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While at times downplayed or overlooked, accuracy in dosing is emerging as a significant barricade to the acceptance of natural cannabis as a real medicine. Unfortunately yet understandably, the fact that precise dosing remains elusive is perfect ammunition for those promoting the perceived superiority of marijuana therapies produced by pharmaceutical companies.
Even where there is an acknowledgment that the actual plant is as or more effective than pharmaceutical cannabinoid extracts like Sativex – for an example see GW Pharmaceutical’s own research on the “entourage effect“- patients using the actual cannabis plant remain unable to quantify exactly how much medicine they are introducing into to their systems during treatment. No current method of administration is exempt from this shroud of uncertainty.
Independent testing commissioned by a variety of news outlets including The Cannabist, CBS and USA Today revealed that not one of the commercially prepared marijuana edibles analyzed contained the dose claimed on the label. The exposés were a stark reminder that proper cannabis edible preparation is indeed a scientific process requiring both efficient extraction and, even more difficult, precise decarboxylation. They were also an unsettling wake up call to patients relying on those dosage claims when pursuing treatment for serious medical conditions. In the quest for an accurate dose, those patients who prefer to smoke or vaporize face an even more complex web of variables heavily dependent on the composition of the starting material and the capabilities of the apparatus used to heat and inhale it.
While perhaps a mere inconvenience for recreational enthusiasts or patients who have mastered a treatment regime through trial and error, the inability to accurately dose can be a complete torpedo for the canna-curious patient or medical professional. Without the certainty we have come to expect and demand in a clinical setting, the would-be patient (perhaps someone who has never recreationally consumed cannabis) can become validly fearful of over- or under-medicating.
The lack of precise dosing platforms can also cause the skeptical to wonder whether the purported benefits of cannabis are merely anecdotal illusions promoted by people who just want to get high. These concerns are exacerbated from the physicians’ point of view. Consistency and reproducibility are cornerstones of prescription treatment. Expecting mainstream doctors to recommend that patients ingest an unknown quantity of cannabinoids opposed to other measurable, albeit often more dangerous, treatments is a tough ask.
A lack of reliable dosing is not only cited by doctors as a barrier to use but is a common basis for federal denial of proposed human trials, forming the crux of a vicious cycle that forever suspends cannabis in Schedule 1 purgatory.
The fog surrounding the efficacy of various administration methods exists not because the answers are particularly difficult to uncover or processes unduly expensive. Instead, the confusion and misinformation is a direct byproduct of cannabis’ long-suffering illicit status and underground existence.
Luckily, the expansion of medical cannabis legislation into an increasing number of states allows for greater technical exploration of these critical topics. For example, testing performed by a Boston-area laboratory, MCR Labs, is providing dosing guidance for patients who vaporize. The ISO-17025 accredited laboratory, owned and staffed by chemists with mainstream pharmaceutical roots, performed an initial round of testing to produce qualitative data demonstrating cannabis consumption rates when using a popular vaporizer, the Magic Flight Launch Box.
Understanding that patients would benefit from knowing how much THC was consumed with each inhalation and how many repetitions were needed in order to exhaust available THC, MCR devised a testing protocol to uncover the preliminary answers. During the experiment, a patient employed the slow draw method recommended by Magic Flight in its instructions and medicated with cannabis that had been tested to determine the starting amount of potential THC.
Progressive repetitions were performed and tested, resulting in data points for the maximum THC (defined to include decarboxylated THC and THCA) remaining in the sample after one and up through forty inhalations. The results of the testing, outlined in the chart below, show a steady linear consumption of maximum THC over the forty inhalations. A significant amount of degradation from THC to CBN, however, was also noted throughout the process.*
Initiatives like MCR’s are a critical first step in empowering patients with data that will allow greater control over medicating with the natural cannabis plant. Moreover, despite their controversial status within the cannabis community, there is no doubt that the development of cannabis-based pharmaceuticals benefits patients and the industry as a whole. The notion that cannabis can be incorporated into a regulated drug will, for many, validate the concept of cannabis as legitimate treatment option. More valuable for patients, though, is the byproduct of the pursuit of FDA approval for cannabinoid pharmaceuticals: reliable human trials demonstrating effective dosing ranges for a host of afflictions.
What patients have known to be effective for centuries is being confirmed by modern science. Given the means to accurately dose using the cannabis plant, patients can easily mirror therapies shown to be effective in pharmaceutical studies. Improving upon the current methods of preparation and administration and pursuing novel options that improve accuracy are the keys to bridging the natural/pharmaceutical divide.
*Additional testing scheduled at MCR will provide more concrete dosing advice applicable to the most popular vaporizers and will also explore important nuances of consumption including vaporization yield, rate of decarboxylation and degradation of THC during vaporization, as well as parallel studies related to the vaporization of CBD.
Photo Credit: Scott Churchill