Accurate Education – Marijuana (Cannabis) – Dosing: “Pot” vs. Pharmaceutical Products

Marijuana (Cannabis) – Dosing: “Pot” vs. Pharmaceutical

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.

 

When transitioning from the use of “pot (weed),” or marijuana plant products to pharmaceutical grade “medical marijuana products,” it is helpful to understand how the two different products compare to one another regarding comparative dosing.

The following section provides anecdotal guidelines based on estimates provided by recreational use “authorities.”

  

See:

Marijuana – Legislative Update for Louisiana

“Medical Marijuana” – Getting Started

Marijuana (Cannabis): Potential for Harm 

Marijuana (Cannabis): Side Effects and Drug Interactions

 

Cannabinoid-Based Medications:

Over-the-Counter Cannabinoid Medications:

 

Palmitoylethanolamide (PEA)

Palmitoylethanolamide (PEA)

 

Cannabidiol (CBD)

Cannabidiol (CBD) – Introduction

Cannabidiol (CBD) – Clinical Use and Dosing

Cannabidiol (CBD) – Drug Actions & Interactions

  

Prescription Cannabis-Based Medications:

FDA-Approved Prescription Cannabis-Based Medications

Louisiana-Rx Cannabis-Based Products – “Medical Marijuana”

 

Clinical Applications of Cannabis:

Cannabis – Anxiety (coming soon)

Cannabis – Chronic Pain Overview

Cannabis – Fibromyalgia

Cannabis – Headaches (coming soon)

Cannabis – Inflammatory Bowel Disease (coming soon)

Cannabis – Neuroinflammation (coming soon)

Cannabis – Sleep (coming soon)

 

The Medical Science of Cannabis:

The Endocannabinoid System

Marijuana – Pharmacokinetics

Marijuana – Cannabinoids and Opioids

 

Understanding Marijuana Products

Marijuana – Botanical

Marijuana vs. Hemp

Marijuana – Ingestible (Orals & Edibles) coming soon

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Topicals coming soon

 

Cannabinoids:

Cannabidiol (CBD)

Cannabigerol (CBG) (coming soon)

Cannabinol (CBN) (coming soon)

Tetrahydrocannabinol (THC) (coming soon)

Tetrahydrocannabivarin (THCV) (coming soon)

 

 Terpenes:

Terpenes – An Overview

   

See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)

  

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

cannabis-caduceus

This section is frequently updated for accuracy and completeness.

 

Marijuana Dosing – “Pot (weed)” vs. Pharmaceutical Products

 

When transitioning from the use of marijuana, particularly smoking joints or bowls in a pipe or bong or vaping, it is helpful to get some estimate of how much THC is generally delivered from plant-based use. Of course many variables come into play making exact comparisms impossible. But it is possible to get ballpark estimates one may use to guide the transition from use of plant to pharmaceutical products.

 

Common methods of marijuana use include smoking flower (the unrefined bud of the marijuana plant) or concentrate (cannabis products refined from flower into a more potent form, such as wax, shatter, resin, use of which is often referred to as dabbing), vaporizing flower or concentrates, eating foods that contain cannabis, and using topical solutions that contain cannabis.

 

Since smoking and vaping are the most common methods of use in those who engage marijuana for medicinal purposes, this section will focus on these two methods. The more potent forms described above have a wide range of THC concentration, ranging up to concentrations >30-80%, and would be much more difficult to predict actual THC doses.

 

Smoking a “Joint”

With respect to smoking pot in the form of a joint, research indicates the average amount of marijuana plant in a joint is 0.3 mg. Obviously, if one roll thin “needles” or fat “hoagies,” one should adjust this estimate. In assessing the THC content of contemporary pot, the percentage of THC in the pot ranges from very low (<5%),  to low (5-10%), moderate or “good pot” (10-15%), strong (15-20%) and very strong (>20%). Most patients use 1–3 g of herbal cannabis per day. < 5% of patients use > 5 g per day . Tolerance does not develop to the benefits. Over time dose escalation is not generally observed.

 

 

It is estimated as a ballpark figure that for each percentage of THC in the pot, smoking an average joint would dose one at 1 mg of THC. In other words, smoking an average joint of 1% THC pot (weak pot) would deliver a 1 mg dose of THC and smoking an average joint of 10% THC pot (average pot) would deliver a 10 mg dose of THC and smoking an average joint of 15% THC pot (good pot) would deliver a 15 mg dose of THC. This estimate would be dependent also on how deep one inhales and how long one holds their inhalation before exhaling.

 

Smoking a “Bowl”

Smoking a “bowl” in a pipe or bong would equate to the use of about 0.25 grams, slightly less pot than an average joint. But this method is thought to deliver 10-20% more THC. Thus, one might predict one bowl would deliver 1.2 mg if smoking 1% THC pot (weak pot) or 22 mg if 15% THC pot (good pot).

 

Vaping

Vaping is considered a more efficient method of THC dosing and is estimated to deliver about 1.5 times as much THC or a little more as compared to smoking. Thus compared to smoking an average 10% THC joint that would deliver about 10 mg of THC, vaping the same amount of this pot would deliver about 15 mg of THC.

 

In summary, these estimates are necessarily inaccurate but are provided to establish some ballpark estimates to guide one in transitioning to pharmaceutical cannabis-based products with defined amounts of THC dosing. Additionally, studies have determined that pot smokers tend to overestimate their use of pot.

 

Most importantly, one must remember that the final therapeutic benefits as well as side effects are not determined by THC alone but depent largely on the other constituents present in either the plant or the pharmaceutical product. These consitituents include not only the very important CBD but also other cannabinoids and terpenes found in both plant and pharmaceutica products. Furthermore, not only the amounts but also the ratios of these other constituents may be important.

 

 

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

International Cannabinoid Research Society

International Cannabinoid Research Society – Home page

 

You Tube video marijuana education links:

Cannabis The Evil Weed (2009) part 1 of 16

 

 

  1. Introduction to Medical Cannabis (Module 1) – The Endocannabinoid System by Dr. Towpik
  2. Introduction to Medical Cannabis (Module 2) – Pharmacology & Phytocannabinoids by Dr. Towpik
  3. Introduction to Medical Cannabis (Module 3) – Chronic Pain, Palliation & Case Studies by Dr. Towpik
  4. Introduction to Medical Cannabis (Module 4) – CINV & Epilepsy by Dr. Teh
  5. Introduction to Medical Cannabis (Module 5) – Adverse Effects & Potential Drug Interactions
  6. Introduction to Medical Cannabis (Module 6) – Patient Care, Dosing & Titration by Dr. Teh

 

 

Lay-person Websites

These lay-person websites appear to be good resources for exploring medical marijuana. However, as is the case generally regarding medical applications of marijuana and its constitnuents, there is a huge amount of information that is not based in good science and relies on anecdotal (word-of-mouth) evidences. Reader, beware:

 

  1. www.CannabisBusinessTimes.com
  2. www.CBDschool.com
  3. www.gfarma.news
  4. www.GreenCamp.com
  5. www.Healer.com
  6. www.Marijuana.com
  7. www.MedicalJane.com
  8. www.profofpot.com
  9. www.ProjectCBD.org
  10. www.Weedmaps.com

 

References:

Medical Marijuana – Plant-based Dosing vs. Pharmaceutical-based Dosing

 

Resources:

A simple guide to pot, THC and how much is too much (Los Angeles Times)

How Much THC Is in a Dab, a Bowl and a Joint? (High Times)

 

 

References:

  1. Measuring cannabis consumption – Psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) – 2017
  2. Quantifying Cannabis – A Field Study of Marijuana Quantity Estimation – 2018
  3. Bayesian inference for the distribution of grams of marijuana in a joint. – PubMed – NCBI – 2016

   

Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendationsCanadian Family Physician – 2014

 

Medical Marijuana – Potential Harms Associated with Cannabis Use

  1. Brief Review of Human Studies Regarding Increased Risk of Harm with Cannabis Use – State of Minnesota – 2016

 

Medical Marijuana – Driving

  1. Establishing legal limits for driving under the influence of marijuana – 2014
  2. Medical Marijuana and Driving – a Review – 2014
  3. Impact of Prolonged Cannabinoid Excretion in Chronic Daily Cannabis Smokers’ Blood on Per Se Drugged Driving Laws – 2013

 

Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post

 

Medical Marijuana – Opioid Drug Interactions

  1. The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014
  2. Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011
  3. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol. – Role of phenolic hydroxyl groups in the resorcinol moiety – 2011

  

Medical Marijuana – Pain

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015
  7. Cannabis for the Management of Pain – Assessment of Safety Study (COMPASS) – 2015
  8. Smoked cannabis for chronic neuropathic pain – a randomized controlled trial – 2010

 

Medical Marijuana – Tolerance Reversal

www.Healer.com

  1. Cannabis Sensitization 6 Day protocol – Healer.WorkBook – Inhalation
  2. Cannabis Sensitization 6 Day protocol – Healer.WorkBook – Tincture

      

Medical Marijuana – Pharmacokinetics

  1. Human Cannabinoid Pharmacokinetics – 2007
  2. Δ9-Tetrahydrocannabinol (THC), 11-Hydroxy-THC, and 11-Nor-9-carboxy-THC Plasma Pharmacokinetics during and after Continuous High-Dose Oral THC – 2009
  3. Dronabinol oral solution in the management of anorexia and weight loss in AIDS and cancer – 2018
  4. MARINOL® (Dronabinol) product info – 2017

    

Medical Marijuana – Product Evaluation

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
  2. Recommended methods for the identification and analysis of cannabis and cannabis products – 2009
  3. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016

 

Medical Marijuana – Sleep & Sleep Apnea

  1. Medical Cannabis and the Treatment of Obstructive Sleep Apnea – An American Academy of Sleep Medicine Position Statement – 2018
  2. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. – PubMed – NCBI
  3. Misc Abstracts @ Obstructive Sleep Apnea – 2017
  4. Cannabinoid May Be First Drug for Sleep Apnea – 2018
  5. Pharmacotherapy of Apnea by Cannabimimetic Enhancement, the PACE Clinical Trial – Effects of Dronabinol in Obstructive Sleep Apnea – 2018

 

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Cannabimimetic phytochemicals in the diet – an evolutionary link to food selection and metabolic stress adaptation? – 2016
  10. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  11. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  12. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  13. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  14. Systematic review of systematic reviews for medical cannabinoids – 2018
  15. Adverse effects of medical cannabinoids – a systematic review – 2008
  16. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  17. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  18. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  19. Clinical Pharmacodynamics of Cannabinoids – 2004
  20. Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  21. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  22. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  23. Pharmacology of Cannabinoids
  24. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  25. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  26. The Cannabis sativa Versus Cannabis indica Debate – An Interview with Ethan Russo, MD – 2016
  27. Review of the neurological benefits of phytocannabinoids – 2018
  28. Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinic… 2017 – PubMed – NCBI

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