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How to start Medical marijuana information
alz+
Posted: Thursday, September 4, 2014 11:52 AM
Joined: 9/12/2013
Posts: 3579


First link I found on dosage. Women and elderly and compromised always start any medication or herbal supplement at low dose. 

  

http://greenbridgemed.com/2014/03/14/dr-allan-frankels-early-version-initial-dosage-and-administration-guide/ 

  

  

download the pdf 

  

http://greenbridgemed.com/wp-content/uploads/kalins-pdf/singles/dr-allan-frankels-early-version-initial-dosage-and-administration-guide.pdf 

  

   

  

  I could not copy / paste the article...but found Dr. Frankel an Internist with 35 years experience developing guidelines for prescribing (and the various forms cannabis comes in) to be solid and helpful information.  


DR ALLAN FRANKEL’S EARLY VERSION INITIAL DOSAGE AND ADMINISTRATION GUIDE

 

I. GENERAL:
The cannabis plant contains over 100 different cannabinoids around 150 terpenes and perhaps another 100 or so other Amide molecule and flavonoids. Precise dosing of these components, accompanied by comprehensive studies, is the only way we can move forward scientifically. This guide is our first attempt to describe our dosing and administration experience with cannabis medicine.
II. THE MOLECULES OF CANNABIS
CANNABINOIDS
The most well known cannabinoids are THC (Tetrahydocannabinol) and CBD (Cannabidiol). Additional cannabinoids such as THCV, CBC, and CBG are being studied internationally, which clearly demonstrate the huge clinical impact they are having. THC is the most psychoactive cannabinoid in the plant while CBD is non-psychoactive and even counteracts much of the psychoactive effect of THC. The actions of these two cannabinoids will be discussed below.
TERPENES
Terpenes are essentially small cannabinoid molecules that are found in nearly all plants we know. The terpenes and related flavonoids are the molecules that give cannabis it’s taste, scent and character. In addition, many terpene molecules are active at several central nervous system receptors, receptors throughout our bodies and contribute to many important clinical benefits we achieve from cannabis. We all generally get a good feeling from smelling a lemon. This is due to a terpene called limonene found in lemons and other citrus fruits and also present in cannabis. All the various cannabinoids, terpenes, flavonoids and other alkaloids combine to give us the effects we desire.

Forms and Delivery
The methods by which cannabinoids and their associated molecules are processed into a deliverable form of medicine are either through whole plant extraction or via molecular/synthetic means.
The primary delivery methods of such forms of cannabis medicine are:
• Inhaled
• Ingested
• Sublingual/Oral Bucal
• Topical (either systemic or dermal)
• Rectal
For the purposes of this guide, we will be presenting information on “whole plant extractions” and the dosing of whole plant extracted CBD and THC via the sublingual/oral buccal method.
The dosing of whole plant extracted CBD and THC is VERY different from the dosing of molecular/synthetic forms of cannabis medicine. As an example, for anxiety, as little as 2 mg of whole plant extracted CBD is quite effective, but in Europe there are numerous references to using hundreds of mg of molecular/synthetic CBD to achieve a similar result. So, when reading various doses, be certain to know what form of cannabis medicine is being referenced.

III. THE PSYCHOACTIVITY SCALE

A physician always explains to a patient the indications and effectiveness of a medicine and the side effects that may be associated with such medicine. With the dosing of cannabis medicine, the degree to which a patient may experience psychoactivity, or “stoniness”, is critical to convey to the patient. A ten point scale has evolved where a score or “PA” (Psychoactive) of 1 will have nearly zero psychoactivity, while a score of 10, means significant psychoactive effect.
Physicians should instruct patients to use the psychoactive number as a guide to how “altered” they will feel. As always, there are a number of individual-to-individual differences, but the general rules seem to be holding true. It is important to remember, that this is not a scale of “effectiveness” for any given illness or patient, but simply a measure of expected psychoactivity.

III. ADMINISTRATION OF EXTRACTS (PLEASE SEE PRODUCT SECTION BELOW FOR DETAILS OF EACH EXTRACT)
It is always encouraged to start with a single spray of extract. The first dose should always be taken when in a comfortable environment where driving will not be required. The patient should swallow FIRST, before administering the extract. This is to dry the mucosa and help the extract maximally absorb. The extract should be sprayed under the tongue and using your tongue, GENTLY spread the extract on the soft pink tissue in your mouth. Be CERTAIN to only do one or two “swipes” around your mouth. If too much saliva is generated the medicine will be diluted and then swallowed and much of the benefit lost. IF a second or third spray is indicated, wait one minute in between sprays. (Multiple light coats are better than one heavy coat)
MAXIMUM BENEFIT of sublingual dosage is 45 minutes. Do not eat or drink anything for 15 minutes after administering the sublingual dosage. Duration of action is up to 4-8 hours.
If more than six sprays is required twice daily or more, please consult with your physician to consider alternative ways of using the extracts.
With rich CBD extracts, increasing the dose is very safe and generally entirely free of side effects. With the rich THC extracts, EXERCISE CAUTION!! It is strongly advised to take a single spray and wait 90 minutes before taking a second spray.
It is possible and often desirable to mix the rich THC extract with the rich CBD extract, for example taking one of each sprays at a time. Make 1 spray changes every day or two as tolerated.

INITIAL DOSING RECOMMENDATIONS FOR VARIOUS DISORDERS

The dosing presented herein is to be considered only a rough INITIAL guide. Although a reasonable amount of clinical data supports this dosing, it is still based upon a small but growing body of experience, which now needs formal documentation. This section will be frequently updated, as more information is collected.

Anxiety/Insomnia/Panic Disorders

EXTRACTS SUGGESTED: #1, #2 and#3 are the most common extracts to be used in these disorders. There are however, as always, exceptions. A patient with very good THC tolerance can often tolerate a #5 or 1:1 CBD:THC very well and treat both their anxiety syndrome and pain with a single extract. For others, little THC is tolerated and for many, more THC at night and less during the day is often a good approach. For example, perhaps using a low psychoactive extract such as #1 or #2 during the day will rarely cause much psychoactivity. This same person might do better with some additional THC at night.
Generally 2 mg (1 spray) of a rich CBD extract taken every 8-12 hours as instructed above is sufficient. Most patients do fine with 4 – 8 mg every 24 hours, but it is fine to add one or two sprays or 2-4 mg as needed throughout the day. THC is generally poorly tolerated in patients with anxiety but there are MANY exceptions. Sometimes, in order to control anxiety or panic disorders, more THC is required than expected. In general, if a patient is started on a high ratio CBD extract and is not doing well as the dose is slowly increased, it is often required to add more mg of THC to the daily regimen.

 

 

 

 

- See more at: http://greenbridgemed.com/2014/03/14/dr-allan-frankels-early-version-initial-dosage-and-administration-guide/#sthash.QKXims0b.dpuf

 

Ha ha! My vision so poor today and the font so pale  did not know I DID copy and paste the article 3 TIMES! Another First. Tah dah!