How to “Start Low and Go Slow”— Determining Dosages

What is CBD?

CBD, or cannabidiol, is a non-intoxicating cannabinoid derived from hemp—a close “cousin” of cannabis or marijuana. Non-intoxicating means it will not get you high but may help with several issues such as pain, sleep disturbances, inflammation, depression, anxiety and may support the nervous, digestive, immune and cardiac (heart) systems. Side effects are relatively uncommon but may include dry mouth, diarrhea, fatigue, sleepiness and changes in appetite. Always talk to a knowledgeable doctor and pharmacist if you are considering using CBD—it may interact with your current medications.

Starting Doses

We generally recommend that you “Start Low and Go Slow” meaning that you start with the lowest dose possible and, while keeping track of your responses, increase very slowly until you achieve your desired health goal.

Science is not yet at the point where we can say “Start with x mg of CBD”. That will take more research to determine. When we recommend “Start Low and Go Slow”, it is a slow, safe and steady way of determining your best possible dose– but it depends on your patience and your careful observations of how you are responding to the CBD. The more complete rationale for this approach is described later in this article and the “Start Low and Go Slow” approach has shown itself to be very useful for many people. It is a safe way to determine your best dose– and it can save you money both in the short and in the long run.

The Lowest Dose Possible

This depends to some extent on your chosen “delivery system” for the CBD—in other words, it will depend on whether you intend to use oils/tinctures, edibles, capsules or vapes. As an aside, vapes are not generally recommended except in acute (sudden) conditions such as sudden pain.

· If you are using oils or tinctures—the lowest dose possible is based on how much you can accurately measure using a dropper. These are usually 1 mL or about 20 drops. (For reference, a teaspoon is about 5 mL so a teaspoon would be equivalent to 5 dropperfuls or 100 drops.)

· If you are using capsules or geltabs, the smallest dose available usually is 5 mg. These cannot be easily divided.

· If you are using an edible that can be cut I half or quarters, to determine the amount in that half or quarter, divide by 2 or 4.

· Some vape pens can be adjusted to provide a measured dose.

· With topicals, start out with a pea-sized amount and slowly increase the amount.

o Topicals tend to work a bit more quickly—you should know if it is working within about 20-30 minutes. After that point, if the pain is still there, use a slightly larger amount (bean-sized, for example). Most people will get relief when the amount of CBD used is about 10-50 mg, depending on the area covered, the severity of the pain and the amount of CBD in the product. It is important to understand that with many topicals, you won’t know how much CBD you are using because it can be difficult to accurately measure the amount of a gel, balm or lotion you are using.

Common Starting Doses

With oils and tinctures, you have a wider range of possible starting doses—it would be reasonable to start with 10 drops (or, in the example above, 1.67 mg. [ 10 x 0.167 mg/drop]). If the oil/tincture bottle contains a total of, say, 500 mg (or 16.67 mg/mL and 0.833 mg/drop). A reasonable starting point may be 1-2 drops. Edibles can give you a similar range of starting doses– it may be easiest to use an edible that you can easily divide into 2, 3, 4 or more equal-sized pieces.

Remember, if you are a larger person, you may need more CBD to achieve effectiveness, but the same overall principle applies– start low and go slow!

Topicals can be a bit more difficult because most commonly, the total amount of CBD is provided as the total amount in the entire container. As described above, start with a pea-sized amount of a topical and slowly increase the amount– from pea-sized you may go to bean-sized and then the size of a small coin (eg. an American dime) to a larger coin (eg. an American quarter).

Some physicians may recommend a slightly higher starting dose—5 mg. If you choose to start at about 5 mg, in the above (boxed) example with 0.167 mg/drop, you would be starting with 30 drops or 1.5 dropperfuls. (5 mg ÷0.167 mg/drop = 29.94 drops or ~30 drops= 1.5 dropperfuls).

Why might you choose a higher starting dose? One good reason (as opposed to rushing through the process!) would be that you are a bigger person. Dosages are often calculated by weight because larger people often need more of a substance to experience an effect. If you are a larger person (over 100kg or 220 pounds), it is reasonable to start at a slightly higher starting dose– from about 5-10 mg. The larger a person you are, the more CBD you may need to be effective.

Another rational reason to start with a higher initial dose is, for example, your depression, anxiety, or sleep issues are significant factors in your life. This is understandable, but the other variables—mainly, how your body will respond to CBD—can’t be predicted. So, even if you have a significant issue you are trying to address, starting at a low dose (eg. 5-10 mg) will allow you to control the process more, find YOUR best dosing regimen….AND save you money in the long run. If your healthcare provider suggests a starting dose—go with their advice! They know you better than we do and can provide a reasonable starting dose based on your condition, your medical history, your current medications, and your weight.

The rationale for “Going Slow”

Admittedly, this can be a long process to find YOUR “best” dose. However, it is recommended for several different reasons.

· Currently, there is not enough solid research to give more specific guidelines.

· Each person can react differently to the same dose. This can vary because of weight, age, other medications, and how significant your health issue is. It can also vary because individuals may process the same amount of CBD differently.

CBD is processed by the liver and there are wide genetic differences between how different livers may process the CBD. Some people, for example, may even have what are known as “paradoxical” responses to CBD—instead of helping them sleep, for example, CBD may keep them awake! This happens most commonly in my experience in those with a genetic predisposition to alcoholism. The body’s biochemistry is a marvelous thing—but there are still many unsolved questions. Using this process you can find out for certain if CBD can help you—and find YOUR best dosing without any potential adverse effects.

· The common adverse effects are relatively uncommon and relatively minor. Still, we want to ensure that you minimize those adverse effects while maximizing potential benefits.

· Overdosing is very uncommon—most studies have indicated that people can take up to 1500 mg of CBD per day safely. Overdoing CBD may result in extreme drowsiness, an upset stomach, nausea or diarrhea, but there are no records of any deaths associated with CBD (as long as you don’t try to drive or climb a mountain!).[1] However, overdosing is obviously something you need to avoid.

· We still don’t know enough about the interactions CBD may have with prescription medications.[2] CBD, along with every other substance you ingest, is processed (detoxified) by a set of liver enzymes known as the CytP450 (or just P450) group. There are two phases in the liver’s detoxification process. During these processes, one substance may increase one subset of enzymes that results in either the substance being MORE or LESS active. Your doctor—and especially your pharmacist, can help you learn what the potential interactions of CBD and YOUR medications might be and adjust accordingly. I can’t emphasize enough that you need to communicate fully with BOTH your physician and your pharmacist if you are currently taking other prescription medications, especially those that come with the “Grapefruit Warning” because CBD and these medications affect an important member of the P450 group—CYP3A4 and can result in significant interactions.[3]

· This approach can save you money.

How to “Go Slow”

Here’s the approach I recommend.

· First, write down your health goals—this will allow you to more objectively determine if those goals have been met. Leave room for any adverse effects you may experience—and for any benefits you are experiencing!

· Given your “delivery system”—oils/tinctures, edibles or capsules—start with the low dose and wait at least an hour and assess—are you feeling better, the same or worse? Are there any signs that the CBD is working at this dose—are you feeling less pain, are you drowsy, are you feeling anxious? If you are not experiencing anything, repeat the same dose 3 times a day for at least 4 days. Some recommend waiting at least a week, but 4 days seems a good compromise between truly assessing your response and waiting so long you either give up or jump to a higher level too fast.

· After this initial assessment period, if you feel you need to increase the dose, try to increase it by no more than 1.5 times. So, if your initial dose was 5 mg, when you increase, try not to take more than 7.5 mg. This is not based on research—it is based on clinical experience. Again, a lot of this will depend on your choice of oils/tinctures, edibles or capsules. It is most easily accurately done with tinctures or edibles, but the choice is yours.

· Take this slightly increased dose for at least 4 days again and record your responses.

· Repeat as needed until you find your best dose.

Final Thoughts

CBD is a very safe substance, and many can benefit from its use.[4] There are no “miracle” drugs out there, but CBD may very well be something you can use and benefit from. Using this approach will allow you to find your best dose while minimizing any adverse effects and interactions with your medication(s). It is VERY important that you find a knowledgeable physician (and pharmacist) to help you through the process, particularly if you are taking other medications. Also, make sure to ask your physician if – once you find your “best” dose of CBD—if you can try decreasing any other medications that may be addressing the same issue.

References

[1] https://www.openaccessgovernment.org/take-too-much-cbd/71920/#:~:text=The%20general%20consensus%20among%20professionals,disorienting%20side%20effects%2C%20not%20death.

[2] Landmark CJ, Brandl U. Pharmacology and drug interactions of cannabinoids. Epileptic Disorders. 2020 Jan;22:S16-22.

[3] Brown JD, Winterstein AG. Potential adverse drug events and drug–drug interactions with medical and consumer cannabidiol (CBD) use. Journal of clinical medicine. 2019 Jul;8(7):989.

[4] Iffland K, Grotenhermen F. An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies. Cannabis and cannabinoid research. 2017 Jun 1;2(1):139-54.