Key Definitions
Introduction
When consuming Cannabis it is worthwhile noting the bioavailability of the constituents being consumed. Bioavailability refers to the extent and rate at which the active ingredients access the site of action (Le, 2022). The following is a list of the bioavailability of the main constituents in Cannabis and the two most common Cannabis consumption routes (Chayasirisobhon, 2020) (McGilveray, 2005) (Lim, et al., 2020):
- Ingested THC = 4-13% bioavailability. A maximum bioavailability of 95% can be achieved using oral dronabinol (a naturally or synthetically produced THC).
- Inhaled THC = 10-35% bioavailability. A maximum bioavailability of 69% can be achieved using a smoking machine (e.g., a vaporiser).
- Ingested CBD = 6-16% bioavailability.
- Inhaled CBD = 11-45% bioavailability.
There are many different manors of preparing and administering Cannabis and its constituents. They can be broadly summarised as oral (e.g., capsules), inhaled (e.g., vapes), sublingual (e.g., tinctures), ophthalmic (e.g., eye drops) and rectal (e.g., suppositories). Table 1 summarises preparations that have been researched and their associated general dosages for different medical indications (Amar, 2006) (Hazekamp & Grotenhermen, 2010) (Kowal, et al., 2016) (Legare, et al., 2022).
Table 1: Preparations and per day dosages of Cannabis and its constituents for different medical indications.
Titration, in the context of Cannabis consumption, refers to slowly increasing the dose of Cannabis medication by small amounts over a period. This is done to determine a dose that is effective for your individual needs. The following provides rough guidance for self-titrating medical Cannabis (regardless of preparation) during the day and night (MacCallum & Russo, 2018):
Daytime Titration Routine
- Days 1 & 2 – take 2.5 mg of THC once a day.
- Days 3 & 4 – if no effects were felt then take 2.5 mg of THC twice a day.
- Days 5 & 6 if no if no effects were felt then take 2.5 mg of THC three times a day.
- If no effects are felt after day 6 then increase your dose every 2 days such that you do not consume more than 15 mg of THC two to three times a day.
- If side effects are felt, then drop to your previous or most tolerated dose.
- To reduce feeling “high” consume medicines that contain CBD and THC.
Nighttime Titration Routine
- Day 1 & 2 – take 2.5 mg of THC at bedtime.
- Day 3 & 4 – if no effects were felt increase the dose to 2.5 mg of THC.
- Days 5 & 6 – if still no effects were felt increase the dose by 2.5 mg of THC.
- Continue to increase your dose by 2.5 mg of THC until the effects are felt.
- If side effects are felt, then drop to your previous or most tolerated dose.
When self-titrating, note that effects take about 5-10 mins to manifest in smoked Cannabis, 60-180 mins in orally consumed Cannabis and 15-45 mins for oromucosal administered Cannabis.
CBD produces fewer adverse effects than THC and as such self-titration can begin between 5-20 mg (MacCallum & Russo, 2018). The following provides rough guidance on titrating CBD to find out if it is effective in treating a patient’s medical indication (MacCallum, et al., 2021):
Day- or Nighttime Titration Routine
- Day 1 & 2 – take 5 mg of CBD twice a day.
- Day 3 & 4 – if no effects were felt, increase the dose to 10 mg of CBD twice a day.
- If no effects were felt after day 4, then consult with your healthcare provider on either increasing your CBD dose beyond 20 mg a day or changing your treatment to THC or a TCH/CBD mixture.
Disclaimer
The information presented in this post is intended as an informational guide. The remedies, approaches and techniques described herein are meant to supplement, and not to substitute for, professional medical care or treatment. They should not be used to treat a serious ailment without prior consultation with a qualified health care professional.