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Outreach, Education, & Research on the Medical Benefits of Cannabis
Dosing and Side Effects – My Compassion | Outreach, Education, & Research on the Medical Benefits of Cannabis

Each strain of the plant has its own cannabinoid and terpene profile and subtly different effects. Whether you use a Sativa or Indica dominant, or a Hybrid it makes a difference on how it affects your mind and body.

Side Effects

Currently no significant interactions between cannabis and other drugs are known at this time, though research indicates when used with opiate painkillers the effects are enhanced. Little is known about the interaction with other pharmaceutical medications, but it is something to consider when using cannabis. It is important to talk to your Doctor if you are using cannabis for medical purposes as some studies have shown interactions with barbiturates, theophyline, fluxetine, disulfiram, sedatives, antihistamines.

CBD (Cannabidiol) and THC (tetrahydrocannabinol) share a special interdependent relationship and work together to increase one another’s therapeutic benefits. CBD is a non-psychoactive compound. THC is psychoactive and, therefore, may produce euphoric or dysphoric effects. A patient’s sensitivity to THC is a key factor in determining appropriate dosages and ratios for a CBD-rich treatment regimen. CBD can lessen or neutralize the psycho activity of THC. So an increased ratio of CBD-to-THC means fewer mental effects.

  • Indicas can cause drowsiness – avoid driving or operating heavy machinery when using your medicine.
  • Sativas have a more energetic effect however; patients have reported increased heart rate due to anxiety.
  • Change your strain if the one you’re using seems to be losing its effectiveness.
  • Experiment with high CBD strains, particularly for nausea, appetite, and pain.

What is my dose?

How much cannabis do I use?  What is the dose for condition X, Y, or Z ?

This is the pressing question that all want to know!  If you do get an answer, you are likely to find that no two consultants, pharmacists or physicians are likely to respond with the same information.  There is no easy formula! We are all programmed by Western medicine to believe that there’s a specific, ideal protocol for a particular condition.  This is not the case with cannabis or other botanical medicines (in fact dosing of traditional medications is an oversimplification to support a one-size-fits-all approach).  Furthermore, there is a good explanation for this as it is due to our individual metabolisms, and something called “epigenetics”. Epigenetics is defined as follows, “…the inheritance, by mechanisms other than through the DNA sequence of genes.”  It is a modern term that describes several factors that may influence an individual’s more subtle genetic expression like lifestyle factors such as diet, obesity, physical activity, age, tobacco smoking, alcohol consumption, utilization of pharmaceuticals, environmental pollutants, psychological stress, and working on night shifts.… these are all factors that a clinician may typically consider in the question of dosing recommendations.  A simple way to think about epigenetics is “endocannabinoid tone”.

 What is the ECS?  What is endocannabinoid tone?

The endocannabinoid system (ECS) is the exquisitely important system in our body that interacts with chemicals we produce internally called “endocannabinoids” and also interacts with phytocannabinoids (from cannabis) and is responsible for homeostasis – our bodies way of maintaining stability.

Endocannabinoid tone – refers to the health status of our own personal endocannabinoid systems (ECS).

Cannabis, as a botanical medicine, is designed to interact with one’s own chemistry gently.  Cannabis is not a pharmaceutical medicine that is designed to overpower one’s own chemistry.

What is tolerance?

Tolerance results from the continued stimulation of cannabinoid receptors leading to desensitization and reduction in the available receptors to interact with cannabinoids, also known as “down-regulation”. This is similar to how tolerance to any medicine occurs. Tolerance means you require more to achieve the same effect. It is possible for tolerance to happen within a few weeks of using cannabis regularly at higher doses. If you inhale more than three or four times a day, you are likely developing tolerance. If you take more than 20 mg of cannabinoids by oral ingestion in a day you may develop tolerance.  When starting a new regimen, one must clarify and target your goals. One must ask…how do I view cannabis–as medicine or as a substance similar to alcohol?  Are you new to cannabis and use a small to moderate dose or a longer-term consumer of cannabis who, through the years, has maximized their cannabis dose?  Some indications that you may be developing a tolerance include noticing you are using a higher dose to get the desired effect, or the effect of your stable dose seems to be diminished.

What is a tolerance break?

Most individuals using cannabis will experience tolerance at some time.  If this occurs, there are a couple approaches to management. The simplest method is to take a cannabis break and not use cannabis again for a few days. For those using higher doses, maybe over 40-50 mg/day, or who use concentrates may need to take a break for several days—even up to a week or a bit longer.  This approach is like hitting a “re-set” button.  Another approach involves using THC and CBD to selectively reduce the effects of the other (some of the characteristics are opposite between the two cannabinoids and also, they interact at different receptors).  For many conditions, it is feasible to take advantage of some of the overlapping characteristics – both THC and CBD are anti-inflammatory in nature,  are effective at muscle relaxation, and may both be used as anti-nausea agents. Tolerance reduction is accomplished by alternating between CBD-rich products and THC-rich products to accomplish the same result while using smaller doses of each. This strategy can give you the relief you need while avoiding a tolerance build-up.

How about drug interactions between pharmaceuticals and cannabis?

Does cannabis interact with your current medication regimen? This is a critical discussion topic to have with your pharmacist or doctor.  Drug interactions with cannabis exist, especially when cannabis is added to existing pharmaceutical regimens at high doses, however, the presence of clinically meaningful interactions is not well documented and with a few exceptions, some believe the interactions to be mostly inconsequential. This topic is currently not well understood, as the required research has been inhibited by the Drug Enforcement Agency’s scheduling of cannabis.

The very best approach to dosing cannabis is the “Start low, go slow, stay low” method of titrating to your effective dose.  More IS NOT necessarily better!

What are the best methods of taking cannabis?

What type of cannabis products are available to you in your area? If availability of cannabis products is limited or is not legal in your state, are CBD-only products an option? (The whole plant is best as it includes the full complement of cannabinoids, terpenes and flavonoids with more robust therapeutic effects – keep in mind it is always preferable to include at least a small ratio of THC in a formulation, which the current laws do not necessarily allow for in all US States. Furthermore, research has shown that a lower effective does of cannabinoids is required when whole plant is used versus an isolated compound – like THC free CBD.)

For new users who require very low doses – start with the lowest dose and go up from there. Be patient, as it may take a few weeks to determine your optimal dose and begin to feel its effects. Using inhalation, only one or two puffs may be necessary. For edibles including sublingual and swallowed dosage forms, 2.5 – 5 mg of cannabinoids is a good starting dose, or if you’re highly sensitive, perhaps less.  Ultimately, your dose and time to make progress depends on the type and severity of your condition, what pharmaceutical medications you’re taking (as well as those epigenetic factors previously mentioned).  For example: If you’re taking an opiate for pain control even 5 mg of cannabis will not likely have an effect. For topicals, — you just rub it on and see what happens.

How often should I take a dose of cannabis?

How often depends upon the product and your symptoms. Some people use their medicine pro re nata, which means only when they have symptoms.  The table below summarizes the basic ways to intake cannabis, the average onset and duration of effects and typical considerations for use when selecting your preparations.

Type of medicinal cannabis dose Time to onset of effect       (typical uses) Observed duration

 of effect


Smoking flower in joints, bongs and pipes or vaporized — chronic use is associated with respiratory symptoms such as bronchitis – NOT lung cancer or COPD

5-10 minutes

(rapid onset is useful for quick relief of symptoms – for example: nausea/pain, break through insomnia)

2-4 hours
Orally ingested

Oils, capsules, edibles and swallowed liquids

60-180 minutes

(may be better for chronic diseases/symptoms)

6-8 hours
Topical preparations

Salves, lotions, suppositories – primarily local absorption

Variable onset, typical is 30-60 min

(best for localized effects such as focused muscle or joint pain)

2-6 hours (variable)

Recreational administration includes shatter, ‘wax’ and dabs, and are concentrates that deliver very high doses of THC with a high risk of euphoria, impairment, toxic psychosis and sudden drops in blood pressure. These approaches are inappropriate for medical applications.

Thinking through your specific needs is critical.  For example: When using cannabis to help you get to sleep (and stay asleep) you will want to select something that lasts six to eight hours, an inhaled dose may help one get to sleep but would not help one sleep throughout the night.  In this situation, it may be useful to combine an inhaled and an edible form. A second example is if you have arthritis pain only when walking a lot, you might take a medicine before you walk that lasts about four hours—or apply a topical prior to your excursion.  Those with chronic or constant symptoms might want 24-hour coverage —with current cannabis dosage formulations this approach would mean taking an oral form such as a capsule, for example, three or four times daily to experience sustained effects.

Don’t consume THC and drive; it can impair motor skills. To date there is no law in place that defines a specific time a person should wait before driving or operating heavy machinery. Because people and potency of strains and products vary so greatly, it is always wise to wait until you feel the effect has completely worn off.

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