In cannabis culture where the goal finding the strongest products, microdosing is the counterbalance that takes a “less is more” approach.
The practice of microdosing is becoming a practical way to incorporate cannabis into everyday life, without the noticeable side effects typically associated with getting high.
“In all medicine, with all drugs, you look for the minimum effective dose. Period,”
said Dr. Allan Frankel, a preeminent Los Angeles physician.
Frankel was diagnosed with a heart condition in 1999 that doctors estimated would end his life within six months. His own patients suggested medical marijuana based on their experiences of coping with debilitating conditions. Today, Frankel attributes his survival partially to medical marijuana “I’d been depressed and cannabis stopped the depression,” he said. “It gave me something to look forward to. My brain was turned on.” Frankel has actively incorporated marijuana into his practice, helping patients determine their best dose, as well as the amount of THC and CBD for their conditions.
Finding an individual’s dose involves some experimentation. Just like any substance that pass the blood-brain barrier, each person reacts to substances that cross this threshold differently. A person’s weight, height, metabolism, diet, and overall health can affect their sensitivity to THC. Edibles are the product of choice for microdosing, as the amount of THC is easier to identify thanks to labels and packaging and allows for a more discreet delivery system during the day.
Being able to use cannabis to treat the symptoms of depression and anxiety can be crucial for those dealing with these illnesses in the workplace. Susannah Grossman, Principal at Verdant Communications and COO of Mountain Medicine, switched to a job where marijuana was not welcome in the workplace. After experiencing side effects from antidepressants, she tried microdosing after learning about marijuana’s ability to treat depression.
“I had a major fear that I wouldn’t be able to write or work,” she said. “But it’s been just the opposite. Microdosing has helped me focus and accomplish more.”
It took time for Grossman to find the best dose for her, but Dustin Sulak, a medical marijuana doctor in Maine, has developed a simple method for determining one’s dose: “Abstain from cannabis for two days. On day three, consume one milligram of THC and one milligram of CBD, preferably in a tincture or oil where they can be measured precisely. Before consuming, ask yourself three questions, and answer on a scale of one to 10: How easy is it to breathe, how comfortable and calm does your body feel and how easy is it for you to smile authentically, to feel content and grateful?” Sulak recommends increasing the dose milligram by milligram until the effects become just noticeable.
The concern with any medical marijuana regimen is developing a tolerance. Sulak recommends refraining from all cannabis consumption for 48 hours, “That’s all – that’s the magic time when tolerance gets re-set.” Grossman keeps tabs on her consumption and takes breaks to keep her tolerance low. She takes a balanced dose of 5mg CBD and 5mg THC, “But there’s something about the THC in sativa strains that I enjoy,” she said. “It lifts my spirits – gives me a sense of playfulness.” She added, “And I’m still getting a ton of work done!”
Among the more than 110 medically therapeutic cannabinoids found in marijuana, the big players are THC and CBD. The influence of CBD-only cannabis oils, which cause no euphoric high, is so great that 13 states have passed limited medical marijuana laws targeted only at CBD extracts.
Products like Charlotte’s Web, an increasingly popular pharmaceutical-grade CBD (cannabidiol) extract from Colorado that’s available in capsule, oil, and tincture form, are being used by patients in several states where they are legal. Instead of activists on bullhorns, the loudest — and most persuasive — voices for at least limited medical cannabis legalization are those of the parents of very sick children.
Children with intractable epilepsy, especially those who have tried all conventional pharmaceutical treatments but gained almost no benefit, are using CBD oil to control seizures with amazing efficacy. Unfortunately, CBD is not an end-all cure. It does not work in all cases.
Charlotte Figi & Benton Mackenzie
Charlotte Figi, a nine-year-old Colorado resident, has become the poster child of pediatric medical marijuana. She inspired the creation of a family of CBD-rich Charlotte’s Web products (named by its producer, CW Botanicals, in her honor) to reduce her epileptic seizures. Use of CBD oil has reduced Ms. Figi’s seizure activity by 99.7 percent (before CBD treatment, she suffered between 400 and 1,000 seizures per week).
Benton Mackenzie, a man from Iowa, was suffering from aggressive angiosarcoma, a highly invasive form of cancer. He used high-CBD strains of cannabis to treat his condition — some of which, like Valentine X, provide a 25:1 CBD to THC ratio. For two years, Mackenzie was able to hold his angiosarcoma at Stage 1 though the use of high CBD cannabis.
After being busted for cultivation and incarcerated, where he was obviously deprived of his cannabis medicine, Mackenzie’s cancer progressed from Stage 1 to Stage 4 in only six weeks. Although highly anecdotal, this case is convincing evidence for the power of the CBD cannabinoid to prevent tumor growth and possibly kill cancer cells.
The medical benefit of certain cannabinoids, like CBD, has been clearly illustrated both anecdotally and via limited medical research. The good news is that actual extract products, like Charlotte’s Web, are finally becoming available and legal in many states.
Beyond Extracts: Synthetic Cannabinoids
While cannabinoids are typically isolated via extracts, they have also been synthesized by pharmaceutical companies. In fact, the FDA has approved both Marinol (dronabinol) and Cesamet (nabilone), two forms of synthetic THC.
Unfortunately, these man-made products have garnished mixed — and often negative — reviews from patients with multiple sclerosis, epilepsy, and cancer. This indicates that there may be other chemicals and elements available in CBD oil extracts that simply aren’t present in synthetic versions of these cannabinoids. (It is already understood that certain cannabis terpenes play a role in regulating the amount of cannabinoids that reaches the brain.)
Dustin Sulak, an osteopathic physician and advocate of integrative medicine in Maine, succinctly summarized the attitude of the medical establishment toward cannabinoids and whole plant cannabis medicine:
“Many physicians cringe at the thought of recommending a botanical substance, and are outright mortified by the idea of smoking a medicine. Our medical system is more comfortable with single, isolated substances that can be swallowed or injected.”
“Unfortunately, this model significantly limits the therapeutic potential of cannabinoids.”
Think Outside the Box
When considering medical cannabis, one must think outside the box and not constrain the issue to only whole plant cannabis that is smoked, vaped, or used to create edibles.
In the case of children, a cannabis-derived medicine that provides no euphoric high, is easy to administer, and delivers significant relief for some patients is where medical science and nature work in tandem to provide sometimes remarkable efficacy.