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Dosing and Delivery of Medical Marijuana

Marijuana has medical value. Much unlike pharmaceuticals marijuana comes with few side effects, which does not include death. We have been (unfortunately) conditioned to believe marijuana is only for ‘getting high,’ among other things. Yet, I would argue even that relaxing your mind (for some) using THC can be beneficial to overall health, especially as it pertains to everyday stressors, I digress early… There are different administrations, dosing amounts, and frequency of taking this medicine to consider because medical marijuana is not standardized. More studies are becoming available proving the medical benefits of marijuana; out of 4 scientific databases there are about 24,000 abstracts as of 2017. However, medical marijuana, or using marijuana medically, is more than simply getting high. And your Doctor’s are not learning about it in medical school. So let’s learn more together now!

First, let’s go over some common misconceptions:

-Using medical marijuana is equivalent to getting high; actually low doses provide therapeutic relief without the “high.”

-Medical marijuana is addictive and a gateway drug; it is very rare for marijuana to be physically addictive and in the way of gateway drugs it is not and can not be proven because of the inaccuracies, there’s too many other factors to consider marijuana playing a role in users trying or using other harder drugs.

-Medical marijuana can kill you. It can’t, even if you overdose.

-Medical marijuana will make you lazy and unmotivated. While some strains and the amount consumed may lead to couch-lock, but making you lazy and unmotivated, no.

-Medical marijuana cause lung cancer and kills brain cells. Medical marijuana is known to cause cancer cell death, and it’s a neuroprotectant as stated in the government held patent - US6630507B1.

So how do we use medical marijuana? First, what are your goals? What do you want to achieve with using medical marijuana? Do you want to improve your quality and length of sleep? Reduce pain enough to do the things you love everyday? Reduce anxiety and stress to live life everyday? Deciding what you want out of using medical marijuana is were to start. Get clear, and specific on your goals. Write them down.

Then, “start low, go slow.” It’s a great way to get optimal benefits using the lowest, effective dose to achieve your goals. Please note, using too much marijuana will decrease its effectiveness and increase its negative side effects. What you want to do is start with a subtherapuetic dose, a micro-dose of 1mg-2mg at a 1:1 ratio of THC:CBD (if you are extra sensitive to medicine in general use a higher CBD:THC). Keep a journal of the strain (including indica vs. sativa), administration, dose, timing of administration, frequency of administration, any/all feelings after using, how long those feelings lasted. As well as any other information you want to include like: daily nutrition including hydration, exercise, and daily activities. Also, consider a daily regimen; your choice of all or any morning, afternoon, evening/bedtime.

Try your first days (Days 1-3), attempting to feel only the slightest effect and build cannabinoid receptors. On day 4, increase the dose by 1mg of marijuana beyond the minimal effect keeping in mind the symptomatic relief you want to achieve. The goal is to discover your lowest therapeutic dose of marijuana to effectively achieve your personal goals.

The downside, however, is that everybody’s body responds differently and builds tolerance at different rates. Some people experience their desired effects with lower doses, some with higher; and it’s not related to your body weight. This is important as I mentioned earlier that you want to “start low, and go slow.” So you’ll want to titrate (increase your dose) slowly. Please note there is, and may come, a point in which higher doses aren’t providing the same benefit as before. Which is why it’s important to keep a journal. If you are needing a higher dose to get the same effect(s) then you have likely exceeded your optimal therapeutic dosage.

In order to appropriately find the right strain for your condition or goals, it's also important to know what’s on the market now. The THC:CBD ratio is paramount and must be considered when formulating dosages.

Here is a short list to generalize what’s currently available:

-Type 1 (THC-dominant) – High THC, low CBD

-Type 2 (THC & CBD) – Mixed THC and CBD cultivars

-Type 3 (CBD-dominant) – High CBD, low THC (There is also THC-Free CBD, understand you lose the entourage effect but you can still benefit especially if your livelihood is in consideration).

-A fourth type to know about (and may be more important in the future) are varieties which prominently express other not-so-well-known cannabinoids, like CBG or THCV.

Next to consider is whether the strain is an Indica or Sativa. Indica is commonly relaxing, sedating, and calming. An easy way to remember is Indica=In-da-couch. Sativa provides a more energetic and uplifting effect. Again, understand every person is different and you may have opposite experiences with these species. Find what is best for your condition and goals, and try different strains until you find what works best for you.

Now I do want to talk about overdosing. Again, medical marijuana (itself) will not cause death. Symptoms of marijuana overdose, closely mirror the symptoms you may hope to relieve, like: nausea, vomiting, diarrhea, sweating, spasms, tremors, anxiety, panic attacks, paranoia, discoordination, and disturbed sleep. Extreme overdoses can lead to hallucinations and even acute psychosis. THC is non-toxic, and won’t harm you, even in high doses.

Here are a few remedies to try in case this happens:

-Lemon zest, simply grind a lemon peel and sprinkle it on some food then eat it and the food.

-Drink a cup of chamomile tea to help you relax and relieve the psychoactive effects.

-Hydrate, hydrate, hydrate and wait it out. You’ll be back to normal soon.

Now let’s go over the different delivery methods. Here’s an easy chart to show you different ways of administration:

We will start with inhalation. It’s recommended by Dr. Dustin Sulak to smoke out of an herbal vaporizer or long-stem glass or ceramic pipe. First start with a single inhalation and check in with how you are feeling. Wait 15 minutes before inhaling again. If necessary add a single inhalation every 15-30 minutes until your desired goals are achieved. You can repeat this process for 3 rounds and can perform this up to 3 times per day.

The oral/mucosal application can come in the form of tinctures or lozenges; anything you hold in your mouth or under the tongue. Know there is a difference between an oil based tincture and an alcohol based tincture. Instructions for tinctures are generally placing drops under your tongue, allowing them to be absorbed through the mucosal membranes for a short period of time, then swallowing the rest. But instructions may be different depending on your condition and the base of the tincture.

Ingestion is anything that must move through your digestive tract. Edibles are a big part of this administration. However, edibles can be difficult to dose due to either being mislabeled, too much is consumed, and the ingredients in the final product. Capsules are also considered an ingestible. A recommended starting dose for ingestibles: Beginner 1-5mg, Moderate 5-10mg, Expert 10+ mg

Topical applications include salves, balms, massage oils, any skin care products. Which you can rub into any spot on your body from head to toe. However, do not use topicals on open wounds or broken skin.

Transdermal applications include patches & gels which you would apply to veinous parts of your body such as the top of the foot or the inner wrist. Some balms and creams may be transdermal because they may have a deeper penetration than a topical. Be sure to read the label. Please also do not use transdermals on open wounds or broken skin

Suppositories are an application to consider whether vaginal or anally, depending on your condition and research. Please look into whether this is a good option for you and your goals.

In summary, medical marijuana is a journey. Be patient and open to trying the best administration, strain for your condition and goals. Be willing to learn and talk about all the details of medical marijuana. Have a starting point, a methodology and a program for titrating from that starting point to determine what works best for you based on your individual condition(s) and/or goals. It’s possible to enhance your cannabinoid upregulation by eating more omega 3 & 6 foods, dark chocolate (over 80%), and voluntary exercise, to name a few. Understand too medical marijuana is not a “magic pill” please consider eating more organic, non-gmo fruits and veggies, stay hydrated with high quality water, move your body, keep calm and get great sleep.

-Written by Marcella Povis


CBD: A Patient’s Guide to Medicinal Cannabis--Healing without the High by Leonard Leinow, Juliana Birnbaum, Michael H. Moskowitz

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