‘Microdosing’ can provide just enough cannabis for medicinal effects
April 10, 2019
For many of us who came of age in the 1960s and 1970s, smoking pot (also called marijuana or cannabis) was an integral part of the social scene. But whether we never touched the stuff, gave it up decades ago or still maintain a relationship with the plant, many boomers today are eagerly exploring cannabis in its various forms to address a whole host of conditions, including chronic pain, anxiety and insomnia.
Older adults, particularly those over 65, represent one of the fastest growing segments of the cannabis consumer market, according to New Frontier Data, a leading cannabis market research firm. Medical marijuana is now legal in 33 states and the District of Columbia; 10 states also permit recreational use.
‘Microdosing’ Cannabis for Medicinal Benefits
Still, many people who could benefit from cannabis are reluctant to do so out of concern over “getting high.” This aversion to intoxication is one of the factors driving the meteoric popularity of hemp-based cannabidiol (CBD) products, which contain only trace amounts of tetrahydrocannabinol (THC), the psychoactive compound in cannabis. Yet CBD alone is considered to be less effective for medicinal purposes without the presence of THC.
The good news is that it takes very little THC to safely achieve significant therapeutic effects. This is the rationale behind “microdosing,” an approach to using medicinal cannabis in very small doses to achieve medicinal benefits without the high.
Dr. Dustin Sulak, a Maine-based osteopathic physician who has treated thousands of patients with medical cannabis, is a strong advocate of microdosing and believes it is especially helpful for older adults.
“Microdosing involves using cannabis at a dose below that which would cause impairment, either to relieve symptoms or simply as a tonic, to promote health and prevent disease,” Sulak says. “Basically, my entire practice involves treating patients through microdosing. They are looking for relief, not to get high.”
Microdoses Vary By Individual
Sulak emphasizes that what constitutes a microdose will vary from person to person, based on physiology, the type of cannabis product selected and many other factors. He typically advises his patients to choose a cannabis product that contains a specific ratio of THC to CBD, depending on their condition.
Sulak also recommends using an oil or tincture administered under the tongue, which is broadly effective and well tolerated. He finds this is the best method to achieve very specific dosing, down to the smallest increments.
Patients start with a dose that has no effect, then gradually increase it until a notable positive effect is observed. If a higher dose causes dizziness or sleepiness, it is an indication that the ideal microdose has been exceeded. The adverse effect will be mild because the extra dosage is so small.
Cannabis for Acute and Chronic Conditions
Dr. Jordan Tishler, a cannabis physician and instructor of medicine at Harvard with a practice in Boston, also treats his patients for pain and other chronic conditions using very low doses of THC. For Tishler, the preferred mode of delivery for fast treatment of acute conditions, such as migraine headaches, is inhalation of very small quantities of vaporized flower — a part of the cannabis plant. Vaporization is achieved using a technologically sophisticated portable convection device, better known as a vaping device.
For chronic conditions that need ongoing maintenance, including amyotrophic lateral sclerosis (ALS), multiple sclerosis and Parkinson’s disease, Tishler’s treatment plan may center around low-dose gummy chews.
Dr. Laurie Vollen, a cannabis physician in the San Francisco Bay Area, also recommends vaping very small, controlled quantities of flower. But she cautions patients to avoid disposable vape pens, which can contain toxic chemicals and have not been proven clinically safe over long-term use. Vollen teaches her patients, whose average age is in the 70s, how to use a vaporizer in a special “Inhalation 101” course she developed.
Before Tishler’s patients go to a dispensary, he counsels them to avoid certain products, including disposable vape pens and cannabis lotions and balms for the skin, which are costly and, in his opinion, of questionable utility. Flower is the most economical form for purchasing cannabis, so it has the added value of being a highly cost-effective way to manage your medicine, he says.
Sulak points out that cannabis is an excellent anti-inflammatory and pain reliever. And because the only possible adverse effects from properly microdosing cannabis are mild, transitory and easy to notice, it is much safer than over-the-counter drugs like ibuprofen and acetaminophen, which can quietly damage the gastric lining, kidneys and liver.
Tishler says it’s the THC in cannabis that works on pain. And he contends that the psychoactive side effects from THC are not something to be feared. “There are plenty of medications, including opioids and even antibiotics, which affect our mental state. Those are just side effects that have to be managed,” he says.
One positive aspect of a cannabis-induced mental state is how it influences the “affective component of pain,” or how we relate to it psychologically and emotionally. As Sulak observes, “Patients report that not only is the pain a little less intense, but it is less bothersome — that it doesn’t get in their way anymore.”
Cannabis for Sleep Issues
Sulak also notes that he gets excellent results using cannabis to treat sleep disorders in all ages, but particularly in older adults.
“Cannabis isn’t a hypnotic,” he explains, “so it won’t knock you out like pharmaceutical sleep aids. But it will mitigate the symptoms that are disturbing sleep, like pain or discomfort, anxiety, excessive mental activity or restless limb syndrome. And one can be more liberal with the dosing before bedtime, because once a person is asleep, any impairment won’t matter. Yet, like any sleep agent, there is a potential risk of falling that needs to be taken into account.”
He says he’s has also had extremely good results using cannabis to treat “sundowning,” a state of confusion and agitation some people with dementia experience in the late afternoon and evening.
Sulak believes a small daily dose of cannabis can work as a kind of tonic for general wellness, too, improving resilience to stress, decreasing inflammation and promoting healing. “It may even be more powerful for keeping people healthy than it is for treating people with severe conditions,” he says.
Find What Works for You
Vollen, Sulak and Tishler concur that CBD without some measure of THC is not an effective medicine. According to Sulak, “A lot of people are misled because they think they are trying cannabis with an over-the-counter CBD product, and they are disappointed when it doesn’t work. CBD is a great medicine but it’s very weak and people usually need a lot of it to address their symptoms, which becomes cost-prohibitive. So they try a little and then give up. My biggest piece of advice is to find cannabis-derived CBD which contains some THC.”
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