New, Expert Guidance on the Dosing and Administration of Medical Cannabis
Spectrum Therapeutics continues to invest in the advancement of the science of medical cannabis, with the goal of achieving better understanding, safer use, and improved outcomes.
A recent initiative supported by Spectrum Therapeutics has resulted in expert, consensus-based guidance on the dosing and administration of medical cannabis for three key patient types.
Background to the publication
Following legalization in Canada and other jurisdictions, many healthcare providers have come to recognize the value of integrating medical cannabis into treatment plans for a variety of conditions; globally, the use of medical cannabis to help alleviate symptoms of chronic pain continues to increase.
The two most common and best understood cannabinoids found in medical cannabis are THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol). (For more information on THC, CBD, and the THC:CBD ratios found in Spectrum products, see this primer on the Spectrum Therapeutics framework.)
As evidenced in the publication, the use of these cannabinoids has been associated with improved pain-related outcomes, quality of life, daily function, and opioid sparing.
The need for expert guidance
There has been limited scientific data to direct healthcare providers in the dosing and administration of medical cannabis. To meet the need—and demand—for authoritative guidance on the topic, Spectrum Therapeutics convened an international panel of 20 experts in cannabinoid medicine and pain. Together, they worked to establish consensus-based recommendations for the safe and effective dosing and administration of medical cannabis.
The results of their efforts have been published in the Journal of Cannabis Research*, and the full scientific article is available for free, making it easy to share with your healthcare provider. You can access the full article here.
Three new protocols
The expert panel developed three new protocols for oral dosing of medical cannabis:
For the majority of patients, the Routine protocol is recommended. Under this protocol, treatment begins with a CBD-dominant cannabis cultivar, at a dose of 5 mg twice daily, in order to avoid early adverse events. Titration is slow and managed to reach treatment goals, with a maximum dose of 40 mg/day of CBD. At that point, if treatment goals are not being met, the authors suggest adding THC at 2.5 mg/day up to a maximum of 40 mg/day.
Routine Dosing and Administration Protocol for Medical Cannabis
* Refer for expert consultation if considering > 40 mg/day THC
For patients who may be more sensitive to drug effects, the experts created the Conservative protocol, which similarly begins with a CBD-dominant cannabis cultivar, but titrates CBD more slowly and introduces THC in smaller amounts.
The Rapid protocol is designed for patients who require urgent management of severe pain or palliation, and for those with significant prior use of cannabis. It begins with a balanced CBD:THC cannabis cultivar, then titrates the dose of both cannabinoids at the same time, shortening the entire process.
For a more detailed explanation of these protocols, with diagrams, view the full scientific article.
A medical-cannabis first
As far as we know, these protocols represent the most recent expert-consensus based recommendations on the dosing and administration of medical cannabis.
These protocols are easily paired with the guidance offered by the colour-coded Spectrum Therapeutics framework, which helps healthcare professionals and patients communicate clearly about product selection by organizing them according to THC and/or CBD content. Under the framework, CBD-dominant products are marked yellow; those with a balance of CBD and THC are blue; and THC-dominant products are red.
Our hope is that these recommendations will support clinicians and patients in achieving safe and effective dosing and administration of medical cannabis.
* Bhaskar, A., Bell, A., Boivin, M. et al. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 3, 22 (2021). https://doi.org/10.1186/s42238-021-00073-1
Spectrum Therapeutics supported the development of these expert, consensus-based recommendations through an arms-length grant, which means it did not have influence on the design, data collection, analysis, or the publication.