Cannabis Ingestion Routes and Dosing Strategies

The effects of medical cannabis will vary according to the type of cannabis ingested and the dose used. This guide should be used as an adjunct to asking questions and receiving advice from both a primary care physician and your certifying cannabis physician.

Cannabis will likely have similar effects regardless of the route of ingestion. However, there are some considerations when contemplating a given dosage provided through a specific route. Caution should always be taken when using an unfamiliar product or when embarking on a new route of ingestion. It is hard to go wrong with the general mantra “start low and go slow” in order to properly recognize cannabis’ psychoactive effects and properly titrate the dose.

Inhalation

Inhalation via nebulization, vaping, or smoking introduces THC into the bloodstream very quickly. Within 30 seconds to a minute blood levels rise and patients will experience a sense of euphoria and other cognitive effects allowing them to recognize the need to titrate their dose. Effects from smoking will last between 1-2 hours typically.

Oral

Oral or sublingual preparations that are sprayed under the tongue or incorporated into a hard candy that can be left in the mouth will allow THC to enter the bloodstream in 25-45 minutes. The effects of ingestion will last from 3-4 hours. Unlike edibles that are eaten, sublingual preparations avoid the first-pass effect whereby the liver attempts to detoxify the blood. This is important because a much lower dose of THC can have a significantly more potent effect when ingested in this way as opposed to eating the same does.

Edible

Edible preparations whether eating the cannabis plant itself or consuming food cooked with cannabis oil will take the longest period of time to have effect at 60 to 90 minutes. The effects can last from 6-8 hours, with a slow rise in the increase of effect and a slow decrease over that time frame.

Things To Consider

It’s important to consider that with longer-acting routes of ingestion it becomes increasingly difficult to judge the effect. Caution should be used when increasing the dose of cannabis if the patient is still in a window where the effect from the first dose is not complete. Patients will need to be aware that the effects may last quite a long time and impair their ability to drive safely for a period of hours after use. Overdose is most common when small children with lower body weight ingest edible formulations, which can lead to respiratory depression and can be life-threatening. When using a sublingual or edible formulation consider using one-half (50%) of the recommended dose. Observe its effect for at least one hour before trying the second half. Remember your edible preparations are a cannabis introduction device, they’re not simply food. If given a pie of pizza, for most people it would be instinctual to say I don’t need to eat an entire pie if they’re not that hungry. Remember you can always cut a gummy or break a cookie and eat a portion of it as well. Don’t feel obligated to eat the whole “pie” or dose.

How Much Cannabis Is Correct For Me?

The dosing of cannabis can be complicated because it will vary amongst individuals. Keep in mind that every person will have a different density of CB1 (reacting with THC) and CB2 (reacting with CBD) receptors in different areas of the body. Two people could use the exact same dose through the exact same route and have markedly different experiences. This is why “start low and go slow” is important as a rule of thumb.

If we take our cues from nature both THC and CBD are meant to be consumed together. Unfortunately, the commercialization of cannabis for recreational markets has led to an increase in THC present in cannabis plants with a subsequent decrease in CBD. Many cannabis plants sold for recreational use currently have little to no CBD. This is an important point to consider for the following reasons.

How Does CBD Work?

CBD itself has its own effects and medical utility. CBD acts as a potent anti-inflammatory, it’s been shown to have direct effects on mitigating anxiety and seizures in addition to perhaps most notably it having prominent tumor suppression effects through various different mechanisms. Just because it’s not psychoactive doesn’t mean that CBD isn’t bioactive! So decreasing CBD in order to increase THC may be good for business in the recreational market, but it decreases much of the therapeutic potential from cannabis usage.

Just as importantly we know that high THC content cannabis comes with a higher risk of side effects due to its sympathetic stimulation, vasodilatation effects at high doses, and its ability to stimulate the brain especially in patients with anxiety or PTSD. CBD binds to and partially blocks the CB1 receptor, mitigating some of these effects of THC. Using THC in conjunction with CBD is safer for the patient and helps patients that lack experience with cannabis to titrate more appropriately by providing a buffer for increasing THC content.

Therefore it is recommended that patients always seek to use preparations that have a combination of both THC and CBD. If in given state preparation in the form of tinctures creams, ointments or vapes ONLY have THC, patients are encouraged to supplement with high-grade CBD at the same time.

Things To Remember

Remember there will be a trial and error period with cannabis dosing due to the difference in products consumed, the route of administration, and the individual differences of patients. High THC content preparations should be avoided, instead, preparations with CBD should be used to mitigate the potential side effects of THC and for its own medical value. Always allow time for effects to take place when using edible or sublingual preparations. Never take more cannabis because you haven’t achieved the desired effect until that window of time has passed. Always keep in mind that you may not be able to operate heavy machinery including a car for hours after ingestion. Finally, remember that you are free to cut and titrate doses from a dispensary. Just because a given product is sold in 10mg of THC DOES NOT mean a patient can’t or shouldn’t cut it into halves, thirds, or even quarters.

Darren Cobham McAuley DO FAOASM, CEO and Founder
Concierge Medical Cannabis, October 2021

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