Product and dosage suggestions for high tolerance?

by HelloMD

I went to a dispensary over the weekend and got two vapes. One was 110mg (I believe) of CBD for my lower back pain and the other was a little stronger at 250 mg. The guy explained to me that it would help me with all of my symptoms (chronic lower back pain, insomnia, and anxiety). But after spending almost $100 on those, they aren't touching me at all. Now while I understand that I have to try different things to find out what works best for me, I also can't afford to keep "testing" products out. I don't have much money so I'm hoping i can find something within the first couple tries. Also, maybe I should have mentioned this to the dispensary, but my tolerance to meds in general is very high. I can take 1600 mg of Advil for my back pain before I start to feel the pain relief. So I'm starting to think now that maybe I have to apply that tolerance to marijuana as well? The guy at the dispensary was pretty adamant that I would notice a difference with the vape and that I would be able to sleep better, but honestly, it's not touching me. Any thoughts or recommendations on what I should do?


Answers


Answer - Doctor Mark Edmunds

Tolerance is effected by many factors, including individual metabolism and frequency and duration of use. Rather than increasing your dose over time as your tolerance builds, it may be better to lower your tolerance by decreasing the dose and frequency of use. Similarly, some patients take a "drug holiday" for several days or weeks to cleanse themselves of cannabis and "reset" their endocannabinoid receptors.

Edibles, because they are longer acting, have to be taken less frequency than inhaled medicine and maintain cannabinoid levels at a more constant levels. This may help prevent the development of tolerance as compared to frequent, high-dose spikes of vaporized cannabis.


Answer - Dr Patricia Frye

For long term users, I advise patients to abstain from cannabis use for 48 hours then to resume at about 1/3 the dose they were using and titrate up to the effective dose. It sounds as if your case may be a little different. I would recommend trying a tincture sublingually. You lose quite a bit of medicine to the atmosphere with inhalation and as Dr Edmunds stated, the effects are short lived. True edibles (cookies, etc) lose quite a bit of medicine to the digestive process and renders the cannabis to be more psychoactive. With tinctures (chocolates and lozenges act more like tincture in that they melt and stay in your mouth longer), the medicine is absorbed through the small capillaries in the oromucosa of the mouth and very little is "lost". The drops are placed under the tongue and should be held there for 60 -90 secs before swallowing. It takes about 20 mins to observe the effects. So you have to titrate your dose by adding a drop or two every 20 mins or so until your pain is relieved - then add up the number of drops you've used and that's your dose for the next time. When used properly, the effect of tinctures can last 5-6 hrs. I would also suggest using a variety that has both THC and CBD. While they are individually good pain relievers, together they synergize each other's pain relieving effects. The CBD will mitigate the psychoactivity of THC. Also... acetaminophen potentiates the pain relieving effects of THC so try taking a dose at the same time you use the cannabis. A 1:1 THC:CBD strains that is particularly good for pain and very mentally relaxing is MediHaze. If too much psychoactivity, try a strain with a 1:2 ratio.


Answer - Founder and Patient Advocate

I'm sorry to hear that you're having a tough time with your back; is the pain causing your insomnia?

Here's the thing; not all pain patients respond to CBD alone. You may need to have a more balanced product with some THC included to get a good response. I've worked with many, many pain patients who only get partial relief from CBD. Patients tend not to need much THC to get a lot of relief; even at lower doses it can make a big difference. I've found that small amounts of THC are especially helpful for nerve pain, so if you have sciatica or shooting pains down your legs, it's certainly worth trying.

It's important to remember to avoid Sativa sources of THC since it can make anxiety worse.

If THC during the day isn't an option, you may get relief from a topical. Topicals will not make you feel high, but they work very well for pain. Two of the best that I've tried are made by Daddy Bones, as well as Salvation made by a collective in California called WAMM.

Another possibility is that even though that vape has 250mg of CBD in it, how much are you getting with each puff? Are you absorbing it efficiently? It could be that the dose you are getting is too small to help you. Also, vaped cannabis usually provides relief for a few hours at a time; you might want to look into capsules or tinctures for longer lasting relief.

The Capsule Cooperative carries a variety of CBD capsules, but we also offer a 1:1 CBD/THC capsule that's great for pain. Try a week of 10/10 or 20/20 at night, and a 20mg CBD capsule during the day; you might find that upping your CBD dosage and including some THC works a lot better than vaping.

I hear that high doses of NSAIDS aren't touching your pain, but tolerance there doesn't necessarily mean that you have a tolerance to cannabis. CBD works on similar pathways, but there's still enough of a difference that Motrin tolerance shouldn't translate over to CBD tolerance. When you find the right kind of cannabis, you may be pleasantly surprised by how little cannabis you need to make a big difference in your pain.


Answer - Hans Park MD

I think the ideas from Dr.'s Frye and Edmunds are excellent as are the thoughts from @artemiscrow. Since you've already purchased the 2 CBD vape cartridges, I might suggest that you keep both of them and when you've been able to save enough, buy a cartridge that predominantly THC (in low or medium dose) or tincture that is mainly THC. To take advantage of the en\tourage effect seen w/ co-administration of diff. cannabinoid combos like CBD and THC together, I would then suggest taking a puff of either CBD vaporizer and within minutes also administer a small dose of THC via vape or tincture so you effectively combine the effect of these two different cannabinoids. "Drug Holidays"/ short term abstaining from med cann is also a good idea periodically imho. I hope this helps!