An ongoing issue with medical cannabis at the moment is the need for a standardised dose. Safe baselines are needed in order to determine a particular individual’s perfect dose of cannabis. The plant provides a potent medicine, and as with all other medicines, it requires a framework that will minimise harm to the consumer. Standardised dosing may be what this framework requires as a starting point. But what is the ideal cannabis dose?
Although many of us see cannabis as harmless, someone new to medical cannabis may see it differently. If you are unfamiliar with cannabis, incorrect dosing can lead to adverse effects such as anxiousness, confusion or paranoia. All of which are no fun for both the recreational and medical consumer.
The current medical cannabis landscape is almost defined by inconsistency. Areas all over the world have varying levels of medical cannabis programs. Some have well versed doctors who specialise in cannabinoid therapies, while other doctors aren’t even aware of the endocannabinoid system yet.
With greater cannabis acceptance as a whole though, we are seeing a growing collection of clinical cannabis research. However, within this research, there are discrepancies in dosing of THC and CBD. Establishing what makes up a dose of cannabis is incredibly difficult.
The best dosing advice that can be given now, and has been given for decades when it comes to cannabis, is to ‘start low and go slow” when administering or consuming medical cannabis. This is not enough for a formal medicine. When you take a Panado, you know the effect that one or two will have, and something similar is required for cannabis.
Why We Need a Standard Cannabis Dose
Cannabis products are gaining some serious diversity, both in types, quantities, ratios and administration methods. An article published in 2019 called Addiction affirms the necessity for a standardised unit of THC, across the various methods of consumption.
A standardised dosing procedure would allow for safer patterns of use. This notion has been presented before as the need for more standardised and accurate dosing is not a new concept. Measuring the grams of cannabis for example, or having a universal joint size. However, neither of these accurately measure the varying concentrations of THC that may be present in certain joints. Consumption methods, such as joints, dabs or edibles, all have different THC concentrations – and the same can be said for different strains of cannabis flower.
An answer to this was proposed in the study linked above, in the form of a 5mg standard THC unit in all cannabis products and across the consumption methods. This approach echoes the way consumers have been taught to purchase other medications or even alcohol.
A 5mg dose can provide positive effects regardless of the consumption method, while simultaneously minimizing the potential for adverse effects. This will also help consumers determine the number of doses they will obtain from a given product.
Research has suggested that labels which list the number of doses in a product are more understandable and effective than simply stating the milligrams of a cannabinoid.
Research Requires Standardised Dosing
The National Institue on Drug Abuse’s (NIDA) Cannabis Policy Workgroup has noted the development of a standardised unit dose as a priority going forward. According to Nora Volkow and Susan Weiss, both NIDA representatives, “A standardized measure for THC content in cannabis products is necessary to advance research both on the adverse effects of cannabis and on the drug’s potential medical uses.”
Universal units of THC may provide greater clarity into understanding the inconsistencies within cannabis based research. This is true in particular in regards to cannabis’ influence on brain development, cannabis use disorder, psychosis and addiction.
According to Weiss and Volkow, ongoing studies and those of the past that have explored the effects of cannabis on brain development and cognition of children and adolescents often exclude important details on the THC levels within the products used for research purposes.
Some findings do point to adverse effects after a single instance of cannabis consumption, while others report no differences with regular exposure. The lack of information regarding THC levels are likely to contribute to the discrepancies in research findings.
Why is THC Dosing so Important?
Cannabis has come a long way since the 70s, with much higher levels of THC today than ever before. This also makes cannabis the most intoxicating it has ever been.
While many more consumers are searching for an experience which won’t leave them curled up on the floor, strains with high THC content are still ever-present. The University of Mississippi in the United States collected over 18 thousand samples over the past 10 years with help from NIDA, and noted that the average THC concentration rose from 8.9% in 2008 to 17.1% in 2017, and several more European countries noted a similar increase. This increased potency has also been linked with higher addiction rates and been greatly associated with adverse effects.
Furthermore, THC can have opposing outcomes at different dosage levels, which is a phenomenon known as the bidirectional effects. An example can be seen in recent research which has shown that higher doses of THC can increase depression, anxiety and greater confusion. Meanwhile, lower doses have been observed to reduce anxiety, distress and perceptions of stress.
Similar effects have been observed in the relationship between cannabis and nausea. Small doses can lessen symptoms, but high chronic doses can result in a condition known as cannabinoid hyperemesis syndrome, provoking intense vomiting and severe abdominal pain. A consumer’s enjoyment and success with medical cannabis all depend on accurate dosing.
An Expert’s Perspective
Dr. Jordan Tishler, a medical cannabis expert and Instructor of Medicine at Harvard Medical School, believes that a 5mg dose is ideal for both research and clinical purposes.
“Most medicines have a starting dose or unit dose, and then they are used in multiples of that dose as needed,” explained Tishler. “A conventional medication might come in 5 mg, 10 mg, 20 mg, and 40 mg tablets, for example. This is based on research that defined the unit dose initially and then showed that the unit dose was correct and that multiples, up to a point, had increasing effectiveness.”
He further explained that in his clinical experience, 5mg represents an accurate baseline. However, he did point out that “a fixed unit dose does not mean that that will be the only dose available, or that patients must be constrained to only that dose. It is a way of standardizing research or clinical use so that results can be predictable and reliable,”
Tishler believes that this standardised unit will be applicable across all consumption methods. But this brings the question of how this will work for vaping or smoking. How do you measure a 5mg inhale?
“In my practice, I sometimes prescribe cannabis use by inhalation—vaporization of flower only, no smoking or oil pens,” said Tishler. “In this case, which is the most difficult to regulate, you can simply use a specific level of THC in the flower, 15-20%, and the methodology of taking a puff—a slow, full breath in—to get a unit dose that’s fairly reliably 5 mg.”
Tishler doesn’t foresee any drawbacks of a standardised dosing system. “It’s not all that often that I agree with NIDA, but this standardization is exactly what we need now to promote research and have more widely applicable results.”
Standard Dosing of Other Cannabinoids
A standard unit dose of THC may contribute to our understanding of the effects of other cannabinoids. “If the THC level is a constant, then we’re better able to discern what the effects of the medication that are not THC-related may be,” pointed out Tishler. “Ultimately, as those other cannabinoids are better understood, they too will need to be standardized.”
The 2019 study on addiction mentioned earlier in this article had hinted at standardised CBD doses, which may be recommended going forward. Seeing as the demand for CBD is increasing, learning about health impacts and applying a standard dose may be helpful.
Furthermore, CBD has been observed to manage some of the adverse effects of THC, without dampening THCs positive impact. A standard CBD dose may make higher THC doses more predictable and manageable.
Needless to say, an ideal cannabis dose is needed for the progression of cannabis as a medicine.