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By now, it is a common refrain: the weed is getting stronger. Recent research backs this up. For example, data from the National Institute on Drug Abuse reveal that the level of THC in cannabis samples seized by law enforcement averaged 4% in 1995. By contrast, in 2022, the average level of THC was upwards of 16%.

However, some seasoned cannabis connoisseurs may find this surprising for the opposite reason. In states such as Washington, Oregon, and Nevada, it is not uncommon to find laboratory-tested flower boasting THC levels upwards of 30%—far higher than the previously mentioned average potency of 16%. While it is certainly possible to cultivate cannabis with levels of THC surpassing 30%, the lack of standardized testing methods and oversight of cannabis testing laboratories means that it is also possible that certain unscrupulous brands are engaging in “lab-shopping,” whereby testing labs that systematically demonstrate higher potency levels are sought out. This in turn creates greater incentives for labs to continue using methods that yield higher potency than levels than are actually present, and a feedback loop is born.

With all of these conflicting messages, cannabis consumers may be left wondering how to make sense of dosing, particularly when it comes to addressing medical conditions. While structural interventions are needed to better regulate the testing and labeling of cannabis potency (such as through the standardization of laboratory testing methods), the goal of this article is to empower patients and consumers to take charge of their own cannabis journeys by shedding light on what we do know about dosing cannabis, and what remains to be discovered.

The Endocannabinoid System (ECS)

Every discussion on cannabis dosing starts with a basic understanding of the endocannabinoid system (ECS). Like the Central Nervous System, the ECS is a bodily system possessed by all vertebrates. The ECS can be described as a vast network of compounds and receptors that, when working properly, help the body maintain homeostasis (balance). The first endogenous (internally-produced) cannabinoid, anandamide (named after the Sanskrit word for “bliss”), was discovered in 1992 by Dr. Raphael Mechoulam and his team of researchers. Dr. Mechoulam et al. found that anandamide binds to the same receptor as the main psychoactive molecule found in cannabis, tetrahydrocannabinol (THC). Several years later, Dr. Mechoulam identified a second endocannabinoid, 2-AG, which binds to the same receptor as cannabidiol (CBD) and produces similar effects, including pain relief. Thus marked the official discovery of the ECS.

Disturbances in the ECS have been linked to numerous health conditions, including migraine, irritable bowel syndrome, and fibromyalgia. It is speculated that this is why supplementation of the ECS with exogenous cannabinoids—cannabinoids produced by the cannabis plant, such as THC and CBD—can be beneficial for individuals living with certain health conditions. And, because of how extensive endocannabinoid receptors are within various organs of the body, it is possible that targeting ECS dysregulation can produce benefits for a wide range of conditions. However, consumption of cannabis is not the only way to affect ECS “tone.” Other factors that influence the ECS include exercise, acupuncture, and consumption of omega-3 fatty acids, for example.

Cannabis Dosing and the “Goldilocks Zone”

Almost every medication or supplement has a therapeutic window: that is, a dose in which the medicinal benefits are maximized, while adverse effects are minimized. Even compounds that have no known toxicity level can hurt your wallet if taken in excess. For example, excess vitamin B2 (riboflavin) is excreted in the urine, meaning that you are almost literally flushing money down the toilet when you consume more than your body needs.

Cannabinoids are no different: take too small a dose, and you may not experience the medicinal benefits. Take too much, and you may experience unpleasant and even dangerous side effects, such as rapid heart rate or cannabis hyperemesis syndrome (CHS). Additionally, cannabinoids like THC can demonstrate biphasic effects—that is, THC may produce opposite effects at higher doses than it does at lower doses. One example of this is anxiety: lower doses of THC may alleviate anxiety, whereas higher doses may exacerbate it. The goal, then—particularly for those who use cannabis to alleviate medical conditions—is to find the “Goldilocks Zone” with your cannabis dosing.

Finding Your Ideal Cannabis Dose

If you are completely new to using cannabis, it is crucial to remember the mantra “start low, go slow.” It is always possible to take more, but it is never possible to take less—particularly when it comes to intoxicating cannabinoids such as THC. Start with one to five milligrams, ideally during a time of day when you have no other obligations and in a comfortable setting where you will not be disturbed. Over several days or weeks, gradually increase your dose until you find your Goldilocks Zone. Become familiar with the different consumption methods and their onset times. In general, inhalation methods (e.g., smoking, vaping) have the shortest onset time, whereas methods involving ingestion (e.g., edibles, tincture) have the longest. Avoid taking another dose within two hours of the first and note that factors including what you have had to eat, your sleep and hydration levels, etc., can impact cannabis’ effects. If you are taking other medications or supplements, be sure to familiarize yourself with cannabis’ potential drug interactions. Finally, learn how to read cannabis product labels and Certificates of Analysis (COAs). While imperfect due to reasons stated previously, labels and COAs will still provide your best guide for estimating the potency of your products. For best results, assume the potency is slightly higher than that listed on the label or COA.

Certain exceptions aside, most cannabis consumers do not require astronomical doses of cannabinoids to achieve therapeutic effects. One paper described that, based on prior research on medical cannabis patients, doses of 20 to 30 milligrams of THC per day were ideal for achieving therapeutic benefit while minimizing adverse effects. However, every individual possesses a unique ECS, and cannabis medicine should be highly tailored to each patient. Therefore, if you have found your Goldilocks Zone, ideally working with the support and guidance of your doctor, stick with it!

One phenomenon that may be experienced by frequent cannabis consumers is the development of a tolerance, whereby higher doses are needed to achieve the same therapeutic effect. In some cases, developing a mild tolerance can be beneficial for minimizing adverse effects and becoming more comfortable with your therapeutic dose. However, if you find you are having a hard time suppressing symptoms of your medical condition even while taking higher doses (especially if you were previously able to achieve relief at lower doses), it may be helpful to consider taking a tolerance break. Even a 48-hour break followed by the slow reintroduction of cannabis over several days may be enough to reset your tolerance to a more manageable level. Other signs that a tolerance break may be warranted include having to dose more frequently or spending more money on cannabis than in previous months. Remember to keep an inventory log of your symptoms to track your progress over time. There are many logs available for free on the internet and via mobile apps, or you can make your own—just be sure to include fields to record date and time of use, product and quantity used (bonus points for logging additional product details such as strain, cannabinoid and/or terpene content, etc.), symptom severity, side effects experienced, and any other information that may be relevant to your condition (e.g., drinks of water, hours of sleep, other medications taken). See also ASA’s Patient’s Guide to Medical Cannabis for worksheets to help you evaluate your cannabis use.

Of course, talk to your doctor (or a trusted friend or family member) if you find you are having more serious problems with your relationship to cannabis.

The Need for Research

Unfortunately, cannabis’ classification as a Schedule I drug under the Controlled Substances Act makes conducting high-quality research on dosing difficult. In particular, randomized controlled trials are needed to examine the effects of different dosages on people with certain traits (e.g., age, sex) or medical conditions, identify effective protocols for taking tolerance breaks, and determine how various cannabinoids and terpenes work together to produce specific effects.

To fill this void, Americans for Safe Access has developed a comprehensive legislative framework that would, among other things, facilitate research on medical cannabis, create safety regulations that protect and support patients, and ensure patients’ rights to housing, employment, and more are protected under federal law. This legislation would also ensure greater accountability for testing and labeling of cannabis products so that consumers can be more confident in their dosing. Read more about the Medical Cannabis and Cannabinoid Act and take action today!

About the Author: Shelby Huffaker, MPH is Chair of the San Diego chapter of Americans for Safe Access and a public health research coordinator who studies substance use. Her passions include cannabis, harm reduction, and the sociology of health, particularly as it relates to stigma and health equity. In her free time, Shelby enjoys running, singing in the shower, traveling, and spending time with her dog, Kai.