Practical considerations in medical cannabis administration and dosing
Abstract
Cannabis has been employed medicinally throughout history, but its recent legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such treatment. With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable. In this article, the authors endeavour to present concise data on cannabis pharmacology related to tetrahydrocannabinol (THC), cannabidiol (CBD) et al., methods of administration (smoking, vaporisation, oral), and dosing recommendations. Adverse events of cannabis medicine pertain primarily to THC, whose total daily dose-equivalent should generally be limited to 30mg/day or less, preferably in conjunction with CBD, to avoid psychoactive sequelae and development of tolerance. CBD, in contrast to THC, is less potent, and may require much higher doses for its adjunctive benefits on pain, inflammation, and attenuation of THC-associated anxiety and tachycardia. Dose initiation should commence at modest levels, and titration of any cannabis preparation should be undertaken slowly over a period of as much as two weeks. Suggestions are offered on cannabis-drug interactions, patient monitoring, and standards of care, while special cases for cannabis therapeutics are addressed: epilepsy, cancer palliation and primary treatment, chronic pain, use in the elderly, Parkinson disease, paediatrics, with concomitant opioids, and in relation to driving and hazardous activities.
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Two publications and one poster addressing dosing of CBM have been identified.
“Two publications and one poster addressing dosing of CBM have been identified.130–132”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [130]
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- Authors
- MacCallum, C. A., & Russo, E. B.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- MacCallum, Caroline A.
- Russo, Ethan B.
- Venue
- European Journal of Internal Medicine
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 49
- Pages
- 12-19
- ISSN
- 0953-6205 (ISSN-L)
- OpenAlex
- W2781755317
- Cited by
- 663
- References
- 77
- Citations by year
- 2026: 50 · 2025: 59 · 2024: 79 · 2023: 91 · 2022: 108 · 2021: 119 · 2020: 78 · 2019: 58 · 2018: 21
- FWCI
- 8.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- medical cannabis, tetrahydrocannabinol, cannabidiol, Sativex, Epidiolex, cannabis pharmacology, oral administration, dose titration, adverse events, drug interactions, epilepsy, chronic pain, Parkinson's disease, elderly patients
- MeSH terms
- Cannabidiol, Cannabis, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Combinations, Humans, Inflammation, Pain, Dronabinol, Medical Marijuana
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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