Here is another wrapper from a medical cannabis product:
THC potency is 2mg and CBD potency is 50mg. This is a CBD-rich product with a ratio of CBD:THC of 25:1 (take the CBD potency and divide by the THC potency). A product such as this is unlikely to cause any significant psychoactivity as the total THC of 2mg is lower than the recommended starting dose of 2.5mg. A starting dose of 10mg CBD is recommended. For this product, one-fifth of the product is equal to 10mg.
Here is a wrapper from another medical cannabis product:
THC potency is 15mg and CBD potency is 15mg. This is product with a ratio of CBD:THC of 1:1 (take the CBD potency and divide by the THC potency). A product such as this is may cause psychoactivity in a new or inexperienced patient. This product should be divided into 6 separate pieces in order to get 2.5mg THC and 2.5mg CBD. Since the THC effects of this product may be strong for some patients, the recommended approach is to start at a low dose and and wait for the effects, only taking another small dose if no effects are felt.
The following doses are guidelines only and may vary based on the medical condition being treated. Medical supervision is highly recommended prior to starting cannabis treatment. These doses are for adults only. Pediatric patients should not be using cannabis products without medical supervision.
THC dosing guidelines:
CBD dosing guidelines:
If you have a product with equal amounts of CBD and THC, use the THC dosing guidelines so as to avoid unwanted side effects from taking too much THC.
Be aware that patients with the same medical conditions can and will find different results even if using the same cannabis chemovar, same dose and same CBD:THC ratios. Using trial and error to find what works for your specific situation is the best way to obtain the best results. Using tested cannabis products is the only way to keep track of what works and what doesn’t.
In my clinical practice, I have seen patients with the same medical conditions use different delivery methods and different doses. Why is that? Remember that each person has a unique metabolism and a unique endocannabinoid system resulting in a unique response to cannabis medicine. An example of this is a mother and adult daughter, both with long-standing debilitating migraine headaches, who came to see me. The daughter had experimented with cannabis prior to her office visit and she reported that if she vaporized THC-rich cannabis at the onset of the symptoms, the migraine did not progress and within 30 minutes all symptoms had disappeared. She shared this information with her mother and encouraged her mother to try using the vaporizer in the same manner. Her mother found that the migraine headache pain increased with vaporized THC but sublingual application of a combination CBD+THC tincture eliminated her migraine symptoms. This example illustrates that even people who are genetically related can respond differently to different delivery methods and different combinations of cannabinoids.
Sometimes patients who have never used cannabis before may not feel any effect with first time use. These patients may get frustrated and take more, which can result in an undesirable “overdose” effect (tachycardia, excessive sleepiness, anxiety and/or paranoia). If you try cannabis medicine and don’t feel anything, you can take another small dose but if you still don’t feel anything, stop and try again another day. No one knows why some people don’t feel the effects the first time, but we think the body may need to be exposed to the medication before the effects can be felt. Sometimes with first time use, too, a patient may deny feeling any effects, but those around the patient will notice the patient is acting differently.
The adult son of one of my breast cancer patients, who was suffering terrible side effects from chemotherapy, reported at a follow-up visit that the first time his mother used cannabis, she got out of bed (where she had been spending most of her time) and began to make dinner. She was chatty and happy for the first time in months and he said the whole family felt relief that “mom was back to normal.” The fascinating part of this story is that when I asked the patient how cannabis made her feel, she said she didn’t really feel anything unusual or different, she just felt like she could get up and make dinner. It was only after a few times of use over the course of a week that she was able to notice that she felt happier, had more energy and was back to a more regular routine.
Overdose is more common by the oral ingestion route as dosing by this delivery method can be difficult to determine and the breakdown product of THC is quite psychoactive and long-lasting. There is no danger of respiratory arrest or death. Overdose of THC can cause rapid heart rate, orthostatic hypotension, altered time perception, paranoia, anxiety, impaired motor coordination, delusional thinking, excessive sleepiness and/or a sense of impending death (perceived harm).
If you take too much THC-rich cannabis and feel badly from it, reassure yourself that you are safe and that nothing bad is going to happen. Try to lie down and sleep or distract yourself with television. In Ethan Russo’s terrific paper “Taming THC”, antidotes for THC overdose are described and include cold lemonade, calamus root, pine nuts, and peppercorn, as all of these contain terpenoids that counteract the undesirable effects of the overdose. Also, CBD-rich cannabis can lessen the THC-induced overdose symptoms. Some patients seek care in the ER and can be treated with benzodiazepines for the anxiety. Once the cannabis wears off, there can be residual effects of lethargy and/or headache but these will usually resolve quickly.
Overdose can result in a patient’s reluctance to use cannabis again but can easily be avoided by only using a small amount of THC-rich cannabis at a time and also using cannabis that contains CBD, which can buffer the psychoactivity of THC.
I often explain to my patients that there are two ways to approach cannabis use. One is the recreational approach and one is the medicinal approach. The goal of recreational use is to “get high.” The goal of a medicinal dose is to treat the medical condition. For some patients there is overlap, and the sensation of “feeling high” is truly a feeling of relief from physical and/or psychological pain. This is extremely valuable for many patients that are suffering, giving them much needed respite and an improvement in their quality of life.
For others, a smaller dose alleviates symptoms and psychoactivity can be avoided. Using a CBD-rich medicine (higher CBD:THC ratio) will prevent psychoactivity, but if relief is not achieved, adding THC may be helpful and should not be feared. A medicinal dose of THC can usually be found. Many of my patients use THC and have found an effective dose for their medical condition that does not cause psychoactivity. It may take trial and error, starting with a low dose and increasing little by little to find the “sweet spot.”
