People often ask “I suffer from x condition (e.g. anxiety, chronic pain). Please give me advice on what CBD:THC profile to take, how much and how often.” For those who are interested, having our cannabinoid-terpenoid table open alongside this article is useful for getting a broad understanding of what different cannabinoids (e.g. THC, CBD) and terpenes (e.g. linalool, limonene) do. We also have a glossary of medical marijuana jargon if you come across a scientific term you do not understand.
Related to this are other questions, such as “What strain should I take, and what range of cannabinoids and terpenes are best for my condition/s?” In some ways, this is a good, because patients are becoming increasingly aware of the concept of chemovariance. That is, there are various compounds in the cannabis plant that, in certain ratios, could be more (or less) beneficial. The combination of the cannabis plant’s flavors (flavonoids), smells (terpenes), and cannabinoids all contribute to its uniue effects – referred to as the entourage effect.
On the other hand, there is a little rain that comes with this silver lining, because we often have to answer these questions with, “We do not know. We just don’t have the clinical studies showing for definite which cannabinoids and terpenes – and in what ratios – can be used for specific conditions… [But with a glimmer of hope]… yet”.
However, this doesn’t mean that there aren’t some key things that a patient can can consider when deciding what profiles and strains they may find benefit from …
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Table of Contents
- What condition/s are you using the cannabis for? Do you suffer from more than one (comorbid) condition?
- Are you taking any other medications alongside cannabis?
- Ask yourself, “What do I hope to achieve with the help of cannabis?”
- Cannabinoids are biphasic …
- Remember, everyone’s endocannabinoid system (ECS) is different …
- A wide range of cannabinoids and terpenes may be best, especially to start with.
- Don’t forget the acidic cannabinoids, like THCA and CBDA.
- On “cannabinoid hunting”.
- Cannabis Dosing Table
- Are you using cannabis at night or daytime?
- Remember: not all products are the same!
- Ingestion method – tinctures & edibles for anxiety and depression, or a vape?
- Rick Simpson Oil (RSO) treatment
1. What condition/s are you using the cannabis for? Do you suffer from more than one (comorbid) condition?
There are many people who go to the doctors and say, for example, “I’m suffering from irritable bowel syndrome (IBS), and I’m looking for cannabis to help with that.” Then, at the end of the appointment, they say something like, “Oh, and I suffer from depression, too.” This is a problem in all of medicine, and not just in the medical cannabis world.
Perhaps two of the most common comorbid conditions are anxiety and depression. Those of you who have read through many research studies will notice that many people who suffer from depression also suffer from anxiety.
Anecdotally, some will see certain patterns in preference that those who suffer from depression tend to prefer sativas, whilst those who suffer from anxiety tend to prefer indicas. However, a person who suffers from anxiety may want to use low levels of THC, but not too much, as THC in high doses can trigger anxiety. The anxious-depressive will likely need the THC for mood elation in order to combat depression as well, but again keeping in mind that a little bit too much THC may trigger anxiety. Learning how to “balance” the THC with CBD and other cannabinoids seems to be key.
One solution for someone with comorbid anxiety and depression? Microdosing a small amount of THC via tincture or edible (say, around 3 mg), or taking the dose in a vape pen for situations when a more immediate effect is needed (e.g. a sudden anxiety attack). Another option would be to try and find sativa/indica hybrids in the right ratio to help with both disorders.
A similar line of thought can be used with other comorbid conditions as well, where microdosing a therapeutic level may be ideal in order to see where you feel most comfortable. A total of 2.5 mg of cannabinoids may be a good place to start.
At this point, it is worth asking, “What precisely makes a particular strain what it is?” To try and break down what is a complicated subject matter, keep the following in mind:
- Rather than trying to think “what strain do I need for which condition?”, it might be better to look at a more standardized measurement. Cannabinoid-terpenoid ratios are likely to be more important than the strain name itself. Different strains can have a similar or the same ratios, and this is likely to be a better indication of effect.
- With this in mind, it should also be stated that, even though the indica/sativa distinction is a rough one, there are some patterns. Indicas generally do (but not necessarily always) contain more CBD (as well as terpenes such as myrcene) than sativas. Sativas from equatorial regions, meanwhile, seem to generally contain more tetrahydrocannabivarin (THCV) than indicas, and seem to more often contain terpenes such as limonene and beta-caryophyllene. Alpha- and beta- pinene seem to be present in both types of cannabis to varying extents. Ruderalis plants have often been tested to have high amounts of CBD.
- Hybridization has blurred the lines of distinction between cannabis varietals, meaning that the same genotype can express distinct phenotypes with their own cannabinoid-terpenoid ratios. This can improve hybrid vigor and sometimes even save genetics from extinction, but there is value in keeping landrace, non-hybridized strains for their potentially unique properties.
- Certain strains may contain very unique and beneficial (or sometimes potentially even neutral or harmful) cannabinoids. Remember, there are around 150 different identified cannabinoids/sub-cannabinoids, and around 212 terpenes in the cannabis plant. Different environments and conditions will effect what ratios are expressed in the plant. Measuring for all of them accurately in a plant that usually expresses high amounts of variation is extremely difficult.
- One of the reasons why companies like GW Pharmaceuticals are able to create relatively stable 1:1 THC:CBD ratios in products like Sativex (actually closer to 49:51 THC:CBD due to a small problem in the original assay) is because they have cultured one strain that produces CBD only, another that produces THC only, extract the cannabinoids, and then mix them together. Those making tinctures or products from plants grown by themselves or others in vastly different environments are likely to be unable to achieve such consistency.
- However, whilst these products may not be perfect, they may well contain things that products such as Sativex don’t contain. Again: there are hundreds of cannabinoids/sub-cannabinoids. Whether the plants produced by companies such as GW Pharmaceuticals contain even ratios of all the cannabinoids and terpenoids other than THC and CBD is questionable.
- Natural phytocannabinoids derived from the actual cannabis plant usually seem to be more well-tolerated than their synthetic counterparts. There is likely to be some value in semi-synthetic and synthetic cannabinoids in a medical setting, but care must be taken with these substances.
- To reiterate: different people suffering from different conditions are likely to require different cannabinoid-terpenoid ratios and dosages. There may be patterns with regards to condition and commonalities in physiology, but overall it seems everyone has a unique ECS; and to which degree there is a difference needs to be ascertained.
2. Are you taking any other medications alongside cannabis?
CBD deactivates the liver enzyme, cytochrome P450. Many drugs are metabolized by this enzyme, including benzodiazepines, antiepileptic drugs (AEDs), diuretics and many others – over 50% of drugs are metabolized via the cytochrome P450 and other CYP enzyme pathways. THC and CBN are thought to desensitize cytochrome P450 as well, but to a lesser extent than CBD.
This means that care must be taken if other pharmaceutical drugs are used in combination with cannabis, as well as potentially meaning that fewer other drugs need to be taken. So, for example, a person who is suffering from epilepsy may need to taper the amount of AEDs they need to take.
3. Ask yourself, “What do I hope to achieve with the help of cannabis?”
Do you want to be able to walk a mile? Do you want to be able to walk around during the day without a cloud over your head? Do you want to be able to sleep and/or eat properly? Have some goals in mind, and this will help you figure out the best dosing strategy for your needs.
4. Cannabinoids are biphasic …
This means that they can have two different effects, and what effect they have is very dose-dependant. For example, a low dose of THC may have anti-anxiety effects at small doses, and cause anxiety at higher doses. This means that, for some people, low doses are needed …
5. Remember, everyone’s endocannabinoid system (ECS) is different …
… Meaning that some people may need high doses of a particular cannabinoid or set of cannabinoids. Of course, this is condition-dependant as well. Moreover, as everyone has a different endocannabinoid system (ECS), what works for one person may not work for another. Although it’s definitely worth asking others what their preferences are, it’s more important to find your own therapeutic range.
Now, although everyone has a different ECS, there may be some generalizations we can make. The age of the patient makes a difference, and younger people may be more prone to the negative effects of THC, whereas older people may benefit from a small dose of THC. Due to hormonal differences, women may also be more sensitive (as well as potentially more tolerant) to the effects of THC. As for weight, the effect cannabinoids have do not seem to be influenced so much by it. We do not know precisely why this is, and it is possible that body-mass index (BMI) has some sort of effect upon how much THC is retained in the body, but it could be due to the total “concentration” of cannabinoid receptors in the body.
6. A wide range of cannabinoids and terpenes may be best, especially to start with.
Anecdotally, the most popular strains people mentioned using (most notably Blue Dream and OG Kush) tended to have very wide terpene profiles. Part of this may be because these are just the two most popular strains, but there could be a very good reason for this.
The cannabis plant, just like the human body, has its own checks and balances. Should one particular compound overproduce, another compound will be released to mitigate the effects of that compound.
A wide terpene and cannabinoid profile may help reduce the negative effects of other compounds to some extent. Again, much of this is condition-dependent, but it is a concept worth bearing in mind should you be tempted to start hunting for a particular compound.
We must be careful of saying, “this strain (e.g. Blue Dream) will definitely contain these terpenoids and cannabinoids.” Yes, some strains of cannabis do seem to follow a certain pattern, but this can change significantly over time. Even cannabis plants that are reproduced asexually can differ, as mutations arise.”
Growing the same genetics in a different environment can also affect the cannabinoids and terpenes it contains. The cannabinoid-terpenoid profile of a cannabis plant also depends upon when it was harvested during its flowering cycle – basically, it makes a difference if a plant was harvested at 9 weeks or 10 weeks. Some say that, when a plant has more clear and cloudy trichomes (small “hairs” that contain the cannabis plant’s cannabinoids, flavonoids and terpenes), it has more psychoactive effects. As the trichomes turn a darker and more amber color, the effect is thought to be more “relaxing”, as the THC degrades into CBN.
7. Don’t forget the acidic cannabinoids, like THCA and CBDA.
By this we mean the acidic, non-decarboxylated precursors to THC and CBD, tetrahydrocannabinolic acid (THCA) and cannabidiolic acid (CBDA). “Decarboxylation” refers to the loss of a carbon dioxide (CO2) molecule. Losing CO2 via light, heat or pressure turns THCA into THC and CBDA into CBD.
THCA and CBDA work synergistically with other cannabinoids, and increase their therapeutic effects by several magnitudes. THCA combined with CBD, for example, may have significant anti-inflammatory properties – more than just using one or the other on their own.
Also, acidic cannabinoids are often very volatile, meaning heat, light and air will convert them into THC, CBD etc. and degrade over time. This means that the only feasible way for many to get these compounds is by ingesting whole plant preparations that have not been extracted using heat. High-quality, tested ethanol extractions, oil extractions and pressure extractions are likely to be best (depending upon condition) for medically-minded people.
Although there is some debate around how useful the acidic cannabinoids are, there is some evidence suggesting that they have their uses. The sceptic would point out that a cannabinoid that is not affecting any receptors in the body are not having any medical effect. Others, however, point that there do seem to be some studies showing that cannabinoids like CBDA have significant anti-inflammatory properties.
8. On “cannabinoid hunting”.
Every so often, we see the marketing machine going into overdrive, and certain cannabinoids and terpenoids become the flavor of the month. CBD is perhaps the biggest example of this, and many people say things like “I just want the CBD, not the THC” This is the wrong way of going about things. Moreover, it’s unscientific. Some people, for example those who suffer from cancer or neurological conditions such as multiple sclerosis, may need THC in order to beat pain and/or spasms.
Also, without the THC, the CBD generally doesn’t do as good a job. CBD is a powerful antiemetic. Combine a little THC and CBDA with that, and the CBDs becomes an even more powerful antiemetic with fewer side effects. For a person with ADD/ADHD, a sativa with THC and terpenes like limonene, pinene and beta-caryophyllene may be useful, although those who are prone to anxiety may wish to give such a profile a wide berth. Do not be lulled by marketing, and do not pay too much heed to those who speak ill of THC or any other cannabinoid or terpene. The entourage effect is very real.
Yet, for all the problems associated with “hunting” for specific cannabinoids and terpenoids, it does seem that some conditions respond best to certain profiles. We do not know precisely which profile is best for which condition (the human trials still need to be done), but there do seem to be some patterns. The following table will hopefully illustrate this, but please be warned that this is more “theoretical” and based upon observations rather than any definitive clinical evidence. We also recommend taking any advice on strains with a pinch of salt, but we hope that it gives a place to start from.
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Cannabis Dosing Table
Download Our Dosing Guide for Common Qualifying Conditions
9. Are you using cannabis at night or daytime?
Many patients will want to keep awake and have their wits about them during the day, and so will likely avoid using too much THC. Conversely, at nighttime, THC, linalool and myrcene may be more helpful (high amounts of CBD can actually help many people keep awake). As an example, some patients may use a CBD:THC ratio of 3:1 during the day, and then a 1:3 ratio at night in order to help them sleep, and essentially mixing the ratios together so they are 1:1 overall, assuming that both products have an equal total cannabinoid content. The terpenoids matter, too. Where limonene and beta-caryophyllene may promote wakefulness in combination with THC and CBD, linalool and myrcene may promote restfulness in combination with THC and CBD.
10. Remember: not all products are the same!
Think that all 3:1 preparations (or indeed any other ratio) are the same? Think again! Different extraction methods will likely have different effects, so a 3:1 CBD:THC ratio from one company will differ quite significantly from another company’s preparation. This is because both companies will likely be using different plants to make their products, meaning that there may be many other cannabinoids and terpenoids getting into the preparation, on top of any differences in extraction technique.
Assuming we are writing about tinctures, the oil that is used as a base will affect absorption rate to some extent as well – olive oil and MCT oil are the usual choices, due to them being more readily absorbed and their potential health benefits.
Other things to consider …
Ingestion method – tinctures & edibles for anxiety and depression, or a vape?
Remember: eating cannabis can be more powerful than vaping. Tinctures can be similarly powerful to edibles. Microdosing tinctures & edibles is ideal for longer-term relief, whilst vapes can provide more immediate relief. Again, microdosing is ideal for anxiety and depression. You can learn how to make your own cannaoil or cannabutter here.
Rick Simpson Oil (RSO) treatment
This method of treatment is usually for those who suffer from cancer. Whether such high doses are required to treat cancer is questionable, but the ultimate aim is to be able to consume 1 gram of RSO a day. The usual treatment plan lasts around 12 weeks, and involves increasing tolerance to high amounts of THC.
Week 1 – Half a grain of rice of RSO, 3 times a day.
Weeks 2 – 5 – Doubling of intake every 4 days.
Weeks 5 – 12 – 1 gram a day for about 60 days.
You can check out more about the pros and cons of each ingestion method here.
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Although we cannot give you any definitive advice on what type of cannabis or what cannabinoid profile may be best for you, both scientifically and legally, we hope that we can help patients to some extent, as there is precious little information on all of this. The general advice would be to start slow and low, and work to a level where you feel most comfortable without necessarily being too “high” or “stoned”.
Now, before we bid you adieu, we’d like to thank Mara Gordon of Aunt Zelda’s, Professor Roger Pertwee, Jeff Raber and many others (honestly, the list is long), who have helped us understand dosing and titration so much better. Let’s hope that the laws surrounding cannabis are at least loosened, if not thrown away completely, so that we can get a better understanding of how to utilize the medical potential of this amazing plant.