Cannabis Dosing: Delivery Methods & Dosing Guidelines

[SweetSue]

I recently took an online course on Cannabis Delivery and Dosing taught by Deborah Malka, MD, PhD.

This thread is my notes, with some additional materials added. There will be other additions as I get further into the study of all things cannabis. I welcome any information you might have that you believe the community could benefit from regarding the safe dosing of cannabis.

We're at a turning point with the therapeutic uses of cannabis. As more states legalize more clinicians are following their patients closely and compiling data that we've hungered for all along. I'm honored to be able to make this little offering to the cause of helping us get a better handle on the most efficient and effective methods of dosing this nearly miraculous herbal medicine.

Please make this thread a place to explore the many ways cannabis can be utilized for healing and health maintenance. Read, question, discuss, contribute. We're all in this together, and this many creative minds let loose can only bring us to some surprising discoveries. Let these initial posts of mine be just the tip of our iceburg.

 

[SweetSue]

Cannabis Tolerance: More is not always better.

Most people only know to increase the dose when cannabis begins to work less effectively. Unfortunately, this can work against you, since an overload of cannabinoids will cause a decrease in receptors. It's part of the way your body evolved to protect you from overstimulation. Most chronic users are working with an overstimulated system and have developed a tolerance to the meds, leading to the need to consume more and more cannabis to get the same effect.

If you use concentrates or strains with extremely high cannabinoid counts your system will build tolerance faster.

CBD-dominant strains produce a different type of tolerance than THC-dominant strains. If you can toggle between strains high in each of these cannabinoids you can potentially limit the development of tolerance. You heard me say "potentially" right? This is still new learning, so we're still lab rats, to some extent.

The Herbal Holiday

It's an age-old policy when working with herbal therapies to regularly challenge the treatment, to see if you need the dose you've been using. This should be part of your own protocol. If cannabis is working for you, take a brief holiday to see if it's possible your Endocannabinoid system has begun to pick up the slack and you don't need as many supplemental cannabinoids.

Some recommended schedules for the Herbal Holiday:

* 1 - 3 weeks out of every 3 - 4 months
* 5 - 7 days a month
* 1 day a week
** If stopping meds isn't an advisable option, change strains. In particular, try to change up the levels of CBD and THC.

The Herbal Holiday resets your tolerance level, requiring less cannabis to get the desired therapeutic effects.

On a personal note, I'm finishing up my own herbal holiday, following Dr. Sulak's 6 Day Sensitization Protocol, and I can tell you this isn't an easy thing to do if you're a chronic user at the levels most of the successful harvesters on this site reach. We're kind of a special group, with more access to better quality cannabis than the average Joe. At noon today I finally break my protocol and find my new tolerance level.

I won't be repeating this again, if I can help it. I'll choose the occasional break for a day or two. I do recommend you test your own system, at least once.

 

[SweetSue]

Dosing Guidelines - New to cannabis
- Start sub-therapeutic. Determine how many doses you'll be taking in a day.

- Increase to a minimal noticeable dose for three days.
* Administer a small dose and wait five minutes.
* If you feel anything at all from that dose, stop and go about your day.
* Repeat this for your other scheduled doses.

During this time your body's developing sensitivity to cannabis and making more receptors.

- Increase to an effective therapeutic dose on Day 4.
* Keep checking your inner inventory to assess your response to cannabis.
* Repeat the process you've followed up to now. Administer a small dose and wait five minutes. This time though, you're going to keep going until you get the relief you were seeking. Be careful to go slow. After all the work to get here you don't want to overshoot.

If you take a dose, after waiting the five minutes, and your scores on the inner inventory drop, back off one administration. That drop in scores indicates you overshot your optimal dose by one administration.

The Inner Inventory

This is a self-awareness technique used by Dr. Dustin Saluk to teach his patients to increase awareness of their body in the early stages of dosing. It's a helpful tool at any time.

Before and five minutes after the dose sit and ask yourself these three questions.
1) Take a deep breath. How easy was that to do? Rate it on a scale of 1-10, 1 being "Ouch!" and 10 being "Ahhhhh....."

2) How comfortable is it for you to sit still? Again 1-10 with 1being "difficult, if not impossible" and 10 being "no trouble at all."

3) How are you feeling mentally and emotionally? Rate as 1 being "Stressed to the max!" and 10 being "Peaceful and calm."

Write this down every time you dose during the early stages of setting the dose. After you find your optimal therapeutic dose, test it out for 2-3 dosing sessions. After that you don't have to wait five minutes between administrations.

Dosing: Experienced consumers of cannabis

Many chronic users of cannabis have often compromised their Endocannabinoid systems with overstimulation. This causes a decrease in available cannabinoid receptors. You find yourself needing to take more and more to get the same effects. Dr. Sulak and his associates have designed a Six Day Sensitization Protocol that will essentially reset your tolerance levels up to a 60% increase in cannabis efficacy. Think of that for a moment - you'd be able to get the same results with up to 60% less cannabis.

Here's a link to the post describing this protocol.

Resetting the Endocannabinoid System: A Six-Day Sensitization Protocol

Dr. Sulak's site, Healer.com, has a wealth of support information to help you through this process. I'm working through it myself r I that now, and I'll tell you, it's doable, but for a chronic user with high consumption history, it's no easy thing to do and I was thankful for their available resources of movement and diet choices to compliment and stimulate the Endocannabinoid system. He's gone out of his way to make this process as painless as possible. I highly recommend you at least check out his site.

Everyone has their own optimal dose. This is one of the defining characteristics of cannabis therapy. This protocol will help you find yours.

Dr. Sulak recommends you switch from inhalation delivery to an oromucosal delivery using a liquid extract (tincture fits the bill). This will help you prevent symptoms instead of chasing after them.

To both mitigate the side effects of THC and to enhance the benefits of THC adjust the ratios of CBD:THC.

 

[SweetSue]

Let's begin with some basic points.

Cannabis is an herb. You shouldn't think of it in the same way you do a pharmaceutical drug. Herbal medications work with your body to affect lasting change, change on a cellular level. This means you'll need to take it for months, not days, to get the desired effects when treating disease.

A good rule of thumb would be one month of healing for every year you've been challenged with the disease, but this is just a guideline. Every individual responds differently to cannabis, so every protocol needs to be individually tailored to the patient.

The frequency and dose depends on the potency and the delivery method. Some guidelines for frequency would be:

- inhalation 5-6 times a day
- sublingual 3-4 times a day
- ingestion 2-3 times a day

Cannabis dosing follows a biphasic curve.

You have an optimal therapeutic dose, where you get the most benefit. Once you exceed that dose you fall into the realm of diminishing returns, requiring more and more meds to get less and less effect. At some point you'll roll into mega doses and the curve starts back up again, but at what cost to budget and frustration?

More is not always better with cannabis. In particular it appears that smaller doses may be more effective for mood management. You always want to start low, at below the therapeutic dose, and increase slowly to find your personal sweet spot.

START LOW - GO SLOW​

Everyone reacts differently and you need to keep in mind that your body is still producing endocannabinoids, and that's going to effect your overall need for supplemental phytocannabinoids. Work up to the therapeutic dose slowly and thoughtfully.

Smaller amounts of cannabis raise the serotonin levels. Higher amounts of cannabis will suppress serotonin. Serotonin is a major neurotransmitter contributing to feelings of happiness and well-being, keeping the gastrointestinal tract running smoothly, regulating mood, appetite and sleep. It has functions with memory and learning and is a growth factor for some cells, possibly having a major part in wound healing.

You can appreciate how valuable it'd be to get the dosing levels worked out, just in this one case.

Cannabis works with your Endocannabinoid system in a way that allows your body to interact with it in a non-toxic way. Cannabis won't kill you or destroy one body system while you're trying to heal another, unlike many pharmaceuticals. It's a frightening thought that the number one cause of death in the U.S. is complications from prescription drugs. Cannabis offers us a better, safer option.

One last point here: full plant extracts will be more effective if they contain the range of components found in the plant. All of the components work together in synergy. The production of CCO is a frequent exception, since the heat used in the processing of CCO destroys the terpenes and flavonoids, very big power players in the synergistic entourage effect.

I've just been informed that big companies with deep pockets have developed expensive techniques that preserve the many components of cannabis in the oil. We don't have that luxury out here in the trenches, but if you have access to such an oil and can afford it, go for it.

 

[SweetSue]

Let's look at some delivery systems for cannabis.

SMOKING
* This is the classical method, the one almost everyone's familiar with.

* Options include:
-plant material (leaves and buds)
- concentrates
- keif
- hash
- waxes
- CCO

* Contrary to popular thought cannabis has no connection to lung cancer, and has been shown to be mildly protective against lung cancer.

* Smoking can irritate the bronchial system, causing coughing and inflammation.

Smoking takes effect within 3-5 minutes and peaks in effectiveness in about 60 minutes, lasting for 2-4 hours. The cannabinoids pass through the lungs, right into the bloodstream.

Water pipes are a recommended method of smoking. The water will cool the smoke, even as it mitigates some of the effects of the smoke. Joints aren't recommended. You get too low a dose with a joint (see below) and you won't control the dose with a joint. You'll keep smoking it to keep from wasting it. Save your joints for recreational purposes.

DOSING WITH COMBUSTION

* The average joint has between 0.5 - 1.0 grams of cannabis.

* 1 gram of cannabis has approximately 100-200mg of cannabinoids (10-20%)

* The maximum THC absorbed by a patient smoking a 1 gram joint with 10% cannabinoids is only 16.3 mg. To begin with, you lose a lot to side stream smoke. The rest of the loss is in diminished bioavailability.

* A daily dose level can be between 1-12 grams.

* Frequency of dosing is between 1-6 times daily.

* Effects last 2-4 hours.

Advantages
* Smoking is the most common delivery system used, and the one most people are familiar with.
* There's a rapid onset. (3 - 5 minutes).
* No preparation is needed, so it's very convienient.
* Easily portable.
* Simple to do.
* You can pick and choose the strain for the moment and use it to effect.
* This is the least expensive delivery method, due to low equipment cost.

Disadvantages
* Smoke is involved. Smoke has some negative side effects, primary bronchial irritation and coughing.
* The effects usually fade within 2-4 hours, not long enough to carry you through the night. This is a short-acting method.
* This delivery system is not recommended for rapid mood cycling.



VAPORIZING

A vaporizer heats the plant material to a specified temperature below the point of combustion, between 180-200 degrees Celsius (356-392 degrees Fahrenheit). This releases the resin in the trichomes in a cloud of vapor. There's no smoke.

*This is the recommended delivery system for persons with respiratory disease.

* Concentrates vaporized in pens are partial plant extracts that usually lack the full entourage effect, since the terpenes are so easily destroyed in the processing.

* A study of the Volcano vaporizer showed 36-61% THC in the sample, so vaporizing offers about the same level of available cannabinoids that you get with smoking.

DOSING WITH A VAPORIZER

* Vaporizing may not be as efficient as smoking (tabletop equipment is much more efficient than portable units). You may need more plant material to get the same results as with smoking. It may require up to twice the produce to get the same effect as with smoking.

* Concentrates offer higher cannabinoid numbers in a smaller dose size. For example, 0.1 gm of wax can deliver 65 mg of cannabinoids. Concentrates are dispensed using a vaporizer pen.

* The effects last 2-4 hours.

* Dose 1-6 times daily.

Advantages
* Vaporizing is a rapid onset (5-10 minutes).
* There's no smoke, and consequently, no health concern.
* There's no irritation of the throat and lungs.
* You can pick & choose the strain choices.
** This is the only short-acting, no risk method available.

Disadvantages
* The device can be cumbersome and bulky for transport.
* The portable devices aren't as efficient.
* The equipment is more costly.
* Vapor pens are designed for concentrates, some of which contain residual butane. There also may be that lack of the entourage effect I was talking about earlier.
* It may be too short-acting (2-4 hrs).

TOPICALS

* Topicals are cannabinoids bonded to alcohols, oils, or petroleum jellies.

* Cannabis can be applied topically to relieve symptoms and as an antiseptic.

* Since applying cannabis topicals to the skin doesn't effect the central nervous system receptors the chance of psychoactivity is reduced to minimal.

* Skin conditions respond positively to cannabis topicals, as does peripheral pain.

* There's a cannabis patch available on the market, designed to penetrate the skin and gain access to the bloodstream.

* Other additions that can help cannabinoids penetrate the skin barrier into the bloodstream include DMSO and the terpene limonene.

Options for topical usage (This is in no way an inclusive list.)
* salve for skin conditions
* oil for massage
* cremes for joint pain

DOSING TOPICALS

* You'll need a higher dose, determined by the area to be covered.

* Once absorbed through the skin the effects last 4 hours or longer.

*Use estimates may be 0.5 gm to 10 gm per dose (5-10 mg of cannabinoids per dose). The cannabis patch has 12 mg of cannabinoids.

* Topicals can be applied up to 4 x a day.

* High Dose Use: Apply oil directly to skin cancer and cover with a bandage. Every 3-4 days refresh with new oil and a new bandage.

They don't recommend you do this without medical supervision. I can certainly understand their thinking, but I know of at least one member who did just this, on his own, but still under his oncologist's care. It's just his oncologist doesn't work with cannabis. Thankfully, he was still open to the self-medication.

It took him less than 30 days to eliminate that pesky melanoma.

Advantages
* Topicals give no psychoactive effects.
* Topicals can help with peripheral and local symptoms.
* They're easily portable.
* Topicals are moderately long-acting. (4-6 hours)
* Using alcohol extends the shelf life.

Disadvantages
* Topicals can be oily, messy, and smelly.
* There's a widely variable range of potency. It can be challenging to get any precision.
* They're only good for external symptoms.
* Unless you prepare them at home you usually can't choose the strain.
* Making Topicals requires a large amount of plant material, which can get expensive.
* Topicals take time to prepare.

RAW PRODUCT

* This is very popular in Northern California, where they have easy access to fresh plants. Cannabis can be eaten raw either by eating tender young leaves right off the plant or by juicing leaves and buds. When eaten raw it can irritate the mouth, throat and stomach.

* The raw buds and tender leaves are high in chlorophyll, oxygen, minerals, vitamins, antioxidants, cannabis and terpenes.

* Raw material is often juiced with other fresh veggies, making it a super green food.

* The raw plant has medicinal value because it's filled with the acid cannabinoids, the precursors to the non-acid forms. They have tremendous anti inflammatory potential and act to modulate the immune system.

* A typical juicing regimen would be a large juice divided up into 4-5 doses, suggesting the raw cannabis is acting for 4-6 hours per dose.

* Absorption is through the digestive system into the bloodstream.

** USE A WHEATGRASS JUICER. Cannabis resin will gunk up a regular juicer.

RAW DOSAGE

This is a new therapy and it's still trial and error.

* The cannabinoid acids have no psychoactive effect. However, other plant components - among them terpenes - may effect mood or energy. Most, if not all of the terpenes are retained.

* Dr. William Courtney (the authority in cannabis juicing) recommends using 25 large fan leaves or one bud a day doe general health maintenance.

* Thirty large leaves from a flowering plant were found to contain a combined total of 11.5 mg of THCA and CBDA.

* Leaves, in general, have 10% the level of cannabinoids as bud.

Advantages
* Raw cannabis is a super food, high in chlorophyll, vitamins, minerals, and many other beneficial nutrients.
* There's a rapid onset. (Within 15 minutes)
* Tremendous success has been witnessed with raw plant dosing for chronic disease.
* There's no health risk.
* It's moderately long-acting, apparently between 4-6 hours.
* It's food as medicine.

Disadvantages
* Ingesting raw plan material may irritate the stomach.
* Unless you grew it yourself you can't be certain there's no mold or other contaminants, like pesticide.
* Juicing equipment is rather expensive.
* There's a lot of time in preparation, and it can't be stored.
* Consuming raw plant requires a dependable supply, something that can be challenging, if not Impossible.

 

[SweetSue]

More delivery systems

INGESTION

Eating cannabis usually leaves you with a stronger, more deeply felt effect that will last for hours. It takes more plant material or concentrates to get the effect than smoking does though, up to three times the quantity. This sounds crazy given the cost of cannabis, but remember it lasts 2-3 times longer in the system, so that's really not as bad as it seems at first.

* Onset can be delayed up to an hour or two, if you do nothing to enhance the bioavailability. We have a plan for that on site that we're pulling together at the moment. It'll be posted on this thread as soon as possible.

* The effects will peak and be available for 1-6 hours, dependent on the severity of what you're treating and the strength of the patient's digestive system.

* The liver converts THC into 11-hydroxy-THC. This metabolite is in smaller concentrations when you smoke, because the cannabinoids go straight to the brain, bypassing the liver that first time. 11-hydroxy-THC is a potent psychoactive metabolite, but it's also effective as a sedative. It does, however, lack the same medicinal benefits that THC offers.

If you use techniques of competitive inhibition you can increase the number of THC molecules that make it through the liver unmolested and still medically beneficial. Here's a link to some good ideas on doing that.

Competitive Inhibition

* Bioavailability is pegged at 6-20%.

At 6-20% bioavailability 1 gram of cannabis will supply 20 mg of cannabinoids, only 1-4 mg of which will be THC.

* Edible preparations are a great option if you're dealing with a chronic condition, where you want high doses that will carry you through a 24-hour period.

* The cannabinoids that make it through the stomach and the liver are absorbed through the intestinal tract into the bloodstream.

* The canna foods you're using have to be digested too, so a big part of the effectiveness of this delivery method hinges on the health of the patient's digestive system.

DOSING CANNA FOODS

* Always precede your canna dose with a small oily meal. Something as small as a tablespoon of coconut oil will keep your liver occupied as the cannabinoids are squeaking through, allowing more medicinally valuable cannabinoids to get through without being metabolized.

* The effects begin somewhere within 2 hours of ingesting.

* It's easy to overdose on edibles, and once in, you can't get them out. They have to work through the system. Start small and increase slowly. Wait 12 hours between the initial doses and evaluate carefully. Utilize the Internal Inventory.

The Inner Inventory.

This is a self-awareness technique used by Dr. Dustin Saluk to teach his patients to increase awareness of their body in the early stages of dosing. It's a helpful tool at any time.

Before and five minutes after the dose sit and ask yourself these three questions.
1) Take a deep breath. How easy was that to do? Rate it on a scale of 1-10, 1 being "Ouch!" and 10 being "Ahhhhh....."

2) How comfortable is it for you to sit still? Again 1-10 with 1 being "difficult, if not impossible" and 10 being "no trouble at all."

3) How are you feeling mentally and emotionally? Rate as 1 being "Stressed to the max!" and 10 being "Peaceful and calm."

Write this down every time you dose during the early stages of setting the dose. After you find your optimal therapeutic dose, test it out for 2-3 dosing sessions. After that you don't have to wait five minutes between administrations.

* Use depends on the potency of the substance prepared, for example, 1/4 of a cookie, 1 tablespoon of butter, one capsule, etc. As such, doses for capsules can range from 0.1-0.5 gram/capsule, and ten times higher (10-50 gm/capsule) if those capsules have CCO in them.

* A typical capsule dose would be 3 x/day for 24 hour coverage.

* If the digestive system is compromised the effectiveness of the dose can suffer up to a factor of 10.

HIGH DOSE OPTIONS

This is for edible or rectal doses.

Capsules with CCO can be made to typically carry 25-100 mg of cannabinoids in each.

CCO is a thick and sticky concoction that's stored in syringes, and may hold up to 800 mg of cannabinoids/ml of oil. We have numerous places on site that can assist you in producing your own. I maintain a study hall dedicated to this very subject. Feel free to stop in and ask questions.

Cannabis concentrates with coconut oil can be cut with a knife into grains.

Some cancer patients use over a gram of CCO /day.

Advantages
* No smoke to deal with.
* This delivery system is long-lasting, bringing up to 8 hours of effect. It's one of the few delivery systems that'll get you through the night.
* It's food as medicine. It doesn't get any more basic than that.
* Prepared foods can easily be stored in frozen form for months.
* You can dose as with other oral meds, 3x/day.

Disadvantages
* Edibles have that slow onset, unless you bio bomb it. (See link above)
* It may be too long-acting for some. You can't turn it off.
* Preparing edibles takes more resources.
* It may cause stomach irritation, so be alert for that possibility.
* Precise dosing is challenging, given the wide variability of the foods and the strength and health of the patient's digestive system.


SUBLINGUAL (OROMUCOSAL) DELIVERY

Cannabis can be delivered through the mucosal lining of the digestive tract by using a tincture. Tincture are extracts of cannabis into an organic solvent, such as alcohol or glycerin. They're absorbed directly into the bloodstream in the mouth (under the tongue is an effective location) and as you swallow.

* It doesn't have to be digested.

* There are a number of products that will have submucosal absorption, including lozenges, lollipops, mouth strips, gum, mouth spray and tablets.

* Mucosal absorption has a more rapid onset of action, less than 30 minutes, but can last as long as 4-6 hours.

TINCTURE VS OIL

* Both products can be delivered by sublingual (oromucosal) absorption.

* Tincture is absorbed rapidly, while oil gets stored in fat cells and released over a longer span of time.

* Alcohol is an efficient extraction method, pulling out chlorophyll and all the cannabinoids and terpenes.

* Glycerin is less efficient than alcohol, with a lower yield. It doesn't retain chlorophyll, but does pick up the cannabinoids and terpenes.

* You can increase the potency of your glycerin tincture by doing a second round with fresh material. Strain and press out the original plant material and replace it with fresh. Follow your process once again, typically another 1-2 months.

* Oil extraction is very efficient in yield, retaining all of the cannabinoids. However, the process leaves the chlorophyll behind and the heat typically used in the process destroys the terpenes and flavonoids.

* Cannabis fluid extracts come in bottles with droppers for dosing.
Average concentrations of prepared tinctures:
- alcohol: 10-15 mg cannabinoids/ml
- glycerin: 3-10 mg cannabinoids/ml
- oil: 1-2 mg cannabinoids/ml. (Can be more with better extraction practices and a potent strain.)

SUBLINGUAL DOSING

* A moderate dose is required.

* There'll be a moderate onset in 15-30 minutes.

* Absorbed in the mouth, the dose is good for 2 hours. Swallowing, the dose will carry for 3-5 hours. Much depends on the potency of the meds.

* Mouthstrip dosing is every 2-4 hours. Canna strips contain 20 mg cannabinoids/strip.

* Start Low and Go Slow
- Begin with a few drops and gradually increase to several droppersful per dose.

* One dropper is approximately 1 ml.

* A typical tincture dosage is 3-4 x/day for 24 hour coverage.

* You're looking for 5-20 mg cannabinoids/dose.


Advantages
* There's a rapid onset, within 15 minutes.
* Products are easy to transport.
* There's no cannabis odor. This is a stealthy delivery method.
* It's easy to get a measured dose, and it's easy to repeat that measured dose. Consistency of dosing makes this delivery method a preferred one by many physicians.
* Most products have a long shelf life.
* The doses are moderately long-lasting at 5-6 hours.

Disadvantages
* Unless you make your own you can't choose the strain being used.
* Good products may be difficult to procure commercially, especially the invaluable mouth spray.
* There's a widely variable range of potency.
* Products can be more difficult to make at home.
* Most products don't taste very good.


RECTAL DELIVERY

There's no denying the fact that rectal delivery works. There's still a lot of controversy in the medical community concerning this, but we have members who can testify that the delivery method works, in that they're still alive and actively eliminating cancer from their own bodies. So the medical community can debate this point all they want. Until a believable study comes along to convince us that we're all spitting into the wind, we stand behind our belief that suppositories infused with CCO will indeed help your body guide itself back to homeostasis.

* Most of the meds will be absorbed directly into the bloodstream. This means no first-pass through the liver, a very desirable effect. If you incorporate competitive inhibition into the regimen, you can do better than average on the second time through the liver too. Worth looking into.

* Suppositories are effective vaginally too.

* Suppositories are made with cannabis infused cocoa butter. Delivery can also be done with a syringe using coconut oil.

* This method has been a good choice for delivery into the pelvic and lower abdominal areas. According to cajuncelt this has also been shown to benefit patients treating breast cancers, and I know other members have spoken of patients they've known who used suppositories to successfully treat lung cancer.

* The FORIA vaginal suppositories are 240 mg THC + 40 mg CBD. A good example of the potential.

RECTAL DOSING

This is an area of treatment in its infancy, so we're still learning as data accumulates. In the medical community it's a limited patient pool. This will change as the wave to legalize sweeps the country.

* Suppositories are typically made with cocoa butter or coconut oil. These carriers will help speed absorption.

* Effects can begin within 15 minutes and last 6-8 hours.

* Similar doses to those administered orally can be achieved, from a low of 10 mg to as high as 200 mg/dose.

* This route is suitable for those in need of high dose therapies but cannot or do not want to take the oral route, for example someone who can't swallow or someone who doesn't want to get the psychoactive effects.


Advantages
* You can target the local pelvic and lower GI areas.
* There's increased bioavailability, compared with oral dosing.
* It may be more cost effective for higher doses.
* You can achieve higher doses with less psychoactivity.
* The dose is moderately long-lasting.

Disadvantages
* The method is relatively new to the medical field, so supporting data is difficult to find at this time.

* There's little information available about dosing, because at this stage, most of it's being done at home, in private, in states and countries that enforce prohibition and tie the hands of the professional caregivers.

* Unless you make your own, strain-specific products are not available.

* This is not a popular choice for most patients. Most aren't familiar with the method and even more are uncomfortable with the idea.

Let me share with you the perspective of an actual patient who overcame this discomfort, speaking to another patient reluctant to try suppositories.

You've been a survivor for a long time. That's a blessing for sure. But just know that the chemo only kills/contains the weak secondary cancer cells leaving the root cancer to grow stronger. That's why the recurrence & the chemo not working & needing to be changed.

What bothers you more? Chemo, toxins, poison, hospital, infusion room, IV, port, side effects, needles, meds to"help"....

Or an all natural suppository 2" up your rectum causing very welcomed effects?

Easy choice for me.

Rectal delivery works. Enough said.

 

[SweetSue]

USING CANNABIS TO TREAT SPECIFIC CONDITIONS: THE IMPORTANCE OF DELIVERY AND DOSAGE

INSOMNIA​

* Choose an indica for the soothing effects.

* Choose a delivery method that'll carry through the night. Inhalation, with its 4-hour window of effectiveness, doesn't fit this bill. Choose sublingual delivery instead.

* Indica chocolates sometimes have some CBN in them, the best sedative cannabinoid, but don't leave any hangover in the morning.

* There is a CBN patch on the market.

* You can wean off sleeping pills if you choose a long delivery method. This usually won't be possible with inhalation.

* Although it can help to use a hybrid or a high CBD indica strain in the evening to relax before sleep time, avoid using CBD right before bed. It's actually an "alerting" cannabinoid.

* Myrcene (a major cannabis terpene) has a sedative effect. Choosing a strain known to be particularly high in myrcene can be helpful.

CHRONIC PAIN​

This is the most common condition for which cannabis is being used. It usually requires round-the-clock dosing for adequate pain management.

* Choose sublingual or edibles for the longer-lasting effects and the deeper intensity.

* THC amplifies the effects of opioids. Combine the two and you can begin to wean off the opioids.
- Taking as little as 1 mg of THC prior to an opiate dose will improve the potency of the opiate and extend the therapeutic window. You should never let an opioid pass your lips before you take a small dose of cannabis.

* THC is an analgesic (a pain reliever)

* CBD doesn't treat pain directly, but rather positively effects inflammation and neuropathy.

* A dosing strategy: Use a 1:1 ratio of CBD:THC with low psychoactivity during the day and an indica for nighttime dosing.

* A good starting point is 10-20 mg of cannabinoids 3x/day.

Treating different types of pain
* Nerve pain = THC and CBD, either alone or together
* Muscular pain = THC
* Bone pain = THC + CBD
* Inflammatory pain = THCA or THC
* Skeletal pain and internal muscle spasms = CBD

MOOD DISORDERS​

Now you have to pay attention to strains.

Get this part right. Confusing this point will not not go well.
** Depression calls for a sativa-type stimulant.
** Anxiety calls for a relaxant, so choose an indica hybrid or a CBD-rich strain.

Both conditions will challenge you. Usually a choice of a hybrid or a mix of THC/CBD will do the trick.

* With anxiety avoid high doses of CBD, as this may cause anxiety.

* Bipolar Disorder and rapid cycling do better if you choose a delivery method that's more long-acting. Inhalation is a poor choice. Edibles or sublingual would be preferable.

* ADHD may respond well to a sativa stimulant in place of the oft-prescribed amphetamines.

* PTSD is an anxiety disorder. THCV is a helpful addition, in that it'll reduce the adrenergic stress symptoms.

My own daughter is challenged with severe anxiety and PTSD. I can speak from personal experience to the effectiveness of a CHD-rich strain to control the symptoms of PTSD. When she doses they disappear.

* Schizophrenia responds best to the anti-psychotic effects of CBD-rich medications.

ANTI-INFLAMMATORY​

​

* CBD meds are anti-inflammatory, as are the cannabinoid acids (THCA, CBDA, CBCA). They can replace NSAIDS and muscle relaxers.

* Anti-inflammatory relief may need to be in place for weeks or months to be most effective. Keep at it. If you quit early you miss the results. Keep at it.

* THC multi-tasks as an anti-inflammatory, a muscle relaxer and a pain reliever.

* Autoimmune diseases respond well to anti-inflammatory drugs, so include both THC and CBD.

* Topicals do well for inflamed joints or back pain.

* Choose CBD rich for the day and a high THC indica for night meds.

Dosing tips: A Summary

* For psychoactive effects, choose a high THC content, sativa for daytime and indica for night dosing.

* To counter depression, fatigue, or lack of focus choose moderate to high THC content.

* Pain responds to THC. Pain usually means opiates were prescribed and now there's dependence that must be overcome. THC is an effective tool in breaking this dependence.

* Anti-cancer high doses of both THC and CBD are called for. THC will have strong anti-tumor effects, while the CBD will limit the ability of the tumor cells to spread (anti-metastatic).

* Non-psychoactive use: The cannabinoid acids will work as an anti-inflammatory as well as an anti-anxiety medication.

* When treating Insomnia, use an edible or sublingual, preferably an indica high in myrcene.

* For anti-anxiety or anti-psychotic choose strains or meds high in CBD or an indica hybrid.

* Seizures require ultra-high CBD meds, in excess of a 4:1 ratio of CBD:THC. The higher the ratio of CBD the better.

* All cannabinoids have anti-inflammatory and immune modulating effects.

* We're learning that it's the terpenes that direct the action of the cannabinoids. Try to use meds with the entire blend of components from the plant, if at all possible. The entourage effect shouldn't be discounted.

Some closing thoughts

This therapy path has the advantage of being completely non-toxic and devoid of dangerous side effects. Everyone has their own optimal therapeutic dose. Take the time to find yours or your patient's. This medicine isn't easy to come by and the more efficiently we learn to utilize it the less stress we bring on ourselves. I'm all for less stress and more effective healing.

Be responsible. Start low and Go slow. We're all new to this, so don't hesitate to ask questions until you have clear understanding.

I hope this is useful to you all. It was an honor to pull it together.

 

[SweetSue]

Some of the medications cannabis can replace

* Antiinflammatories
* Muscle Relaxants
* Analgesics (pain medications)
* Antihypertensives (blood pressure medications)
* Glaucoma medications
* Neuropathic medications - Nervines
* Antiheumatics (DMARDS) (rheumatoid arthritis medications)
* Antipruritics (anti-itch medications)
* Antidepressants
* Anti-anxiety medications
* ADHD stimulant medications
* Anti-seizure medications
* Sleep aids
* Anti-emetics (anti-nausea and vomit medications)
* Broncodilators

 

[SweetSue]

For more information:

This is by no means a complete list. There are numerous organizations spreading the word, with more popping up every day. If you can add to this list please do. Our own site has a wealth of information on all things cannabis. Go exploring our on site resources. I often find that doing a search on google brings me right back here anyway.

National Organization For The Reform Of Marijuana Laws - NORML.org - Working to Reform Marijuana Laws - NORML.org - Working to Reform Marijuana Laws

Americans For Safe Access - Medical Marijuana - Americans for Safe Access

Project CBD - projectcbd.com

Patients Out Of Time - patientoutoftime.org

United Patients Group - United Patients Group - Medical Marijuana Cannabis News, Research and Information

The American Alliance For Medical Cannabis - letfreedomgrow.com

 

[SweetSue]

Supporting documents

Cannabis does not cause lung cancer.
Tashkin DP. Effects of marijuana smoking in the lung. Ann Am Thorac Soc. 2013, 10(3):239-47

Carter GT, Weydt P, Kyashna-Tocha M, Abrams, DI. Medicinal cannabis: Rational guidelines for dosing. iDrugs 2004, 7(5):464-470

Gieringer D, St. Lauren J, Goidrich S. Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds. Journal of Cannabis 2094, 4:7-27

The onset and therapeutic window of oromucosal delivery.
Safavid Oromucosal Spray 5.2 Pharmacokinetic properties.

The lipophilic nature of cannabinoids in relation to topical applications.
Wallace W. Method of relieving analgesia and reducing inflammation using a cannabinoid delivery topical liniment. 2005, freepatientsonline.com

Raw dosage guidelines.
Lee M. Juicing Raw Cannabis. O'Saughnessy's, Winter/Spring 2013, 27

Rectal delivery of cannabis works.
Brenneisen R, Egli A, Elsohly MA, Henn V, Spiess Y. The effects of orally and rectally administered delta 9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients. Int JClin Pharmacol Ther. 1996, 34(10):446-52

Chronic use leading to desensitization and down-regulation of receptors.
German J. Marijuana and the brain. Part ll: The tolerance factor. High Times, July 1995, Marijuana and the Brain, Part II: The Tolerance Factor

Challenging the therapy.
Castleman M. The new healing herbs: The classic guide to nature's medicine. 2001, Rodale Press Inc.

 

[Pigeons420]

Well done! Great work here. I think I'm gonna take this one and stash it into my info box!!

 

[SweetSue]

Thanks Pigeons. I've missed you. This project, on top of doing the Sensitization Protocol, kept me completely tied up for over a week. I can't wait to get high. Let me get to bed already. I've fixed the bad links and I'm so tired right now I could cry.

Goodnight my friend.

 

[Canna Montana]

Thank you so much for taking the time to do this Sue! You have proven yourself to be such a strong member here once again. I'm glad I saw this journal. Have a good day Sue.

Sent from my SM-G935V using 420

 

[SweetSue]

Thank you so much for taking the time to do this Sue! You have proven yourself to be such a strong member here once again. I'm glad I saw this journal. Have a good day Sue.

Sent from my SM-G935V using 420

It was my greatest pleasure. This is just a beginning. So much to learn and share. I feel like I fell into my own personal little heaven. That Rob would make it possible for me to teach and share across digital space, and to be surrounded by all this love...... Well, I'm home.

 

[SweetSue]

Funny share - I finished my 6-Day Sensitization Protocol and I reached for the water pipe just now while reading something. More habitual than anything else. Then I stopped myself, looked at the clock and came here to review how long a combustion high should last.

Drat!! It says 2-4 hours, which means it's irresponsible of me to jump the gun by an hour. So, on one hand, how nice that I could stop here and find that out, but dang! I have to be responsible today and tomorrow to set the doses. Lol!

 

[SweetSue]

ORAL DOSING RANGE (as used by Dr. Sulak in his practice)

0.015 mg/kg/day - 30 mg/kg/day

For example, 1-2100 mg daily for an adult weighing 70 kg (154 lbs)

Think about that for a few minutes. This speaks so profoundly to the safety of cannabis as a healing herb. What I need 200 mg of cannabinoids per dose for may be something you can effectively treat at 50 mg per dose.

Find your own optimal therapeutic dose. Don't let someone else do that for you. They don't walk around in your skin.

 

[sareciag]

This was extremely informative..Thank you for the information.

Sent from my SM-G360T1 using 420

 

[JBUptown]

Good Day Sue!

I've been looking forward to the fruits of your studies for a couple of weeks, and I have been fully rewarded for my patience! I don't know that I would have cleansed and purged while working so diligently on this information, but I say that from a medical POV, not a recreational one. You are a walker of the talk!

I have been experimenting with raw cannabis for a while, it's anti-inflammatory effects are easily on par with the Big Pharmas COX inhibitors. Keeping a supply of fresh cannabis growing for ingestion is a challenge, but after a few years I have built up enough frozen cannabis to keep myself on my protocol. Shakes, smoothies, salads, juices and other food combos work very well with fresh whole cannabis for my disease (RA). It took a few months, but eventually chewing on a cured bud became tolerable and eventually turned into a positive oral experience. Have you ever chewed and cheeked a potent bud for 10 minutes? It was kinda yucky at first ... OK it was nasty! But the positive effects coupled with the earthy taste and odor eventually trained my brain to desire the BudChew. Certainly an acquired taste!

I'm looking forward to your future pubs and studies, great job Sue! Thank you immensely for your efforts.

Best Of Buds

JB

 

[SweetSue]

Thank you JB for that eloquent post. My pleasure, I assure you. This is just the beginning. Today I stumbled into a site that has some of the most complete information I've found for dosing CCO. I'm so excited about deciphering this new info and getting it posted here.

Working on this kept my mind from going nuts on the protocol.

Studying raw consumption I find I'm drawn to it. I eat baked buds, so I imagine fresh would be appealing. In my study of this course she mentioned that one of the drawbacks of raw was it couldn't be stored. I couldn't figure out how that statement correlated with those of you that freeze.

I'm beginning to think its most beneficial to take cannabis in as many different ways as you can. In the same respect I'm beginning to explore the idea of oil made from many strains as opposed to one or two. How about ten? Think of the possibilities. Figure out the terpene challenge and we're rolling.

 

[arteekay]

Adding this thread to my signature, this needs to be right at hand.



Living up to and well beyond that MotY moniker. We are all so lucky to have you here Sue.

Thank you.