Last month we presented 8 useful recommendations for the new user of cannabis. For this installment, we offer more practical tips for the first-time user of medical marijuana.
1. More is not always better!
When starting with cannabis to help relieve symptoms, start with a low dose, and go slow. Start at a low amount such as 1-2 milligrams and you increase as needed either every dose or every few days depending on the side effects experienced. If you feel dizzy or lethargic, you should either stay at this dose or lower the dose and stay at that amount for a few days before increasing. An average optimal dose is usually between 2.5-10 milligrams. At lower levels, you may experience better mood, reduced anxiety, and less pain without any adverse effects.
With increasing dosage, effectiveness may decrease as side-effects increase. This effect on the benefit of marijuana is called the “biphasic” response.
2. Higher THC concentration of herbal cannabis may allow utilization of lower amounts. Adjust your dose accordingly.
Keep track of the THC content of your products. Higher THC (and CBD) concentration can allow a reduction in the amount used to gain the same effect. Lower amounts needed help control costs too.
3. Getting “high” is not required to attain symptom control.
Experiencing a marijuana high is not necessary to achieve optimal symptom relief.
4. THC-mediated side effects such as fatigue, rapid heart rate, and dizziness are avoidable when the starting dose is low and titration is slow. Slow upward dose adjustment promotes tolerance to the psychoactive effects of THC, which is especially important for user new to cannabis.
Again, start with a low dose and increase to relieve symptoms while minimizing the chances of side effects. Always keep a record of your dosage for safety and repeatability of dosing. See last month’s article on recommendations for a cannabis diary.
5. For chronic conditions and symptoms, long acting oral preparations such as tinctures and edibles are recommended.
One milliliter or ml (cc) is about 16 – 20 drops depending on the dropper. A ¼ dropper dose (0.25 ml) is about 4 – 5 drops. Remember these conversions when starting out with a low dose. Always check the package to see if a different conversion is recommended for a particular product.
6. Dosage adjustment is easier with an oral THC preparation (gummy, tincture) vs. inhalation (plant, oil) since the concentrations of THC and CBD should be provided by the producer.
When starting always cut an edible (gummy) into halves or quarters. Remember that onset of effect may take up to 90 – 120 minutes. Do not take a second dose until you are sure of the effect of the first dose.
7. For cannabis inhalation, start with 1 inhalation and wait 15 minutes. Then, increase by 1 inhalation every 15-30 minutes until desired symptom control has been achieved. Always be aware of the THC concentrations of your marijuana products.
8. Vaporization (“vaping”) can be used as supplemental as-needed technique for episodic worsening of symptoms.
9. Vaporization is subject to more variability which can influence the estimated dose: size of vaping device chamber, depth of inhalation, breath holding, strength of THC in the product, etc.
Most cartridges are 0.5 ml in volume. On average, a cartridge contains about 100 puffs (which may vary depending on the depth of inhalation. An estimate of the dosage of THC can be calculated dividing the THC content of the cartridge by 100. Calculation of the dosage of a single puff when vaping flower (or smoking) is much more difficult and relies more on the number of puffs needed to relieve symptoms.
General starting dosage recommendations:
Days 1–2: 2.5 mg THC-equivalent at bedtime. Start at 1.25 mg if young, elderly, or other concerns are present.
Days 3–4: if the previous dose tolerated, increase by 1.25–2.5 mg THC at bedtime.
Days 5–6: continue to increase by 1.25–2.5 mg THC at bedtime every 2 days until desired effect is obtained.
In the event of side effects, reduce to the previous, best-tolerated dose.
Keep a record of your dosage, response, and side-effects so that appropriate adjustments can be made. Also, remember that switching forms of marijuana (i.e. vape to edible) may alter the amount needed to achieve a desirable response.
10. Some patients require THC for daytime use depending on their symptoms. Consider the use of a more stimulating variety unless sedation is the desired result. Most patients dose orally two to three times per day.
A recommended schedule for daytime use:
Days 1–2: 2.5 mg THC-equivalent once a day
Days 3–4: 2.5 mg THC twice a day
Increase as needed and as tolerated to 15 mg THC-equivalent divided BID-TID
Doses exceeding 20–30 mg/day may increase adverse events or induce tolerance without improving efficacy
Finally, a little about CBD:
CBD can balance THC side effects, especially during daytime use.
CBD-predominant varieties of cannabis have fewer adverse events. For most conditions, CBD doses of 5-20 mg per day orally in 2 to 3 divided amounts may be beneficial for many.
Using CBD-predominant varieties (chemovars) with the smallest amount of THC can provide the greatest improvement in symptom control, function, and quality of life, with fewest adverse events.
For more reading and helpful information, click here.
If you are a qualifying patient who is suffering from one of the qualifying conditions and is seeking medical marijuana treatment, schedule a telemedicine evaluation, and gain access to Ohio dispensaries. You can schedule your appointment by calling us at 866-457-5559 or book your appointment online.
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