Daily therapeutic use Titrating medical marijuana dosages

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Most people are familiar with the use of smoked marijuana for symptomatic relief of chronic and acute health disorders, but there is much more to know about this traditional herbal remedy.

"Its margin of safety is immense and underscores the lack of any meaningful danger in using not only daily doses in the 3.5 - 9 gram range, but also considerably higher doses."

Physician, researcher, court-qualified cannabis expert

The phrase "medical marijuana," as commonly used, refers to the cured, mature female flowers of high-potency strains of cannabis or a conversion thereof. Since cannabis is an annual plant, it is logical to measure its use as an annual dosage. Many patients need three pounds of bud or more per year. A smaller number of daily use patients smoke six, nine, 12 pounds or more per year for chronic conditions, but dosage varies with each person and how they consume it.

Potency is one factor, but other concerns affect titration, as well. "Whether a one gram marihuana cigarette contains 2% or 8% THC, the cigarette will generally be smoked so as to deliver the smoker's desired cannabi-noid dose," NIDA researcher Dr. Reese Jones noted in the UC San Francisco CME class syllabus Cannabis Therapy (June 10, 2000, p. 315).

Chronic pain patients tend to use larger amounts, while acute and terminal patients may use less. Conditions like glaucoma or MS may require continuous use to prevent attacks. Health conditions may periodically or cyclically improve or get worse, causing usage to fall or rise. Some require daily and multiple-daily dosages.

The means of ingestion also affects patient dosage. Smoked cannabis provides rapid and efficient delivery. Most patients consume it this way, but some wish to avoid the smoke. "Vaporizing" it (heat without combustion) may require twice as much. NIDA estimates that eating requires three to five times the smoked dosage. This means that a patient who smokes a pound per year needs about four pounds for the same effect if they eat it, although often they prefer a combination of the two. When eaten, cannabis' effects are spread out over a longer period of time (see graph). This may be particularly good for sleep or situations where smoking is impractical or impossible, but due to its delayed onset and varied metabolic activity, eaten is hard to titrate. Consumable goods spoil over time, there is a learning curve to prepare recipes, and not every attempt produces usable medicine. Making kef, hash, tinctures, oil, extracts, topical salves and liniment all require ample amounts of cannabis. Patients need an accurate scale to measure, track and titrate their own personal dosage and supply of cannabis.

All patients have the need to obtain and possess an adequate supply for some period of future need. Since patients can't simply go to the pharmacy to get this medicine, they are forced to stockpile. From three to six pounds is reasonable as a personal supply. Potency diminishes with age, but cannabis can be stored in a cool, dry, dark place for years on end without significant loss of effect.

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