Accurate Education – Marijuana (Cannabis): Dosing

Marijuana (Cannabis) – Dosing

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.

 

The use of marijuana for medical purposes remains highly controversial and is compromised by a lack of good quality evidence regarding the specifics of clinical effectiveness and the details of treatment including dosing frequency, amount and duration. The following information is provided as an introduction to what is believed to be true about medical uses of marijuana. There will surely be more information to come.

 

The emphasis regarding dosing of  “medical marijuana” on this site is focused on the products legally available in Louisiana and are based largely on recommendations provided by GB Sciences, the provider of cannabis-based products manufactured from LSU-grown marijuana. Additionally, many medical journal publications are referenced on this web site that explore clinical therapeutics and dosing of cannabis-based products otherwise available outside of Louisiana.

  

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 – THC Pharmacokinetics

Marijuana – CBD 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 – An Overview

As noted in the introductory marijuana (cannabis) medical use overview, our current understanding of medical uses of cannabis is limited, based on only a rudimentary beginning of research. The nature of the research currently available to the medical community to direct clinicians toward safe and effective therapeutic applications of cannabis  is very limited and based mostly on observational studies which provide very limited useful information to guide cannabis prescribing. Because of this state of knowledge, dosing recommendations are also compromised. As such, the best rule for cannabis products dosing is to “Start low, Go slow.” 

 

Also, it is important to remember that dosing for one condition will not necessarily be the same for a different condition. For example, the dose of THC to stimulate appetite is different than the dose to treat nausea associated with chemotherapy. Furthermore, the dose to treat pain is still different and may vary even more depending on the type and location of pain.

 

In addition to strength of dosing (number of milligrams), an important variable in determining dosing with cannabis-basesd products is the balance or ratio of the cannabinoids, particularly THC and CBD. It has been established that the ratio of THC to CBD influences the clinical benefit as well as the likelihood and severity of side effects. Ultimately, however, the final determination of optimal dosing will be individually determined for each patient and initially will likely require trial and error dosing.

 

At this stage of our clinicsl understanding and limited product availabililty, dosing recommendations will be based on THC and CBD content as well as type of product (tincture vs capsule) and method of use (oral, sublingual or vaped) – See below. The clinical effects of marijuana come from not just THC and CBD, but are determined by both the concentrations and ratios of these two constituents as well as influences from the many other cannabinoids and terpenes found in the plant. As research progresses, it is hoped that a greater understanding of the potential benefits of these other constituents will lead to the inclusion of these constituents in therapeutic cannabis-based products allowing for more specific therapeutic applications and dosing.

 

The following is a brief summary of therapeutic effects associated with THC and CBD:

 

THC (tetrahydrocannabinol)

THC is responsible for many of the clinical effects of marijuana, including the analgesic, anti-spasmodic, anti-tremor, anti-inflammatory, appetite stimulant and anti-nausea properties.  THC and its active metabolite, 11-Hydroxy-THC. produce the “high” or euphoria associated with use of marijuana.

 

CBD (cannabidiol)

CBD does not produce the mind-altering “high” effects like euphoria but it does reduce anxiety and enhance sleep. CBD is a versatile anti-inflammatory analgesic, operating through numerous distinct mechanisms. It has anti-convulsant, anti-psychotic, antioxidant, neuroprotective and immunomodulatory effects. CBD is also thought to reduce nausea, particularly related to chemotherapy. In combination with THC, CBD modulates some of the side effects of THC, including reducing THC-induced anxiety.

See: Cannabidiol (CBD) – Introduction

 

Combinations of THC and CBD

As noted above, not just the total amount of THC and CBD are important factors in dosing but also the ratio of these two constituents with one another. While specifics remain unknown as to ratio dosing, some generalities have been suggested.

 

Remember the caveat that applies to starting most new medications, that is to “Start low, Go slow” when initiating treatment. Due to the greater potential for adverse side effects with THC compared with CBD, it is generally wise to also start with lower ratios of THC to CBD. That is, initiate doses of combined THC and CBD with mixtures with lower, rather than higher content of THC vs CBD.

 

Formulations with equal THC:CBD ratios of 1:1 

Conditions of pain, including cancer pain, intractable non-cancer pain and pain of muscular dystrophy and Parkinson’s. However, it is suggested in cannabis-naive patients or those who haven’t used cannabis products for a long time to start with a CBD-rich formulation to avoid side effects, although doses of higher THC:CBD ratios may be required to achieve optimal benefit. This recommendation holds true for muscle spasm, spasticity and multiple sclerosis as well.

 

CBD-rich Formulations

Seizure disorders may respond better to ratios with higher CBD content than THC (“CBD-rich formulations) as does autism.

 

THC-rich Formulations

Conditions that may respond better to THC-rich formulations include Crohns, PTSD, glaucoma, HIV and other conditions of cachexia (wasting syndromes), Parkinson’s and chemotherapy-induced nausea and vomiting. In most cases, however, the THC-isolate formulation is not recommended as the sole formulation due to the greater risk for side effects and the lack of entourage effect/synergistic benefit. When higher THC doses are required due to tolerance, it is recommended to supplement THC-isolate formulations with a broad spectrum or full spectrum CBD product, titrating their ratios based on indiviual needs.

 

The suggestions above represent general recommendations but each individual needs dosing to be tailored to meet their specific needs based on their personal responses to the cannabinoids including therapeutic benefits and adverse side effects. There are many variables that come into play regarding dosing, including genetic variants in cannabinoid metabolism and drug interactions. It will often require some degree of trial and error to establish optimal dosing with cannabinoids with most individuals, with optimal dosing defined as the lowest dose with the maximal benefit and no side effects.

 

Dosing – Important Considerations

First of all, when recommending dosing to determine an optimal dose, the definition of “optimal dose” is the lowest dose necessary to achieve a therapeutic goal with no adverse side effects.

  

Potential for Side Effects

Due to expected side effects such as sedation, cannabis-based products  should likely be started at night prior to going to sleep. For those who feel activated by cannabis-based products, morning dosing should be initiated. Cannabis should be utilised with caution or avoided in unstable cardiac conditions, such as angina, due to poential for rapid heart rates and drop in blood pressure due to THC, but there are no QTc issues.

 

 

Route of administration
Cannabis-based products can be placed under the tongue (subingual), in the buccal space adjacent to the gums and cheeks (buccal), inhaled, or taken orally as capsules or lozenges and swallowed. The onset and duration of action of a product will vary depending on which route is employeed.

 

(1) Sublingual and buccal products are fast-acting (10-30 minutes to onset of maximum effect) and will sustain their activity to a moderate degree. Because sublingual and buccal preparations will also be swallowed with saliva, they do share limited properties of oral, swallowed products.

 

(2) Inhaled, or vaped, products provided by metered-dose inhalers (MDIs) have the fastest onset of action (5-10 minutes to onset of maximum effect) but the shortest time of activity. The safety of vaped products has recently come under scrutiny due to users developing serious pulmonary complications including death. The circumstances appear to suggest the problem may come from additives to the products but definitive answers to the underlying cause remain elusive. Caution is advised, particularly to avoid vaping products with Propylene Glycol.

  

(3) Orally swallowed products have the slowest onset of action (1-3 hours to onset of maximum effect) but the longest time of activity. Both THC and CBD are lipophilic molecules meaning they dissolve well in fat but not water. This characteristic slows and limits their absorption from the gut. Absorption will be increased substantially if they are ingested with or after eating foods containing fats or oils. The presence of fats or oils in the gut stimulate the release of bile salts into the gut that facilitate absorption of fatty compounds, including THC and CBD.

 

While being absorbed from the gut, THC and CBD are metabolized by CYP enzymes in the intestine. Furthermore, oral products will pass through the liver before reaching the blood stream to achieve their effects. Passing through the liver allows tTHC and CBD to be metabolized and these breakdown products, or metabolites, provide their own therapeutic effects and side effects. Thus oral products may offer different therapeutic effects than the same product used buccally or inhaled.

See: Marijuana (Cannabis) – Pharmacokinetics

 

Tolerance to Cannabinoids

As with opioids, the degree of a patient’s tolerance to cannabinoids will be an important variable in establishing the optimal dose. For those patients with a long established history of marijuana use there may be significant tolerance to the therapeutic effects of cannabinoids which may require higher doses to achieve benefit. Those individuals without previous exposure to marijuana or cannabinoids will be expected to have minimal tolerance and should be started at lower doses.

 

Dosing Strategies

  1. General approach to cannabis initiation is ‘start low, go slow, and stay low’.
  2. THC-related side effects such as anxiety, fatigue, tachycardia and dizziness are avoidable when starting dose is low and titration is slow
  3. Medical cannabis patients treating chronic conditions/symptoms should start with oral preparations which are longer-acting and with a CBD-predominant formulation with the smallest amount of THC to get the greatest improvement in symptom control, function, and quality of life, with fewer adverse events.
  4. Getting euphoric effects or a “high” is not required to get symptom control.
  5. CBD can balance THC side effects and CBD-dominant preparations have fewer unwanted psychotropic effects but may require higher dosing, sometimes up to 300 mg/day.
  6. Dosing with cannabis products with balanced THC:CBD @ 1:1 ratios may be guided by established dosing with Sativex, a pharmaceutical product approved for use and widely prescribed in Canada and Europe as well as >100 countries. Sativex contains 2.7mg THC/2.5mg CBD per 0.1 ml spray and has a maximum recommended dose of 32.4mg/30mg/day. A preponderence of medical literature guiding recommendations of therapeutic benefits from cannabinoids is based on studies incorporating Sativex.
  7. Tolerance does not develop to most benefits so dose escalation over time is not generally seen.
  8. Starting doses of THC should be 1-2 mg, initiated at bedtime to reduce side effects. Higher starting doses should be limited to those with current cannabinoid use experience.
  9. THC dosing can be increased as needed every 2-3 days, including increasing frequency of use to 2-3 times/day, generally up to 15 mg/day.
  10. THC doses higher than 20-30 mg/day are generally not needed or recommended. For those who appear to have high tolerance requiring doses higher than 30 mg/day, a cannabinoid “reset” or sensitization protocol is recommended. See “Cannabinoid Sensitization Protocol.

  

Dosing – Louisiana GB Science Products

 As of July, 2019 the preliminary cannabis-based products to be available in Louisiana are limited to GB Science products, tinctures only. They differ by their concentrations and ratios of THC to CBD. The contents of other cannabinoids and terpenes are unknown.

 

Please note also that the cannabis-based products approved and to be distributed in Louisiana are NOT FDA-approved and therefore will not be covered by insurance. Additionally, they would be considered illegal in states or countries that do not have appropriate laws legalizing marijuana, so caution should br exercised if traveling with these medications.

 

Furthermore, transporting a cannabis product across state lines, especially into a cannabis-illegal state could make one susceptible to federal criminal charges of transporting controlled substances across state lines.  Do not transport cannabis-based products in your luggage into other countries.

 

Each of the three tincture products listed below are dispensed in 30 mL bottles with a 1 ml dropper designed to provide dosing of the medication in increments of 0.1 – 1 ml.

 

1) THC-RICH (100% THC) SUBLINGUAL TINCTURE (GBSL-THCR-TI)

Potency: 300mg THC/30 mL (10 mg THC/mL).

 

Initial recommended starting dose:

Naive patients start with a sublingual dose of 0.25 mL (2.5mg THC) 1 time per day for 1 week.

Experienced patients start with a sublingual dose of 0.5 mL (5.0 mg THC) 1 time per day for 1 week.

 

If desired therapeutic effect is not achieved after 1 week:

Patients may take initial dose 2 times per day for 2 weeks.

 

If desired relief is not achieved after 3 weeks:

Patients may take initial dose 3 times per day for 2 weeks.

 

For greater relief:

Naive patients may increase initial dose in a stairstep manner by adding 0.25 mL to initial dose for a 2-week period until desired relief is achieved (e.g., progress from initial dose of 0.25 mL to 0.5 mL to 0.75 mL to 1.0 mL).

 

Experienced patients may increase initial dose in a stairstep manner by adding 0.5 mL to initial dose for a 2-week period until desired relief is achieved. Daily doses of THC in excess of 20-30 mg generally not necessary or advised.

 

(2) BALANCED THC:CBD (1:1) SUBLINGUAL TINCTURE (GBSL-1:1-TI)

Potency: 150 mg CBD:150 mg THC/30 mL (5 mg CBD:5 mg THC/mL).

 

Initial recommendation:

Naive patients start with a sublingual dose of 0.5 mL (2.5 mg CBD:2.5 mg THC) 1 time per day for 1 week.

Experienced patients take 1.0 mL (5 mg CBD:5 mg THC) 1 time per day for 1 week.

 

If desired relief is not achieved after 1 week:

Patients may take initial dose 2 times per day for 2 weeks.

 

If desired relief is not achieved after 3 weeks:

Patients may take initial dose 3 times per day for 2 weeks.

 

For greater relief:

Patients may increase initial dose in a stairstep manner by adding 0.5 mL to initial dose for a 2-week period until desired relief is achieved.

 

(3) CBD-RICH CBD:THC (20:1) SUBLINGUAL TINCTURE (GBSL-CBDR-TI)

Potency: 1200 mg CBD:60 mg THC/30 mL (40 mg CBD:2 mg THC/mL).

 

Initial recommendation:

Pediatric patients take 0.25 mL (10 mg CBD:0.5 mg THC) every 8 hours for 2 weeks.

Adult patients take 0.5 mL (20 mg CBD:1 mg THC) every 8 hours for 2 weeks.

 

For greater relief:

Patients may increase initial dose in a stairstep manner by adding 0.25 mL to initial dose for a 2-week period until desired relief is achieved.

  

   

Dosing – Dried Cannabis

See: Marijuana – Inhaled (Smoked and Vaporized)

The determination of dosing is one of the major stumbling blocks in the study of medical marijuana. This is because marijuana, a plant, varies widely in the amount and ratios of the pharmacologically active constituents present depending on a multitude of variables. Depending on the plant there may be over 100 pharmacologically active constituents all of which vary depending on the genetics of the plant, the conditions in which the plant was grown, how and when it was harvested and other variables. As such there is a huge variability in the potency and expected effects between different plants.

 

As noted above, the major pharmacologically active cannabinoids in marijuana are THC and cannabidiol (CBD). The average contents of THC and CBD in dried plant preparations of marijuana confiscated from 1993 to 2008 in the United States were 4.5 and 0.4, respectively, although these contents vary widely. In the last decade these percentages have increased in different strains to more than 3-5 times as potent.

 

A 2015 study published in the Journal of Pain, a publication of the American Pain Society, evaluated the use of controlled dosing of herbal cannabis in 215 patients with chronic pain. In this study, herbal cannabis containing 12.5% (+/- 1.5%) THC was evaluated for safety and effectiveness over a one year period, one of the few long term studies evaluating cannabis for pain. Unfortunately, the content of CBD and other cannabinoids and terpenes was not reported.

 

The median daily dosage among cannabis-using participants was 2.5 g/day (range = .1–13.4); 11 (5%) patients received doses of >3 g/day. Fifty-eight participants (27%) used smoking as the only route of administration, 130 (61%) used a combination of smoking, oral, and vaporization, and 17 (8%) consumed cannabis orally only. Improvement in pain and quality of life was significant compared with placebo. While there were no serious effects reported, most patients (190 of 215; 88.4%) experienced at least 1 non-serious side effect compared with the placebo control group (184 of 216; 85.2%). This difference was not statistically different.

 

Dosing – Other Cannabinoids in Other States and Countries

 

Canadian Guidelines – 2014

Based on Canadian guidelines published in 2014, smoked cannabis might be indicated for patients with severe neuropathic pain conditions who have not responded to adequate trials of pharmaceutical cannabinoids and standard analgesics. Smoked cannabis is contraindicated in patients who: (1) are 25 years of age or younger; (2) have a current, past, or strong family history of psychosis; (3) have a current or past cannabis use disorder (marijuana addiction); (4) have a current substance use disorder (addiction to other drugs); (5) have cardiovascular or respiratory disease; or (6) are pregnant or planning to become pregnant. It should be used with caution in patients who smoke tobacco, who are at increased risk of cardiovascular disease, who have anxiety or mood disorders, or who are taking high doses of opioids or benzodiazepines.

 

Based on these Canadian guidelines, when smoking is advised (which it is generally not), initial dosing recommendations for smoked marijuana are usually for small amounts of lower-potency marijuana. For example, the starting recommended dosing is 1 inhalation of a 9% maximum THC “joint” once per day. This can be increased to a maximum recommended dose of 1 inhalation 4 times a day, resulting in approximately half a “joint” per day (or 400 mg). Patients should not operate dangerous equipment or perform potentially dangerous activities after use. This includes no driving for at least 3 to 4 hours after inhaled medical marijuana, 6 hours after oral ingestion, and for at least 8 hours if they experience a subjective “high.”

 

Higher doses are sometimes used. It should be noted that if patients use a 5 gram dose of 15% THC, this represents approximately a 20 times higher dose than the recommended 400 mg of 9% THC. Higher doses, especially at this level are associated with significantly higher risk of adverse side effects (see below). In marijuana resin (commonly referred to as hash or hashish), the average contents of THC, CBD, and CBN are 14.1, 2.5, and 1.9%, respectively. Other commercial products including oils and edibles may contain even higher potencies.

   

Germany

In Germany currently there are 14 types of cannabis flowers that can be prescribed, with THC concentrations varying between 1% and 22% and CBD concentrations varying between 0.05% and 9%. Dosing information for specific indications is not available but the German Narcotic Drugs Act sets the maximum amount that can be prescribed within a 30-day period at 100 g cannabis in form of flowers, regardless of THC content. While  THC-containing capsules and oil are not permitted under the German Narcotic Drugs Act, they can be prescribed for individual therapeutic trials as compounded medications in the form of drops, capsules or inhalation solution. Apparently, their recommended daily doses of THC range between 5 and 30 mg.

    

 

 

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 –Dosing

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

 

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 – 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

   

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

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

Supplements recommended by Dr. Ehlenberger may be purchased commercially online or at Accurate Clinic.

Please read about our statement regarding the sale of products recommended by Dr. Ehlenberger.

Accurate Supplement Prices