Are there any strategies in which patients with chronic non-cancer pain can find their optimal dosing regimen without consuming high doses of THC?
As stated by the authors of “Brief Commentary: Cannabinoid Dosing for Chronic Pain Management” in the Annals of Internal Medicine, “We advocate a “start-low, go-slow” dosing philosophy, applied to both quantity and adverse effect profiles. We recommend starting with CBD extract, 5 to 10 mg twice daily, to be increased weekly over 1 to 2 months until pain relief is achieved. If CBD extract alone provides insufficient relief, we suggest adding THC, 1.0 to 2.5 mg, and slowly titrating up as needed.”
Can THC or CBD products be sold as dietary supplements?
No. “Based on available evidence, the FDA has concluded that THC and CBD products are excluded from the dietary supplement definition …[as per] the FD&C Act… Under that provision, if a substance (such as THC or CBD) is an active ingredient in a drug product that has been approved…, or has been authorized for investigation as a new drug…, then products containing that substance are excluded from the definition of a dietary supplement.”
CBD is legally sold in US supermarkets, pharmacies and convenience stores. CBD is also legally sold in Canada. So, is it legal to transport CBD across the US/Canadian border?
According to the Canada Border Services Agency website,the transporting of cannabis (in any form, including oils containing THC or cannabidiol) into or out of Canada without special authorization from Health Canada is a serious criminal offense.
Does pretreatment with CBD prevent the transient psychotic symptoms induced by THC?
According to a study by Bhattacharyya et al., pretreatment with CBD does diminish THC’s psychotic effects. This particular study involved 6 healthy volunteers who were given THC intravenously on two separate occasions – once with a placebo pretreatment and once with a CBD pretreatment.
Do patients treated with cannabis‐based medicines require special attention during the perioperative period?
Yes, they do, according to the European Pain Federation position paper. Some studies evaluating the effects of cannabis-based medicines “have suggested that there were antagonistic effects between propofol and cannabis, thus requiring increased propofol dosages for the induction phase. Cannabis use is also associated with increased sedative effects of anaesthetic drugs. Cannabis users may require higher dosages of analgesics for the post-surgery period.”