What is a tolerance break?
A tolerance break (sometimes referred to as a ‘t-break’ or ‘cannabis holiday’) is when you give your body a break from your medicinal cannabis treatments for a period of time to reset your cannabinoid receptors and get the most out of your medication. We know that regular use of THC-containing cannabis medications can cause patients to develop a tolerance to the therapeutic benefits of their treatments, meaning they may stop experiencing the same results or relief that they usually would with their regular dose of medication.1 A tolerance break helps counteract this effect by resting and resetting the receptors in your body that interact with medicinal cannabis treatmetns so you can return to your preferred dose or even lower to achieve your desired therapeutic benefits.
Understanding cannabis tolerance
When using medicinal cannabis to treat the symptoms of a medical condition, our goal is always to find the right type of treatment – including format, cannabinoid content and terpene profile – as well as the right dose to help you find relief while maintaining a sense of homeostasis or balance within your body. All of these factors vary depending on the needs of each individual patient, and what works best for you may not work for someone else’s symptoms or physiology.
As a medical cannabis patient, you may be prescribed any combination of CBD-only treatments, THC-only treatments, or combined treatments containing both CBD and THC, as well as other minor cannabinoids (such as CBG or CBN). The way these cannabinoids affect you and impact your tolerance varies depending on how they interact with your endocannabinoid system (ECS). The ECS is the molecular system responsible for regulating and balancing many processes in the body – including immune response, communication between cells, sleep, digestion, stress, pain response and more. The ECS is made up of cannabinoid receptors, endogenous cannabinoids (endocannabinoids), and the enzymes responsible for the synthesis and degradation of the endocannabinoids.
Let’s look at the different ways CBD and THC interact with our ECS and affect our cannabis tolerance.
Cannabidiol or CBD is one of the most abundant in a long list of cannabinoids found in the cannabis plant, alongside THC. Unlike THC, CBD won’t bring on a feeling of being ‘high.’ CBD is known for its calming effects on the body, with potential therapeutic benefits ranging from relieving anxiety and depression to reducing seizures, pain, inflammation and more.
We know that the cannabinoid CBD has a narrow side effect profile.2 It’s non-impairing,3 and because it works indirectly, rather than directly, with our ECS (and binds only weakly to our cannabinoid receptors) there is little risk of CBD causing an imbalance or flooding our ECS. This means that you will likely be able to maintain your ideal dose of CBD without building up a tolerance, developing unwanted side effects or needing to adjust your dose too much. If you take CBD only treatments, you may benefit from taking breaks to reset your system and help maintain the effectiveness of your treatments, if your doctor advises you to do so. There is a very low risk of experiencing withdrawal symptoms during a CBD break.
When it comes to THC, things work a little differently. THC is a psychoactive, intoxicating cannabinoid that acts directly upon the body’s ECS4 by stimulating our cannabinoid receptors (CB1 and CB2). THC’s potential therapeutic benefits range from pain and nausea relief to reducing inflammation, anxiety, insomnia and more. Because the ECS is responsible for maintaining balance and harmony in the body, the effects of THC will be dose-dependent. Meaning the correct dose of THC can help create balance, while too much THC over too long a period of time can cause an imbalance. Not only that, but research has shown that regular users of THC-containing cannabis treatments develop a tolerance to both the impairing effects, as well as the therapeutic benefits of the plant over time.This means that THC users may start to notice they are not achieving the same level of relief with their usual dose after a period of consistent use.
Thankfully, this built up tolerance is not a final, permanent state of regular cannabis consumption, but rather a temporary state of decreased sensitivity to cannabis that fluctuates depending on the pattern of cannabis use. This means that you can reset your cannabis receptors, lower your tolerance, regain your sensitivity and keep your cannabis dose within the ideal range for your needs (and your budget) by taking breaks from your treatments – with the guidance and support of your prescribing doctor.
Does tolerance mean you’re addicted?
Developing a tolerance to a substance is often associated with chemical dependence and addiction, but tolerance is not necessarily synonymous with addiction. Tolerance can occur after normal prescription drug use, recreational drug use and alcohol use. If tolerance occurs alongside more concerning signs like heavy use (i.e. beyond what is prescribed), risk-taking behaviours and neglecting responsibilities, it could indicate a more serious problem like addiction.
Medicinal cannabis is known to have a low to moderate risk of dependence that is significantly lower than alcohol, nicotine, caffeine and prescription drugs like morphine and opioid medicines.5 Taking tolerance breaks can reduce the amount of THC you need to feel the therapeutic benefits of your medicine and reduce the risk of dependence. For most people, there is a low risk of withdrawal symptoms when taking a tolerance break. Talk to your prescribing doctor if you believe you are experiencing any signs or symptoms of cannabis dependence or withdrawal before or during your tolerance break.
What happens to the body during a tolerance break?
When you’ve been consuming THC for a while, your brain may decrease its cannabinoid receptors to try and rebalance itself. The constant activation of your ECS’s cannabinoid receptors by the THC can cause them to ‘downregulate’ and reduce their sensitivity to cannabis. This downregulation becomes cumulative when cannabis use is repeated before the cannabinoid receptors have fully upregulated after the last exposure to THC.
When you take a break from THC, you’re allowing your cannabinoid receptors to adjust and balance themselves out chemically so that you can regain sensitivity to cannabis and achieve your desired therapeutic benefits without having to increase your dose and flood your cannabinoid receptors.
What are the benefits of tolerance breaks?
Tolerance breaks can help you get the most out of your medicinal cannabis treatments in a number of ways. If you’ve developed a tolerance to the effects of your treatment, you may find that you’re needing to increase your dose of THC to high levels to find relief from your symptoms. But when you do this, you’re actually running the risk of overwhelming your endocannabinoid system.
Phytocannabinoids – like those found in cannabis, including THC and CBD – interact with our ECS and in varying ways. THC can activate specific cannabinoid receptors to produce a psychoactive effect, which may help to relieve pain, reduce nausea and vomiting, increase appetite, improve sleep and more. While CBD interacts with our opioid, dopamine, and serotonin receptors, giving it the potential to reduce pain, depression and anxiety while boosting the immune system and helping with addiction. Because THC works so directly upon the ECS and cannabinoid receptors, using too much can actually flood these receptors, potentially leading to dysregulation within the body and unwanted side effects like insomnia, anxiety and more.
Ensuring you are not overwhelming your ECS with THC by taking a break from your treatments, rather than continually upping your dose, will help maintain balance within your body. This will allow you to continue using THC to improve ECS function and assist with pain relief, sleep, anxiety and more, rather than creating dysfunction.
And because tolerance breaks can help you keep your dose at the ideal level you and your doctor will have decided upon without increasing to high levels, they can also help you make your medication last longer. This means less money spent on treatments, less scripts to fill and more benefits from your treatments over time.
How do I know if I need a tolerance break?
If you’re not getting the same results you usually would with your regular dose of medication, it may be time for a tolerance break. Depending on your symptoms and condition, this might mean you’ve stopped experiencing the same amount of pain relief and have had to increase your dose, or you’re finding you’re more restless at night when your medication would usually be helping you sleep. You might feel your anxiety symptoms creep up or you may need to take more of your treatment to combat nausea. Or, you might just be running out of your medication earlier than expected. Whatever it looks like for you, your medication’s reduced effectiveness may be due to your built up tolerance – and it’s likely a good time to consult with your doctor about how to combat this.
How do I take a tolerance break?
Depending on your situation as a medical cannabis patient, you may be a daily user of medicinal cannabis who relies heavily on your THC-containing treatments to manage your symptoms and go about your daily life, and the thought of taking a break from them may be daunting. Or, you might find the break to be manageable. That’s why it’s so important to consult with your prescribiing doctorand work out a plan for your tolerance break – including when you will take your tolerance break, how long you will take it for, how you can manage your symptoms during that time and how to resume your THC treatment at the end of your break.
Essentially, you will choose a start and end date for your break, and during that time you won’t consume any medicinal cannabis treatments.
How long should a tolerance break be?
There is no universal ideal timeframe for taking tolerance breaks, though it is generally accepted that a tolerance break should be at least 48 hours long to give your cannabinoid receptors enough time to start to reset. For long-time users who want a true reset and for THC to leave the system entirely, some patients take tolerance breaks ranging from a few weeks to a month to get back to optimal endocannabinoid system functioning. It all depends on your individual situation and your doctor's advice.
Resuming THC use after a tolerance break
When restarting your treatment at the end of your tolerance break, your doctorshould provide you with a new starting dose that may be about half of your original dose so you can titrate up slowly to find your new ideal dose. If your new dose is the same or even lower than your original dose and you are achieving your desired therapeutic results, then your tolerance break was likely effective. In some circumstances, your doctor may prescribe a new type of medicinal cannabis treatment with varying cannabinoid ratios and terpene blends for you to try at the end of your tolerance break. This can help your receptors kick back in to get the most out of your medicinal cannabis treatments.
If you’re not already, it might also be a good idea to start taking a small amount of CBD alongside your THC treatments, or to start taking a full spectrum cannabis medicine which contains THC, CBD and a range of other beneficial cannabinoids and properties. CBD may help to mitigate or reduce the undesired effects of THC, and full spectrum medicine containing both cannabinoids can help to keep your dose of THC down thanks to the synergistic effect cannabinoids and terpenes have on the ECS. Talk to your doctor to find out if these treatments might be right for you.
Regulating your ECS during your tolerance break
The phytocannabinoids found in the cannabis plant– like THC and CBD – are just some of a number of natural tools we can use to strengthen our endocannabinoid system and help our body achieve a sense of homeostasis (balance). When taking a break from THC-containing treatments, there are some things you might like to try to support your ECS and help manage your symptoms:
- Consume Omega-3 fatty acids and vegetables high in vitamin C
- If you are able, try to get some exercise, as it has been shown to increase endocannabinoids6 to help maintain homeostasis within the body.
- Because prolonged periods of stress can contribute to the impaired development of new endocannabinoid receptors, and increased amounts of the stress hormone cortisol interfere with the function of our CB1 receptors, reducing stress is also a good way to regulate the ECS.7 If you were using THC to help manage stress, talk to your doctor about other ways to manage your stress during your tolerance break.
- Try to lower your alcohol intake.8
Not all of these tools will be achievable or effective for patients with severe symptoms. Talk to your doctor about ways to manage your symptoms and regulate your ECS during your tolerance break.
How to correct sleep during your tolerance break
In addition to looking after your ECS during your tolerance break to help minimise your symptoms, you may want to pay attention to how your tolerance break affects your sleep. Many patients use medicinal cannabis treatments to help with sleep issues, and you may find that abstaining from cannabis makes it difficult to wind down at night. If this happens to you, you might like to try the following tips:
- Try and do some physical activity during the day to help regulate your sleep-wake cycle and improve overall cognitive function and sleep quality
- Try to limit your caffeine intake, particularly in the afternoon and evening
- Stick to a sleep schedule where you try to wake up and fall asleep at the same time each day
- Limit screen time before bed
- Don’t go to bed feeling too full and try to eat dinner several hours before you go to bed
- Find ways to regulate stress and anxious thoughts that may be keeping you up at night
- Try herbal teas (like chamomile) or supplements (like passionflower and lavender) which can help with sleep
If you’re worried about how your tolerance break might affect your sleep, it's a good idea to talk to your prescribing doctor about lifestyle, medicinal or herbal alternatives for sleep that you can rely on during your break from medicinal cannabis.
Navigating tolerance breaks with your doctor
If you find your current dose of THC-containing cannabis medication is not as effective at relieving your symptoms as it usually is, it might be time for a tolerance break. T best place to go for guidance is an experienced cannabis clinician.
These experts can help you to develop a plan of action for your break – including the duration, when to take it, how to manage your symptoms, and how to restart your THC treatment once you've finished. With your doctor’s guidance, you should be able to return to your ideal dose of medical cannabis treatment to get your desired results, and together you can make any required adjustments to your treatment plan so that you can get the relief you need from your treatments.
- Mason NL, Theunissen EL, Hutten NRPW, Tse DHY, Toennes SW, Jansen JFA, Stiers P, Ramaekers JG. Reduced responsiveness of the reward system is associated with tolerance to cannabis impairment in chronic users. Addict Biol. 2021 Jan;26(1):e12870. doi: 10.1111/adb.12870. Epub 2019 Dec 22. PMID: 31865628; PMCID: PMC7757162.
- Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015 Oct;12(4):825-36. doi: 10.1007/s13311-015-0387-1. PMID: 26341731; PMCID: PMC4604171.
- Thomas R Arkell, Danielle McCartne, Iain S McGregor, Medical cannabis and driving, Australian Journal of Medical Practice, Volume 50, Issue 6, June 2021, doi: 10.31128/AJGP-02-21-5840
- Alger BE. Getting high on the endocannabinoid system. Cerebrum. 2013 Nov 1;2013:14. PMID: 24765232; PMCID: PMC3997295.
- Nutt DJ, King LA, Phillips LD; Independent Scientific Committee on Drugs. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010 Nov 6;376(9752):1558-65. doi: 10.1016/S0140-6736(10)61462-6. Epub 2010 Oct 29. PMID: 21036393.
- Desai S, Borg B, Cuttler C, Crombie KM, Rabinak CA, Hill MN, Marusak HA. A Systematic Review and Meta-Analysis on the Effects of Exercise on the Endocannabinoid System. Cannabis Cannabinoid Res. 2022 Aug;7(4):388-408. doi: 10.1089/can.2021.0113. Epub 2021 Dec 3. PMID: 34870469; PMCID: PMC9418357.
- Hill MN, Patel S, Campolongo P, Tasker JG, Wotjak CT, Bains JS. Functional interactions between stress and the endocannabinoid system: from synaptic signaling to behavioral output. J Neurosci. 2010 Nov 10;30(45):14980-6. doi: 10.1523/JNEUROSCI.4283-10.2010. PMID: 21068301; PMCID: PMC3073528.
- Pava MJ, Woodward JJ. A review of the interactions between alcohol and the endocannabinoid system: implications for alcohol dependence and future directions for research. Alcohol. 2012 May;46(3):185-204. doi: 10.1016/j.alcohol.2012.01.002. Epub 2012 Mar 27. PMID: 22459871; PMCID: PMC3327810.
The information on this website is provided for educational and informational purposes only and not intended for use as medical advice. Polln is not promoting the use of medicinal cannabis. Medicinal cannabis in Australia is scheduled medication and regulated by the Therapeutic Goods Administration (TGA). Details about medicinal cannabis as a scheduled drug can be found on their website. If you would like to explore medicinal cannabis for your chronic condition, please consult with a doctor.
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