QUESTION: I have questions about the use of cannabinoids in various types of illness as well as the differences in types of product, CBD versus THC as well as side effects.
ANSWER:
There are two major components of cannabinoids:
- Tetrahydrocannabinol (THC) – More psychoactive
- Cannabidiol (CBD) – Less psychoactive
Two common Cannabis species:
- Sativa: considered higher THC
- Indica: considered lower THC
Common Forms of Cannabinoid Dosing:
- Dry plant (Smoke, Vaporize)
Multiple component use (pain, immune, cancer)
Fresh plant (whole juice – like wheat grass juice)
Often higher CBD content (immune, cancer)
Low psychoactivity - Oil extraction
Typically higher THC (multiple component use) - Tincture (often 10-30% THC)
If prepared cold low THC / high CBD content
If simmered or cooked then prepared higher THC content
Normally the THC (calculated) concentration should be listed - CO2 extraction
Typically higher CBD content (immune, cancer)
CLINICAL BASICS: For most oncology and other chronic pain patients I recommend the following:
CBD Oil preparations during the day QD to TID
- Titrate up based on prior tolerance and effect of particular product – generally a drop the size of a rice grain for the concentrated CO2 extracts and 1-3 mL for something like Rick Simpson Oil
- THC Tincture at night / after dinner
- Start with 2-5 Drops (gtt) in some water or tea and titrate up.
- If there is a high level of pain and the CBD product is not helping:
- With the caution of no driving or machinery operation add THC tincture on top of the CBD doses. Same titration of 2-5 gtt per dose
Raw Leaf Juice: This is an excellent source of CBD only (children or THC sensitive adults).
Vaporized product: If no lung involvement the patient can use this for any THC appropriate indication.
Titration: It is critical that any compound (THC, CBD or mixtures) be titrated up. Cannabinoid naïve patients (no cannabinoid use within one year or more) can have psychoactive or uncomfortable side effects (sleepiness, hallucination, dizziness or ataxia etc.) if the dose is escalated too quickly. Often these effects wane or disappear with use, and allow dose escalation.
In pain cases and other immune uses: CBD during the day titrate from 100 mg to 250 – 1000 mg in 2-4 divided doses.
- Add THC if required for pain, sleep or anxiety tincture of 20-30% THC concentration
- Generally best after cognitive or mechanical requirements are met for the day (driving, concentration etc.)
- I typically recommend dinner time and after doses except in extreme symptoms.
- Titrate to symptom control.
In oncology cases: CBD during the day titrate from 250 mg – 2000 mg in 2-4 divided doses
- Add THC if required for pain, sleep or anxiety tincture of 20-30% THC concentration
- Generally best after cognitive or mechanical requirements are met for the day (driving, concentration etc.)
- I typically recommend dinner time and after doses except in extreme symptoms.
- Titrate to symptom control
* Please note that the above is a very basic outline of this topic and much more detail is required for complete understanding.
