Cannabis Dosing — What is Self-titration? (THC)
This article is about figuring out one’s ideal dose of THC (the intoxicating chemical in cannabis). If you’re looking for information on CBD dosing strategies, please view this article.
Cannabis dosing is all about finding your own personal “sweet spot” that dose that is high enough to give you therapeutic results, but low enough that is doesn’t produce undesired (side) effects.
The term titration refers to the art and skill of gradually increasing (and/or decreasing) dosage of a medication to find the best dose for an individual.
Many patients find their “sweet spot” is actually a range, since different factors can impact how you respond to cannabis on any given day. Oral preparations can give especially varied results, depending on what you have or haven’t eaten and whether you take oral cannabinoids with or without food. Cannabinoids are 4x more bioavailable with food, so if you eat them with fat your body will digest them better. Why is this, you may ask? Because when you eat fats, your body releases chemicals to digest those fats. A drop or two of cannabis oil might not trigger this reaction on its own, in which case the cannabis oil (or edible) might not be effectively digested.
Your CannyNurse™ can work guide you through the self-titration process.
Cannabis is not a one-size-fits-all medicine.
The most important thing to keep in mind though is this: more is not always better when it comes to cannabis (or life, despite what advertisers would like you to believe!).
When figuring out your ideal dose of THC (whether it’s delta-8 THC or regular delta-9 THC), is to:
Start low, Go slow, and Stay low.
In their landmark article, Practical considerations in medical cannabis administration and dosing, MacCallum and Russo (2018) give the following advice for titrating one’s THC dosage:
“Oral THC preparation effects are usually easier to judge vs inhalation as the concentrations should be available from the producer. Vaporisation is subject to more variables which can influence estimated dose: size of chamber, depth of inhalation, breath holding, strength of THC in the chemovar, etc. Ideally, the patient would start using a THC-predominant preparation at bedtime to limit adverse events and encourage development of tolerance. However, this is not a must.
- Days 1–2: 2.5 mg THC-equivalent at bedtime. (May start at 1.25 mg if young, elderly, or other concerns).
- Days 3–4: if previous dose tolerated, increase by 1.25–2.5 mg THC at bedtime.
- Days 5–6: continue to increase by 1.25–2.5 mg THC at bedtime every 2 days until desired effect is obtained. In event of side effects, reduce to previous, best tolerated dose.
Some patients require THC for daytime use depending on their symptoms. Consider use of a more stimulating chemovar unless sedation is a desired result. Most patients dose orally two to three times per day.
Consider the following regimen:
- Days 1–2: 2.5 mg THC-equivalent once a day
- Days 3–4: 2.5 mg THC twice a day
- Increase as needed and as tolerated to 15 mg THC-equivalent divided BID-TID
- Doses exceeding 20–30 mg/day may increase adverse events or induce tolerance without improving efficacy.
Use of high doses of THC-predominant cannabis above 5 g per day are probably unjustified, except in the case of primary cancer treatment (vide infra), and suggest possible tolerance or misuse. THC tolerance may be readily abrogated via a drug vacation of at least 48 h, and preferably longer. Patients may then find that much lower doses provide symptomatic benefit equal to or better than previously experienced (see suggested regimen devised by Dustin Sulak, DO: www.healer.com).
CBD-predominant chemovars produce fewer adverse events, but there are no established dosing guidelines or maximum doses established except in psychosis (800 mg) and seizure disorders (2500 mg or 25–50 mg/kg) . For other indications, many patients obtain benefits with much lower doses, starting with 5–20 mg per day of oral preparations divided BID-TID, which may reduce attendant expense.”
These guidelines can be viewed in brief in the following infographic.
MacCallum, C. A., & Russo, E. B. (2018). Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine, 49, 12–19. https://doi.org/10.1016/j.ejim.2018.01.004