THC concentration in medical cannabis use

Medical cannabis products come in a wide variety of concentrations. Some dried herb strains contain very little cannabinoid, either THC or CBD. At the same time, some extracts from the plant are concentrated to achieve very high potency. Products with over 90% THC content are not uncommon. What sort of strength or potency is best for you? It might surprise you to find, that with cannabis, “Less is More”.

Medical cannabis in Canada is labelled with a “percentage THC”. If this is dried cannabis, this really refers to the THC that is potentially available once your weed has been heated up, or decarboxylated. Dried cannabis is typically available with THC or CBD in the 5-30% range. One benefit of a lower THC product is that patients who are new to the effects of THC will be less likely to develop increased anxiety or paranoia when using this. This is called ‘starting low and going slow’ and is in keeping with the College of Physicians and Surgeons of Ontario guidelines as well as the guidelines of the College of Family Physicians of Canada. It might surprise you to know that another benefit of lower THC concentration cannabis could be improved symptom control.

Dosing inconsistency and potency

Medicines do not need to be concentrated to be effective. In fact, diluting medications can add a margin of safety and reduce the risk of overdose. This is especially true when the method of dosing is inconsistent. With vaping, a small puff and a deep inhalation provide very different doses. Where under the tongue oils, and gel caps can be measured, inhalations do not typically provide a standardized dosage like an asthma inhaler does.

One goal of using medical cannabis is to provide consistent symptom relief. Another goal is to reduce the risk of impairment wherever possible. Finally, there is a concern that higher THC concentration cannabis may contribute to psychosis and cannabis dependence. If you are concerned about or have a loved one you are concerned about, consider taking this quick 8 question screening test for problem cannabis use.

Finally, another issue with high THC cannabis is that, well, if it is all THC, then we are missing out on other potentially beneficial cannabinoids, like CBD.

So what does the research say?

In a study of 263 patients with poorly controlled pain, those receiving 21 mg of combined THC and CBD each day had improvement in pain levels, more so than the group that received 52 mg daily. The group that received 83 mg daily had pain reduction the same as placebo but with more side effects.

Typically, medications have what is called a “monophasic dose response relationship”. This is just a big phrase that means the more you take the more effect you will get. Cannabis is a medication that just does not follow this rule. If you were to graph the effect of cannabis dosing, it would look something like an upside down “U”. At first, increasing from very low doses produces more of the desired effect, but after a while, higher doses actually cause more and more side effects, while providing less relief.

 

Our Recommendations

At Weedwell™, our goal is to ensure our patient’s safety while providing them with the relief they deserve. While mindful of possible interactions, we often prescribe CBD oil to be taken under the tongue. We sometimes prescribe THC oil, always with the support patient’s need to safely use it. When a client needs fast relief, dry herb of a specific cannabinoid concentration and dose can be vaporized and inhaled. We hope to see quick acting cannabinoids in a safe metered dose format available soon.

For many conditions CBD alone may be effective and there is no worry when it comes to driving or being impaired. Sometimes THC can add to the therapeutic effect of THC and sometimes THC on it’s own may be the best choice.

If you will be using dried herb with THC for your medical condition, remember the rule to “start low and go slow”. This means both for dosage and THC concentration. Consider THC concentrations no higher than 5-10% and discuss your results with your care provider. If you are using oil under the tongue, up to 30% THC may be reasonable. Keep in mind the slower onset of action. If you do not feel the desired effects do not repeat a dose for at least 4 hours just to be safe. Once again, use our dose calculator to figure out how many milligrams of THC you are dosing. We often start clients who are using THC for sleep at 2-5 mg of THC combined with the same amount of CBD.

 

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