SANBORN — “Start slow and go low” is a phrase in the cannabis industry about how to approach dosing. But nurses specializing in medicinal use of cannabis say too many consumers are influenced by marketing to try high doses of gummies and other products, leading to negative results.
Despite the revised reputation of cannabis-derived products as having little potential for dangerous overdoses, nurses speaking at SUNY Niagara’s Cannabis Conference on Tuesday said that because few people receive professional guidance on using cannabis to relieve pain, nausea, insomnia, and anxiety, they are vulnerable to dosing mistakes that can leave them with panic attacks, dizziness, and hallucinations. They said trained nurses are available to assess individuals’ needs and recommend choices.
“We want to support patients to use cannabis safely and effectively, and to use the least amount effectively,” Carey Cadieux, PhD, past president of the American Cannabis Nurses Association, said. “Patients are kind of out there on their own and don’t have information on self-titration. Some dispensaries are like Disneyland — there’s a million products.”
Ariane Williams, a cannabis nurse educator in Texas, said the typical patient she works with is seeking cannabis products to manage sleep and pain.
“It is incredibly safe compared to other things, but it’s not like it has no issues whatsoever,” Williams said. “A dose that works for me might not work for somebody else. So we need to build safety around the medicine. It’s especially important in preventing adverse reactions. There’s so much magic that gets overlooked in the low doses. I would probably have them start with half a gummy. If it doesn’t have an effect, it doesn’t mean it’s not working.”
“Once we get them started, we have to teach them about the endocannabinoid system,” Williams said. To improve the body’s balance in uploading cannabinoids, she said patients should engage in 20 to 30 minutes of enjoyable exercise per day and “eat the rainbow” of foods containing flavonoids.
“For many patients, just adding in cannabis is not enough,” she said. “A lot of what we do is teaching people to use it as one tool, among many tools.”
Each nurse had their own stories of individuals with negative experiences because of a lack of guidance. Cadieux spoke of a hospice patient who was sent to a dispensary. Cadieux said the man was sold a candy bar with 100 mg of THC, a cannabis compound, and advised to take half.
“He takes 50 mg and has a terrible experience and never uses cannabis again,” she said.
Sammie Pyle, founder of Nursing Nature’s Way, said many patients believe that the highest percentage of THC is what they need.
“I feel like a lot of people who are dabbling in cannabinoids are just going for THC because that’s what they know,” Pyle said. “That’s not really the case at all. I’d say 20 mg, up to 30 mg balanced with other cannabinoids, is really the sweet spot for patients.”
Williams said she has started patients on 1 mg to 2 mg of THC, slowly increasing it from there. She said that because a patient has a diagnosis that qualifies them for cannabis doesn’t fully describe what they need.
“We need to look at the whole picture,” she said. “It’s also identifying when too much occurs and it exacerbates symptoms. I’ve had patients hallucinate on 5 mg. I always aim for a very underwhelming experience.”
Nurses said consumers interested in guidance for using cannabis therapeutically can contact professional associations, including the American Cannabis Nurses Association, American Cannabis Network, and Cannabis Nurses of Color.