The Paradoxical Power of Medicinal Microdosing

How smaller doses of cannabis can help with anxiety and other disorders.

Psychology Today

April 23. 2019

Samoon Ahmad M.D.

As more Americans become acquainted with cannabis following its legalization for either recreational or medicinal purposes, they are learning first-hand what researchers have known for years: Regular cannabis users can develop a tolerance to the psychoactive effects of Δ9-tetrahydrocannabinol, the primary intoxicant in cannabis that is typically referred to as THC. Heightened tolerance is not a life-threatening issue, because it is virtually impossible for a consumer to stay conscious long enough to consume a lethal amount of THC. But, a heightened tolerance can become costly, and it can increase the likelihood of unwanted side effects associated with heavy cannabis use.

For those who may be considering cannabis as a way to manage symptoms of their condition, this blog examines the importance of better understanding dosage and its role in potential side effects. Importantly, it should also be noted that this blog does not sanction the use of cannabis categorically, and advises one consult a physician for treatment and oversight for any ailment.

For those already consuming cannabis and who have found that their tolerance has become too high, evidence suggests that tolerance can be reduced by less frequent cannabis usage or by taking a hiatus from the drug. A 2016 study out of Yale University found that chronic users’ tolerance began to wear off after just two days of abstinence. Furthermore, the study observed that the brain’s sensitivity to THC continues to increase for at least 28 days following cessation, though it does not reach the levels exhibited by control subjects within this time. Research has also shown that some patients who use cannabis may be able to reduce their tolerance to THC by reducing their dosage.

What is Microdosing?

Microdosing is an amount of a drug large enough to produce therapeutic benefits but small enough to avoid the feeling of being intoxicated (known as a sub-perceptual effect). It provides those who consume the drug with the benefits associated with medicinal cannabis, as well as a clearer head and experience. Some studies have even found that small doses can be better for patients with specific ailments, and that large doses can exacerbate the very symptoms cannabis has been prescribed to treat.

Consumption of red wine presents a similar parallel. Several years ago, the media published numerous articles espousing that red wine improves heart health. This connection between heart health and red wine consumption was contingent, however, upon moderate drinking: the health benefits of red wine are tied to moderate wine consumption, not drunkenness. Drinking wine, beer, or spirits to the point of excess on a regular basis can be detrimental to one’s cardiovascular health.

The media and the American pubic have far greater familiarity with alcohol, so this distinction between moderate and excessive drinking is common sense. The media and the American public have far less familiarity with cannabis and the science behind it, and therefore consumption volume is far less understood. Many incorrectly believe that the health benefits of THC-rich cannabis are tied to intoxication or that, if one does not feel intoxicated, then the medicine is not working.

An increasing body of medical evidence suggests that the amount of THC one needs to consume to experience the medicinal effects of cannabis is significantly lower than the amount one must consume to experience its psychotropic effects.

Take anxiety for instance. “All other things being equal,” a paper released by the Alcohol and Drug Abuse Institute at the University of Washington states, “THC appears to decrease anxiety at lower doses and increase anxiety at higher doses.” Citing a 2017 study from the University of Chicago, the paper continues, “A low dose of THC (7.5 mg) reduced the duration of negative emotional responses to the task and post-task appraisals of how threatening and challenging the stressor was. In contrast, a higher dose of THC (12.5 mg) produced small but significant increase in anxiety, negative mood and subjective distress at baseline before and during psychosocial stress test.”

This one finding does not suggest that lower dosages are more effective than higher dosages when it comes to treating all afflictions. However, the Chicago study is not an outlier. A study on neuropathic pain, based on research performed at UC Davis between 2009 and 2011, found that “cannabis has analgesic efficacy with the low dose being, for all intents and purposes, as effective a pain reliever as the medium dose.”

Determining the Correct Dose

In an interview with Rolling Stone, Dustin Sulak, a Cannabis Medicine physician based in Maine, emphasized that tolerance for THC is far from uniform. It does vary from patient to patient. For Dr. Sulak, it is important to search for each patient’s threshold.

He accomplishes this by asking patients to abstain from consumption for two days. This serves to help reset their tolerance. He then advises them to very gradually consume small amounts of cannabis over several hours until they have found a comfortable dosage. By following this incremental approach, they can discover their threshold. “Below [this threshold], they’ll experience a gradual increase in health benefits,” he said, “and above it, they’ll start building tolerance, experiencing diminished benefits and more side effects, like short-term memory loss and clumsiness.”

As cannabis sheds its image as an illicit drug, more consumers are likely to perceive it more like a medicine and less as a vehicle for self-medication. As this happens, they will find that excessive usage does not necessarily maximize cannabis’ benefits and that smaller doses can, in many cases, better alleviate pain, reduce anxiety, and improve overall well-being—as well as save on costs.

For ages, the cannabis plant and its derivatives have been consumed or used by many who prefer to alleviate anxiety and stress with a natural remedy versus pharmaceutical or other treatment options. Nevertheless, a professional is better positioned to advise on any potential issues as well as short- and long-term psychotropic effects. Oversight is even more critical and advisable in adolescents, who are more likely to experiment with cannabis as a drug and who are at a higher risk for detrimental effects.

The risk-benefit ratio of cannabis usage is driven by numerous factors dependent on each individual’s genetics and environment. There is no one-size-fits-all prescription even in microdosing. For cannabis to be optimally incorporated into one’s wellness regimen, patients should work with their physicians to develop a treatment plan that works for them. It is especially important to be forthcoming if cannabis is accompanied by other medications, so that potential risks of polypharmacy can be managed.