DOSAGE: A SHORT INTRODUCTION
Many patients and even a few physicians have little idea of how to dose and deliver herbal cannabis medicines. Our only media models for cannabis use are stoner comedies, such as the Cheech and Chong movies or Pineapple Express. The model of cannabis dosage portrayed in these films is as inaccurate as learning how to drive an automobile by watching the chase sequences in Fast & Furious.
A more rational approach to medical cannabis dosage is to use the smallest effective amount of cannabis that delivers the desired symptomatic relief. This minimum effective dose is summarized quite simply by the phrase, “just a little bit.”
“Just a little bit” emphasizes the small, controlled, and measured dosage approach to herbal cannabis. It can be challenging for patients new to cannabis to avoid overmedication, since many of the tools—such as bongs (water pipes) and vaporizers—don’t come with detailed instructions encouraging informed, controlled dosage. Consistent overmedication with herbal cannabis can lead to tolerance to cannabis’ medicinal effects, requiring increased dosage in order to relieve symptoms that were previously relieved with smaller doses.
Media portrayals of cannabis use encourage patients to develop a skewed sense of the size and frequency of appropriate cannabis dosage.
Dose guidance is especially useful with THC-dominant cannabis medicines, which can be highly psychoactive. But what’s a dose? The best-studied cannabis medicine is Marinol, the prescription synthetic form of THC. Clear dosage guidelines are well understood for Marinol and can provide a starting point for developing dosage guidelines for herbal cannabis. A Marinol dose begins at 2.5 milligrams of THC for appetite stimulation. For chemo-induced nausea an effective Marinol dose can exceed 15 milligrams, depending on patient’s height and weight. Psychoactivity is typically noticed by most patients at a dose of 5 milligrams of THC, so a 15-milligram THC dose can produce high high levels of psychoactivity that may be very unpleasant. Recent studies have shown that cannabis doses that deliver between 2.5 and 10 milligrams of THC can address a wide range of symptoms with tolerable levels of psychoactivity. There is increasing evidence that the other primary cannabinoid, CBD, found in some varieties of cannabis, can in fact reduce THC’s psychoactivity levels.
