THC Dosing that Applies to All Medical Cannabis Patients is Hard to Create

Jessica McKeil October 23, 2020 0 comments

The inability to create standardized THC dosing for various conditions is one of the reasons we’re behind on cannabis medicine.

In the early days of medical cannabis, the standard recommendation (or prescription) was typically quite vague. It was common practice for physicians to hand out scripts for “one to two grams of flower.” Through today’s lens and a better grasp of cannabinoid science, this standard is very much outdated. We now know that THC dosing is much more complicated than these old protocols suggested.

The need to standardize THC dosing has been an ongoing concern for everyone involved in medical cannabis: regulators, researchers, patients, and physicians. The medical cannabis realm needs easy to follow dosing guidelines, which reduce risks and improve benefits. But is a standard dose even possible? It turns out, a ‘standard’ dose of THC continues to mystify scientists.

The Challenges of Finding the Right THC Dosing

From one patient to the next, a single serving of THC tends to unleash a variety of effects across a wide spectrum. For some, a 10 mg dose of THC is over powerful, uncomfortable, and unpleasant. For others, 10 mg is barely perceptible. Some experience anxiety, while others feel euphoric, or increased sensitivity to pain versus pain-relief. What is going on?

Over the years, researchers have identified several factors that influence an individual’s experience with THC. These include Body Mass Index (BMI), experience with THC, gender, age, medical conditions, and more.

The problem? Fitting together all these influential puzzle pieces to develop a standard protocol. Researchers are only just grasping these complexities, but true guidelines are likely years away. As one example, older adults feel the THC’s effects much stronger and for a longer duration than younger demographics do.

In a second example, a 2008 study published in the Journal of Analytical Toxicology, reported that people with a higher BMI tested positive for THC metabolites much longer than those with a lower BMI. This suggests that weight plays into how our bodies process and store THC. [1]Goodwin, R. S., Darwin, W. D., Chiang, C. N., Shih, M., Li, S. H., & Huestis, M. A. (2008). Urinary elimination of 11-nor-9-carboxy-delta9-tetrahydrocannnabinol in cannabis users during … Continue reading

But even with this evidence, we don’t yet have guidelines on an effective THC dose based on age or BMI. If the goal of standard THC dosing is to deliver the most benefits, with the least amount of risk to the greatest number of patients, we still have a long way to go.

A New Proposal for Standardizing a THC Dose

In 2019, the Society for the Study of Addiction published “‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration.” This review was an attempt, by authors Tom Freeman and Valentina Lorenzetti, to compile all available resources on current standards. How do governments regulate dose size? What are patients relying on? What does the research suggest? [2]Freeman, T. P., & Lorenzetti, V. (2020). ‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration. Addiction (Abingdon, … Continue reading

Freeman and Lorenzetti concluded, “Similar to alcohol units, we argue that standard cannabis units should reflect the quantity of primary active pharmacological constituents (dose of THC).” Considering THC is the cannabinoid responsible for the intoxication, and the majority of adverse events, this makes sense.

The authors argued that many current methods completely fail to quantify a dose. Like the gram-based prescriptions of days gone by, other units commonly used among medical cannabis patients (ex: a joint) fail to capture the potency and effectiveness.

But what should this standard be? As per their assessment of current opinions, regulations, and usage, THC dosing should be set at 5 mg increments. This would apply to all products, including concentrates, edibles, flowers, and more.

How to Safety Get Started with THC Dosing

How should patients approach THC-rich medical cannabis to reduce the risk of adverse events, but reap the maximum therapeutic impact? Today, most cannabis-fluent healthcare professionals suggest a patient-driven process of titration. Self-titration is the process of slowly increasing dose to achieve medicinal value, without increasing side effects.

With the new suggested THC dosing guidelines suggested by Freeman and Lorenzetti, what is a safe way to titrate up to a therapeutic dose?

  1. Choose a route of administration and product which is easy to use, and that allows for consistent, precise doses. Generally speaking, commercially available edibles, tinctures, isolates, sublingual tabs, and capsules are a safe bet. Smoked and vaped products are harder to control.
  2. For patients with no experience with cannabis or THC, begin with a 2.5 mg dose. Other patients who have consumed cannabis in the past may want to start with a 5 mg dose. It’s also wise to dose right before bed, instead of in the morning.
  3. Maintain this initial dose for three days. Monitor for any effects.
  4. After three days, if you felt no medicinal effects on symptoms (and no adverse reaction), increase the dose to 5 mg and 10 mg respectively.
  5. Maintain this dose for three days. Monitor for any effects.
  6. Continue to repeat this process until you experience medicinal benefits, or once side effects become challenging. You have achieved your ideal dose.

THC Dosing Standards, A Long Way Off

Freeman and Lorenzetti’s suggested dose size of 5 mg is likely more useful and lower risk than current regulatory guidelines. Typically a single serving is standardized at 10 mg, but not all patients benefit from this dose.

Even with their updated THC dosing guidelines, scientists are still a long way off from truly understanding the highly-individualized effects of THC on the human body. With so many influencing factors, from BMI to gender to age, it will likely be several years before a personalized THC dosing protocol is possible. Until then, patients must learn the ins and outs of self-titration.

References

1Goodwin, R. S., Darwin, W. D., Chiang, C. N., Shih, M., Li, S. H., & Huestis, M. A. (2008). Urinary elimination of 11-nor-9-carboxy-delta9-tetrahydrocannnabinol in cannabis users during continuously monitored abstinence. Journal of analytical toxicology, 32(8), 562–569. https://doi.org/10.1093/jat/32.8.562
2Freeman, T. P., & Lorenzetti, V. (2020). ‘Standard THC units’: a proposal to standardize dose across all cannabis products and methods of administration. Addiction (Abingdon, England), 115(7), 1207–1216. https://doi.org/10.1111/add.14842
Author avatar

Jessica McKeil

Jessica McKeil is a freelance writer focused on the medical marijuana industry, from production methods to medicinal applications. She is lucky enough to live in beautiful British Columbia, Canada where the cannabis industry is exploding. When not writing, she spends much of her time exploring in the coastal forests.

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