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How the same thc dose can have different effects

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Rolling a cannabis joint

There is no one-size-fits-all answer to which medical cannabis products are best for a given patient, but if you base your decision on science and pay attention to the importance of dosing, you can make much more informed — and safer — decisions about your treatment, according to Dr. Linda Klumpers. How you take that cannabis product can be even more consequential.

“Patients should get the relevant science that’s relevant for them,” and they should understand the importance of dosing and administration methods, Dr. Klumpers told The Cannigma. “Some people might not even be aware that if you take exactly the same dose of a different administration method, that it will also give a different effect.”

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Rolling a cannabis joint
Rolling a cannabis joint. (El Roi/123rf)

She added that many patients operate under the assumption that medical cannabis products are more tested and regulated than recreational cannabis products — when in fact the opposite can be true. 

A lot of times, what you see on the dispensary shelf might not actually be all that accurate, in particular when it comes to THC level, according to Klumpers. 

With many cannabis products, even in states with robust regulation and quality control, there is a bias in the cannabis industry toward using labs that consistently produce higher THC scores in their lab results. 

“Growers want a desirable outcome, and there’s more money for higher THC flowers. So they want the THC percentages that are as high as possible,” she explained. What happens is that if a company sees that one lab is reporting higher THC levels than another, they’ll go with the one that is reporting higher levels, even if it’s not totally accurate.

A neuropsychopharmacology scientist, Klumpers founded Cannify in 2016. Cannify has produced a quiz which, based on information patients provide, provides them with reports about cannabis treatments that have helped people dealing with similar health conditions. The report also includes a list of cannabis products available in the person’s state, as well as educational information about cannabis-related science and research.

She added that prospective cannabis patients should also make sure to speak to their physician, and that “there are a few aspects to understanding whether a product might be suitable for you or not.”

Klumpers spoke to The Cannigma ahead of the International Society of Cannabis Pharmacists (ISCPh) “Clinical Cannabinoid Pharmacy 2020,” an online conference to be held later this week. Klumpers will give two separate talks, “Phytocannabinoid Formulations and Pharmacodynamics” and “Cannabinoid Metabolism and Drug-Drug Interactions,” both to be held on Friday. 

So how should a patient go about choosing a cannabis product?

The process can be difficult with cannabis, largely due to the wide variety of names for different products, which often seem to have been chosen without any rhyme or reason. According to Klumpers, consumers shouldn’t look at the strain name. “It’s better to think in terms of chemical profiles rather than the strains because strains are not always consistent. Manufacturer A might do this and manufacturer B might do something else.” 

Also, different patients can have vastly different responses to the same cannabis treatments.

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When it comes to standardization of cannabis products, so that they can more resemble traditional pharmaceuticals, Klumpers pointed to cannabis extracts Sativex and FDA-approved Epidiolex as examples of products that allow for more precise and informed dosing, but added that there is no reason that the same can’t be done for cannabis flower — if the right standardization is put into place.

“Even for established pharmaceutical drugs, the percentage of treatment success is almost never 100 percent. So that is very important to realize, and that can be related to the compound and to the dose.”

Klumpers added that “if you want to achieve a predictability that is comparable to that of pharmaceutical drugs, that is very well possible.” 

“If we look at the flower itself, in the Netherlands there is already, so-called standardized products on the market. I think there are five varieties with different THC and CBD concentrations. In terms of the predictability of those products, it has nothing to do with the fact that it’s flower. Flower might be as predictable as a tablet, as long as it has a consistent chemical profile.”

Variability always comes into play when looking at products — and the methods of administering them. 

“There are so many different product types, so many different types of flower, and even within one strain of flower, you have various product types. You have various concentrates — butter, shatter, resin, and whatnot,” Klumpers said, before adding the “hundreds of different vape brands with different mechanisms and temperature,” which make it even harder to find a standardized way to prescribe and use medical cannabis. 

Yet another reason why it is important that patients get the scientifically-based know-how they need and consult with health care professionals.

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