How much CBD should you take for chronic pain? An international task force has issued guidelines

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We’ve known for years that CBD and THC are effective treatments for chronic pain (see, for example, JAMA and the National Academy of Sciences). The real question has always been about dosage: How much do you take, how often, and for how long?

We got an answer this month from the Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain. They’ve issued treatment guidelines aimed at doctors because, they say, too many of them simply don’t know how to prescribe cannabinoids.

“There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen,” says task force member Alan Bell, MD, of the University of Toronto. And because they “believe it’s extremely important to bring [medical cannabis] to patients,” they’ve issued the following protocols based on patient characteristics:

A routine protocol consists of:

  • starting with a 5 mg oral dose of a CBD-predominant product twice daily;
  • titrating as needed by 10 mg every 2 to 3 days until the patient reaches their treatment goal, or 40 mg daily;
  • adding (if needed) 2.5 mg of THC; and
  • titrating by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg THC is reached.

A conservative protocol, for the frail and older adults, people with multiple conditions or on multiple meds, and/or those with mental health disorders, consists of:

  • taking a 5 mg dose orally of a CBD-predominant product once daily;
  • increasing as needed by 10 mg every 2 to 3 days until the patient reaches their treatment goal, or 40 mg daily;
  • adding (if needed) 1 mg THC; and
  • increasing by 1 mg every 2 to 7 days until a maximum daily dose of 40 mg THC is reached.

A rapid protocol, for patients with severe pain or functional impairment and/or have taken medical cannabis before, consists of:

  • starting with once- or twice-daily oral doses of a THC-CBD product that contains 2.5 mg to 5 mg of each cannabinoid; and
  • titrating by 2.5 mg to 5 mg of each cannabinoid every 2 to 3 days until the patient reaches treatment goals, or a maximum THC dose of 40 mg per day.

Bell told Medpage Today that they didn’t set a maximum treatment age as many clinicians reported seeing the best results among geriatric patients. And they didn’t set a minimum age for either CBD or THC as many pediatric patients are given very high doses of CBD for epilepsy, and they simply couldn’t agree on what that age should be for THC.

Medical cannabis isn’t for everyone: Pregnant and breastfeeding women and people with psychotic disorders shouldn’t be given cannabinoids. And they cautioned against mixing medical cannabis with anticoagulants, immunotherapy, or the epilepsy med clobazam.

They suggest you take cannabinoids orally because of “ease of dosing and safety.”

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