Dr. Sulak’s Answer
Most people use the term “cannabis oil” to refer to an incredibly potent cannabis concentrate that is often made with an organic solvent, such as ethanol, and heat. The concentrate is very sticky and difficult to handle, so it is usually stored in an oral syringe for accurate dosing and easy administration. Most people take the oil by mouth, either swallowing it or allowing it to dissolve and absorb in the space between the gums and the inner surface of the cheek.
Most of these preparations are at least 50% cannabinoids by weight. People usually start with a very small dose, about the size of a grain of rice or less, which might deliver 20-50mg of cannabinoids, and gradually work up to several hundred milligrams per day.
I’ve heard numerous success stories from patients who have used this high-dose approach to treat cancer. Others have indicated success in treating neuropathic pain and autoimmune conditions using these very high doses after low doses did not work.
On Healer.com, I often emphasize the efficacy of very low doses of cannabis. I suspect that the physiologic effects of ultra-high dose cannabinoids are vastly different from low doses, and I sometimes consider an ultra-high dose trial in the rare cases when the low-dose sensitization program is not effective for my patients.
The average inhalation of smoked cannabis delivers 0.5-2mg of cannabinoids, depending on the starting material and smoking technique. That means you would have to take several hundred puffs of cannabis smoke in a single day to reach levels comparable to those using cannabis oil. I definitely don’t recommend it! For most people without respiratory problems, I think smoking 1-5 puffs per day is an appropriate dosage and effective delivery method that is unlikely to cause harm to the lungs or reparatory tract. Even better, I encourage my patients who smoke to try vaporizing or the “Switching from Inhalation to Tincture” program on this site.
While the use of high-potency cannabis oil is an exciting development in the world of cannabinoid medicine, I must emphasize that people who use these products are at much higher risk of adverse effects. I have seen patients who’ve been using cannabis for decades, and are very comfortable with the psychoactive effects, experience a very unpleasant delirium after testing a single rice grain of these products. By starting at a very low dose, for example a quarter rice grain, and very gradually increasing the dose over several weeks, most can avoid such an experience by gradually building tolerance to the psychoactive effects -but please be careful and work with an experienced provider!
Dustin Sulak, D.O.