While the potential medicinal applications of cannabis are increasingly promising, it is still a substance which can have potentially strong effects on a patient’s body and mind. As a result, it is important to approach medical cannabis under the supervision of your prescribing physician and Patient Educator. Dosing is an important pillar in the safe use of medical cannabis, particularly for new patients – it refers to how much medical cannabis, in what form, is taken at what intervals, and tracked. This post will briefly discuss how to track and dose with medical cannabis. However, it should be noted that each dosing strategy should be tailored to each patient based on their particular needs and the evaluation of their prescribing physician and Patient Educator.

Onset

Dosing and tracking medical cannabis depends on the cannabinoid mix a patient consumes and the method by which they do so. Different ways of consuming medical cannabis have different onset profiles, with some resulting in earlier effects for a shorter time and others which take more time. We discuss this in more detail in our post on Cannabis Metabolization, but we’ll cover the basics here.

With inhalation, cannabis is quickly absorbed and reaches a high concentration almost immediately, and then spread throughout the body. Peak THC concentration via inhalation occurs in 10-15 minutes before receding almost completely within about an hour. Onset with ingestion occurs more slowly, taking about 1-2 hours to see an effect with peak concentration occurring over the course of 3-6 hours. The effects of ingested THC recede over the course of 24 hours. Ingestion is also affected by whether an individual has eaten or not, and this is covered more in our post on metabolization.

Dosing

Health Canada states that “there are no precise doses or established uniform dosing schedules for products such as fresh marijuana, smoked/vapourized marijuana, or cannabis oil”. At the same time, physiological and psychological responses to cannabis are highly individual, leading Health Canada and medical professionals to recommend a low dosage and slow titration approach. This means that patients should start with a low dose and gradually increase it until symptom alleviation is achieved. Patients should start on a low THC strain and gradually increase concentration if needed, while monitored regularly by a medical professional to determine effectiveness and an optimal strain for the patient. Other points that a patient should consider are intervals between doses (typically a minimum of six hours in between), maintaining a consistent dosing schedule and increments, and whether they should or should not eat before treatment.

While undertaking titration, patients should be tracking their dosing and its effects. Patients will receive a dosing calendar or titration chart from their patient educator, along with product recommendations.

The other aspect of tracking is a journal in which patients should record entries for each day and indicate when they took their dose, onset, duration, and effects. Patients should be attentive to intoxication, sedation, heart rate (whether noticeably higher or lower than normal), and any state of unease or discomfort. All patients should immediately stop treatment if undesirable effects occur, such as disorientation, dizziness, loss of coordination, agitation, anxiety, rapid heartbeat, chest pain, low blood pressure or feeling faint, depression, hallucinations, or psychosis. If any of these or other unexpected or undesirable symptoms occur, stop your dosing and consult with your prescribing physician and Patient Educator.

For first time patients, Health Canada and medical professionals recommend a very low dose (~1mg THC). Various peer-reviewed studies indicate that the majority of medical patients report consuming between 1-3 grams of dried cannabis per day. First time patients should also consider having someone they trust with them the first time they consume medical cannabis.

Most importantly, all dosing plans should be designed in consultation with a patient’s prescribing physician and their Patient Educator. The staff at Hello Cannabis is always ready to answer any questions you have on your medical cannabis journey.

References

  • Cooke, J. THC Metabolism. The Sunlight Experiment: https://thesunlightexperiment.com/blog/2016/4/5/how-is-thc-metabolised
  • Dowsett, L.E. et al. 2017. Cannabis Evidence Series: An Evidence Synthesis. Calgary: Government of Alberta.
  • Health Canada. 2013. Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids. Government of Canada: https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/information-medical-practitioners/information-health-care-professionals-cannabis-marihuana-marijuana-cannabinoids.html
  • Health Canada. 2016. Access to Cannabis for Medical Purposes Regulations – Daily Amount Fact Sheet (Dosage). Government of Canada: https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/information-medical-practitioners/marihuana-medical-purposes-regulations-daily-amount-fact-sheet-dosage.html
  • McCormick MC et al. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington: The National Academies Press, 2017.
  • Nahtigal et al. 2016. The pharmacological properties of Cannabis. Journal of Pain Management, 9(4), 481-491.
  • Rupp, M. Human Metabolism of THC. Sapiensoup Blog: https://sapiensoup.com/human-metabolism-thc
  • Sadhir. 2016. Pharmacology of Cannabis. Journal of Pain Management, 9(4), 375-379.
  • Stott CG, White L, Write S, Wilbraham D, Guy GW. A phase I study to assess the effect of food on the single dose bioavailability of the THC/CBD oromucosal spray. Eur J Clin Pharmacol. 2013 Apr;69(4):825-834.