Explaining titration and dosing in medicinal cannabis

Whether you’re an experienced medicinal cannabis patient or prescriber, or just starting your journey, we know that titration and dosing can be complicated. The answer to “how much should I take” is often one that is not as straightforward when compared to conventional medicines.

While it may be complicated, it is incredibly important to understand dosing and titration in order to provide patients with repeatable and reliable results when they need it most. This article will explore the ways that patients can evaluate the active ingredients contained within dried cannabis flower and best practices for titration. 

Challenges with medicinal cannabis

Medicinal cannabis is available in a range of product formats and corresponding administration methods. Between these different formats there is significant variation in onset time, bioavailability, duration and ease of dosing. Products that are easiest to accurately dose like oils and capsules often don’t have the rapid onset time and high levels of bioavailability when compared to dried cannabis flower. These reasons may contribute to why dried cannabis flower currently makes up the vast majority of products prescribed today in Australia.

Medicinal cannabis flower, however, can be challenging to accurately dosing and titrate due to some key factors. These can range from determining the weight of cannabis flower administered, variance in cannabinoid profiles between flower strains, different options for temperature during vaporisation and length and depth of breath when inhaled. All of these factors may make it difficult for some patients to find and adjust  their optimal dose. 

What is titration? 

In the simplest terms, titration is the process of gradually increasing the dose of a medication over time until the desired result is achieved. We recommend that patients work closely with their healthcare professional during this initial titration process. 

We always recommend to patients and healthcare professionals to follow the “start low, go slow” approach to titration as outlined by the Therapeutic Goods Administration (TGA). Patients should start with a low dose of medicinal cannabis and gradually increase this amount over time until they find the dose that achieves their optimal therapeutic outcome. 

It should be noted that dosing is highly individualised and patients should work closely with their healthcare professionals to determine the optimal dosing schedule. An optimal dosing schedule is one where medicinal benefit is maximised within the individual patient’s context. Body composition, targeted symptoms and experience with cannabinoids will all impact the therapeutic effect of medicinal cannabis, so one size truly does not fit all. 

We aim to support our patients by providing them with tools to better evaluate how their medicinal cannabis works for them. To support our patients’ titration journey we have developed a patient dosing diary to keep track of the dose administered, time and effect on symptoms in order to fulfil a titration schedule. 

Email us to receive a copy of Kind’s Patient Dosing Diary.

How can patients measure their medicinal cannabis flower dose? 

While titration is important, it is a relatively well defined process by which patients can gradually increase the dose administered over time. However, what is especially difficult and all too important in this process is accurately defining the dose of active ingredient administered.

When comparing oil to dried cannabis flower, the challenges in deciphering dosages becomes apparent. For example, an oil product may contain 100mg of CBD per ml which makes it extremely easy to identify the volume of oil required to administer a designated dose of the active ingredient. In this case, if you wanted to administer 20mg of CBD you would take 0.2ml of oil. This process is relatively straightforward. 

With dried cannabis flower it becomes slightly more complicated to identify what value (weight) of flower to administer to achieve a defined THC and/or CBD value (mg). While most flower products identify the total amount of cannabinoids in a given container they may in some cases also be classified as a percentage value. 

In order to determine what weight would be required to achieve a specific dose of an active ingredient, a patient needs two things; a scale and a calculator. If a patient already has a sense of what gram value of cannabis flower works for them and wants to determine the approximate total cannabinoid value contained within it, this formula can be followed: 

1. First weigh the amount of flower and define its value in grams (g) 

2. Multiply this value by 1,000 to determine the total weight in milligrams (mg). For example, if the weighed amount is 0.2g:
(0.2g*1,000 = 200mg of dried flower)

3. Next, multiply the weight in milligrams by the percentage of cannabinoid (usually THC or CBD) as labelled on the packaging. For example, in medicine labelled 17% THC:
(200mg*0.17 = 34mg of THC within 0.2g of a 17% THC flower)

4. This reveals the approximate total cannabinoid active amount in milligrams within the given weight of dried cannabis flower

‍Our patient dosing diary walks you through this process visually as shown below:

Alternatively, if patients want to determine how much flower to administer to achieve a predetermined cannabinoid value this formula can be followed:

1. Identify the desired cannabinoid value in milligrams
(i.e. 50mg THC)

2. Identify the percentage strength of the cannabis flower (available on the label)
(i.e. 20% THC)

3. Identify the total amount of THC contained within 1g of flower by multiplying the weight by percentage strength
1000 [1g weight in mg] * 0.2 [20% THC] = 200mg THC per 1g of flower 

4. Take the value of THC per 1g flower and divide it by your desired dose
200/50 = 4

5. Divide 1g by this value to determine the flower weight necessary to achieve 50mg
1/4 = 0.25g is equal to 50mg THC

Conclusion 

While this process may seem daunting for new patients or prescribers, it is important to understand active ingredient dosing of medicinal cannabis flower. Once this has been understood by patients, it enables far greater accuracy in evaluating and tracking differences between dose amounts and strain strengths. We’re happy to help any prescriber or patient learn more about dosing and titration, so please reach out should you have any questions.