Alt-Health: Dosage for Dummies

We are at a tricky crossroads in drug history. Along with opening the door to promising medical treatments, marijuana is poised to become the next legal recreational drug in Rhode Island. Therein the problem lies. Because of the relative safety of pot compared to pharmaceuticals, street drugs and alcohol (no deaths from its use have ever been recorded), people can have a pretty casual attitude about getting stoned. We forget that pot is also a powerful drug used to treat serious medical conditions and, as such, the idea of dosage is an important one.

When legislators passed the law that allowed medical marijuana in RI and other states, they left something out: medical accountability. Doctors are allowed to recommend medical marijuana, but cannot actually prescribe it. For some reason, no one realized that if doctors can’t prescribe medical marijuana, they also can’t give any advice on proper dosage. This same lack of foresight seems to have been applied in states where recreational pot is legalized — no one has educated the public about responsible use — so it’s up to you, the consumer, to learn some facts, the same as you would if you were buying a car. Let’s start with the basics:

The chemicals responsible for the effects of marijuana are collectively called cannabinoids. This group includes tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is what gives the floaty, euphoric high; CBD is the nonpsychoactive component of marijuana that has a wide range of therapeutic effects. Recreational pot is more likely be a variety with high THC levels, since CBD sometimes has no high at all.

There are two main sub-species in plants: Cannabis indica and Cannabis sativa. Hybrids and cross-breeds have mixed characteristics of both species. Sativa has very high THC levels and low or no CBD levels. Indica’s chemical profile shows a more balanced mix, with moderate THC levels and higher levels of CBD. Today, due to the advent of medical marijuana, a much greater emphasis is being placed on cultivating plants with high CBD levels and very little THC.

Marijuana is used in a variety of ways. It be smoked or vaporized, taken in tablet form or ingested as edible food products. Here is where you really need to know your stuff, because every time that you hear splashy headlines (“teens overdose on pot and are taken to emergency room!”) the case involves edible marijuana. Here’s why:

While the effect of inhaled medical marijuana is apparent immediately, edible marijuana can take hours to kick in. If you don’t know this, you can make some serious mistakes. It’s just too easy to eat a brownie, wait a few minutes and say, “Geez, nothing’s happening! I’m going to have another brownie.” Before you know it, an hour has passed, you’ve eaten three brownies instead of one, then at hour 3, the effect starts kicking in. And we aren’t talking about a momentary rush here. The effects of edibles can sometimes last for a day or more and can cause disorientation and panic.

Something else you need to know: If you smoke pot for recreation, it behooves you to keep your doses low, and to wait as long as possible in between highs. Why? Because people develop a resistance to pot very quickly. If you smoke a lot of cannabis on a constant basis, after a while all you don’t really get high, you just walk around in a low grade fog that dulls your intelligence and shortens your attention span. It can also make you depressed as hell. If you want cannabis to be a pleasant experience, use some sense and moderation. You’ll spend far less cash and get a cleaner, happier high.

Medical marijuana is a whole different ball game. Patients using pot to treat illnesses are less interested in the high, and more intent on relief of pain or other symptoms. They often benefit far more from pot species with a very high CBD level and minimal amounts of THC. In fact, many of the hybrids being developed for medical use now have no high at all. For example, an oil derived from cannabis is now being recommended for children with severe forms of epilepsy that do not respond to traditional medications. It performs miracles and the kids do not get even remotely stoned.

Patients who get licensed for medical marijuana would do well to consult with the caregivers at compassion centers. These workers have extensive knowledge of cannabis and none of the restrictions placed on doctors. They give great advice on varieties and dosages. For a thorough education, I highly recommend reading the authoritative text on cannabis, “Rational Guidelines for Dosing” by Gregory T. Carter, MD., at: beyondthc.com/wpcontent/uploads/2012/07/DosingGuidelinesCarter.pdf