Choosing the right dose of marijuana can be very tricky. People often take too much, thinking that it’s the amount of cannabis, as opposed to the amount of the active ingredients that make the difference. In other words, the effects are just as much tied to potency as they are quantity.
One puff from marijuana that contains 20% THC would have four times the amount of THC as a puff from a different chemovar with 5% THC. But how much THC should you consume? How many times a day? And do the same guidelines apply to CBD products? On a recent episode of The Cannabis Enigma podcast, Dr. Ethan Budd Russo answered exactly those questions.
How much THC should you take?
If you’re a new cannabis patient you may have heard a general dosing recommendation to “start low and go slow.” But how low, and at what rate you should increase your dose?
According to Dr. Russo, the best practice for new patients would be to start at around 2.5mg THC. This is enough to treat various symptoms for some people but might go unnoticed for others.
If you’re a more experienced user — or less sensitive to THC — you can then titrate up to 5 mg, a dose most people are likely to feel. 10mg THC is a dose that could fit experienced users who don’t find relief with lower doses, but it would likely be too high for inexperienced patients.
Like with other treatments, you might also be wondering what’s the right frequency (i.e. how many times daily). According to Dr. Russo, “somewhere between 15-30mg of THC” would be the desired total daily amount. Clinical research suggests that anything more than 30mg a day is likely to increase the side effects of THC, and you probably won’t feel any difference in terms of treating your symptoms. In fact, some studies have suggested that higher doses may be less effective than lower doses to treat pain. One exception Dr. Russo noted was cancer patients looking to directly treat tumors, where higher doses of THC might be needed.
But these numbers are only a rule of thumb. The effectiveness of THC can be influenced by other compounds such as CBD and various terpenes found in the cannabis plant. For instance, if CBD is present in your cannabis product (and again, depending on its quantities), you might be able to increase the amount of THC you can tolerate — CBD may counteract some of THC’s side effects, especially THC-induced anxiety. This is an example of the entourage effect theory, according to which the various chemical ingredients in cannabis can interact with one another and influence the user’s experience and therapeutic effects
Another factor that can play a role is your tolerance to THC. Everyone has a different tolerance to THC, and it’s not necessarily related to how long one has been consuming cannabis. This might be related to a concept known as endocannabinoid tone, referring to the unique profile of one’s endocannabinoid system. Yet another factor that can play a major role in influencing the effects is the marijuana delivery method (smoking, vaping, tinctures, edibles, etc.)
As stated earlier, 2.5mg of THC is a great starting dose for new users, but even that is not terribly straightforward. The effects of inhaling 2.5mg of THC is very different from taking 2.5mg orally or sublingually. The administration technique can greatly alter the effects of cannabis. Inhalation is influenced by factors such as smoking vs vaping, how deep one inhales, and how long one holds that inhalation. Also, when it comes to oral and sublingual administration, absorption of oral cannabis medicine can be highly influenced by what the user has eaten recently.
Percentage of THC vs milligrams of THC
There are thousands of marijuana varieties out there with different THC concentrations. Your ability to assess how many milligrams of THC is in each puff, joint, or bud, is closely correlated with the THC concentration. If you have two different chemovars, one of which has a 6% THC concentration and another that has a 24% THC concentration, a joint of each will contain significantly different amounts of THC.
Whereas a 6%-THC one-gram joint would contain 60mg of THC, a one-gram joint of 24%-THC cannabis would contain 240mg of THC. In other words, taking a puff from the joint with the higher THC concentration would be equal to taking four puffs from the lower-THC concentration marijuana. It is important to know how concentrated the product your consuming in order to best ensure you get the desired result from your marijuana dose.
How to titrate cannabis
When you take THC products, the time between the moment you administer it and when you begin to feel its effects is known as onset of action. Onset may vary depending on your biology, but is primarily driven by your chosen delivery method. Inhaled (smoked/vaped) cannabis kicks in very rapidly — the effects can be felt within minutes, with peak effects around 10 minutes, and can last approximately 2-4 hours. So you can start with a puff or two, wait 10-15 minutes (depending on how careful you want to be) to see if you get the desired effect, and then repeat accordingly.
Sublingual administration (tinctures/oils) is a common method of taking cannabis that is said to kick in approximately 15-45 minutes after it is absorbed under the tongue. Similar to orally administered cannabis, the effects will last for roughly 6-8 hours. With sublingual cannabis products you should wait at least 45 min before taking a second dose, if not longer. Despite being widely reported that sublingual administration has a faster onset than oral cannabis, the limited available studies do not support these claims.
Ingested cannabis products (edibles) take much longer to be absorbed and have an effect, where onset can take 1-3 hours. Similar to sublingual application, the effects can last for 6-8 hours. So remember to be extra careful not to increase the dosage too quickly with edibles — it’s totally normal if you don’t feel anything in the first few hours. With edibles, patience is key.
Developing tolerance to THC
Some people may develop a tolerance to THC over time. Keep in mind you don’t necessarily have to get high in order to get the benefits of cannabis. Even if you develop a tolerance to the intoxicating effects of cannabis, the therapeutic effects can still be occurring. According to Russo, “it’s quite different to what we see with opioids where often there is dose escalation, increase in side effects, dependency, craving, and all those problems.”
One recent study did, however, seem to find that “the dose of cannabis used to manage pain increased significantly over time.” This concept holds especially true in chronic cannabis smokers significantly exceeding the dosing recommendations listed above. Developing tolerance and requiring dose escalation not a surprise to pharmacists, as tolerance most medications over time via something known as downregulation. What makes cannabis unique is the ability for the body to re-sensitize to cannabis very quickly.
How to dose CBD products
Dosing CBD products is a different story. When considering pure CBD products (isolates) as opposed to whole-plant extractions or flowers, you’ll typically need much higher doses compared to THC, according to Dr. Russo. For instance, when treating acute anxiety, a common dose is several hundred milligrams, while in the case of psychosis, it’s approximately 800mg of CBD per dose. And for some forms of severe epilepsy, CBD is doses as high as 25mg per kilogram per day — that’s 2000mg of CBD isolate in an 80kg adult.
A 2019 review of existing research found that CBD dosing in a variety of conditions such as seizures, anxiety, and Parkinson’s disease, the doses ranged from 1-50mg per kilogram per day.
Interestingly, much like with THC dosing, the entourage effect also plays a role when dosing CBD. We know from clinical research that the effective dose of CBD for epilepsy can drop by 20% if there is even a little bit of THC that accompanies it.
Unlike pharmaceutical treatments where you take one pill twice a day, for example, medical marijuana is a bit more complicated to dose. Since it has more than one active ingredient that interacts with different targets in your body, and since we all have different endocannabinoid systems, different people may require different doses. Hopefully, with time, research will lead to more information about how to properly dose cannabis. But the bottom line is that the required dose of any whole-plant treatment will probably always vary from one person to another. For now, just remember to start low and go slow in order to get the most out of your cannabis.