Cannabis Dosing: Less is (Usually) More

Cannabis is unlike any other medicine due to its wide range of effective dosages, incredible safety profile, broad physiologic mechanisms of action, and versatility in treating a wide range of symptoms and diseases.  Using the correct dose of cannabis is the single most important factor in having a successful therapeutic relationship with this powerful herb.  

Unlike most medications, cannabis cannot be prescribed at a certain quantity and frequency based on body weight, age ,and medical condition.  We all have a unique internal chemistry, and the cannabinoid system is very complex, so vastly different dosages will be best for different people. Instead of depending on a medical provider (or anyone else) to tell you what your optimal dosage is, we’ve found a simple method that works much better for determining what’s best for you personally.

At our three Integr8 Health clinics in New England, my colleagues and I treat approximately 18,000 patients with medical cannabis as part of an integrative medicine approach to health.  One of our most fascinating findings has to do with optimal dosage.  When I started my practice, I was surprised to see that some patients were using very low dosages (e.g. 1 puff), while other patients require much higher dosages (e.g. an entire large joint or a potent edible) to achieve optimal benefits.  Over time, I began to notice that most patients using small amounts of cannabis were getting better and more sustainable results than their high-dosage counterparts with similar conditions.

Eventually I discovered that most people have a certain threshold dosage of cannabis, below which they’ll actually experience a gradual increase in health benefits over time, and above which they’ll start building tolerance, experiencing diminishing benefits, and more side effects.  This dosing phenomenon is known as a biphasic dose-response curve.

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Preclinical research supports these observations, demonstrating that administration of cannabinoids can upregulate endocannabinoid system function at acute and lower doses via increased endocannabinoid production, cannabinoid receptor expression, and cannabinoid receptor affinity, as well as downregulate endocannabinoid system function upon persistent agonism (e.g. long-term high doses) via membrane receptor endosome internalization – the cell literally pulls the cannabinoid receptor inside, where it is no longer available to be stimulated.

Working with patients, I eventually developed a program to help new cannabis users find their optimal dose in 4 days, and the “sensitization protocol,” which allows current users to reset the sensitivity of their endocannabinoid system and achieve much better results with a lower dosage in only 6 days.  Afterwards, 90% of patients who try the sensitization protocol are able to decrease their dosage while improving benefits, and the average dosage reduction is 56%.  This reduction not only improves benefits and reduces side effects – it saves patients a lot of money, and potentially makes more cannabis available for those with limited access.

Ten percent of patients seem to require a higher dose to achieve optimal results – often a much higher dose.  For example, while 3-5 mg of cannabinoids may provide relief for a sensitized patient, others may do best on 300-500mg per dose!  Interestingly, if the dosage is increased slowly and carefully, patients are often able to tolerate huge amounts of cannabinoids with minimal side effects.  Certain conditions, such as cancer and chronic infection, may respond better to very high doses, in some people.

In general, patients with greater resilience and who are closer to balance in their physiology are more likely to succeed with lower dosages, while patients who have been sicker for longer sometimes may require aggressive dosing to control the disease process, then are able to convert to low dosages later, after they too are closer to health and balance.

By Dustin Sulak, DO

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