Ask the Pharmacist

Q) Last week you discussed the various forms CBD is available. Can you provide some information on how much I should take?

A) As we discussed last week, with the changing laws and the opening of the retail cannabis market, more people than ever are considering CBD as an option for unresolved chronic health issues such as pain, anxiety, insomnia and many others.

Given how long and widespread cannabis has been used, it is surprising there is a lack of scientifically proven recommendations when it comes to how much CBD one should start with and how to increase the dose if need be.

There are several factors that might impact the dose you choose to start with. These would include your age, general level of health, the degree to which the ailment is impairing your life and your established level of sensitivity to medications that you have trialed in the past. But in general, the following are decent guidelines for most people.

In the treatment of pain, there is a lot of evidence that CBD, with or without the addition of TCH can help many people for a variety of different types of pain. These include arthritis pain, the pain from multiple sclerosis, cancer type pain and neuropathies among others. In fact, there is a prescription cannabis spray called Sativex that has approval from Health Canada to be used in the treatment of cancer pain and seems to be effective for other causes of discomfort (note that Sativex is equal parts CBD and THC so it will cause some level of impairment.

A good starting dose for most people to try a CBD dominant product for pain would be 5mg of CBD twice a day. Give it a few days to work, as the pain modulating effects of CBD build up over time, so increasing the dose on a daily basis is not an accurate way to find the best/ lowest effective dose for you. After five days, if the pain relief is not sufficient, and side effects are minimal, consider increasing the dose by an additional 5 mg at each dosing interval. This can be continued until you achieve your goals (a tolerable level of pain), side effects become an issue or you reach a dose of 40mg per day. At this dose, if still ineffective, consider adding some THC at a dose of 1-2 mg either once or twice a day and increase this too, if needed, at weekly intervals until pain relief is felt or a maximum dose of 40mg of THC a day is reached.

Doses used in trials can go much higher than this but at doses past 40mg it would be wise to bring an expert/ doctor into the situation for further advice.

The other major reason most people report trying CBD is to help them cope with stress and/or anxiety. There is some degree of evidence supporting the use of CBD in the treatment of several different types of anxiety type such as generalized anxiety disorder, post-traumatic stress disorder and social anxiety disorder.

Interestingly, there is some evidence that THC may make anxiety worse which falls in line with the many pop culture references we have seen over the years where the actor smoking a joint becomes comically paranoid. For those with pre-existing anxiety, an increase in those types of symptoms would be far from humorous. Dosing suggestions in the treatment of anxiety vary from 25mg to 75mg of CBD per day, usually starting at a 5mg twice a day. Like pain, there are doses in the literature that have been used for anxiety that go all the way up to several hundred mg’s of CBD, but once again these should only be considered under the guidance of an expert.

While there are many other potential uses of CBD (behavioural symptoms of dementia, relief from the symptoms of inflammatory disorders such as Crohn’s…) time and space dictate that we’ll address just one other indication, sleep. Like the other disorders we have talked about, there is still insufficient evidence to wholeheartedly recommend trying a CBD product for insomnia. There is preliminary evidence that CBD can help with insomnia, REM sleep behaviour disorder and excessive daytime sleepiness disorder. In general, doses effective for improving sleep tend to be significantly higher than for other purposes. One should start with a low dose, but not too low as some experts believe that low doses of CBD can actually have a “stimulant” type of effect. Most suggest starting at 40mg, taken 30 to 60 minutes before bedtime, and slowly increase the dose over time if needed. Doses in trials have frequently gone beyond 300mg but once again, people wishing to use higher doses should seek professional advice.

In the next few years, a number of studies will be completed that will give us a far better read on just how effective CBD is for the variety of reasons people take it for. They will also provide us with more concrete guidelines when it comes to the dosages we should use. Until then, the doses suggested above are at least a decent starting point as you seek to improve your health.

For more information about this or any other health related suggestions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness destination.