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Experts on cbd oil for pain dosage

CBD Dosage: How Much Should You Take?

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Table of Contents

  • Determining the Best CBD Dosage for You
  • How to Calculate CBD Dosage
  • How to Take CBD

Cannabidiol (CBD) is growing increasingly popular, thanks to its many purported health benefits and non-intoxicating properties (most CBD products contain less than 0.3% tetrahydrocannabinol, or THC). In fact, 60% of U.S. adults have tried CBD at some point and believe it has medicinal benefits, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll. As research evolves and sheds light on CBD’s efficacy, especially for pain relief, more and more people are adding it to their daily wellness regimens.

Consumers can choose from a variety of CBD products, from oils to gummies to vapes to capsules. But figuring out the safe and effective CBD dose for an individual is a complex decision.

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Here’s how to find the right CBD dosage for you and how to consume it safely.

Determining the Best CBD Dosage for You

With the exception of one CBD product, a prescription drug used to treat seizures associated with particular syndromes, the Food and Drug Administration (FDA) doesn’t regulate the use of CBD. (In fact, it’s illegal to market CBD as a supplement or add it to food.) Therefore, it’s best to consult a doctor with experience in CBD administration to determine your ideal dosage.

Expressed in milligrams (mg), CBD dosage largely depends on the conditions and symptoms you’re trying to treat and your unique endocannabinoid system, which is associated with motor control, behavior, emotions, the nervous system and homeostasis. CBD dosage remains an area of active research—more large, high-quality studies are needed in different populations to determine appropriate dosing, efficacy and safety guidelines.

“It’s best to start small and gradually increase your dose up to a level that gives you the desired effect,” says Cheryl Bugailiskis, M.D., a cannabis specialist at Heally, a telehealth platform for alternative medicine. Your starting point might look like half a CBD gummy or a drop of oil. Ideally, navigate this process under the guidance of a qualified physician.

If you’re still not sure where to start, mydosage.com offers a questionnaire and CBD calculator to help you based on your specific symptoms and usage goals.

How to Calculate CBD Dosage

When you consume CBD gummies, capsules or softgels, dosage is typically expressed per unit. For example, there may be 50 milligrams of CBD in each individual gummy. These products don’t offer much dosage flexibility since you can’t split up capsules easily. For instance, if one softgel capsule didn’t provide your desired result, you would have to take another full capsule, doubling the total dose.

CBD oil, on the other hand, makes it easier, to begin with a small dose. But calculating CBD oil dosage can be less straightforward. Oils and tinctures tend to come in a dropper bottle and, typically, only the total liquid volume and CBD contents are listed on the label. For example, the label might simply state there’s 1,500 milligrams of CBD in the 30-milliliter bottle.

But what does 1 milliliter look like? Due to the current lack of regulation of CBD, this calculation can be tricky. Start by figuring out the volume of a single drop in your dropper, which is usually 0.05 milliliters, according to Dr. Bugailiskis. If you’re unsure, ask the company.

Here’s where math comes in. Let’s continue with the 30-milliliter bottle with 1,500 milligrams of CBD and 0.05 milliliters in a single drop as our example.

1500mg÷30mL = 50 mg/mL

This bottle contains 50 milligrams of CBD per milliliter. Let’s see how many milligrams are in a drop:

50mg/mL ×0.05mL/drop = 2.5mg/drop

Each drop contains 2.5 milligrams of CBD.

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Next, you can calculate how many drops you need to reach your goal dosage. Let’s say you want to consume 25 milligrams each day.

25mg÷2.5mg/drop = 10 drops
10 drops ×2.5mg = 0.5mL

With this CBD oil dosage calculator as your guide, you would find that you needed to consume 10 drops, or 0.5 milliliters, to reach 25 milligrams. And if you intend to consume 25 milligrams daily, you can expect this particular bottle to serve as a 60-day supply.

Some CBD products do some of this math for you and illustrate how many milligrams are in a milliliter, some even marking these points on the dropper so you know exactly what you’re taking.

CBD Dosage for Different Ailments

Without FDA approval, there is little guidance in the U.S. on how much CBD a person should consume for various conditions.

In many medical studies on CBD, you see administered doses reach hundreds of milligrams a day, which sounds severe compared to our starting dosage example of 25 milligrams. However, Steven Phan, founder of Come Back Daily, a CBD dispensary in New York, points out that patients in these studies are often dealing with serious flare-ups and pain-inducing conditions compared to everyday dispensary customers.

Below are clinically-studied CBD dosages based on different ailments and conditions. Note: Some of the formulations studied contained THC as well—not all available dosage research sticks strictly to CBD.

Condition Dose* Anxiety 300mg–600 milligrams a day [1] Linares, Ila M. et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test . Brazilian Journal of Psychiatry. 2019;41(1):9-14. [2] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients . Neuropsychopharmacology. 2011;36(6):1219-1226. Select forms of epilepsy Starting at 2.5 milligrams per kilogram of the person’s body weight twice daily [3] EPIDIOLEX- cannabidiol solution. DailyMed. Accessed 7/4/2021. Central neuropathic and cancer-related pain A maximum of 30 milligrams a day (or 12 sprays) [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021. Opioid addiction 400 or 800 milligrams a day [5] Hurd YL, Spriggs S, Alishayev J, et al. Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Psychiatry. 2019;176(11):911-922. Arthritis A maximum of 30 milligrams a day (or 12 sprays), or 250 milligrams applied topically [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021.

*Dosages are based solely on small, short-term clinical study results where CBD proved significantly successful over placebo. Much larger studies are needed to further strengthen the evidence.

FDA-approved Epidiolex administers CBD orally as a liquid to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis complex. The dosage of Epidiolex is determined by taking the patient’s weight in kilograms (kg) into account.

Several countries, including Canada and those in the U.K., have approved the use of Sativex, an oral spray with equal amounts of CBD and THC, to treat pain stemming from multiple sclerosis. Canada has also approved it for treatment of cancer pain.

The medical and research community still has a long way to go before figuring out what dose works best for each condition. At an individual level, consumers can experiment with caution until they find what works best for them.

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How to Take CBD

Popular ways to take CBD include:

  • Oils and tinctures (extracts of plant material dissolved in ethanol): A liquid that comes in a bottle with a dropper
  • Gummies: A soft, chewable candy that’s often fruit-flavored
  • Sprays: A liquid that comes in a bottle with a nozzle for spraying into the mouth
  • Capsules: Tablets or softgels that are ingested by mouth
  • Vapes: CBD oil that’s heated without ignition, resulting in an inhalable vapor
  • Flower: Dried hemp plant that’s often ignited and smoked
  • Edibles: Any food that CBD oil has been added to, such as brownies or chips
  • Drinks: Any beverage that’s infused with CBD, often in the form of hemp extract
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Your CBD product of choice will largely depend on your personal preferences, as well as your budget since prices vary depending on the potency of ingredients and manufacturing processes. Different mediums also offer varying levels of bioavailability—or how much of what you take is actually absorbed into your bloodstream to have an effect. For example, if you ingest 10 milligrams of CBD via 1 milliliter of liquid, your body might absorb about 60% of it, or about 6 milligrams.

Cannabinoids generally have a low bioavailability compared to other substances, according to Jordan Tishler, M.D., a physician specializing in cannabis treatment in Massachusetts. However, “products that contain emulsifiers like egg yolk (brownies) or lecithin (some gummies) do better,” he says.

With that said, ingesting CBD via gummies or other edibles may take longer to take effect since the CBD has to travel to your digestive system to be broken down and absorbed.

Can You Take Too Much CBD?

Like with any substance, you can take more CBD than your body can handle. Studies show doses up to 1,500 milligrams a day have been well-tolerated, but every person is different [7] Bergamaschi MM, Costa Queiroz RH, Zuardi AW, Crippa JAS. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current Drug Safety. 2011;6(4):237-49. . Ingesting too much CBD can cause unpleasant side effects, such as dry mouth, nausea, diarrhea, upset stomach, drowsiness, lightheadedness and general disorientation. While rare, liver damage can also occur.

What’s more, CBD can have serious interactions with certain medications. In evaluating available information on five prescription CBD-based medications, researchers found 139 medications could have a potential drug-drug interaction with CBD [8] Kocis PT, Vrana KE. Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions. Medical Cannabis and Cannabinoids. 2020;3:61–73. . People who take certain blood thinners, heart rhythm medications, thyroid medications and seizure medications need to be particularly careful.

At the end of the day, not all supplements are created equal, which is why it’s important to work alongside a health care provider when adding CBD to your wellness regimen and research reliable brands. And while emerging research and anecdotal evidence is promising, more large, randomized-controlled trials are needed to further understand the benefits of CBD and its dosing.

CBD for Chronic Pain: Experts Developed Dosage Protocols

In journalism and media industry for more than twenty years, worked for a number of media companies. Business editing, research and PR specialist. Covering industry and science news for Ilesol Pharmaceuticals.

CBD for Chronic Pain: Experts Developed Dosage Protocols

The world experts in medical cannabis and cannabidiol have developed three dosing and administration protocols for patients with chronic pain. For those who are using CBD for chronic pain, oil or capsules are found to be the best way of administration.

At the last US national conference on pain management, organized in September 2020 by PainWEEK, dr. Allan Bell from the University of Toronto and his colleagues presented a new publication – The Consensus Recommendations on Dosing and Administration of Medical Cannabis to Treat Chronic Pain . The recommendations are the results of a modified Delphi process. The process is one of several methods developed to identify the collective opinion of experts.

Chronic pain affects around two billion people worldwide. It is associated with impairment in physical and emotional function, reduced participation in social and vocational activities, and lower perceived quality of life.

As it’s well known, medical cannabis has been used to treat chronic pain for centuries. The patient-reported data shows that chronic pain management is one of the most common reasons for medical cannabis use. However, there is not enough scientific data on the effects of cannabis in the treatment of chronic pain.

We are witnessing an increase in the number of countries in which medical cannabis use got approved in recent years. The World Health Organization has recommended rescheduling cannabis in the international drug control framework to a less stringent schedule. Consequently, on December 2nd, 2020, the United Nations Commission on Narcotic Drugs removed cannabis and cannabis resin from Schedule IV of the 1961 Single Convention on Narcotic Drugs . This vote should clear the way for further research in the area of medical use of cannabis.

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Bridging the Evidence Gap

As the scientists behind the new recommendations point out, there are so far low or moderate levels of evidence to support the use of cannabinoids for the treatment of chronic pain. As a result of this evidence gap, there are limited scientific data to guide dosing and administration of medical cannabis in clinical practice.

To bridge the gap between a lack of evidence and increased use of medical cannabis, they conducted a modified Delphi process with 20 medical cannabis leaders across nine countries to develop consensus-based recommendations for the safe and effective use of medical cannabis to treat chronic pain.

CBD for Chronic Pain: Global Taskforce

They conducted a multi-stage modified Delphi process. The 20-member global task force received an initial clinical practice survey. It helped in the understanding of how patients are being treated with medical cannabis across different countries. A draft of consensus questions was developed and reviewed twice by the 9-member scientific committee before being sent out to all task force members for two rounds of pre-voting. A threshold of ≥75% agreement was predetermined for declaring consensus. Following the pre-voting rounds, there were two virtual meetings for voting on the remaining key questions.

Three Protocols: Routine, Conservative and Rapid

There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed and categorized as Routine, Conservative, and Rapid. The clinician and patient may choose to move between the protocols as necessary.

The experts found that oral administration with oil or capsules should be considered a recommended administration format. If breakthrough pain management is necessary, dried flower vaporization was found to be the recommended mode.

The routine stream is designed for the majority of patients with chronic pain. The recommendations included: Initiate on CBD-predominant variety at a dose of 5 mg CBD twice daily. Titrate the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. When up-titrating either cannabinoid, the total daily dose can be divided into 2-4 administrations.

The conservative protocol is recommended for patients who may be more sensitive to medical cannabis effects and who would prefer to prioritize safety. Clinically frail patients, the elderly, those with complex comorbidities, polypharmacy, and/or mental health disorders, may also be appropriate for the conservative approach. The recommendations included: Initiate on CBD-predominant variety at a dose of 5 mg once daily. Titrate the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC.

The rapid stream was designed for individuals who require more rapid titration or earlier initiation of THC such as patients with severe pain or functional impairment, or cannabis experienced patients. The recommendations included: Initiate on a balanced THC: CBD variety at 2.5-5 mg of each cannabinoid once or twice daily. Titrate by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.

Individualized Therapy

It is important to note that every patient is different, and medical cannabis treatment, like most other therapies, should be individualized to the patient, the experts concluded. Sharing treatment decision-making with the patient is necessary, and establishing treatment goals during the initial medical consultation may enhance patient outcomes and adherence to medical cannabis treatment. Future randomized control trials examining the safety and efficacy of medical cannabis will be required to clarify if the developed protocols result in improved patient outcomes. In this light, the expert recommendations on the dosage of CBD and THC for chronic pain will be updated as soon as new clinical trial evidence becomes available.

Reviewed by Sasha Bajilo, founder of ILESOL Pharmaceuticals, an industrial scale producer of CBD products and formulations. Expert on Hemp/Cannabis policy, member of the Croatian Ministry of Health regulatory commission for medical cannabis.