Q: Is it true that the less medical marijuana cannabis you consume, the greater the benefit?
You may have heard of “microdosing,” the practice of taking tiny hits of marijuana to get the maximum therapeutic benefit without the high that, let's face it, can get in the way of workaday activities.
There's solid evidence supporting this concept of “less is more” when it comes to medical marijuana.
For example, in a 2012 study published in the Journal of Pain, patients with advanced cancer who had pain that wasn't controlled with opioids were given a THC and CBD mouth spray in different doses. The patients who received a low dose of one to four sprays a day experienced greater pain relief than those given the higher dose of 11 to 16 daily sprays.
A later study, in the same journal, found that a mere four puffs of vaporized cannabis was just as effective in relieving treatment-resistant nerve pain as larger doses and was, the researchers wrote, “unlikely to have significant impact on daily functioning.”
Though “microdose” is becoming popular parlance in cannabis culture, many health experts reject the term. Dr. Allen Frankel an internist who in 2007 started Greenbridge Medical, a Santa Monica, California, practice specializing in medical cannabis, is a leading authority on cannabis dosing. He told Marijuana.com that he prefers to talk about best or correct dose rather than microdose.
“Microdose doesn't really have any meaning,” he said. “I've heard some people say, cut an edible in quarters and that's a microdose. From a medical standpoint, that's extremely vague on what the actual dose is.
“I will say that from the beginning we've always been low-dose users because we found that was effective. My definition of a correct dose of cannabis is the lowest dose that works for that patient in that moment in time. Sometimes it will be two milligrams; sometimes it will be 30.”
The impact of a minimal hit can be dramatic, Dr. Frankel said. That was the case of an elderly woman who recently came into his office accompanied by her son, who was alarmed that his mother was losing weight rapidly because she had no appetite. Frankel recommended 1½ milligrams of THC.
“Within half an hour she devoured all the muffins her son had brought in,” he said. “We're talking about a few drops here, not a dropperful. For a helluva lot of people, you'd be blasting them with an entire dropper.”
That's true, in part, he noted, because today's marijuana is a lot stronger than the weed of a few decades ago. “Levels of THC have skyrocketed since the early '80s,” Frankel said, “going from 2 percent to 20 or 25 percent.” That means there's a lot of potency in a couple of puffs, drops, or bites of an edible.
Conditions such as fibromyalgia, migraines and irritable bowel syndrome; and mood disorders such as anxiety are often caused, Frankel said, by a deficiency in the internal endocannabinoid system (ECS). A low dose of THC, CBD or a THC-and-CBD combination is often enough to reset the ECS. What's more, over a period of a few months, patients are often able to lower the dose further or even discontinue their marijuana meds entirely, Frankel said.
Chris Emerson, Ph.D., a molecular chemist who's the founder and chief science officer of Level, a San Francisco-based cannabis company that has a product line of low-dose sublingual tablets, agrees.
“Taking cannabis can allow the body to self correct so your ECS system is in balance,” he told Marijuana.com. “Then you'll need less for the body to maintain that equilibrium.”
Emerson noted that what's a therapeutic minimal dose for one person might be too much or too little for someone else.
“What's challenging is that everyone has their own ECS system,” Emerson said, “so we all have a different response to cannabis.” Factors such as metabolism, weight and gender (women tend to need smaller doses than men), if you're a daily marijuana user or haven't consumed in a decade, will all play a role in how marijuana affects you.
“Cannabis is a journey,” he said. “It should be safe, it should be enjoyable. And that means it can take a lot of trial and error to find what works for you.”
He suggested beginning that journey by abstaining from marijuana for 48 hours. Then, start with 3 milligrams or less of THC, “so you can understand what that small amount does to you.” On another day, try 3 milligrams or less of CBD.
Over the next week or so, experiment with different ratios, keeping the total at 3 milligrams. Once you've established some baseline insight into what's effective in helping you achieve your goal — pain relief, better sleep, sharpened focus, anxiety relief, or a pleasant buzz — you can hone in on even more precise formulas. You might want to continue experimenting with different doses and ratios, as well as the time of your consumption. Maybe a morning hit works best for improving clarity during the day, while an after-dinner dose sets you up for a restful night. Or, perhaps, you'll maintain the greatest sense of well-being with small hits every few hours.
Frankel suggested sublingual, or under the tongue, drops or tabs as the best way to find your ideal dose. Swallow any saliva in your mouth so you're not diluting your cannabis, use your tongue to swirl the drops around your mouth, and then refrain from foods or drink for the next 15 minutes.
“As you gain confidence it becomes easier to titrate your dose to find precisely what works for you,” Emerson said. “For a lot of people, that's a formulation that gives them a slight mood elevation without feeling high.”
Frankel agreed: “The right dose won't leave you feeling stoned, just great.”