What is Dose Layering and Why is it Important in Cannabis Therapeutics?

Have you ever been given a prescription for a medication and wondered why your doctor told you to take it at the same time every day? Or have you ever wondered why the instructions on the back of your medications say “Don’t take more than X amount in X hours”? Sometimes it’s because of unwanted side effects, like fatigue, disorientation, dizziness, or even stimulation (if it’s close to bedtime). In other instances, it’s because of the time it takes for the drugs to pass through your liver.

Your liver is the main organ responsible for metabolizing drugs due to the increased concentration of enzymes needed to process the drug and make it ready for distribution throughout the body. Cytochrome P450, the family of liver enzymes responsible for the metabolism of many drugs can be affected by various factors that may then affect how a drug is processed. For example, an element in grapefruit juice inhibits one of the enzymes in the CYP450 system, which can increase the bioavailability of certain drugs in the body and create potentially dangerous adverse reactions, including drug toxicity (British Journal of Medical Practitioners, 2012). 

When it comes to cannabis consumption, dosing is very different than conventional pharmaceutical dosing. Our pharmaceutical doses are often decided for us based on the best results for the general population; NSAIDS (non-steroid anti-inflammatory drugs) such as ibuprofen or acetaminophen are generally around 200-250mg with a maximum recommended dose of 800mg per day. 

Optimal cannabis dosing is calculated very differently. Cannabis sativa has been proven to have a wide range of effective dosages (unlike 200mg of ibuprofen), which is all dependent on the individual person.  Cannabis also has been shown to have an incredible safety profile, meaning it’s very difficult to achieve “drug toxicity” and very safe when it does occur. This allows cannabis to be used safely and effectively for a wide variety of conditions and symptoms, but dosing is very individualized.

Dose layering is a dosing method I often use with my clients in order to customize treatments and increase the efficacy of cannabis when managing symptoms.  Dose layering consists of using more than one delivery method and/or more than one product in order to achieve the best results (Sulak, 2021). And the beauty is that “best results” mean something different for everyone.

A client presenting with chronic non-cancer pain who has periodic daily exacerbations or “flares,” daily anxiety, and difficulty sleeping might benefit from higher levels of CBD during the day and higher levels of THC at night. What this will do is allow CBD to address the pain and anxiety during the day without any psychoactive or “euphoric” effects, while the THC at night will help with sleep onset and pain reduction the following day. For breakthrough symptoms, such as spasms throughout the day, inhalation may help, but I would only introduce that after the client is comfortable with the effects of THC. Combining various cannabinoids such as CBD and THC will increase the synergistic effects of cannabis, also known as the “entourage effect.”

Cannabis dose layering can be an extremely effective way to increase the therapeutic benefits of cannabis but requires immense knowledge and experience of cannabis and of the client’s presenting symptoms. Although it is fairly safe to try out on your own, working with a provider who knows and understands the cannabis plant and human physiology is the best way to personalize your cannabis treatment.  Different products and administration methods (such as cannabis edibles, sublingual cannabis, cannabis tinctures, vaporizing cannabis, etc) will affect the intensity and efficacy of the cannabis dosing and extend the cannabis onset time, or “therapeutic window.” Start low and slow and remember that cannabis dose layering is the norm rather than the exception. Personalized cannabis dosing can drastically improve your symptom management and improve your quality of life.

References:

Sulak, Dustin. (2021). Handbook of Cannabis for Clinicians: Principles and Practice. W.W. Norton & Company.

Mazi-Kotwal, N. & Seshadri, M. (2012). Drug Interactions with Grapefruit Juice. British Journal of Medical Practitioners. 5(4):a538. https://www.bjmp.org/content/drug-interactions-grapefruit-juice#:~:text=Grapefruit%20juice%20inhibits%20the%20CYP3A4,may%20produce%20serious%20adverse%20reactions.