no significant pain relief, but patients experienced many more side effects. [ii]

"Cannabis can produce different effects in different people depending on the strain and the amount."

How is that possible? The endocannabinoid system is a delicate, physiological system designed to maintain balance at the cellular level. However, when cannabinoid receptors are overstimulated by high doses of cannabis, the cells draw their receptors inward, where they are subsequently recycled or broken down. [iii] The lower the number of cannabinoid receptors, the weaker the effect of cannabis. This is especially true when the dose is too high. This phenomenon is called "tolerance building" and is experienced by many people who regularly consume cannabis.

"Therapeutic Window"

The term "therapeutic window" describes the range between the lowest effective dose and the dose that produces unwanted or unacceptable side effects. People with little or no experience with cannabis usually have a very narrow "therapeutic window," while regular consumers create a broader "window." This is because individuals build tolerance to the different effects of cannabis at different rates. They build tolerance to these side effects much faster than to the desired ones.

The Two-Way Effects of Cannabis

Depending on the strain and the amount, cannabis can produce different effects in different people, sometimes referred to as bidirectional. For example, people suffering from anxiety who consume a certain amount of cannabis may feel calm. Other people who do not suffer from anxiety may, however, feel anxious when consuming the same amount. The same amount of two different cannabis strains can also have opposing effects. One may produce stimulation, the other sleep.

"By combining THC and CBD, you can make the most of the benefits of cannabis and reduce the number of side effects."

Interestingly, the symptoms of a cannabis overdose are very similar to those that cannabis should relieve when properly dosed: nausea, vomiting, diarrhea, sweating, cramps, tremors, anxiety, panic attacks, paranoia, impaired coordination, and sleep disturbances. An extreme overdose can lead to hallucinations and even acute psychosis.

Fortunately, these symptoms soon subside, and people usually return to their natural state within 12 to 24 hours. Even if a person feels like they are dying from an overdose, such an experience does not cause toxicity or permanent damage. The only exceptions are people with unstable cardiovascular or psychiatric conditions and situations in which an accident occurs.

Combining THC and CBD

Although both THC and CBD work through different mechanisms, they have many overlapping therapeutic properties, including relief of pain, anxiety, seizures, and nausea. By combining THC and CBD, you can make the most of the benefits of cannabis and reduce the number of side effects, such as the psychoactive effects of THC. These are great news for cannabis consumers who want to take full therapeutic advantage of cannabis while keeping a clear head.

Extremely low doses of cannabis can be very effective, sometimes even more so than extremely high ones.

By combining CBD and THC, the aforementioned "therapeutic window" becomes even wider. Consumers should, however, be aware that this also increases the total amount of cannabinoids needed to treat symptoms and diseases.

One example is a study of 177 cancer patients suffering from pain. One group received an oral spray containing THC, while the other group received an oral spray containing a combination of THC and CBD in a ratio of approximately 1:1. Both groups were allowed to gradually increase their dose until they experienced satisfactory relief. The THC group had an average amount of 27 mg per day. The THC + CBD group took an average of almost 60 mg per day but experienced much greater pain relief. [iv] And I have noticed this in other patients as well. By combining THC and CBD, you can achieve better results, but you need to be willing to take higher amounts.

Extremely Low Doses

Some patients do well when consuming extremely large amounts of cannabis (hundreds or thousands of milligrams per day). Everyone should gradually work toward such extreme doses, but some patients are able to reach such doses very quickly and without side effects. Extremely low doses of cannabis can be very effective, sometimes even more so than extremely high ones.

Most people are surprised that they achieve the best therapeutic effects from THC-containing cannabis through low doses, not through those intended to cause a euphoric state. Recently, the popularity of cannabis microdosing has increased, which means consuming non-psychoactive (or only slightly psychoactive) cannabis to improve health and productivity.

People have reported better mood, reduced anxiety, higher concentration, increased resilience to stress, less pain (or less bothersome pain), and other benefits without side effects. Most consumers state that 1-5 mg is best suited for this purpose. Some new evidence even suggests that this method could offer protection against damage to the heart [v] ^{, [vi]} or the brain after a heart attack.

Recommendations for New and Experienced Consumers

People who are just starting to consume cannabis should follow this old saying I learned from a geriatrician: "Start low, go slow, and don't be afraid to miss the whole journey." I have developed a simple program to help you find the right dosage. Along with other programs, such as the guide to purchasing medical cannabis, these programs are available for free at Healer.com.

For experienced consumers who have already built up some tolerance to cannabis, I recommend trying my six-day program, which has already helped thousands of people. It will help you reduce the amount of cannabis by up to 50% while improving the healing effects. If you have not tried using cannabis with tinctures or sprays, and have not yet experimented with a combination of THC and CBD, be sure to try it! It will help you discover the true power of this herb."

Source:

[i] Thompson GR et al. Oral and intravenous toxicity of Δ9-tetrahydrocannabinol in rhesus monkeys. Toxicology and Applied Pharmacology. 1974; 27 (3): 648-665.

[ii] Portenoy RK et al. Nabiximols for opioid-treated cancer patients with poorly controlled chronic pain: A randomized, placebo-controlled, graded-dose trial. The Journal of Pain. 2012; 13 (5): 438-449.

[iii] Hsieh C et al. Internalization and recycling of the CB1 cannabinoid receptor. Journal of Neurochemistry. 1999; 73 (2): 493-501.

[iv] Johnson JR et al. "Multicenter, double-blind, randomized, placebo-controlled parallel group study of the efficacy, safety, and tolerability of THC: CBD extract and THC extract in patients with intractable cancer-related pain." Journal of Pain and Symptom Management. 2010; 39 (2): 167-179.

[v] Waldman M. et al. An extremely low dose of tetrahydrocannabinol provides cardioprotection. Biochemical Pharmacology. 2013; 85 (11): 1626-1633.

[vi] Johnson-Sasso CP, Kao D., Walker LA. Marijuana use and short-term outcomes in hospitalized patients with acute myocardial infarction. Journal of American College Cardiology 2016; 67 (13): 569.

[vii] Fernández-Ruiz J., Moro MA, Martínez-Orgado J. Cannabinoids in neurodegenerative disorders and stroke/brain trauma: From preclinical models to clinical applications. Neurotherapeutics 2015; 12 (4): 793-806.

[viii] Nguyen BM et al. Effect of marijuana use on outcomes in traumatic brain injury. The American Surgeon. 2014; 80 (10): 979-983.

[ix] Di Napoli M. et al. Prior cannabis use is associated with outcome after intracerebral hemorrhage. Cerebrovascular Diseases. 2016; 41 (5-6): 248-255.