There is no great way for patients to standardize how much THC they inhale when they vaporize or smoke cannabis. For simplicity, we will combine both THC and THCA into our term THC for this article (more on that topic in the article Methods of Use).
Concentration of THC
Products have varying concentrations of THC. Marijuana flower can range from hemp that contains less than 0.3% THC to strains with 100 times that amount. Flower can range in strength between two plants growing next to each other and even depending on where on the stalk it is located. Flower picked from the top of a stalk is usually stronger than buds picked on the lower part of a stem. A grower sending their flower to be lab tested can send only the tips of their healthiest most sun-exposed plants to the lab so their strain’s percentage of THC is maximized on the lab results. Consumers buying that strain’s flower that was picked on the lower parts of the crop’s weaker plants will have a much lower potency of medication.
Vape pens and concentrates are no different. There are vape pen cartridges with 10:1 CBD to THC ratios that barely do anything at all compared to cartridges with over 90% THC (or THCA). Concentrates can also range from 50% THC to almost pure 100% THC diamonds (see article on concentrates).
The THC dose of inhaled marijuana also varies depending on how big the inhalation is. A long drag of cannabis will contain many more milligrams of THC than a short puff. Some people take a few puffs at a time. Experienced users can inhale a tall bong full of cannabis smoke. Other patients are so new to cannabis that they cough before the THC reaches their lungs and they actually think they are inhaling but never truly deliver any dose of THC into their bodies. This can literally go on for months or years before someone points out to them that they need to breath in more deeply, chasing their puffs with fresh air (see article on The First Time Using Cannabis).
It is better to purchase products with the highest concentration of THC so that less needs to be inhaled to deliver the same dose. Once a patient is accustomed to inhaling marijuana, they can adapt the size of the puffs they take and understand how much is needed to dose themselves an adequate amount (see Trial and Error). Usually, it’s better to use as little as possible so less tolerance develops over time. Otherwise, it can become very expensive to medicate with marijuana on a daily basis. Alternatively, if there is no cost limitation and high doses of THC are necessary, like in patients treating cancer, a tolerance can be a good thing so the patient has less side effects while dosing as much as they need (see Side Effects of Cannabis).
The Globe Method
While the exact dose of THC inhaled is not possible to be determined, there is a method that Dr. Matthew Roman, MD has devised to at least standardize the amount that is being taken in. Since inhalations vary between patients and in size and volume of smoke or vapor being inhaled, they vary in the milligrams of THC. However, if the patient uses a vaporizer with a clear chamber (a glass globe), they can see the level of vapor before inhaling it. This allows for a consistent volume of vapor before each inhalation and a more standardized dose of THC. We may not know how many milligrams are in the vapor (concentrates vary in concentration of THC), but between inhalations we can keep a consistent amount. It prevents patients who are new to cannabis from using too much. It is also less irritating to the airways when inhaled this way.
In such a vaporizer, the volume inside of the chamber is about 2 milliliters (mL). It is recommended that a patient new to cannabis fills the chamber halfway with vapor (1 mL) and then inhales from it until it is cleared. They should wait about ten minutes to see how they feel and repeat if more is needed to treat symptoms. Once a desired level is achieved, the patient will understand how much vapor is appropriate for them. If they start to develop a tolerance, it will be noticeable because more volume of vapor will be inhaled with each treatment session. Patients can write down and keep a log of how much they need each day to track their tolerance level.
For a more detailed explanation on this standardized method of using cannabis, get a copy of The Clinician’s Guide to Medical Cannabis on Amazon. The book is written for healthcare providers but can be read by patients too. Also, if you are interested in purchasing a vape pen like the one described above, contact us and we can help you find one.
Oral THC Dosing
Patients who become comfortable inhaling vaporized cannabis can try oral products next. The reason it is best so start with small amounts of inhaled cannabis before oral products is that cannabis edibles can range tremendously in their THC content. There are edibles that contain hundreds of milligrams of THC. Products that are manufactured and tested by state-approved labs are usually accurate with their THC content, but home-made edibles are really hit or miss. It is very difficult to know the exact amount of THC in home-made edibles infused with THC butters or oils. For this reason, oral cannabis products are much more likely to cause someone to visit the Emergency Department due to an overdose.
A benefit of using edibles compared to inhaling cannabis is that you can actually ingest products with a known milligram amount of THC. Start with small amounts to understand how the THC affects you. You will have to wait two hours for the onset of the medicine. Because of this, cannabis products taken by mouth should be used earlier in the day, unless they are being used specifically for insomnia. Obviously, dont use them if you have to drive later in the day or have important responsibilities that should be performed while under the influence. Don’t forget to check that your oral cannabis products contain THC instead of THCA, which has no effect in the body when swallowed because it has to be heated up to convert into THC.
Patients who are new to oral cannabis should start with a 12.5mg dose of THC. This is a safe dose that should still have a therapeutic benefit. It’s not enough to over-medicate someone but it is enough to feel the effects. Many products are able to be divided into 12.5mg increments. In many states, there are 100mg square gummies that can be divided into eighths that each contain 12.5mg. Once you are accustomed to the effects of 12.5mg you can increase your dose. Some patients, depending on their conditions, take over one hundred milligrams of THC per dose or more.
If you can’t measure an exact 12.5mg dose of THC, take a very small amount of the edible and go up on the amount on subsequent days until you feel an effect. You want to feel a little high so you know that it is having some effect on your body. If you don’t feel high at all, you probably don’t have enough in your body to have a medical benefit. If you use too much, go down the next day. The key is to use tiny incremental changes over time so you don’t use too much.
Dosing and Baking Cannabis Edibles
For information about dosing and baking cannabis edibles, read our Cannabis Edibles article.
Microdosing is a way to use cannabis in small amounts and low doses of THC. It is typically used on an as-needed basis. This way of using cannabis minimizes the high that a patient experiences. Patients who microdose are usually barely high and can function normally.
The main purpose of microdosing is to stimulate the bodies ability to maintain a mental and physical balance. Doctors call this balance homeostasis. It also provides an anti-inflammatory effect on the body that can keep it youthful by lowering the microscopic wear-and-tear that occurs from microcellular stress and inflammation.
Microdosing is usually reserved for patients who are healthier and live active lifestyles. It treats conditions that require less THC to alleviate them (see table above). One of the main reasons to microdose is to relieve psychological stress. Stress is one of the main causes of long-term morbidity. It results in a release of cortisol, the stress hormone, that leads to plaques in arteries, weak bones, and other significant side effects. Using cannabis in small amounts on a daily basis can lower the amount of stress in life and rejuvenate someone for the next day’s responsibilities.
Minor aches and pains can also be improved with microdosing. When added to a healthy lifestyle that incorporates physical exercise, a healthy diet, and mental well-being, microdosing can be beneficial for long-term optimal health.
Macrodosing is the use of THC in large amounts. The most significant side effect of macrodosing is that the patient gets very high. However, the medicine has a better effect at treating conditions that need a high level of THC. It is important that patients who macrodose do not have significant responsbilities after medicating (driving, work, childcare, etc.).
Concentrates are the best way to macrodose because they deliver a higher dose of THC to the body than anything else.
One of the main ways that macrodosing works is that it can stop some conditions in their tracks, literally aborting them from the body. One example of this is to treat migraines. When a patient has a migraine coming on, it can be a good time to use a high dose of THC to relax the mind and give it rest. This can stop the migraine from continuing or at least make it go away quicker.
Cancer is a condition that requires significant macrodosing. The anti-cancer properties of cannabis are maximized in a dose-dependent way so the higher the dose, the better it works to fight cancer. Rick Simpson Oil is a concentrate that is taken orally by mouth and was developed to treat cancer. You can read more about it on our Concentrates page.
Severe anxiety can also be treated by macrodosing to break negative thought feedback loops. Since marijuana has the side effect of causing paranoia, it should be taken for severe anxiety in macrodoses only by experienced users. Read our Side Effects page to better understand how to stop a panic attack if it occurs during a macrodose treatment.
For some patients, macrodosing at the end of each day is the best way to destress and prevent burn out from a stressful and demanding lifestyle.
|Minor depression, stress, minor aches and pains, IBS||Migraines, PTSD, cancer, acute severe pain, acute anxiety|
Choosing What’s Best For You
Choosing the best treatment for you depends on your condition and your lifestyle. Consider your morals, family, employment responsibilities, need to travel, and anything else that could affect how much you can medicate.
Part of the problem determining what is the best for your lifestyle and condition is how much you can afford to use cannabis. One day we should be allowed to grow our own medicine in our backyards but until then we have to purchase cannabis from dispensaries, which inflate the price. When a dispensary sells cannabis, it is a middle man that purchases the cannabis first from a grower. Then they have to raise the price above what they purchased it for and add taxes to it, which are usually very high because states use medical cannabis as a way to bring in revenue. What this adds up to is a hyperinflated price for a medicine that should cost very little.
The cost of using cannabis can be very expensive for patients who should be using it every day. If you have trouble affording the medicine, try to use as little as you can so you don’t develop much of a tolerance. Once a tolerance is formed, the price of medicating (especially macrodosing) rises exponentially. A good situation is when you can take one to two puffs to medicate. It’s a lot more difficult to afford treatment if you use a full gram of marijuana each time you medicate.
Maximizing THC Percentage
One of the most important aspects of medicating with cannabis is understanding that the active ingredient is THC (and THCA, which turns into THC when it is heated to vaporize/smoke). Many dispensaries try to make money by pushing CBD products onto patients. Please allow yourself to be skeptical of CBD and the CBD industry. The benefits of cannabis are produced by activating the Cannabis 1 and Cannabis 2 receptors in the endocannabinoid system (CB1 and CB2). CBD does not activate these receptors. THC does.
Some dispensaries will say that CBD helps THC work better. This is nonsense. If you want THC to work better, buy a product with more THC instead of one with less THC combined with CBD. Products that contain CBD cost about equally as much (if not more) as those that have only THC but their THC content is diluted so you are paying just as much for a product that is much weaker.
If you feel that you do not need much THC, use less of it rather than purchasing a product that contains less THC in it but also contains CBD. The point of this is to maximize the value of your dollar. If you want to spend less on cannabis, buy as much THC as you can per dollar you are spending and then use as little as you can when you medicate so you don’t develop a tolerance to it.
The prices of cannabis products are mostly based on the form of cannabis and their brand. For example, most marijuana flower will cost about the same amount but some brands will charge more and claim they have better products. Cannabis concentrates are similar: they will cost a similar amount but some brands will overcharge for premium products that have nicer packaging. Don’t let this fool you. What you want to look for is the percentage of THC or THCA in the products you are purchasing.
If you have a choice between a few similarly-priced concentrates, choose the one with the highest percentage of THC so you can use less of it to have the same effect of medication. Do the same with flower. Buy strains with higher THC percentages but average or lower prices. You can literally calculate the highest value product by taking the percentage of THC and dividing it by the cost of the flower/concentrate. Choose the product with the highest value, meaning the best price per milligram of THC.
Cannabis Oil Tip
Most cannabis products are sold by weight (grams, ounces, etc.). There is one important exception to this. There are some oils that are sold by volume. Products that contain cannabis oil in syringes are sold by the volume in the syringe. Their labels still say a percentage of THC but the percentage is calculated based on their weight. Occasionally, they are priced similar to products sold by weight instead of volume. For example, a 1 milliliter syringe might be sold for the same price as 1 gram of concentrate. However, since 1 milliliter of cannabis oil typically weighs almost 2 grams, you are getting almost twice as much THC in the syringe. Keep an eye out for that.
Rick Simpson Oil (RSO) and CO2 oil are forms of cannabis that are sometimes sold by volume and provide a significant boost in value for their cost. Consider that when you go to the dispensary.
One of the most frequent questions that are asked to our medical marijuana doctors is, “Which strain should I buy?” The entire medical marijuana industry pushes the idea that there are strains that are better for some conditions than others. If this were true, wouldn’t we already know by now which strain is best for which condition? Yet the information patients receive from dispensaries changes all the time. Also, the available strains are constantly changing. If there was one strain good for a certain condition, wouldn’t the dispensaries carry that strain consistently instead of changing their strains week after week? All of this suggests that the strain idea is a myth. After all, the active ingredient from all strains of flower is primarily THC. There are no active ingredients present in one strain that are not present in another (unless, of course, we are talking about hemp products that lack THC).
The most common version of the strain myth is that there are sativa strains and indica strains. Let us first understand that the latin name for cannabis is Cannabis sativa. All strains of cannabis are in fact a sativa. There is a purported subcategory of Cannabis sativa that is called indica. These are characteristically more stocky. Then there are hybrid strains. Today, almost all of the strains of cannabis are hybrids, even if they are called an indica or a sativa.
Cannabis is a domesticated plant. Think about other domesticated plants, like apples. There are Washington apples, and Honey Crisp apples, and Fuji apples, and many other cultivars of apple. Cannabis is similar in regard to the indica and sativa strains. At some point, there became two different cultivars of cannabis and people named one sativa and another indica. Today, every crop of cannabis is called a new strain name. It’s like every apple farmer naming their own apples a separate cultivar even though there is almost no difference or new characteristics to it. That is what’s happening with the cannabis industry.
Eventually there will be new cultivars of cannabis that are truly different from others. In the past there already have been some unusual strains. One of the truly most sativa-like of all strains is the Dr. Grinspoon strain from Barney’s farm in the Netherlands. Another interesting strain is White Widow by Greenhouse Seed Company in the Netherlands. That strain’s flower is significantly lighter in color, like the name suggests. These strains have characteristic appearances worthy of a separate strain name but their medical properties still reside in the THCA that they contain, like all strains.
One of the reasons people believe that their are differences between indica and sativa is from the change in effects THC will have based on what people expect from it. The classic strain myth suggests that indicas cause more of a “stoned” feeling that causes people to get sleepy, while sativas cause people to have a “head high” that gives them more energy. This myth has an effect on users because they expect to feel these ways after using different strains.
The natural placebo effect of a drug, especially THC, changes depending on what the person expects to feel. If a patient at a dispensary is told that they are buying an indica that will make them sleepy, it doesn’t matter what strain it is because now that patient will feel like that strain makes them more sleepy compared to other strains. If the patient is told that they will feel more energetic, they will then feel more energetic after using it. This would occur independent of the strain and even if it was a sugar pill. When dispensaries package strains in dark colors and write indica on them with a moon symbol and package sativas with bright colors and a sun on it, they are being disingenuous to patients.
The “Entourage Effect” and Terpenes
Patients are told that there are terpenes in cannabis that have medical properties. They are also told that there are cannabinoids other than THC and THCA that have medical properties. While it is true that there are some cannabinoids with some positive effects on the cannabis receptor, they generally are less effective than THC is.
The “entourage effect” is the idea that these other constituents in marijuana somehow work together to improve the effect of marijuana. Don’t believe it. Focus on the main ingredient that binds the CB1 and CB2 receptors: THC (and THCA because it converts to THC).
If terpenes were responsible for medical benefits in the body, we would be isolating them and selling them as a medication. Pharmaceutical companies would have patents on them. However, terpenes are just organic molecules in plants that add flavors and smells. They do not actually have medical benefits and if they did we would have made drugs out of them long ago. Terpenes are not schedule 1 substances and have been researched. They have as much benefit as pseudoscientific methods of healing like aromatherapy. They might make the cannabis smell nice but they are not going to treat your pain, anxiety, and other conditions the way THC does.
We will be updating our Conditions page in the next few months so you can better understand how specific conditions should be treated with cannabis.
Definitely check out our Cannabis Education section for lots of articles on medical marijuana.
If you would like updates about news related to cannabis laws and legalization and the latest studies, check our our Blog. We post on most Fridays so check each week for updates.
We really feel that the information on our page, including this article, is very beneficial for patients and contrasts with a lot of online marijuana industry misinformation about cannabis. If you agree, please share this article with others so they have a chance to learn about cannabis the way you have.