What Is a Proper Dosage of Medical Marijuana, and How Can Patients Control Their Dose?
General Reference (not clearly pro or con)
Donald Abrams, MD, Professor of Clinical Medicine at the University of California, San Francisco, et al., in their research paper "Medical Cannabis: Rational Guidelines for Dosing," published Jan. 2004 on CannabisMD.org, wrote:
"An experienced cannabis smoker can titrate and regulate dose to obtain the desired acute effects and to minimize undesired effects. Each puff delivers a discrete dose of cannabinoids to the body. Puff and inhalation volume changes with phase of smoking, tending to be highest at the beginning and lowest at the end of smoking a cigarette...
Oral ingestion of THC or cannabis has quite different pharmacokinetics than inhalation. The onset of action is delayed and titration of dosing is more difficult...
Thus, a patient-determined, self-titrated dosing model is recommended. This self-titration model is acceptable given the heretofore-discussed variables as well as the low toxicity of cannabis. This construct is not unique to cannabis. Many other drugs have relatively low toxicity and high dosing ceilings (gabapentin being one notable example), and are titrated to effect."
Their "final dosing recommendations" are displayed in the following chart:
Strength of Cannabis (assuming neglible canabidiol)
Daily dosage of cannabis corresponding to 2.5 - 90 mg of THC
US Office of National Drug Control Policy (ONDCP) Senior Speechwriter Kevin A. Sabet told ProCon.org in a Jan. 22, 2004 email:
"Smoked marijuana has no reliable dosage...
As you know, smoked marijuana is not a medicine since it has failed to pass the scientific trials needed for it to go to market. As a result, marijuana remains a Schedule I controlled substance, as defined by the Controlled Substances Act.
The use, under any circumstance minus FDA-sponsored government trials, of a Schedule I drug, remains illegal.
George McMahon, author and medical marijuana patient of the U.S. Federal Drug Administration's Investigational New Drug (IND) Program, stated in his 2003 book Prescription Pot: A Leading Advocate's Heroic Battle to Legalize Medical Marijuana:
"On average I'll go through ten marijuana cigarettes a day, which is what my protocol recommends. In addition to adjusting dosage by the number of joints smoked, it can be altered within limits by changing how much smoke is inhaled, the time between inhalations and the number of inhalations taken. For me, it all depends on how I'm feeling that day. On good days I smoke a little less, but when I'm hurting I need a bit more."
Ethan Russo, MD, Senior Medical Advisor at the Cannabinoid Research Institute, told ProCon.org in a Dec. 13, 2001 email:
"The dosage of clinical cannabis depends upon the individual patient’s need and tolerance toward side effects.
Many patients require only a few inhalations a day. Often symptoms of disease are well controlled with doses equaling 10 mg or less of THC a day. The IND patients average 10 grams of smoked cannabis a day."
Avram Goldstein, MD, Professor Emeritus of Pharmacology at Stanford University, stated during a medical marijuana conference on Feb. 20, 1997:
"We know that there are no extreme immediate toxicity issues (with marijuana). It's a very safe drug, and therefore it would be perfectly safe medically to let the patient determine their own dose by the smoking route."
Jay Cavanaugh, PhD, National Director of the American Alliance for Medical Cannabis, wrote to ProCon.org on May 21, 2002:
"When patients smoke or vaporize cannabis they can titrate their dose by inhalation. The medicinal constituents are absorbed in the lungs and proceed directly to the brain and general circulation avoiding a first pass through the liver. Patients can ascertain the effectiveness of the medicine within just a minute or two. By waiting between inhalations, patients can achieve the maximum effect with the least possible side effects.
It is vitally important for naive patients (ones who haven't used cannabis socially or recreationally) to be trained by skilled caregivers into how to obtain the best relief with medication that may vary in potency from crop to crop or even in the same cannabis depending upon its age, moisture content, etc. 'Cured' cannabis, for instance, contains higher levels of THC and lower levels of CBD than fresh."
Using the protocols she and colleagues are developing for their research on the medicinal use of smoked marijuana, she recommends that naïve users begin with 1 puff (or toke), usually before bed, to help with symptoms such as pain or spasticity and improve sleep quality.
To get the most out of a dose while limiting the amount of smoke exposure, she tells patients to inhale on the pipe or joint and hold it in their lungs as long as possible.
Experienced users often know what dose is most effective, though Lynch recommends that a dose of 2 to 4 puffs per dose, 3 times per day is reasonable and, depending on response, the dose can be titrated accordingly. (Health Canada has suggested a daily maximum dose of 5 grams.)"
Donald I. Abrams, MD, Professor of Clinical Medicine at the University of California at San Francisco, et al., wrote the following in their research paper "Medical Cannabis: Rational Guidelines for Dosing," published May 2004 on the internet:
"...a patient-determined, self-titrated dosing model (patient calculated or estimated) is recommended. This self-titration model is acceptable given the heretofore-discussed variables as well as the low toxicity of cannabis. This construct is not unique to cannabis."
The Los Angeles Cannabis Resource Center told ProCon.org in 2004:
"Usually a few puffs prior to each meal is sufficient for many patients. Some will require about half to a whole joint prior to each meal. These are usually thinly rolled, about 0.5 grams in weight. Those who prefer non-smoked will often eat one quarter to half a brownie, or use about 0.25 grams in a vaporizer, prior to each meal."