Medical Cannabis Capsule Dosing for Chronic Pain

Start with 2.5 mg THC or less. Wait 2 hours. If pain does not change and you have no severe side effects, increase by 2.5 mg every 2 to 3 days. Most patients reach 5 mg to 20 mg THC per dose. Some need 30 mg or more. Stop at the dose that lowers pain without sedation or anxiety.

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What a Capsule Holds

Medical cannabis capsules contain a fixed amount of THC, CBD, or both. Common strengths: 2.5 mg, 5 mg, 10 mg THC. Some products list 1:1 THC to CBD. Labels state total cannabinoids per capsule. Check the label.

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Onset and Duration

Oral capsules pass through the liver. First-pass metabolism changes THC to 11-hydroxy-THC. This metabolite is stronger than inhaled THC. Onset is 30 to 120 minutes. Peak is 2 to 4 hours. Effects last 6 to 8 hours. Do not take a second dose before 2 hours pass.

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Bioavailability

Oral THC bioavailability is 4% to 20%. The same dose can affect different people in different ways. Food changes absorption. A meal with fat can raise peak levels. Take capsules with or without food, but keep the pattern the same.

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Titration Steps

  1. Day 1: 2.5 mg THC once per day.
  2. Day 3: If no relief, 5 mg THC once per day.
  3. Day 6: If no relief, 7.5 mg THC once per day.
  4. Day 9: If no relief, 10 mg THC once per day.
  5. Continue adding 2.5 mg every 3 days until pain drops or side effects start.

Side Effects and Stop Signs

Side effects include dry mouth, drowsiness, dizziness, fast heartbeat. Stop and call a clinician for chest pain, severe confusion, or fainting. Do not drive after a dose. Do not mix with alcohol or opioids without medical advice.

Evidence and Limits

Evidence for cannabis capsules in chronic pain is mixed. Reviews find small to moderate pain relief for some nerve pain. The FDA has not approved cannabis for chronic pain. Approved cannabinoid drugs exist for other conditions. State medical programs set their own rules.