CDA Maxims are clinical recommendations established from current best evidence and clinical experience of CDA Clinical Staff.
The following have been ascribed as CDA Maxims.
THC Oral daily dosing: 100mg /day*
CBD Oral daily dosing: 300mg /day*
THC Flower dosing: 2grams/ day*
*Less than 5% patients will require or respond treatment above the CDA maximums.
Every patient dose is clinically titrated; the exception is CBD cancer dosing (100mg/day).
Every patient dose is clinically titrated, using “start low and go slow” motto.
The dose where the “high” or “stoned” effects vary from patient to patient and can be from 1mg to 100mg orally, thus THC is clinically titrated for its effects.
Treatment with THC in Paediatric patients should be by experienced clinicians in severe cases only. Inhaled THC in children is virtually unheard of, and not recommend by CDA.
Clinically indicated vapourising temperature for medical flower ranges from 175 Celsius to 200 Celsius. If vapour contains smoke, it is too hot and combusting.
- Grind flower.
- Pack granules into the chamber.
- Set vape temperature.
- Inhale, slow and long for full inhalation, holding inhaled breath for 3 to 5 seconds.
- Wait 10 mins to see if desired symptoms have been controlled.
- If effects have not been achieved, repeat the process increasing inhalations, until
effective or causing side effects.
If effects have not been achieved, repeat the process increasing inhalations, until effective or causing side effects.
The ratio of THC to CBD in the oral THC product takes considerations such as:
- High THC and no/low CBD in THC Tolerant Patients, those with Strong Neuropathic Pain or Insomnia, versus,
- Balanced THC to CBD in the Elderly, THC Naïve Patients, Multiple Sclerosis, Spasm, Dyskinesia or Parkinson’s Disease, versus,
- Low THC and high CBD in Cancer, Resistant Epilepsy, Anxiety, Autism or mood disorders.
Anecdotal evidence has shown Inflammatory Pain and Fibromyalgia both respond to CBD, with around a 50% efficacy for inflammatory pain and up to 95% for Fibromyalgia. Oral CBD can be started at 10mg twice a day and increased weekly up to a maximum of 300mg/day. Doses are escalated weekly until symptoms are relieved or the patient experiences undesirable side effects; looking for the minimum effective dose. For those that are not responding to CBD alone, the gradual addition of THC can often give positive results. The average effective dose of both conditions is CBD 25mg to 50 mg twice a day.
Bolus CBD dosing for 3 to 7 days maybe be beneficial in inflammatory flares and other conditions.
THC initial dose should be 1mg. The onset of an oral dose THC can take 2hrs for effect. Four times a day dosing with a daily increase by 1mg per dose is a standard titration.
THC:CBD ratio can be considered as:
- High THC, with low or no CBD in Tolerant Patients or Strong Neuropathic Pain, and
- Balance or equal THC to CBD in the Elderly or THC Naïve Patients
Starting at 10mg twice a day, increase weekly by 10mg or more, to a maximum of 300mg/day or anxiety relieved or side effects; looking for the minimum effective dose. Anecdotally, Average effective dosage is 25mg to 50mg twice a day.
Always start with 1mg of THC orally.
Oral titration can be more rapid but remember oral doses can take 2 hrs for effects.
Using the THC:CBD ratio General guide, “Treat the patient – not the guideline”. Noting The ratio of THC to CBD should be High THC and Low CBD for Tolerant Patients, versus Balanced THC to CBD for Elderly or THC Naïve Patients.
The THC:CBD ratio is recommended at 1:1, as this reduces the chance of anxiety or other side effects, and, anecdotally can produce a more pleasant sedation.
CBD dose escalation is weekly linear by 10mg or double previous dose until epilepsy relieved or side effects. Effective dosage 50mg-500mg BD.
CBD dosage is currently considered as 50mg BD without titration. For symptom management THC orally titration starting at 1mg four times a day and every 2 hours as required is recommended. Many study protocols have THC 5 to 20mg at night regularly as a treatment, which can be considered by the physician and patient.
CDA general rule of thumb: “Treat the patient – not the guideline”. Make considered decisions about patient management and continuously re-evaluate as patient response may be different for different cannabinoids, terpenes, and products. Adjust treatment to the patient response.
Start low and go slow – it is easier to give more medication to a patient, than it is to take medication out of a patient.