THE REGIMEN
Getting Pain Relief: Setting your personal dose of THC
The initial goal is to find the dose of THC and CBD necessary to get adequate pain relief. If you're able to get good pain relief without opioids, all the better. This is a good indicator of future success. If you've been taking frequent opioid doses over a long time you don't want to discontinue the opioids cold turkey.
Do a gradual withdrawal over weeks or months using daily doses of slow-release cannabis.
If the slow-release cannabis dose isn't giving enough relief after 90 minutes take half the opioid dose.
This approach will usually give you the same relief you were getting from a whole opioid dose alone. Taking the opioid dose along with cannabis in this way three times a day can usually eliminate any withdrawal effects.
The Details
Beginning doses are 2.5 mg each of THC and CBD, taken through the gut so it's long-acting. Although they try to limit THC to 10 mg doses to control euphoria, some patients in Dr. Smith's clinical practice patients going as high as 15 mg of THC to get the relief they sought.
But a good starting point is 2.5 mg of THC and 2.5 mg of CBD, slow-release, 3 times a day.
After two or three days, if you're not getting enough relief, increase the cannabinoid dose to 5mg each of THC and CBD.
Increase every 2 - 3 days in 2.5 mg increments until you're at 10 mg each.
After reaching 10 mg THC/CBD doses the next step is increase the CBD content to 2:1 CBD:THC, then 3:1, and finally 5:1.
If you get to 5:1 and you're not getting the relief you seek, begin to increase THC slowly until you hit the sweet spot. Then stay there.
* The goal here is to increase the cannabinoid doses to be able to control the pain with no more than half the original opioid dose.
Once you've enjoyed several days of consistent pain control, cut the opioid dose in half again, gradually decreasing both the dosing times and dose concentrations. You're unlikely to have any severe withdrawal symptoms or craving of opioids. Your physican can help you by prescribing the opioids in smaller dose tablets. It's easier to drop off small quantities when the pills are 5 or 10 mg instead of 25 or 30 mg.
If you find it difficult to get pain relief without opioids, try substituting a 500 mg Tylenol instead of the opioid. You'll get the "THC effect" without increasing the THC dose. Don't take Tylenol if you're also taking opioids or drinking alcohol. Combining them can damage your liver. We want your liver healthy and strong.
Countering Breakthrough Pain
Cannabis lasts longer in the body than opioids. Following this regimen breakthrough pain may not happen. You'll be using long-acting cannabis. If you have intolerable breakthrough pain in between doses of your long-acting cannabis, take a small dose of a fast-acting cannabis, such as 1 or 2 inhallations of a vaporizer, a couple hits of a joint, or 2.5 mg of a tincture, applied sublingually.
Give this 20 minutes to work before taking a fast-acting opioid pill to counter the pain. If you need the opioid, try breaking it in half and only taking that much. You might be surprised to find that's enough.
The higher your opioid dose, and the more frequent you're dosing, the longer this process will take, but there's an end in sight.
Problems and Pitfalls
The worst symptom of opioid withdrawal is opioid craving. A patient will do almost anything to get the opioids to feed that craving. Cannabis blocks the reward signal triggered by opioids. This works with cocaine, opioids, and gambling. Anything that triggers the reward system in this way can be tempered by cannabis. A healthy ECS does this all the time.
Cannabis tones down the reward response which cuts back on cravings. Cannabis also cuts back on nausea and vomiting, anxiety and agitation when used at the 1:1 ratio.
Countering the argument that using cannabis as a substitute for opioids is simply substituting one addictive drug for another, the GW Pharma studies are indisputable. It tracked several thousand patients on Sativex for a year.
* no dependant behavior was found
* no uncovering of psychosis
* some mild euphoria (we call that a sense of wellbeing)
Some conditions never respond to cannabis or non-opioid medications. The goal is to reduce the opioid need as far as is comfortably tolerable for the patient.
Including cannabis in the regimen will decrease the chance of overdose, improve your mood, and reduce the incidence of constipation and other opioid side effects.
If you stop taking opioids or benzodiazepines and then later get a craving for them, see your doctor. Taking a dose level you used to take before can cause accidental fatal overdose.
Dr. Smith recommends you get an app to track your
- pain level
- cannabis use
- opioid use
- side effects
You can get a printout of the records to take with you for doctor appointments. Consider how much easier this would make life for you and your doctor. Someday our doctors will all have testing facilities so they'll know precisely what's in the medicine you're using, but we're not there just yet.
Consider a support group of others going through the same process. Social support is an important part of strengthening a healing endocannabinoid system.
Let's have a discussion about "getting high." If you're getting high you're flooding your endocannabinoid receptors. This doesn't happen in nature, so the supposition is that you're throwing the system out of balance.
Tolerance buildup explained:
The cells have endocannabinoid receptors, and when you flood the system with phytocannabinoids they can hang around for long stretches of time. After a couple weeks the receptor sites harden (they start off soft and pliable) and sink into the cells (going offline).
It takes about six days, without any external cannabinoid surface activity for the receptors to regenerate, clean themselves up, and resurface. Your endocannabinoid system continues to spontaneously heal you with its signaling work, it's the lack of phytocannabinoid activity that needs to occur to reset those receptors.
In the ECS cannabinoids are created, activate the receptors, and are deconstructed by the attendant enzymes in the blink of an eye, a fraction of a second. When you take cannabis to get high you have a flood of THC attached to receptors throughout the brain causing euphoria for up to hours.
Because this doesn't happen in nature Dr. Smith believes it's wrong to subject the ECS to heightened euphoria. In his own words, "This is not pain relief by intoxication."
It's pain relief because we turned down the volume on the pain perception. To do this most effectively it helps to have all your receptors available.
When you're taking cannabis for pain management you want to avoid euphoria during your treatment phase. This is done by either continuous micro-dosing or balancing the CBD and THC to at least an even ratio. To fully counter the euphoric effects of THC you may need to get to a 4:1 CBD:THC ratio. Everyone is individual.
If you're treating chronic pain and you take too much THC you're working against yourself. Dr. Smith believes patients are using the euphoria to treat emotional pain. Physical pain, from injury or surgery, is a special category. His conclusion is that if you're only treating physical pain, without emotional pain, avoid euphoria.
My personal take-away on this is that if you use cannabis to treat chronic pain, choose your euphoric experiences carefully. Overindulgence for you may result in increased pain perception. No one wants that.
Our community has a better relationship with using suppositories for chronic pain. We may be able to get away with higher THC doses in this manner. This is something we as a community will explore in days ahead.
The most common mistake Dr. Smith sees is the timing of the long-term doses. It takes up to 90 minutes before you're going to feel the desired effects. When you're in pain, 90 minutes can seem intolerably long and there's a great temptation to take an opiod. As an example: If you know you usually take your opioid at 9 AM, take the cannabis dose by 7:30. In this way the cannabis is active when you'd typically be taking the opioid and you might be able to reduce or possibly skip that opioid dose.
Take 1/2 the planned opioid dose if pain is not reduced to comfortable levels.
Most pain patients on opioids have both slow-release and fast-release pills. You mirror this with slow-release cannabis edibles for the base-line meds and fast-release tinctures, bud, or concentrates for breakthrough pain. Two hits from a joint or vape, or 2.5 mg of a tincture under the tongue qualifies as a fast-release dose for breakthrough pain. Pain relief will come within 9 to 23 minutes.
Dr. Smith recommends a CBD only vaporizer. Get your 30 mg of THC through the edibles in three 10 mg doses and use the CBD vaporizer for breakthrough pain. Keep an open mind. CBD has not been shown in trials to moderate pain, but we have members among us who can testify that it does indeed offer a level of relief. We even have one that I just located that used a high CBD chemovar to get away from a long-term opioid regimen. With the rest of this regimen in place you have a good chance of having it work for you, in my opinion.
Don't forget the value of the 500 mg tablet of Tylenol. It'll stimulate the CB1 receptors in the same way THC will. Taking 3 a day is only 1500 mg of Tylenol, a workable dose. No alcohol when using Tylenol.
Pain control is the goal. If you can't function as the member of society your life demands - grocery shopping, caring for the children, going to work, etc...you're not getting pain control. If you're still in pain and you've reached the 10 mg threshold for THC begin increasing the CBD ratio to 2:1, then 3:1, then 5:1 before you increase THC concentrations.
The goal isn't to get to 10 mg of THC, but rather to use it as the upper threshold.
The majority of Dr. Smith's pain patients are using 5 mg in balance 3 times a day. Every patient is individual. You'll have to find your own sweet spot. No one can do that for you.
At 10 mg of THC you begin to feel euphoric. Dr. Smith's contention is that euphoria is a disruption to functionality. My presence proves him wrong to use this as a blanket statement. Lol!
How long will this withdrawal process take?
Your opioid doctor is the main player in this game. The cannabis doctor is assisting the opioid doctor. You and the opioid doctor need to agree on a quit date. This scheduling will depend on how long you've been on opioids, how high the doses are, and what type of opioid you're taking. That date can be as close as a month, more likely to be three months, and in some cases will be six months off.
In Dr. Smith's experience 40% of opioid patients may never be able to get completely free of the drugs. They will, however, be able to dramatically reduce the opioid dose and mitigate the nasty side effects associated with opioid medications.
I believe that the experience of our community supports the idea that by using BioBomb suppositories one can get over that final threshold. This is merely conjecture on my part, garnered from my studies and the interactions I've had with members that have tried them for chronic pain management. It just may be what's needed to break that craving. It certainly is worth the try.
I'd appreciate some input as to what chemovars have worked for you.
Will share in my journals.
beautiful pictures, great info, fine job, Kudos
