A Comprehensive Comparison of Medical Cannabis Dosing with Allopathic Medicine: Challenges and Opportunities for Individualized Therapy

 Melinda D. Atkins, MSc., M.Ed, E-RYT500, C-IAYT

In allopathic (Western) medicine, drug dosages are typically established through clinical trials and consider drug-specific factors like formulation and half-life, as well as patient-specific factors like weight, age, organ function, and genetics. How does dosing for medical cannabis compare with these conventional practices? In what ways does it differ? Additionally, what research or data can provide useful guidance on optimal dosing for medical cannabis?

Medical cannabis dosing should ideally consider patient characteristics, such as weight, age, organ function, and genetics. Although there have been some clinical research trials to inform dosing, especially for those new to medical cannabis, there is limited guidance compared to allopathic medicine. Additionally, some innovative practices in medical cannabis can help refine dosing, such as using nano- or ionized particles or incorporating omega fats into carrier oils to enhance absorption. For topical applications, mild skin barrier disruption can improve absorption of the active ingredient.

Medical cannabis products, whether prescription-based or over-the-counter, should meet standards similar to allopathic medicine, with organic cultivation following Good Agricultural Practice (GAP) and manufacturing under Good Manufacturing Practice (GMP). These products should also be made available to consumers with comprehensive information on cannabinoid and terpenoid profiles, along with certification that they are free from pesticides, microbes, or heavy metals.¹

Given its unique characteristics, medical cannabis should be prescribed on an individual basis, similar to allopathic medicine. Unlike allopathic medicine, where evidence-based treatments rely on large clinical trials, medical cannabis may involve single-patient trials, allowing for a personalized approach to find the optimal combination of plant varieties and dosage forms for symptom management.² However, this individualization also creates challenges. Dispensaries often provide information on strains with precise THC percentages, like 24.34%, without clear guidance on potential variations, error margins, or other factors that could affect potency.³

For chronic conditions, medical cannabis often uses long-acting oral preparations similar to allopathic medicine, but it is a versatile treatment that can address multiple symptoms and conditions concurrently, potentially reducing polypharmacy.⁴  Additionally, medical cannabis can be effective for complex or rare diseases where conventional therapies are inadequate or have severe side effects, such as central sensitivity syndromes (fibromyalgia, chronic fatigue syndrome, migraines, irritable bowel syndrome), as well as multiple sclerosis, neuropathic pain, and refractory nausea.⁵

When prescribing medical cannabis, caution is advised in certain cases, such as unstable cardiac conditions like angina due to the risk of tachycardia and hypotension associated with THC.⁶  Similarly, smoking cannabis should be avoided in patients with COPD or asthma. Use in children and teenagers should be approached with extreme caution to avoid addiction and dependency.⁷

In conclusion, the scarcity of data on medical cannabis regulation and optimal dosing practices underscores the need for more research to assist physicians in making informed decisions. Additional studies can help clarify the safest therapeutic doses and improve the overall understanding of medical cannabis applications.⁸

Resources:

1. MacCallum C, Russo E. Practical considerations in medical cannabis administration and dosing. Cpsa.ca. http://www.cpsa.ca/wp-content/uploads/2018/08/MacCallum-Russo-Practical-Considerations-in-Medical-Cannabis-Administrat....pdf. Published 2020.
2. The Dosing Project. MediCann. https://www.medicann.com/the-dosing-project.html. Published 2020.
3. MacCallum C, Russo E. Practical considerations in medical cannabis administration and dosing. Cpsa.ca. http://www.cpsa.ca/wp-content/uploads/2018/08/MacCallum-Russo-Practical-Considerations-in-Medical-Cannabis-Administrat....pdf. Published 2020.
4. Ibid
5. Ibid
6. Ibid
7. Ibid
8. Mouhamed Y, Vishnayakov A. Therapeutic potential of medicinal marijuana: an educational primer for health care professionals. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001746/. Published 2020.