Decoding the Dose

“Decoding the Dose:   Dose One”
by Emily McSherry
Originally published in the March 2017 issue of Fete Magazine
​
Cannabis has been used for its medicinal properties for thousands of years, but it is only in the past two decades that scientists have researched the plant enough to quantify its healing properties.  The advancement of science has rewarded us with a society that expects precision.   But, sometimes, estimation breeds success.  It is the hypothesis that reaps results.
Last month I informed you of the numerous cannabis related bills floating around our state capitol.  One of these bills, The Compassionate Care Act, is progressing through both the House and Senate subcommittees.  Objections and concerns have been expressed by stakeholders and legislators.  One concern repeated by several legislators is the fact that medical cannabis does not have a prescribed dose. 
Welcome to Dosing 101.
Physicians who prescribe pharmaceutical medications are required to comply with regulations and requirements set forth by the Food and Drug Act, Controlled Drugs and Substances Act, Narcotics Safety and Awareness Act, and the Drug and Pharmacies Regulation Act.  All of this is set forth to protect American citizens because, while drugs can be lifesaving, they can be very harmful.  Yes, indeed, drugs are bad.  Drugs are the leading cause of accidental death in this country.  Over 100,000 people die each year in American due to improper drug use or drug overdose.
No one has ever died due to a cannabis overdose.  Never.  Not ever.  Not once.
This powerfully simple fact makes the quodlibet for cannabis dosing irrelevant.  We have become accustomed to being given exact dosages based on weight, genetic factors, and lifestyle habits.  In many cases, dosing, while never perfect on a case by case basis, does provide panoptic success.  This success is seen mostly in common ailments that are easily treated and cured.  Where dosing requirements flounder is in rare, chronic, and debilitating conditions and diseases.  These are often the ailments for which there is no cure.
I have epilepsy.  There is no cure for epilepsy.  Thankfully it is one of the conditions listed in the Compassionate Care Act (as well as in the Put Patients First Act).  If this legislation were to be passed, a person with epilepsy would be able to receive a recommendation from their physician that would allow them to treat their condition with medical cannabis.  As anyone with epilepsy will tell you, there is a trial and error sequence for finding the correct drug at the correct dose to control seizure activity.  When you finally find the correct dose, your epilepsy changes and you are back to square one.  This is known amongst epileptic patients as “The Medicine Game”.   I have had four neurologists.  Every time that my medicine would need to be adjusted, they would each say, “you know how it goes…play around with the dose in combination with your other medicines to see what works best for you.  Be safe.” 
You see, with debilitating conditions the idea of dosing is relative to the individual because you are looking for the dose that will afford you the highest-level quality of life with the lowest amount of side effects.  You are not dosing for a cure.  (Well, sometimes you are as with the case with cancer, but we will talk about that another time.)
It is impossible to predict which dose, strain, and delivery of cannabis will prove successful for each patient.   The assessment of the efficacy of cannabinoid based medicine must be customized to the individual.
I hope you will enjoy me for next month’s article “Decoding the Dose:   Dose Two” in which we will delve deeper into the dosing of cannabis.