Start low, go slow: understanding cannabis dosing

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As the death knell tolls for prohibition, the rapid proliferation of data supporting the therapeutic benefits of cannabis draws an increasing number of Canadians toward the plant to alleviate common ailments such as insomnia, anxiety, and pain. Inconsistencies in standardized dosing guidelines, however, leave most to fend for themselves as they navigate the murky waters of self-medication.

As one of the country’s best-known patient advocates, Hilary Black found her experience in establishing the B.C. Compassion Club Society in 1997 shed light on the need for clear and precise dosing instructions. Now working as the director of patient education and advocacy for Canopy Growth Corporation, she has refined a system she recommends to clients to allow a positive exploration of medicinal cannabis.

“The best way is to start with 2.5 milligrams of THC [tetrahydrocannabinol] and equal or greater of cannabidiol [CBD] and then step it up day by day by that amount until you find a dose that works for you,” Black says by phone, adding that microdosing, though a much slower process, is the best place to start for new patients.

Although you cannot seriously overdose on cannabis, consumers can suffer adverse effects, like nausea and paranoia, from consuming more than they can handle.

“I’ve seen so many people take too much at once, have a negative experience, and then never want to touch it again,” Black says. “That is worse than taking your time to find the right dose.” She notes that patience, though difficult, is the key to success.

Black suggests a waiting period of 24 hours before a second round so effects can be measured accurately without the risk of cumulative dosing (consuming more cannabis before the onset of the first dose).

Canopy Growth offers this dosage method to its clients, but Adolfo Gonzales, a cannabis-marketing consultant and educator, says that level of specificity is rare when it comes to labelling and consumer education within the rest of the market.

“There are a whole host of mistakes happening because in the grey market there’s no standard protocol for how to package,” he says in a phone interview, “and in the legal sector, where there are protocols, they’re focused on really only providing the cannabinoid quantification of their product very thoroughly, without other important information, like the terpene content.

“They think because they provide those basic statistics now, it [the product] is safe for use.”

As a self-proclaimed data geek with more than 15 years of accumulating patient-needs information, he says consumers are asking for more than just a list of ingredients.

“Companies need to define a minimum dose that is safe for a starter client and describe how to obtain that milligram dosage physically from that specific product format,” Gonzales says, adding that most only provide one or (more often than not) neither. For example, although some companies list a standard dose, they won’t include the fact that “one square of chocolate” or “half a dropper” is the physical amount to obtain said amount of cannabinoids.

California-based company Dosist, which makes the first and only controlled-dose cannabis vaporizer on the market, is an example of the type of company leading the way in mitigating these consumer concerns.

With formulas based on six key “need states” (like “sleep” and “calm”), Dosist pens vibrate to indicate when a user has inhaled 2.25 milligrams of the CBD and THC vapour, eradicating any potential discrepancies. Created with medical-grade materials, the pens are also tamperproof and childproof, and have an entirely sealed system, eliminating questions about product safety.

“Simplicity is the beauty of it,” Dosist president Josh Campbell says.

“Customers know when they grab our pen they’re going to get the exact same experience every time. And we’re clear about how to achieve that.”

Dosist also provides educational materials regarding how to use its product, dosing guidelines, the cannabinoid and terpene profile of the pen’s distillate, thorough testing standards, and recycling options, all in order to alleviate consumer doubt as much as possible.

With the product already available in the U.S., Campbell says the date set for it to enter the Canadian market depends on legislation during the coming months. He says he is working closely with Health Canada to ensure the pens reach retail shelves by June 2019 at the latest.

“It [cannabis] is the only medicine where there is no set dosing, and we want to be part of leading that conversation as Canada moves into legalization,” he says.

Until the federal government creates standardized dosing guidelines considering of both medical and recreational cannabis and allows for controlled-dose products like edibles, however, it is up to the patient to develop a personal routine.

Black says one way to achieve that is through a dosing diary.

“Track your cannabis use, including the time of day, the variety, the cannabinoid profile, the quality, how you’re using it,” she says.

“Then write down what your symptoms feel like beforehand and afterwards.”

Once patients accumulate several weeks of data, it creates a foundation of knowledge on which to develop a self-dosing guideline and can also be presented to medical practitioners as responsible evidence of symptom relief.

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