A Physician’s Perspective on Optimal Cannabis Dosing

Bidirectional Effects of Cannabis

Cannabis also has the ability to produce opposite (or bidirectional) effects in different people, with different strains, and at different dosages. For example, anxious people who take cannabis may relax while non-anxious people who take the same dose can become anxious. The same dose of two different varieties of cannabis can cause opposite effects – one might be an awakening strain and the other might put you to sleep.

Interestingly, the symptoms of cannabis overdose closely mirror the symptoms one would expect cannabis to relieve at appropriate doses: nausea, vomiting, diarrhea, sweating, spasms, tremors, anxiety, panic attacks, paranoia, discoordination, and disturbed sleep. Extreme overdoses can lead to hallucination and even acute psychosis.

Fortunately, these symptoms are all self-limiting, and most people return to their normal selves within 12 to 24 hours. Even though a cannabis overdose may make a person feel like they’re dying, such an experience will cause no toxicity or permanent damage, except perhaps in people who have unstable cardiovascular or psychiatric conditions, or in the case of impairment leading to an accident.

Combining CBD and THC

CBD and THC have many overlapping therapeutic qualities, including relief of pain, anxiety, seizures, and nausea, although they work via different mechanisms of action.  When combined, CBD and THC can enhance each other’s benefits while reducing unwanted effects, including the psychoactive or impairing effects of THC. This is great news for cannabis users who want health benefits while maintain optimal performance at home or work.

By adding CBD to THC, the therapeutic window, described above, becomes even wider. Consumers should know, however, that the total dose of cannabinoids needed to treat a symptom or condition will also likely increase.

For example, in a study of 177 patients with cancer pain, one group received an oral spray of THC, while another group received an oral spray of combined THC and CBD at an approximate 1:1 ratio. Both groups were allowed to gradually increase their dose until they experienced satisfactory relief. The THC group ended up using an average of 27 mg daily, while the CBD+THC group used close to 60 total mg daily, but the CBD+THC group had a superior reduction in pain. I’ve seen this in many patients–combine CBD and THC for optimal benefits, but be prepared to take (and purchase) higher overall dosages.

Ultra-low Dosages

Some patients do well with ultra-high doses (hundreds or thousands of milligrams daily). THC consumers have to slowly work up to these high doses, but many patients can quickly reach high doses of CBD without adverse effects. On the other hand, ultra-low doses can be extremely effective, sometimes even more so than the other extreme.

Most people are surprised to learn that the therapeutic effects of THC-dominant cannabis can be achieved at dosages lower than those required to produce euphoria or impairment.  Cannabis microdosing, taking a non- or slightly psychoactive dose for the purpose of improving heath and productivity, has been gaining popularity.

People report better mood, reduced anxiety, improved focus, enhanced resilience to stress, less pain (and/or less bothersome pain), and other benefits without any adverse effects. Most consumers find that 1-5 mg works well for this purpose. Some emerging evidence even suggests that a practice like this could be protective against the damage of a heart attack or brain injury!

Recommendations for New and Experienced Users

For new cannabis users, I abide by an old adage I learned from one of my geriatrics instructors: “Start low, go slow, and don’t be afraid to go all the way.” I’ve developed an easy- to-follow program to help find your optimal dose, along with other useful resources like a medical cannabis shopping guide, available free on Healer.com.

For existing users who may have built some tolerance to cannabis, I encourage you to try my 6-day sensitization protocol, which has helped thousands of people reduce their cannabis dose by 50% or more while improving the benefits. If you haven’t tried non-inhaled delivery methods such as tinctures or sprays, and if you haven’t experimented with the combination of CBD and THC, I suspect that both of these endeavors will help you continue to unlock the full power of this incredible herb.

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