The Golden Rule – Start Low And Go Slow, Especially With Marijuana

It’s something I try to stress as much as possible when someone who hasn’t consumed THC ever, or in a long time, wants to give it a try. Cannabis IS NOT FOR EVERYONE! It isn’t a silver bullet and there can be negative side effects. I bring this up because of a recent interaction with a patient, we will call him Patient X. 

X has a complicated medical history and like many people, X did some research, and saw the potential benefits cannabinoids have and decided to talk about this option with his care team. (Great job patient X! Always keep your care team as informed as possible).

After talking to his team, he moved forward and received his medical marijuana card. Long story short, patient X picked up a strong product and ended up in the emergency room. 

While X is doing fine now, this was obviously an unpleasant experience, and it probably could’ve been avoided. I had a similar experience when I first got back into cannabis as patient X so I know how scary an accidental overdose of THC can be, despite being relatively fine in the end. 

The important part of this story whether you’re a consumer or provider of cannabis, is to always be cautious when trying a new product, strain, anything! 

The guideline I follow is starting with 0.5‐3 mg and increase by 1‐2 mg once or twice weekly up to 30‐40 mg/day for cannabis naive patients. This was derived by provider consensus guidelines. This doesn’t mean this dosing is “correct,” but it was derived from the best data I found. Feel free to drop links to articles or journals you’ve found useful if like me you enjoy diving into the science behind this. 

Since patient X’s bad experience was with a vape pen, they made sure to let me know, “For now, the only pen I use will be the one I write with.” This definitely made me laugh a little.

I will continue to stress the complexity of the cannabis plant and how as consumers we need to shift our priorities from focusing on the amount of cannabis we take, but rather understanding the science behind the entire plant and how to best utilize this information to get the most out of our medicine.

*Patient consent was obtained, and all PHI has been redacted


Sihota A, Smith BK, Ahmed SA, Bell A, Blain A, Clarke H, Cooper ZD, Cyr C, Daeninck P, Deshpande A, Ethans K, Flusk D, Le Foll B, Milloy MJ, Moulin DE, Naidoo V, Ong M, Perez J, Rod K, Sealey R, Sulak D, Walsh Z, O’Connell C. Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control. Int J Clin Pract. 2021 Aug;75(8):e13871. doi: 10.1111/ijcp.13871. Epub 2020 Dec 18. PMID: 33249713; PMCID: PMC8365704.

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