Marijuana (Cannabis)
Dosing: Flower vs Pharmaceutical Products
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.”
Understanding Smoking and Vaping
Inhalation – Smoking vs Vaping
Marijuana Dosing – Flower vs Pharmaceutical Products
LA Marijuana Products:
LA Marijuana Products: Introductory Principles
LA Marijuana Products: Tinctures
LA Marijuana Products: Vape Cartridges & Vaporizers
LA Marijuana Products: Ilera Vape Formulations
LA Marijuana Products: RSO Formulations
LA Marijuana Products: Plant Flower/Bud Products
LA Marijuana Products: Edible Products
LA Marijuana Products: Topical Products
Links to other Pertinent Educational Pages:
Links to ALL Marijuana Educational Pages
For those interested in pursuing a trial of therapy with cannabis-based products, first read:
Medical Marijuana – Marijuana Use Introduction
Marijuana (Cannabis) – Potential for Harm
Marijuana (Cannabis) – Side Effects and Drug Interactions
Medical Marijuana – Cannabinoids and Opioids
Marijuana Pharmacies/Dispensaries in Louisiana:
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.
Key to Links:
Grey text – handout
Red text – another page on this website
Blue text – Journal publication
Marijuana Dosing – Flower 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. Furthermore, due to their potential for extremely high concentrations of THC it is recommended they be avoided because of significant likelihood of side effects.
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 gm. 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, whereas < 5% of patients use > 5 g per day . Tolerance may develop to the benefits and over time dose escalation may be observed.
It is estimated as a ballpark figure that for each percentage of THC in the pot, smoking an average joint would be dose equivalent to 1 mg of THC for each percent THC in the marijuana. 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 (strong 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 of THC 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 50% 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.
Typical Vaporizers designed for use with loose marijuana flower have a small “oven” chamber that allows for loading up to 0.3 gms of flower to be vaped. The vaporizer heats the flower to 360 – 420 F over about 45 seconds until it is ready for inhalation. There are multiple brands and models available in vape shops and on the internet but they are not sold in LA. One popular oven-style vaporizer is the Pax 2 which sells for $150 on the manufacturer’s website. See: List of Cannabis Flower Vape Devices
Common oven-style vaporizers for use with loose marijuana flower typically have a chamber capable of holding up to 0.3 gm of flower to be vaped. As a rule of thumb, loading 0.3 gm of flower rated at 18% THC would allow for a maximum delivery of up to approximately 50 mg THC, less 30–50% of cannabis lost to ‘side-stream’ smoke, equating to a THC dose of about 25-30 mg 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 depend largely on the other constituents present in either the plant or the pharmaceutical product. These constituents 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
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
- Introduction to Medical Cannabis (Module 1) – The Endocannabinoid System by Dr. Towpik
- Introduction to Medical Cannabis (Module 2) – Pharmacology & Phytocannabinoids by Dr. Towpik
- Introduction to Medical Cannabis (Module 3) – Chronic Pain, Palliation & Case Studies by Dr. Towpik
- Introduction to Medical Cannabis (Module 4) – CINV & Epilepsy by Dr. Teh
- Introduction to Medical Cannabis (Module 5) – Adverse Effects & Potential Drug Interactions
- 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:
- www.CannabisBusinessTimes.com
- www.CBDschool.com
- www.gfarma.news
- www.GreenCamp.com
- www.Healer.com
- www.Marijuana.com
- www.MedicalJane.com
- www.profofpot.com
- www.ProjectCBD.org
- 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:
- Measuring cannabis consumption – Psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) – 2017
- Quantifying Cannabis – A Field Study of Marijuana Quantity Estimation – 2018
- Bayesian inference for the distribution of grams of marijuana in a joint. – PubMed – NCBI – 2016
Medical Marijuana – Prescribing Guidelines
- Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
- Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
- Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendations – Canadian Family Physician – 2014
Medical Marijuana – Potential Harms Associated with Cannabis Use
Medical Marijuana – Driving
- Establishing legal limits for driving under the influence of marijuana – 2014
- Medical Marijuana and Driving – a Review – 2014
- Impact of Prolonged Cannabinoid Excretion in Chronic Daily Cannabis Smokers’ Blood on Per Se Drugged Driving Laws – 2013
Medical Marijuana – Opioids
- Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
- It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
- 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
- Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
- Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
- The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
- The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
- Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
- Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
- Cannabis and the Opioid Crisis – 2018
- Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
- Cannabinoid–Opioid Interaction in Chronic Pain
- Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
- FDA approves CBD drug – Epidiolex – The Washington Post
Medical Marijuana – Opioid Drug Interactions
- The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014
- Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011
- Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol. – Role of phenolic hydroxyl groups in the resorcinol moiety – 2011
Medical Marijuana – Pain
- Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
- It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
- 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
- Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
- Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
- Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015
- Cannabis for the Management of Pain – Assessment of Safety Study (COMPASS) – 2015
- Smoked cannabis for chronic neuropathic pain – a randomized controlled trial – 2010
Medical Marijuana – Tolerance Reversal
- Cannabis Sensitization 6 Day protocol – Healer.WorkBook – Inhalation
- Cannabis Sensitization 6 Day protocol – Healer.WorkBook – Tincture
Medical Marijuana – Pharmacokinetics
- Human Cannabinoid Pharmacokinetics – 2007
- Δ9-Tetrahydrocannabinol (THC), 11-Hydroxy-THC, and 11-Nor-9-carboxy-THC Plasma Pharmacokinetics during and after Continuous High-Dose Oral THC – 2009
- Dronabinol oral solution in the management of anorexia and weight loss in AIDS and cancer – 2018
- MARINOL® (Dronabinol) product info – 2017
Medical Marijuana – Product Evaluation
- The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
- Recommended methods for the identification and analysis of cannabis and cannabis products – 2009
- Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
Medical Marijuana – Sleep & Sleep Apnea
- Medical Cannabis and the Treatment of Obstructive Sleep Apnea – An American Academy of Sleep Medicine Position Statement – 2018
- Cannabis, Cannabinoids, and Sleep: a Review of the Literature. – PubMed – NCBI
- Misc Abstracts @ Obstructive Sleep Apnea – 2017
- Cannabinoid May Be First Drug for Sleep Apnea – 2018
- Pharmacotherapy of Apnea by Cannabimimetic Enhancement, the PACE Clinical Trial – Effects of Dronabinol in Obstructive Sleep Apnea – 2018
Medical Marijuana –Misc
- A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
- Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
- Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
- Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
- Cannabis-conclusions – 2017 National Academy of Sciences
- Cannabis-chapter-highlights – 2017 National Academy of Sciences
- Cannabis-report-highlights – 2017 National Academy of Sciences
- 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
- Cannabimimetic phytochemicals in the diet – an evolutionary link to food selection and metabolic stress adaptation? – 2016
- Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
- Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
- Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
- Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
- Systematic review of systematic reviews for medical cannabinoids – 2018
- Adverse effects of medical cannabinoids – a systematic review – 2008
- Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
- Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
- Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
- Clinical Pharmacodynamics of Cannabinoids – 2004
- Affinity and Efficacy Studies of Tetrahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
- Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
- Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
- Pharmacology of Cannabinoids
- Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
- Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
- The Cannabis sativa Versus Cannabis indica Debate – An Interview with Ethan Russo, MD – 2016
- Review of the neurological benefits of phytocannabinoids – 2018
- 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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