What is the recommended medicinal cannabis dosage?
You’ve probably heard by now that medicinal cannabis (historically known as marijuana, learn more about cannabis language here) is a very personalised medication. Unlike many other medications, there are no standardised dosages for medicinal cannabis. This means that what works best for you in terms of dosage, format, cannabinoid content and other factors may not work for another patient, even if you share the same condition.
So while finding your recommended dosage is a personalised journey you will undertake with your prescribing doctor, there are some general guidelines you can follow.
The main piece of advice you’ll hear is to ‘start low and go slow.’ This is particularly important for beginner cannabis consumers. Your doctor will likely prescribe a low dose and get you to slowly increase this at small increments until you find the best dosage for relieving your symptoms. They will also give you an ideal dose range to work within so that you’re not exceeding the recommended cannabis dosage and flooding your cannabinoid receptors. Through careful monitoring of your symptoms with the support of your prescribing doctor, you should be able to and gradually increase and adjust your treatment plan to find a dose that works best for you.
Let’s look at some of the factors that will play a part in finding your ideal medicinal cannabis dosage.
Factors that can influence dosage:
Bioavailability and methods of consumption
Bioavailability refers to the ability of a drug or other substance to be absorbed and used by the body for its intended purpose. When it comes to medical cannabis, bioavailability determines the rate at which cannabinoids are absorbed and effects are produced in the body. This means that bioavailability determines how quickly and how effectively your medicine will relieve your symptoms, which in turn determines what your ideal dose might be.
Cannabis bioavailability varies greatly depending on your method of consumption. This is because different routes of administration have differing effects on the way the human body absorbs, distributes, processes, and eliminates a substance like medical cannabis.
There are a number of different ways to take medicinal cannabis, and a number of different types and formats of medical cannabis treatment that you may be prescribed. We’ll explore some of these below.
Vaping medical cannabis
In terms of bioavailability, a 2016 study found that some medical-grade cannabis vaporisers, including the Volcano Medic by Storz & Bickel, are capable of reaching bioavailability ratings of between 50–80%.1 This makes the bioavailability of cannabis vapour (with the right vaporiser) significantly higher than other cannabis formats, which may suit medical patients who require more rapid onset and faster relief from symptoms.
For medical uses, vaping is preferable to smoking not only because of its increased bioavailability, but because it maintains cannabinoid content and contains far fewer toxins and carcinogens. It is also supported by the TGA when a medical-grade dry-herb vaporiser is used.
Only use a medicinal cannabis vaporiser if you are advised to by your prescribing cannabis doctor. Learn more about vaping medicinal cannabis here.
Smoking medicinal cannabis
Although smoking cannabis is the most common route of administration for non-medical cannabis use, it is not recommended for medical patients due to the health risks and the variability and unpredictability of each individual patient and their response.
Compared to vaping cannabis with a TGA-approved vaporiser, smoking cannabis comes with far greater health risks, reduced bioavailability (about 30%2) and less active ingredients. At least 40% of the THC dose in cannabis is lost in side stream/combustion when smoked,3 making it difficult to estimate the amount of THC a patient is receiving.
In the aforementioned 2016 study1 which compared the quality of cannabis vapour and cannabis smoke, only 3 non-cannabinoids were found in the cannabis vapour produced by the Volcano Medic, while about 150 chemicals were identified in the smoke of combusted cannabis, including 5 polycyclic aromatic hydrocarbons (PAHs), which are strong carcinogens.
The sublingual method of cannabis medication delivery allows active ingredients to be absorbed directly into the blood vessels of your tongue, bypassing the digestive system. Patients who use this delivery method will place their sublingual medicinal cannabis treatment under their tongue so that mucous membranes – similar to those in the lungs – absorb the cannabis medication into the bloodstream.
Because this method allows the active ingredients in your cannabis medication to bypass the digestive system, its bioavailability is higher than that of edibles and other oral medicinal cannabis treatments, allowing for faster onset and higher concentrations of cannabinoids.
The bioavailability of sublingual medicinal cannabis treatments varies, and can range from slightly higher than oral methods (about 4–20%4) to as much as 92–98% for one studied oromucosal (sublingual) prescription spray.5
Ingestion methods of medicinal cannabis consumption refer to any cannabis medication that is consumed orally – including edibles, oils, tinctures, capsules and extracts. Oral bioavailability is lower than other delivery methods, and is said to range somewhere between 4–20%.4
Despite the lower bioavailability of oral cannabis medications, they typically last longer than other methods of consumption,6 with peak effects occurring about two to four hours after consumption.3 Given the slower onset and longer duration of oral administration this method may be more useful for medical conditions or symptoms where control over longer periods of time is required, much like any other slow release medication.
The active ingredients (e.g. cannabinoids) within your cannabis
Before you find the right dose, your doctor will also need to help you find the right type of cannabis treatment for you and your needs. One of the most important factors they will consider is the active ingredients within your cannabis, including cannabinoids like CBD and THC, other cannabinoids, terpenes and other cannabis compounds.
The active ingredients within your medicinal cannabis treatment will influence the effects your medication has, as well as the dose you will need to take to get relief from your symptoms. Some cannabinoids or cannabinoid combinations and doses may be more effective for relieving certain symptoms, and your doctor will help guide you to find what works for you.
Because of their varying effects, it’s important to note that when consuming THC, you may notice effects more quickly than with CBD. Finding the right balance between CBD and THC and exploring different cannabis treatments, formats and dosage requirements will be an individual process. The goal is to find your optimal therapeutic window where you get the most benefit without unwanted adverse effects.
Whether you are a regular cannabis consumer or entirely new to medical cannabis, your tolerance to your prescribed treatment will impact your cannabis dose. Patients who are new to cannabis are likely to have a low tolerance, and may only need 0.1–0.5 of the starting dose of a regular cannabis user3 to feel its effects. Patients who are regular cannabis consumers may have a higher tolerance, and may be able to start on a slightly higher dose. These patients should be advised to consider their tolerance and the accumulation of THC in fat stores and adjust their dose or take tolerance breaks accordingly.
We know that regular/prolonged use of THC-containing cannabis treatments may cause patients to develop a tolerance7 to the therapeutic benefits of their treatments. This means they may stop experiencing the same results or relief that they usually would with their regular THC dose. Tolerance breaks can help patients reset their cannabinoid receptors and return to their ideal dose (or even lower) to get the desired effects from their treatment, resulting in lower costs over time and a more balanced endocannabinoid system.
Individual differences in ECS
Each of us – whether we consume cannabis or not – has an endocannabinoid system. The endocannabinoid system (ECS) is a molecular system made up of a vast network of chemical signals and cellular receptors located all throughout our brains and bodies. These help regulate and balance many processes in the body – including immune response, communication between cells, sleep, pain, appetite, hormone levels, metabolism, memory, and more.
Because no two bodies are the same, the endocannabinoid system will vary between each individual patient depending on age, sex, health, weight, illness, potential endocannabinoid deficiency and other individual factors.
For example, age and sex of individuals are important determinants for the consequences of cannabinoid exposure on conditions like anxiety, with women having an increased propensity to anxiety-related disorders and biological differences in the endocannabinoid system compared with men.8
So, because the endocannabinoid system varies from person to person, so will our individual responses to medical cannabis treatments, which interact with the endocannabinoid system in a number of ways. This is why finding the right dose for you and your symptoms is an individual process that can only be done through trial and error and with the support of a healthcare professional.
Your treatment goals and what you are using medical cannabis to treat
Depending on your treatment goals and the condition/s and symptom/s you are using medicinal cannabis to treat, your ideal dose may be lower or higher than that of another patient, and that’s something only you and your doctor can determine together based on your individual patient needs. So while there may be general guidelines that your doctor can follow in terms of the type of treatment, the active ingredients and the dose that might be best for your condition and symptoms, it will all come down to how you as an individual respond to your cannabis treatment once you’ve started taking it.
For example, a patient with generalised anxiety, PTSD or sleep issues may see greater results with a lower dose of CBD (e.g. 25 to 75 mg)9,10 than with a higher dose (e.g. 600 mg).11 A patient with epilepsy however, might require 300 to 1500 mg of CBD each day to reduce seizures.12 It all depends on the individual patient’s response to treatment.
By monitoring your progress (a treatment journal which measures your symptoms over time as you find your ideal treatment and dose is a great tool for this) and regularly checking in with your prescribing doctor, you should be able to find a treatment plan and an ideal dose for your treatment goals.
Titrating and microdosing medical cannabis
What is titration?
Titration simply refers to the process of slowly increasing your medication dosage to find the right amount of cannabis that will produce your desired therapeutic effects.
Getting to this point requires a bit of patience, especially for beginner cannabis consumers. Try and follow these steps to find your ideal dosage:
How to find your ideal dosage
1. Start low and go slow
When you are prescribed a medical cannabis treatment, your doctor should discuss your starting dose range with you. Always start with a dose on the lower end of that spectrum and wait until the estimated onset time for your particular product has passed to see if you begin to feel any therapeutic benefits or side effects.
If you’re not feeling the desired effects, you can gradually increase your dose by an amount advised by your doctor until you find your ‘sweet spot,’ ensuring you stick to that dose for at least two to three days each time you increase to give your body a chance to adjust. This process of determining the minimal amount of your medicine that will give you your desired results with minimal side effects is known as titration.
When it comes to medical cannabis, titration also involves finding the right balance between the different cannabinoids (eg. CBD and THC) in your medications, your condition and your body’s individual response.
2. Stay consistent
Cannabinoids take time to build up their effect within your body. For best results, make sure you’re sticking to your treatment plan consistently.
3. Less is sometimes more
Depending on your condition, when it comes to dosing medical cannabis, more is not always better. For some patients living with chronic conditions, smaller doses over a prolonged period of time may be more effective than a high dose. Ensure you’re working with your doctor to figure out what dose works best for you.
4. Pay attention to your body
Like with any medicine, your ideal dosage of medical cannabis can change over time. Whether increasing or decreasing your dosage, the important thing is to listen to your body and what it needs and to check in with your prescribing doctor regularly.
What is microdosing?
In the cannabis world, microdosing refers to taking small, low dose amounts daily (or on most days). Many patients do this in order to reap the medical benefits of THC while avoiding its psychoactive effects of THC that can interfere with the demands of daily life. Depending on your symptoms and condition, some patients may see greater results from a lower THC dose than with medium or high doses. Microdosing should always be done with the guidance and support of your prescribing doctor.
Microdosing may be suitable for patients who want to get the medical benefits of their THC treatment without any of the impairing effects. Microdosing is not suitable for patients who drive on a daily basis, as it is illegal to drive with any amount of THC in your system in Australia.
Microdosing may also suit certain conditions better than others. For example, a 2012 study of patients with advanced cancer who were unresponsive to opioid painkillers found that patients who received the lowest dosage of cannabinoids (CBD/THC) showed the greatest reduction in cancer pain, while those receiving higher doses actually experienced more pain.13 Similarly, another 2014 study of 104 incarcerated male inmates with serious mental illness found that PTSD-associated symptoms like insomnia, nightmares, general symptoms and even chronic pain were significantly improved in participants who received regular, smaller doses of the synthetic cannabinoid Nabilone.14
So while high doses of cannabis may be needed to treat significant symptoms or flare-ups for certain conditions, a lower daily dose or microdose of cannabis over time may actually be more suitable for maximum safety and efficacy in some patients.
How to microdose cannabis medication
To explore microdosing your treatments, you will need to talk to your prescribing doctor and work within the dosage range they recommend for your particular treatment. If you are using cannabis regularly, your doctor may advise that you take a tolerance break before starting your microdosing regime so that you can reset your cannabinoid receptors and start at a lower dose, gradually increasing until you get the minimal noticeable effect.
The way you microdose will also depend on the type of medical cannabis treatment you take and the method you use to take it, as well as whether you use one or a combination of medicinal cannabis treatments. Again, your doctor will be able to help you explore microdosing and find the lowest daily dose that works for you and your condition, so ensure you’re checking in with them regularly and monitoring your progress as you go.
The bottom line
There are no hard and fast rules when it comes to finding the right dose for your medical cannabis treatment, and treatment results will vary from person to person. Your best bet is to ensure you’re working with a qualified and experienced medical cannabis doctor on a treatment plan and dosing regimen that works for you. Monitor your progress, check in with your practitioner regularly and pay attention to how you’re feeling over time. With the right support, you should be able to find a dose that helps you reach your treatment goals.
Medicinal cannabis dosing and titration FAQs
Should you stick to the recommended standard dosage?
Always follow the dosage guidelines provided to you by your doctor, unless you experience unwanted side effects and need to stop your treatment (make sure you let your doctor know if this happens to you). Your doctor will provide you with a dose range to work within for your specific treatment and needs. You should start at the low end of that range and gradually increase / titrate your dose up until you get the effects you desire. Where your ideal dose ends up sitting within the standard dose range will depend on you and your symptoms as an individual.
If you reach the high end of your dose range and still don’t experience relief from your symptoms, you should reach out to your prescribing doctor for further advice on what to do. Be careful about increasing your dose beyond your recommended dose range, as this can flood your endocannabinoid receptors and create an imbalance, leading to symptoms like anxiety and sleep issues. Instead, you should talk to your doctor about other options, including tolerance breaks (if you are already a regular cannabis user), other medical cannabis formats and delivery methods, or other treatment options altogether.
Can you overdose on cannabis?
You can’t overdose on cannabis in the same way that you can overdose on other drugs or pharmacological medications, such as opioids. However, it is possible to have a bad reaction or experience adverse effects, especially when cannabis use is combined with other substances like alcohol.
Cannabis compounds interact with receptors in the brain that influence things like memory, pleasure, and cognition. Unlike substances like opioids and alcohol, these molecules aren't found in areas that control breathing, meaning cannabis is unlikely to cause death on its own. Opioids can kill in high doses by binding to receptors that depress breathing, while large amounts of alcohol can similarly impair the body’s ability to control breathing.
CBD is generally well tolerated as a cannabinoid and is non-impairing, even at high doses.15 On the other hand, the effects of THC can include the ‘high’ feeling commonly associated with cannabis, and can be impairing or sedating in some people at certain doses. Because of this, THC is more likely to cause unwanted side effects like anxiety, confusion, dizziness, slower reaction times and increased heart rate at high doses. In rare cases and at very high doses it can also cause hallucinations, panic attacks, nausea and vomiting. These adverse events are highly unlikely to occur in patients who stick to the dose recommended by their prescribing doctor.
To date, there have not been any reported deaths in teens and adults resulting solely from cannabis use or toxicity.
- Lanz C, Mattsson J, Soydaner U, Brenneisen R. Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis. PLoS One. 2016 Jan 19;11(1):e0147286. doi: 10.1371/journal.pone.0147286. PMID: 26784441; PMCID: PMC4718604.
- McGilveray IJ. Pharmacokinetics of cannabinoids. Pain Res Manag. 2005 Autumn;10 Suppl A:15A-22A. doi: 10.1155/2005/242516. PMID: 16237477.
- TGA, Guidance for the use of medicinal cannabis in Australia: Overview, https://www.tga.gov.au/resources/publication/publications/guidance-use-medicinal-cannabis-australia-overview#route-rules, December 2017.
- Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007 Aug;4(8):1770-804. doi: 10.1002/cbdv.200790152. PMID: 17712819; PMCID: PMC2689518.
- Karschner EL, Darwin WD, Goodwin RS, Wright S, Huestis MA. Plasma cannabinoid pharmacokinetics following controlled oral delta9-tetrahydrocannabinol and oromucosal cannabis extract administration. Clin Chem. 2011 Jan;57(1):66-75. doi: 10.1373/clinchem.2010.152439. Epub 2010 Nov 15. PMID: 21078841; PMCID: PMC3717338.
- Poyatos L, Pérez-Acevedo AP, Papaseit E, Pérez-Mañá C, Martin S, Hladun O, Siles A, Torrens M, Busardo FP, Farré M. Oral Administration of Cannabis and Δ-9-tetrahydrocannabinol (THC) Preparations: A Systematic Review. Medicina (Kaunas). 2020 Jun 23;56(6):309. doi: 10.3390/medicina56060309. PMID: 32585912; PMCID: PMC7353904.
- 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.
- Maldonado R, Cabañero D, Martín-García E. The endocannabinoid system in modulating fear, anxiety, and stress . Dialogues Clin Neurosci. 2020 Sep;22(3):229-239. doi: 10.31887/DCNS.2020.22.3/rmaldonado. PMID: 33162766; PMCID: PMC7605023.
- Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019 Apr;25(4):392-397. doi: 10.1089/acm.2018.0437. Epub 2018 Dec 13. PMID: 30543451; PMCID: PMC6482919.
- Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. doi: 10.7812/TPP/18-041. PMID: 30624194; PMCID: PMC6326553.
- Linares IM, Zuardi AW, Pereira LC, Queiroz RH, Mechoulam R, Guimarães FS, Crippa JA. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Braz J Psychiatry. 2019 Jan-Feb;41(1):9-14. doi: 10.1590/1516-4446-2017-0015. Epub 2018 Oct 11. PMID: 30328956; PMCID: PMC6781714.
- Henderson LA, Kotsirilos V, Cairns EA, Ramachandran A, Peck CC, McGregor IS. Medicinal cannabis in the treatment of chronic pain. Aust J Gen Pract. 2021 Oct;50(10):724-732. doi: 10.31128/AJGP-04-21-5939. PMID: 34590094.
- Portenoy RK, Ganae-Motan ED, Allende S, Yanagihara R, Shaiova L, Weinstein S, McQuade R, Wright S, Fallon MT. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain. 2012 May;13(5):438-49. doi: 10.1016/j.jpain.2012.01.003. Epub 2012 Apr 5. PMID: 22483680.
- Cameron C, Watson D, Robinson J. Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation. J Clin Psychopharmacol. 2014 Oct;34(5):559-64. doi: 10.1097/JCP.0000000000000180. PMID: 24987795; PMCID: PMC4165471.
- McCartney D, Suraev AS, Doohan PT, Irwin C, Kevin RC, Grunstein RR, Hoyos CM, McGregor IS. Effects of cannabidiol on simulated driving and cognitive performance: A dose-ranging randomised controlled trial. J Psychopharmacol. 2022 Dec;36(12):1338-1349. doi: 10.1177/02698811221095356. Epub 2022 May 30. PMID: 35637624; PMCID: PMC9716488.
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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