When I present cannabis dosing information in lectures here and abroad I always suggest folks in the audience not take what I am saying too seriously. However, at the end of the day, as a physician, I did need to decide what seemed “optimal” for the patients I see with cancer. What dose?? What Ratios of cannabinoids?
Here are some thoughts…..
1. Nobody knows what “dose” or regimen is “best” for cancer. In fact, probably a number of different cannabinoid ratios and doses for various patients have anti-cancer effects through a multitude of mechanisms. The fact that RSO started it all, perhaps gives it credibility it does not deserve. It is well known that low dose cannabis can often be more effective against pain than high dose. This study was done twice and published at UCSD.
2. Cannabinoids have bi-modal effects. This means that in general, low dose and high dose can have opposite effects. There are numerous literature sitings using generic “Sativex” in the study, where symptoms of MS, spasticity and other symptoms are better treated at 20-25 mg of whole plant CBD per day than 60-70 mg/day.
3. One of the reasons that many folk read some articles in the literature to support higher dosing, is because they are dealing with either THC or CBD just in it’s molecular state, as opposed to “whole plant”. Plain crystalline CBD is WAY less effective per mg than whole plant CBD. We have tested this a number of times when we got access to a crystalline CBD from STI labs in London. Ten mg of either molecular or whole plant CBD was given to some patients, including myself. It was a totally different experience. Different medicine. Patients needed 1 mg of whole plant CBD to come close to 10 mg of molecular. Clearly the Entourage Effect and Terpenes/Flavonoids are all critical, as well as the plant waxes.
4. In general, in medicine, doses of medications for one disease are not 100 fold different for other diseases. By this I am referring to my experience with many, many hundreds of patients where IN GENERAL around 30-40 mg of cannabinoids seems to be an adequate dose for most of our very sickest people. So, this dose, and lower, works for MS, Alzheimers, Neuropathy, Parkinson’s and many more. Why would cancer require many, many times more with this one medication. I think it is critical to look at what doses are required, i.e. how little, is required to manage most illnesses that respond to Cannabis; why think it should be increased one hundred fold?
5. OPINION:I don’t think a plant is even meant to be used in toxic doses.
6. I have seen at least 7 patients with stage IV cancer who initially responded to RSO dosing and then had new metastases, went on low dose CBD:THC and had clearing of mets. Maybe it happens the other way around as well? I don’t know, but if in doubt, it is so great to treat someone with a dose and ratio that makes them feel better immediately and not sick; they don’t need to “adjust to the THC toxicity”.
7. Finally, working with two chemists, we attempted to approximate the pharmacokinetics of CBD to try guesstimate what local tissue levels of CBD we get with our dosing. As there is plenty of data in-vitro in petri dishes, we worked backwards and came to 40 mg/24 hours.
So, these are all the reasons I use when making a decision. I guess I would have to ask, other than hearing that it does work for some people (which it clearly does), what is the reason or logic or data to justify using high doses? That is a fair question in my opinion.
