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For this week’s edition on CBD dosage I spoke with Bonni Goldstein
, the Medical Director of Canna-Centers and author of “Cannabis Is Medicine
.” I had invited you to send your questions in advance of my conversation with her, and since so many of you contributed (thank you!) and Bonni had so many interesting things to say, I’ve split up the Q&A into three parts. Let’s begin with the foundations of CBD dosing:
Question: How is cannabis medicine different from pharmaceuticals and how does that impact CBD dosage?
Bonni Goldstein: When we think about medicine, we think about a certain quantity that the doctor prescribes. That’s what many people want with cannabis, but that’s not how cannabis works. People have to come to it from a different perspective.
Let’s look at a blood pressure medicine; your doctor says to take one to two pills twice a day, in the morning and at night. Rigid schedule, very easy to do. Why do we do that with pharmaceuticals? These are mostly single compound medications that have been studied in animals and humans, and then passed through the [U.S. Food and Drug Administration] FDA . We know how long they last in the body, how most people metabolize them. That’s how they determined to take one to two pills twelve hours apart.
Compare that to cannabis; for the most part (unless you’re buying a product that has the word isolate, which is just CBD by itself) the whole plant model is different. Because it’s not a single compound, there is the concept of entourage effect
. When you put together each cannabis compound with its medicinal properties, there can be enhancement, and you might be able to get away with a much lower dose.
I always tell people who use CBD, unless you’re being drug tested, you really want to have a little THC in there because you want that entourage effect to help the CBD work better.
How do you know how much CBD to take?
Start low and go slow. With CBD alone you don’t have to go so slow. That mostly refers to THC, so you don’t have an unpleasant experience with taking too much. But with CBD you have a lot of leeway, so start low and go up.
In my clinical practice I have patients that find that 20 milligrams of a whole plant CBD helps them with their pain or anxiety. And then I have other patients that say 20 milligrams didn’t do a thing for them, or 40 or 80 milligrams, they have to take 100 milligrams. Some people feel great with one dose a day, while others take three doses a day or they microdose.
CBD is very different to THC in that it doesn’t bind to the cannabinoid receptor
and gives an immediate effect. It can have some immediate changes; I have patients who report that when they take their proper dose of CBD, the next few hours they don’t feel pain. And then there are others who feel better overtime. We think what’s happening there is that a lot of their inflammation is coming down.
I have an elderly family member who had severe, miserable chronic neck pain and tried everything, was anxious from it and not sleeping. Other modalities had not helped, and they didn’t want to use opioids. When we started CBD, we started at 20 milligrams. And after four, five days, we went up to 40 milligrams, and then up again after a few days. It was on day 21 when this person said: “I don’t have any pain anymore.” Had that person done it on their own, they probably would have quit after the first week.
Sounds like patience and participation are key to finding the right CBD dosage.
That’s the beauty of cannabis. I know it’s a pain in the neck, sometimes literally, to figure out what your dose is, which brand works for you, how many times a day do you need to take it and at what time of the day. You have to be engaged and listen to your body. You have to participate in your own health rather than a doctor just handing you a prescription.
At the same time, some of the benefits I’ve seen over the 13 years I’ve been doing this are so tremendous; to be able to get off toxic pharmaceuticals that have side effects on your kidney, liver, gut, brain. But also, to be able to figure it out on your own. You are customizing for you. It’s not one size fits all, not even for people with the same condition.
In part two of the Q&A with Bonni Goldstein, we’ll look at side effects and possible interactions with other drugs. As always, if this first chapter on CBD dosage sparked any thoughts, send them my way