Ask Dr. Shelley: #002

Ask Dr. Shelley Disclaimer: While every effort is made to convey correct information regarding medical cannabis, please remember this is not medical advice, but simply a guideline for those who may wish to try cannabis. For those living with mental health disorders, such as schizophrenia and bipolar disorder, and for those with heart and lung disease, it is best to discuss these conditions with your healthcare provider to see if cannabis is right for you. It is also very important to note that using cannabis while taking prescribed medications may affect how certain prescribed medications work – some may become more potent and others less so – when using cannabis. Please ensure to discuss with your physician and pharmacist.

Q: How do you determine the dosage (mg) for beginners, intermediate, and long term cannabis users?

Dr. Shelley: For patients starting to use cannabis, the dosage is really dependent on such factors as the reason for using cannabis:  to treat pain, aid with sleep disorders, or manage neuropathic pain, etc. , and if the patient is cannabis naïve or not. Whatever the patient’s level of cannabis use is, it is always recommended to “start low and go slow” to avoid adverse events from occurring, such as bed spins, or wishing you had never taken that extra dose of cannabis oil or edible.

If a patient is dealing with chronic pain, it’s generally recommended to start with CBD oil (cannabidiol) which is the safest and most reliable method to help decrease inflammation in the body and reduce pain. Starting dosages for all users is usually 5mg, taken 2 times a day (morning and afternoon). This can be increased by 5 mg every 1-2 days until there is relief of symptoms. This dosage can be the same for beginners, intermediate or long-term users. CBD generally does not have any side effects, but those most commonly reported include dry mouth and drowsiness, which is dependent on the type of cannabis strain.

If the patient is dealing with neuropathic or ‘nerve’ pain which is often described as a burning, searing, or stabbing pain, the starting doses are the same for beginners, intermediate or long-term users. Increasing the dosage can occur faster in intermediate or long-term users, if they are comfortable.

I cannot stress enough how important it is for beginners to start with a very small amount of THC (tetrahydrocannabinol) at 1-2 mg, and increasing by 1-2 mg/dose every other day, as tolerated. In the medical patient, it really is important to add CBD to the mix, as this will offset some of the psychoactive, or “buzz” effects, of the THC while offering some other benefits.

For those living with insomnia, consuming THC products 60-90 minutes prior to sleep offers a deep, restorative sleep and will reduce the need for sleeping medication; and the dose can be adjusted as required by the patient. As many know, most over-the-counter sleeping medication is addictive and can have significant adverse side effects.

For intermediate or long-term users, the amount of THC can be increased at a faster rate, by 2-5 mg every day as tolerated, or until symptom relief occurs. However, if a patient decides to increase the THC amounts and feels any adverse effects such as dizziness, over-sedation, or nausea, it is advised to decrease the amount to the last well-tolerated dose.

Q: What are the health benefits of consuming cannabis in the form of edibles?

Dr. Shelley: Consuming cannabis in the form of edibles offers a few benefits, purely from a harm reduction perspective, as there is no smoking (inhaling) and the effects are longer lasting. When cannabis is inhaled, the effects are almost immediate, occurring within 2-15 minutes, generally lasting 3-4 hours. Ingesting edibles may take 45-90 minutes to begin to work within the body and lasts between 4-12 hours. This is ideal for patients who need long lasting relief from their symptoms while at work, or during the night while they sleep. It is highly advised to please review and adhere to your Employer’s cannabis policies!

Edibles are discrete and make it easy for patients to ingest. People classically think of edibles as brownies or cookies, but this is not the case, as Cannabis can be infused into a variety of foods: oil or butter for cooking; honey that can be put in tea or on toast, and once the market is ready, beverages. Since edibles are ingested, there is no harm to the patient’s lungs that can occur with combustion of cannabis. Please remember, always to start with a very small amount, and to be patient and fight the urge to take more if you are not feeling immediate effects of the edible. It is advised to wait at least two hours before taking more!

Q: Why do edibles cause a different effect than smoking cannabis?

Dr. Shelley: Think of fast acting and slow acting. If you inhale cannabis, it rockets into your bloodstream VERY quickly, usually within 5-15 minutes, as opposed to ingesting or eating cannabis which can take anywhere from 45-90 minutes before they take effect in the body and last from 4-12 hours. The wide range of time is dependent on if the person has consumed the edibles alone, with another meal or with/without fats. It is also dependent on the person’s liver metabolism.

Delta-9-THC (‘THC’ as everyone knows it) is changed by the liver to 11-OH-THC. When cannabis is inhaled, this step is skipped, and the Delta-9-THC is distributed throughout the body.

When cannabis is ingested, Delta-9-THC is converted to 11-OH-THC before being distributed throughout the body. This new product has a few differences compared to Delta-9-THC, as it becomes water soluble, meaning it can travel throughout the body and pass the blood-brain-barrier more easily than Delta-9-THC. 11-OH-THC can also bind CB1 receptors with 3-7x more affinity than normal Delta-9-THC. These differences may contribute to the increased length of time and psychoactive effects of edibles compared to inhalation. Do not make the mistake of over-medicating when you think your edible is too weak and you decide to take a second bite of that edible. Wait at least 2 hours.

Ask Dr. Shelley…you’ll thank me!


Ask Dr. Shelley about a cannabis related health question

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