Many medical cannabis patients take an overly aggressive approach to treatment. If one hit off a joint or one square of chocolate helps a little, then a whole joint or a whole chocolate bar will help a lot, right? Not quite. In many cases, while taking in ‘more‘ cannabis will make you ‘more‘ high, it won’t necessarily make you ‘more‘ healthy. In fact, reducing your dosage may actually make it ‘more‘ effective.
Dr. Dustin Sulak, the Medical Director of Integr8 Health, LLC, a network of three (3) holistic health
clinics in New England, where he and his colleagues treat nearly 20,000 patients with medical cannabis as part of an integrative medicine approach to health, have found that many of his patients benefit more from low doses—they have better results and fewer side effects.
“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. 1 joint or a potent edible) to achieve optimal benefits,” notes Dr. Sulak. “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.”
Preclinical research supports these observations, demonstrating that administration of cannabinoids can upregulate endocannabinoid system function at acute and lower doses via increased endocannabinoid production[i], cannabinoid receptor expression[ii], and cannabinoid receptor affinity[iii], as well as downregulate endocannabinoid system function upon persistent agonism (e.g. long-term high doses) via membrane receptor endosome internalization[iv]. This dosing phenomenon is known as a biphasic dose-response curve.
Dr. Sulak has moved many patients down to doses as low as 3–5 mg with his “sensitization protocol,” which helps current users to reset their endocannabinoid system. After just six days on the protocol, 90 percent of patients can decrease their dosage with improved benefits. His patients have an average reduction of 56 percent.
“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,” says Dr. Sulak.
Dr. Bonni Goldstein, Medical Director of Canna-Centers, located throughout California, has noticed similar results with her patients. “Many of my patients using low doses for pain, mood, and sleep find that low doses give the effects they are looking for, and over time, due to the enhancement of their endocannabinoid system, they find that they don’t need as much phytocannabinoids to achieve the desired effects.”
Her observations are backed by a study from the Medicinal Cannabis Research Center at the University of California, San Diego, that tested vaping cannabis to treat neuropathic pain. The results showed that patients who used small-dose cannabis (1.29 percent) felt as much pain relief as patients who used medium-dose (3.53 percent) cannabis.
Why might this be? The functioning of the body’s endocannabinoid system, and its interaction with phytocannabinoids (from the cannabis plant), is not yet fully understood—marijuana’s quasi-legal status makes this difficult to study. Dr. Sulak and Dr. Goldstein both hypothesize that small doses of phytocannabinoids enhance the endocannabinoid system, while larger doses cause the system to down-regulate, making the receptors less responsive.
“Cannabinoids are bi-modal effects,” explains Dr. Allan Frankel, CEO of GreenBridge
Medical Services in Santa Monica. “This means that in general, low dose and high dose can have opposite effects.”
He points to studies by GW Pharmaceuticals, makers of Sativex, that show better results from low or medium doses than high doses. One study of cancer patients found that low doses (1–4 sprays per day) resulted in statistically significant reductions in pain and sleep disruption, while high doses (11–16 sprays per day) did not result in better outcomes but did cause a much higher dropout rate (22 percent, versus 5 percent in the low-dose group).
Cancer patients are typically treated with extremely high doses of cannabis, but Dr. Frankel questions the wisdom behind this approach.
“I have seen at least 7 patients with stage IV cancer who initially responded to RSO dosing [Rick Simpson Oil, which is often dosed as high as a gram per day] and then had new metastases, went on low dose CBD:THC and had clearing of metastases.”
He points out that nobody knows what “dose” or regimen is “best” for cancer. “In fact,” says Dr. Frankel, “probably a number of different cannabinoid ratios and doses for certain have anti-cancer effects through a multitude of mechanisms.” He says that, on average, across numerous ailments, his sickest patients use a dose of around 30–40 mg of cannabinoids—far lower than the RSO recommendation.
Dr. Sulak cautions that while he generally sees better results from lower doses, he has observed that about 10 percent of his patients only respond to very high doses—as much as 300–500 mg per dose.
He explains, “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.”
Wondering what dosage is right for you? Contact us for a consultation.
Dr. Sulak’s sources:
[i] Burstein, S, Hunter, S. 1995. “Stimulation of anandamide biosynthesis in N-18TG2 neuroblastoma cells by δ9-tetrahydrocannabinol (THC).” Biochemical pharmacology 49, no. 6: 855-858.
[ii] Cichewicz, D, Haller, V, Welch, S. 2001. “Changes in opioid and cannabinoid receptor protein following short-term combination treatment with Δ9-tetrahydrocannabinol and morphine.” Journal of Pharmacology and Experimental Therapeutics 297, no. 1: 121-127.
[iii] Oviedo, A, Glowa, J, Herkenham, M. 1993. “Chronic cannabinoid administration alters cannabinoid receptor binding in rat brain: a quantitative autoradiographic study.” Brain research 616, no. 1: 293-302.
[iv] Hsieh, C, et al. 1999. “Internalization and recycling of the CB1 cannabinoid receptor.” Journal of neurochemistry 73, no. 2: 493-501.
To determine what works best for the various conditions is going to require that some prerequisites be put in place. The first is for all testing labs, either GC/MS or HPLC follow uniform protocols (one for each type of testing). The second is that they be licensed by the DEA to possess certified samples for calibration purposes. The third is that they be monitored for compliance, preferably by a professional board but by the states if necessary.
Once this is accomplished every package of cannabis distributed should have a bar-graph showing its Cannabinoid/Terpenoid/Flavinoid/Thiol (CTP) content on a pre-paid postcard attached. These should not require any folding, spindling, stapling or taping. There should be @20 questions. The only one of these requiring more than circling or checking should be a line for patients to weite what their disorders are.
When tens of thousands of these have been collected we can collate them and mine the data which shows which CTPs are reported as being most effective. I hypothesize that there will be more than one range which works for different groups of patients.
This will also benefit recreational users by making what it’s called, how it was grown and when it was harvested irrelevant. All that will matter is what is actually there which will make it far easier for budtenders to give their customers exactly what they’re looking for.
Wolf ! Reading your words was refreshing, I am no PhD rocket scientist at all… but have researched cannabinoids as much as Dr Raphael Mechoulam (not).
I concur completely, we want our medicine to be precise as it can be- given the nature of the myriad and manifold healing within cannabis.
Your plan should be looked at closely as a model. Now to prove I am no doctor… help me obtain Doug’s Varin strain OR, tell me how I can obtain 100% pure thcv. Or as I’ve heard 70% thcv and 30 % thc. That is what I want. Preferably in Michigan. Knowing thcV is the sports car of cannabinoids is one thing… but that knowledge is useless if there is none to be had. Any help appeciated
I found this article very interesting. I have a diagnosis of Follicular Lymphoma. I am using 1g per day in suppository form , as well as several other supplements, including B17. How can I contact Dr. Sulak? I would like to have either a phone consult or possibly an office visit. Thank You, Dianne Rizzo
Hello Dianne,
You can reach Dr. Sulak at his office http://www.Integr8health.com
Best,
~Corinne
Great article! I have been teaching people about the benefits of microdosing cannabis for years for free online, and I’m glad to see doctors catching on. It fits from the “common sense” perspective as well as what many patients have observed themselves. For many conditions, getting high is not necessary, and with microdosing, you can even accomplish this with high THC strains!
Can you post your contact info .
Hi. I cant afford consultation. Any direction on dosage would be lovingly received. I.ve read it can be 3, 5, 30, 50, or 300mg, though how can I tell the amount of thc is available from decarboxylated bud and leaf. And will this also contain cbd or should that be taken additionally. Thankyou kindly. Kay
Hello Kay,
Your questions require quite a bit of detail as there a so many products made in various formulations and potencies. Also, the medical history of the patient, symptoms, what other meds they may be on and stage (if it is cancer) are imparative to conculde the optimum approach.
We do offer 30 sessions with a consultant for $50. Our consultants are well versed in this protocol although they do not have a conventional medical background.
If this interests you, please feel free to call our offices to schedule yourself in.
Wishing you a wonderful weekend,
UPG
I love this site! I was wondering if I could take CBD Oil capsules (no THC) as well as the cannabis oil with THC that I have been taking for a couple of weeks.
Jackie,
We would need a bit more information than what you have listed. The test results and the ratios of THC to CBD is an important component to this question. Lastly, what are you treating?
We look forward to helping you find your way!
Sincarely,
UPG
My mom has ovarian cancer stage 1B but has had four metastasis. She used cannabis oil with ratio of 1:1 of THC and CNB. she took half a grain for the first time and 2 hours after taking it her blood pressure increased, heart rate increased, had trouble breathing, had spasms and couldn’t control her muscles. she was unable to speak like her nervous system was harmed. We had to take her to the hospital. Within 6 hours she came to herself. Now she’s afraid to take another dosage. Is this normal?
Mary,
Your mom may have to change her formulation. It is best to get guidance from a medical professional to make sure that you have the correct formulation, no conflictiong medications and the correct dosing. We have oncology nurses on staff that can guide you accordingly. Here is the link the nursing scheduling system.
Best,
Brent
My son has psoriatic arthritis with rheumatoid symptoms also. Do you have any data or experience treating this with Cannabis oil ?
Hello Ronnie,
Arthritis and rheumatoid symptoms can be treated with the proper formulation of cannabis tincture/oil. This is not a one size fits all protocol so it is iparative to speak with a nurse or physician working in the medical cannabis space. Much depends on where you live, are you in a legal state? How old is your son etc….
Please feel free to call our offices for referrals if need be.
Best,
Brent
Hey guys how are you doing i am the manager at Sansal CBD in colorado a new company trying to get CBD oil to everyone who needs it across the country 100% organic grown not that non sense CBD oil from uk the big issue we are having is what to recommend people on dosage for oil we dont want to put to little in a bottle or to much in a bottle thinking you have to take a lot. i am trying to get support and information on actual doses to give the people the best results anything helps.
thank you all,
Justin
Justin,
You are asking a very important question. The reason why we do not see much on dosing is that each patient and each condition requires varying formulations and dosing. Our medical staff asks questions such as stage of condition or when were they diagnosed, age, diet, other meds or supplements, weight etc. Only after these questions are answered can we understand better what to recommend.
If you do not have amedical background you should not be recommending dosing. Because you are a product provider maybe it is best to add a “*” stating to consult with a medical professional.
We are happy to help you further if you would like to call our offices at 415-524-8099.
I hope this helps!
MaryAnn
Hi
This is Danny
My mother age 64 diagnosed with Stage 4 primary lung cancer and secondary urinary bladder cancer and also suffering from plural effusion. Right now I am giving her thc 90:cbd10 ratio 800mg a day. Is this correct or need changes. Please give your vital opinion.
Danny,
Each patient has a different medical history, different current med list, age weight, stage of disease etc, all play a part in the recommended formulation, dosing and potency. This is not a one size fits all, all patients should get medical direction before choosing a product for treatment.
My father was treated successfully for stage 4 lung cancer with a brain tumor. His oil was 4:1 THc dominant.
Feel free to call our offices to discuss if you’d like!
~Corinne 415-524-8099
Corinne
Thank you so much for your help.
Please clear me with this 4 is THC and 1 is CBD is it right ?
Again thank you.
Danny,
A full medical evaluation of the patient is needed to better understand the best formulation.
Michele
Yes, human beings are individuals, and each human being is unique. However, we’re not so unique that our bodies don’t all work pretty much the same way. In other words, in terms of biology, physiology, and yes, systems biology, human beings are far more alike than they are different. If that weren’t the case, modern medicine, developed before we had the tools to probe our genetic individuality, wouldn’t work as well as it does.
James,
As of now, cannabis is not considered “modern medicine”. With more research, more exact dosing will come. As you know, when working with a plant matter as a medicine, there are far less “norms”. Since Cannabis can exhibit a biphasic effect, the treatment of each patient can be very different even in the event that two patients may have the same condition. We are all looking forward to witnessing the reseach unfold but until then, each patient must be treated on an individual basis.
I am a long term (25+ years) HIV+ and chronic Hep B survivor. I also eschew all antiretrovirals and most of traditional western antiviral medicine in my own treatment (and have for many years). The secret to high strength cannabis extract therapy is titration….you need to start very slowly at first. For someone who is totally cannabis “naive” or has a low tolerance, you literally need to start with doses about the size of 1/4 to 1/2 of one grain of standard white rice. Then over a week or two work your way up to a few grains a day. Usually after about a week, you can start to progress in dose more rapidly. FOR ADVANCED CANCER, ADVANCED HIV, OR OTHER ADVANCED DISEASE STATES…WITH CANNABIS, MORE IS BETTER. I have to thoroughly disagree with the overall thrust of this article. Using cannabis to treat pain and for other palliative uses is totally different (I don’t even see why that was brought up in this article). Whole extract multi-cannabinoid, multi-terpenoid extracts seem to have a built in protection against toxicity. The mere fact that no fatal overdose from cannabis, INCLUDING HIGH CONCENTRATION EXTRACTS, has ever been recorded is fairly strong inductive proof to its ultimate safety in the incredibly high dosages now being used to obtain late stage cures of cancer.
Louis,
Thank you for your input. Current studies are proving that in most cases Microdosing is extremely effective. Some physicians believe that you can oversaturate the receptors by using too much FECO oil. One also needs to take into account adverse affects to other medications that a patient may be taking. Opioids are magnified when cannabis is added. This is why we highly recommend speaking with a medical professional in the cannabis field. Titrating down the opiate to add in a FECO oil is very important.
This is not a one size fits all, even if to aptients have the same condition. Heart issues, blood thinners and psych meds are just a few topics that play in to ones target dosing, potency and Formulation.
We always appreciate people such as your self tryingto help others and you are correct, there are no deaths realated to cannabis use alone.
Thank you again!
UPG
Hi all,
In April of last year my mother was diagnosed with Stage IV lung cancer that had spread all over the body and into her brain. Her Oncologist gave her 3-6 months to live. They said if she did aggressive Chemo it could give her up to 9-12 months to live, but she would still be dead within a year. I convinced her to start taking CBD oil (we are fortunate to live in WA state) so I had a great selection and ability to find high quality medicine.
I found her a medical provider who had CBD capsules that were a 25-1 ratio (CBD to THC) so it was heavy on the medicine without the high. I had her taking 100mg of CBD oil per day (with only 4mg THC). She took the capsules for one month before starting any chemo. Her doctors gave her a scan and were surprised to see nothing had spread. She started chemo and continued her CBD’s for several months. By October, just 6 months later, she had another CT scan and it revealed that she was completely cancer free! Her doctors were shocked as they only expected to see a reduction, not it completely gone. They told her to temper her excitement as they expect it to come back soon. I had her continue taking her CBD doses every day since then. She just had another CT scan last week and it was still completely clear! It has now been a full 3 months since he has been declared cancer free and we plan on her continuing to take a daily dose to help keep the cancer from coming back.
With all that said, my thought was to reduce her dose from 100mg per day. I don’t think she needs that much any more and it is quite expensive. I was thinking that 25mg would be sufficient. Does anybody have any suggestions to this? We went with 100mg as an aggressive cancer fighter, right now just trying to decide what a good maintenance dose is.
Can you provide any diagnosis papers to show us the results you claim? I just read so many stories and never saw an official paper or research. Thanks in advance