Cannabis: Ways to Consume

Ways to Consume Cannabis and Dosing

Delivery Methods

Inhalation 

1.Smoking completely burns the inhaled cannabis product. This can be associated with chronic bronchitis. It also completely degrades the cannabinoids and other phyto-chemicals, which may have some influence on the effect.

2.Vaporization heats the cannabis product to at a lower temperature inorder to release the phyto-chemicals which are inhaled. Less heat also means less degradation of the phyto-chemicals. It is also less irritating to the lungs.

Advantages of inhalation include a quick onset (5-15 minutes) and a duration of 2-3 hours. This makes it easier to titrate the dose.  Some clinicians consider it to be the preferable method. There have been no studies linking inhalation to lung cancer.

Oral

1.Sublingual sprays, tincture, and possibly infused oils are held under the tongue to allow absorption directly into the bloodstream. Liver processing is by-passed,  which can make some changes to the phyto-chemicals and possibly the effects. It has a fairly quick action ( 15-30 minutes) and about a 5 hour duration.

2.Infused oils and tinctures can be swallowed by drops or capsules and edibles processed as food or drink. Dosing can be calculated, although it may be more difficult to evaluate since the onset can be 1-3 hours with a 5 plus hour duration. The phyto-chemicals pass through the digestive tract and are processed by the liver prior to entering the bloodstream. There is a greater risk of drug interaction with other medications which are metabolized by the liver. The concentrations  of the contents in edibles is more difficult to determine. Therefore, the labels may not accurately determine the dose ingested. Edibles are the least predictable for medical use. The best information on how to combine cannabis with food can be found at jeffthe420chef.com.

Topical in the form of infused oils, creams and trans-dermal patches can be effective for local applications and absorption into the bloodstream. This may be better for elderly patients since CBD is better absorbed than THC. Onset is about 20 minutes. Duration can be 6-12 hours.

Rectal and vaginal suppositories are available but may be more effective for local use.

Dosing

Finding the correct dose that will be helpful is finding the sweet spot for you. In other words the goal is to use the minimum effective dose. Many times too much can have the opposite of the desired effect. It is not necessary to experience euphoria or intoxication in order to receive a medical benefit. Also different varieties or cultivars can produce different effects. This is where a knowledge of not only the cannabinoid content but also terpene content can be valuable. Most varieties available in dispensaries  have a high THC (this is responsible for euphoria and intoxication) content and a low CBD content. The so-called hemp varieties contain high CBD amounts with almost no THC. For most medical applications a 1:1 ratio of THC:CBD is preferred. This may require mixing Cannabis from different sources. Everyone is different, so titration and experimenting with dosing is necessary. Start low and go slow is the rule to use.

Inhalation provides the quickest effect. Edibles are slow acting. Both can be difficult to dose. The most effective dosing is probably customized tinctures made by you or an experienced herbalist.

I would believe that microdosing with a cannabis extract, adding digestive system healing herbs as well as dietary and the lifestyle changes that modulate your stress response will aid healing of most if not all chronic illnesses.

The following is an excerpt from a Rolling Stone Magazine interview with Dr. Dustin Sulak:  

“I discovered that most people have a certain threshold of cannabis,” Sulak says. “Below it they’ll experience a gradual increase in health benefits, and above it they’ll start building tolerance, experiencing diminishing benefits and more side effects, like short term memory loss and clumsiness.” He adds, “I can’t tell you your perfect dose, but I can teach you how to find it for yourself.”

He describes the system. “Abstain from cannabis for two days. On day three, consume one milligram of THC and one milligram of CBD, preferably in a tincture or oil where they can be measured precisely. Before consuming, ask yourself three questions, and answer on a scale of one to 10: How easy is it to breathe, how comfortable and calm does your body feel and how easy is it for you to smile authentically, to feel content and grateful?”

After writing down your scores, he says, you take the cannabis, wait 45 minutes and ask the questions again. If there’s been no change in your scores and you’ve felt no effect, increase the dose by one milligram.

“You repeat this process over the next few days,” he says, “increasing the dose by small increments. When you reach a point where you feel a difference after consuming, you’ve found your minimal effective dose.”

At this point, he asks patients to continue raising the dose by tiny amounts. At some point, he says, there will be no further benefit from a higher dose. “You’ve established your therapeutic range, and can take the minimum dose.”

I asked how he treats heavy users who’ve developed a high tolerance. Sulak says they begin by abstaining for 48 hours. “That’s all – that’s the magic time when tolerance gets reset.” During that time, he tells them to exercise and eat foods that support the body’s health. Then they follow the same protocol as new cannabis users, gradually increasing the dose until they feel an effect.

Sulak did a survey of 48 heavy users who’d followed the protocol, and found that afterward, they were using less than half the cannabis they’d used before and getting better results. “You’re saving money,” he says. “If you’re a smoker, you’re saving smoke exposure to your lungs, and having less side effects.”

James Brent DDS