Clinical Guidance for Medical Cannabis Dosing

By Michael Peña on May 29, 2018

Everyone has a horror story when it comes to edibles. Though the effects are usually amusing in hindsight, something as simple as a cookie or a brownie can be a recipe for disaster if you take one bite too many. My story came when I accidentally ate too much of a complimentary budtender care package. I’m a simple man—promotional items and eating are kinda my thing. A 1000mg edible, however, is not.

Don’t fear! There’s good news on the horizon for those unable to measure a comfortable dose: Researchers are solving the dosing dilemma for us. 

Caroline A. MacCallum and Ethan B. Russo, both renowned for their research advocating for the use of cannabis in medicine, led a 2018 study published in the European Journal of Internal Medicine. The study said, "[The] general approach to cannabis initiation is ‘start low, go slow, and stay low’.” Straightforward enough, right? More surprisingly, the duo suggested the adverse effects associated with cannabis use are primarily THC-related, and they recommend limiting THC intake to 30mg/day or less, preferably used in combination with CBD. Most of the patients involved in the study smoked one to three grams of cannabis daily, with fewer than five percent of patients using more than five grams daily. They aren’t the first researchers to reach these conclusions, but they are definitely the most credible.

Amongst the enlightened is GW Pharmaceuticals, who manufactures a CBD spray called Epidiolex and a THC version called Sativex. The company recommends beginning treatment with one spray per day (2.7mg THC / 2.5mg CBD), building to a maximum of 12 sprays in a 24-hour window (32.4mg THC / 30mg CBD), roughly the same dosage guidelines put forth by MacCallum/Russo. (This is not a surprise since Dr. Russo was formerly the company's Senior Medical Advisor.) What’s noteworthy is that the FDA will likely approve Epidiolex by late June, making it the first cannabis-based drug to receive federal certification. Could this become the recommended standard for daily dose?

Maybe not. We still have a long way to go before the medical community reaches an agreement on proper dosage. The study suggested, “Physicians of the world remain profoundly uneducated with respect to cannabis and the endocannabinoid system (ECS) that underlies much of its activity. A recent U.S. study documented that 89.5% of surveyed residents and fellows felt unprepared to prescribe, while only 35.3% even felt ready to answer cannabis questions. Additionally, only 9% of American medical schools documented pertinent clinical cannabis content in their curricula.” 

Right now, this sounds like bad news for any edible consumers in the “> 50mg” range, but the jury isn’t out just yet. For now, people should heed the wise words put forth by the cannabis industry’s favorite researchers and “never confuse psychoactivity with efficacy.”

Michael Peña is a Los Angeles-based writer, musician and Kanye West enthusiast. He can be found on Instagram @ilooklikestevezahn.

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