Cannabis:

THC Dosing of Inhaled Marijuana

As most people know, the THC content of marijuana can vary considerably. It is often the case that people will seek out the flower with the highest THC content in the mistaken, belief that they’re getting a better deal. Furthermore, the amount of THC delivered per inhalation varies considerably based on the habits of the individual, but of course, it is largely based on the THC content of the flower. This treatise puts a perspective on the THC content of cannabis flowers and correlates dose of THC when inhaling the flower.

 

See:

 

Key to Links:

  • Grey text – handout
  • Red text – another page on this website
  • Blue text – Journal publication

Definitions and Terms Related to Pain

 

THC Dosing of Inhaled Marijuana

The amount of THC in products currently made available at cannabis dispensaries in Louisiana, as well as most of the rest of the United States, has become increasingly high. THC products such as oil, shatter, dab, and edibles now include THC concentration upwards of 95%. There is absolutely no research that indicates this level of THC is beneficial 0or needed for any medical condition.

The majority of people using cannabis products for therapeutic benefits choose to inhale their product by either smoking or vaping marijuana flower. The focus of this treatise is on the THC content of marijuana flower and to review dosing based on different THC content percentages.

It should be acknowledged that patients with extensive long-term use of cannabis products, especially high THC content products, will develop significant tolerance to the effects of THC, including both therapeutic effects and side effects. Accompanying this increased tolerance is the development of greater likelihood and severity of withdrawal symptoms which is reviewed here.

Clearly, patients with high tolerance to THC will require higher doses to obtain their therapeutic benefits. One might therefore argue for using a THC flower with a high concentration of THC.

But let’s explore the wisdom of that.

Most people will agree with the idea that different strains of flour have different degrees of their therapeutic benefit, whatever benefit that might be. Few people conclude that any strain they select provides the same degree of benefit. Most find that some strains are more effective than others, even when the THC content is the same. This supports the argument that it is not just the THC in a flower that provides therapeutic benefits, but benefits are also derived from other compounds found in TC flower, particularly the terpenes. There is a great deal of speculation as to which terpenes are the best for which therapeutic benefits, but unfortunately there’s no good consensus yet on those questions.

For the purposes of this lesson, let’s make a few assumptions:

  1. One can identify a group of terpenes that is associated with a greater benefit than others, whatever that benefit may be.
  2. Whatever terpenes may be present in a flower, the THC component also provides significant benefits
  3. For the sake of argument, most patients will be able to decide within two or three minutes after taking their first puff, whether or not they need a second or possibly third puff to satisfy their immediate need. In other words, the inhaled dose of a particular flower is usually established within a short period of time. Studies show that onset of inhaled THC effects are within 2–5 minutes and peak effects are within 15–30 minutes.
  1. The impact of inhaling marijuana flower in this short time period is likely driven mostly by the THC content because its effects usually become evident within one to two minutes.  While the terpenes contribute significant benefit as previously acknowledged, it is likely that most of the therapeutic impact of terpenes are more likely to be fully appreciated in a later time frame, minutes to hours after the initial puff.
  2. In most cases, people will know within a minute or two whether they will need to take a second or third puff to complete their dose. Arguably, that decision will be based predominantly on the THC content of the flower, and those who have developed a higher tolerance to THC generally require a higher dose to meet their immediate need.

Now here is the test scenario:

  • An individual with a high tolerance for THC who knows the terpene profile that works best for them presents to the dispensary, asking for a flower with the terpene profile they prefer.
  • The dispensary attendant returns some time later with two flowers with the exact same terpene profile, but one flower has 30% THC, the other flower has 15% THC yet the terpene profiles are identical for each.

Which flowers should this individual with high tolerance select?

So, the individual is offered the opportunity to try them both. First they take a puff from the 30% flower and within a few minutes they are satisfied that they have experienced an adequate dose and they are satisfied that one puff is sufficient.

However, at another time they take a puff of the 15% flower and within a few minutes they realize that just a one puff dose is insufficient, and therefore they take a second puff. Now, after taking a second puff which has now provided them with the same THC content of the previous single puff from the THC flower, the individual again feels satisfied after the second puff which they determine provides a sufficient dose.

So, the 30% flower achieves a sufficient dose with just one puff while the 15% flower requires two puffs to gain the same immediate benefit.

Which flower should be purchased, the 30% or the 15% THC flower?

  1. Should this individual purchase the 30% flower, likely to be a bit more expensive because of the high THC content?
  2. Should they save a little money perhaps and purchase the 15% flower, acknowledging they may need to take two puffs per dose. (Given the fact that most flower is going up in smoke – or vape fumes,  it does not seem likely that they will have to use twice as much of the 15% flower over the long run just by taking a second puff before extinguishing the flower.

What’s the difference between these two experiences?

The difference is, while the immediate response to taking either one puff of 30% flower  or two puffs of 15% flower is essentially the same based on the THC dose, the extended benefit over the next few hours should be significantly greater from taking two puffs of the 15% flower because in doing so, twice the amount of terpenes have been inhaled, which provides significantly greater benefits.

Additional pertinent observations:

  • Purchasing the high 30% THC flower commits one to always taking a high dose of THC since few people adjust themselves to taking half-inhalations.
  • Purchasing the 15% THC flower allows one to have more flexibility in their dosing and allows lower doses when high doses aren’t necessarily needed at the time.
  • The assumption of greater cost of purchasing a high THC dose flower may not always apply and it is possible that taking an extra puff or two of lower dose THC flower will contribute to going through more flower in less time and if so, it might cost a little more. The financial consequence of this decision may favor one choice over the other in different cases, but ultimately this is not a decision entirely based on finances, but based on getting the best therapeutic benefit from the choice of flower and avoiding unnecessary high THC dosing when feasible. As with any drug characterized by the build-up of tolerance and greater need for higher doses over time, it is always better to be somewhat frugal in the use of that drug, be it marijuana or opioids.

 

THC Dosing Comparison in Cannabis Flower for Pain and Anxiety

This treatise compares dosing (number of inhalations) for cannabis flower with THC percentages of 3%, 10%, 15%, 20%, 25%, and 30%, assuming reliance on THC alone for analgesic (pain relief) and anxiolytic (anxiety relief) benefits.

Estimates are based on data assuming THC doses of 5-15 mg (absorbed into the blood) are generally effective for moderate symptoms and assumes inhalation absorption to be approximately  30% of inhaled dose.

Given the relatively recent availability of cannabis products for medical use, many patients have only started using THC products recently and are often older and potentially more sensitive to the side effects. Therefore it is important to emphasize the use of lower THC concentrate products, particularly in the face of dispensaries that offer only very limited selections of cannabis flower that have THC content less than 15 to 20%.

Additionally, it should be noted that frequent use of high-potency cannabis predicts a greater severity of THC dependence that is associated with greater risk of withdrawal symptoms. Interestingly. this effect is much stronger in those under the age of 25. By contrast, use of low-potency cannabis is associated with less dependence and less severity of withdrawal symptoms.

This treatise  provides estimates of THC dosing based on the THC% content of marijuan flower, smoked or vaped.

Overview of THC Dosing and Therapeutic Benefits

THC provides analgesia via CB1 activation in the spinal cord/brain and anxiolysis at low doses by modulating amygdala activity. For pain/anxiety, low-moderate doses (5-15 mg absorbed) are effective; higher doses (>20 mg) increase risks without added benefits. Dosing comparisons assume equivalent absorbed THC (10 mg average for therapeutic effects) and average inhalation (50 mg flower/puff, 30% absorption).

Use of high THC concentration allows fewer inhalations but risks over-consumption, leading to increased likelihood of developing greater tolerance, resulting in the need for higher doses and more expense as well as greater risk of developing dependence resulting in greater risk of withdrawal symptoms.

Just food for thought…

  • is it by accident or by design that medical marijuana dispensaries distinctly emphasize high-dose THC products with very limited offerings of low-dose THC flower products?
  • Does emphasizing high-dose THC products, which are associated with greater dependence and greater withdrawal symptoms, create a stronger demand for their products?
  • As an industry tasked with providing marijuana for medical use, is this practice consistent with the best interest of patients requiring marijuana for medical needs?
  • Is failing to provide marijuana flower products that contain any significant amount of CBD, which allows for lower THC dosing, less dependence, less withdrawal symptoms and fewer side effects, consistent with the best interest of patients requiring marijuana for medical needs?
  • Is failing to educate and emphasize the health benefits of vaping flower vs. smoking flower, consistent with the best interest of patients requiring marijuana for medical needs?
  • Is failure to educate medical marijuana patients regarding the risk and incidence of developing addiction to marijuana associated with regular use, especially with higher doses of THC, consistent with the best interest of patients requiring marijuana for medical needs?
  • Is failure to educate medical marijuana patients regarding how to make the best informed decisions in selecting the most appropriate flower products for their individual needs, consistent with the best interest of patients requiring marijuana for medical needs?
  • Is failure to provide consistent availability of the same marijuana flower products that forces patients to continually select new and unknown flower products they must regularly experiment with, consistent with the best interest of patients requiring marijuana for medical needs?
  • Are the medical marijuana dispensaries providing excellent service that is consistent with the best interest of patients requiring marijuana for medical needs?
  • Are the medical marijuana dispensaries earning the top dollars they are demanding for their products?

… Just food for thought

 

Assumptions for Dosing Estimates

  • Effective Absorbed THC: 5-15 mg for pain/anxiety (average 10 mg; Whiting et al., 2015; PMC, 2018).
  • Inhalation Efficiency: 30% THC absorbed (Huestis, 2007; CCSA, 2019).
  • Flower per Inhalation: 0.05 g (average puff; Veriheal, 2020).
  • THC per Puff: (THC % * 50 mg flower * 0.3 efficiency).
  • Vaping vs Smoking: Similar absorption (vaping slightly higher, 35-50%; used 30% average).
  • Therapeutic Threshold: Low THC sufficient; high THC for potency but not necessity (Frontiers, 2022).

 

Dosing Comparison (Number of Inhalations for 5-10 mg absorbed THC)

 (Assumes no CBD, which increases the risk of THC side effects)

THC %

THC per Puff (mg absorbed)

Inhalations for   5-10 mg THC

Notes

3%

0.45

11-22

Historical low-potency; more inhalations needed, increasing smoke exposure.

10%

1.5

3-7

Balanced for therapeutic; sufficient for pain/anxiety without high risks.

15%

2.25

3-5

Optimal for medical use – effective with few inhalations.

20%

3

2-4

Common in dispensaries; potent but risks anxiety and other side effects.

25%

3.75

1-3

High potency; minimal inhalations but increases side effects risk.

30%

4.5

1-2

Very high; serves recreational high; therapeutic benefits at low doses.
  • Mechanism: THC activates CB1 for pain reduction (spinal inhibition) and anxiety relief (amygdala modulation) at 5-15 mg; higher doses overstimulate, causing anxiety/paranoia.
  • Dosing Considerations: Low % requires more inhalations (e.g., 3% needs 22 puffs for 10 mg), increasing lung irritation. High % allows fewer puffs but risks side effects and over-intoxication. Vaping absorbs ~10% more.
  • Side Effects: Low THC: Mild (e.g., dry mouth 15%). High THC: Anxiety (15%), paranoia (5-10%), tachycardia (5%).
  • Safety Concerns: THC >20% increases psychosis risk 3-5x (PMC, 2018); low THC safer for medical. Compensating low THC with more inhalations increases carcinogen exposure but balances effects with CBD/terpenes.
  • Evidence Quality: Moderate (human pharmacokinetic studies for absorption; observational for therapeutic doses). Low for direct comparisons (no RCTs on % THC vs inhalations).

Arguments against THC >15-20% for Therapeutic Purposes

THC >15-20% is unnecessary for therapeutic benefits (pain, anxiety, sleep) and may serve recreational “getting high” more than medical needs.

  • Evidence Supporting: Low-moderate THC (5-15 mg, ~10-15% flower) is effective for pain/anxiety/sleep without high risks (Whiting et al., 2015; PMC, 2018). High THC (>20%) increases addiction (9%) and psychosis (3-5x risk), with no added therapeutic benefit (Frontiers, 2022). Low THC with CBD/terpenes provides balanced effects (entourage), sufficient for medical (e.g., anxiety relief without paranoia; Yale Medicine, 2023).
  • Evidence Against: For severe pain (e.g., cancer), high THC may provide faster relief (Johnson et al., 2010), but risks outweigh in most cases. Some patients tolerate high THC for sleep (PMC, 2018).
  • Conclusion: No strong argument for >15-20% THC therapeutically; higher serves recreational high. Low THC (<15%) with more inhalations can match effects but increases smoke risks; balanced strains recommended.

Conclusion

There is no good argument for THC content to be higher than 15 to 20% in marijuana flower used for therapeutic purposes. THC contents greater than 15 – 20% serves the purpose of marijuana to get high rather than for therapeutic benefits such as pain, anxiety and sleep which could be sufficiently obtained with cannabis flower with <15% THC in most cases.

Notes

  • Estimates: Inhalations for 10 mg THC (therapeutic average); actual varies by individual tolerance, flower density, and inhalation depth.
  • Clinical Application: Recommend low-moderate THC (10-15%) for therapeutic; higher THC (>20%) increases risks without benefits. Balanced CBD/terpenes enhance low-THC efficacy.

References

  1. THC Dosage- What’s the Right (and Safe) Amount? Good Rx
  2. Cannabis- Inhaling vs Ingesting
  3. Potency and Therapeutic THC and CBD Ratios- U.S. Cannabis Markets Overshoot – 2022
  4. The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist – 2018
  5. Patient-Reported Symptom Relief Following Medical Cannabis Consumption – 2018
  6. Examining the profile of high-potency cannabis and its association with severity of cannabis dependence – 2015
  7. Adverse Health Effects of Marijuana Use – 2016
  8. Whiting, P. F., et al. (2015). Cannabinoids for medical use: A systematic review and meta-analysis. JAMA, 313(24), 2456-2473. https://doi.org/10.1001/jama.2015.6358
  9. PMC. (2018). The problem with the current high potency THC marijuana from the perspective of an addiction psychiatrist. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312155/
  10. Frontiers. (2022). Potency and therapeutic THC and CBD ratios: U.S. cannabis markets oversupply products with high THC. https://www.frontiersin.org/articles/10.3389/fphar.2022.921493/full
  11. Yale Medicine. (2023). Marijuana: Rising THC concentrations in cannabis can pose health risks. https://medicine.yale.edu/news-article/not-your-grandmothers-marijuana-rising-thc-concentrations-in-cannabis-can-pose-devastating-health-risks/
  12. Johnson, J. R., et al. (2010). Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. Journal of Pain and Symptom Management, 39(2), 167-179. https://doi.org/10.1016/j.jpainsymman.2009.06.008
  13. Huestis, M. A. (2007). Human cannabinoid pharmacokinetics. Chemistry & Biodiversity, 4(8), 1770-1804. https://doi.org/10.1002/cbdv.200790152
  14. CCSA. (2019). Cannabis: Inhaling vs ingesting risks infographic. https://www.ccsa.ca/sites/default/files/2019-10/CCSA-Cannabis-Inhaling-Ingesting-Risks-Infographic-2019-en.pdf

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

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

 

 

.