Cannabis Dosing: Start Low And Go Slow

There is a wide therapeutic range for cannabinoid dosing. Patients respond to certain chemovars or preparations in a unique way, and there are too many variables, such as your metabolism, the delivery method, dose, cannabinoid ratio and product formulation, for dosing of cannabis to be standardized.

Dosing of cannabis is not “one size fits all”. It is highly individualized and has been called “patient-determined, self-titrating” by many experts.

The general rule of thumb is to start with a low dose and increase slowly so you can find the dose that helps your medical condition without going overboard. This takes trial and error and usually requires trying different products, ratios and doses to find what works. If you are new to cannabis use, you should wait at least 30-90 minutes before re-dosing, depending on the method of delivery, as you must give the medication a chance to get into your system. Inhalation will give fairly immediate results but all other methods require time for the effects to be felt.

Patients have complained to me in recent years that there are too many cannabis products to pick from and they are overwhelmed when trying to choose their medicine. I teach them a simple approach that is methodical and allows them to find what works and what doesn’t.

• Decide what delivery method you want to try first. Be aware that you may need to try a different delivery method depending on your response but start with a method that is most comfortable for you.
• Think about what effects you are looking for – are you looking for sleep or pain relief or seizure control? Knowing this will help you decide on whether to start with a THC dominant product versus one containing CBD (with either CBD dominant effects or combination effects). Using the chart below, you can look at any product and categorize it by its test results. Knowing which category the product falls into will let you know the likely effects.
• Take a small dose and wait for the effects. Re-dose only if the effects are not felt. It is better to take multiple small doses throughout the day rather than one large dose.
• Give yourself a few days at a certain dose before changing doses or products.
• Keep a log of what you are taking, the dose amount and the dose timing so that you can assess which products worked, what doses worked and how long the effects lasted.

The following chart helps my patients figure out the likely effects of cannabis products:

As you can see, there is overlap in the medicinal effects of the three categories. Many patients who have experience with THC in the past are less fearful of the effects of THC and therefore may choose products with more THC, whereas someone new to cannabis use may be nervous about THC effects and will be more likely to start with high ratio CBD:THC products. There is no wrong choice. You should go with what feels right for your situation and then depending on your response, you can switch products to fine-tune the results. As mentioned above, start low and go slow. Once you have a product, you can use the following dosing guidelines to help figure out a starting dose.

When I meet with my patients, I often show them examples of product wrappers in order to teach them how to figure out which of the above categories the product falls into, and that way they can know the likely effects. This also allows patients to avoid a possible THC overdose, which although it is never fatal, it can be uncomfortable.

Here is a wrapper from a medical cannabis product:

THC potency is 25mg per 1mL and CBD potency is 1mg per 1mL. This is a THC-rich product, which can cause significant psychoactivity if not dosed correctly. For most new or inexperienced users of edible cannabis products, a starting dose of no more than 2.5mg THC is recommended. For this product, only 0.1mL (one tenth of a mL) is equal to 2.5mg.