How do you know if it’s time to take a tolerance break? Dr Niraj Singh, a consultant psychiatrist and member of the Medical Cannabis Clinicians Society, explains.
Dr Niraj Singh
Medical cannabis is used increasingly for a range of conditions including anxiety, depression, PTSD, ADHD, pain, fibromyalgia and others.
But we all need a break from time to time, and so it seems do our cannabinoid receptors.
Readers will be familiar with the issue of tolerance developing with continuous use of medical cannabis. The definition of tolerance is “a person’s diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to the continued presence of the drug.”
The cannabinoid receptor 1 lies mainly within the brain and spinal cord. THC binds directly to this and CBD indirectly. With continuous binding of THC, CB1 become ‘down regulated’ ; this means a decrease in the number of receptors on the surface of target cells, making the cells less sensitive to THC binding.
Medical cannabis users may experience this as their treatment becoming less effective and the requirement to take more for symptomatic relief.
Timing for development of tolerance will depend on one’s history of cannabis use, the chemovar of the product itself and other physiological factors.
At times therefore the CB1 receptors need a rest. With reduced consumption, this gives the ‘overworked’ receptors a break, giving them a chance to expand in number again, a term called ‘up regulation’.
The idea of reducing consumption can be anxiety provoking for users and not an easy one, however the benefits are unquestionable. With up regulation, a lesser amount of medical cannabis product is required for the same effect. Using less product, also means less financial expense.
There is no specific guidance on the time frame for how long a tolerance break should be. Up regulation is said to take place 48-72 hours hours after stoppage and levels out between 21 days and 4 weeks after, so this is the range after which most benefits can take place. This is because THC clears the system completely within this latter period.
A T-break has to be balanced with the patient’s circumstances, current symptoms, as well as risk of any deterioration in health. Treatment dosages can also be reduced gradually rather than sudden stoppage.
It’s important therefore that any tolerance breaks take place during periods of less stress. Alongside ensuring regular exercise and a healthy diet to boost the endocannabinoid system (ECS) is important.
One can still use CBD and terpenes during the tolerance break periods. If there are any problems with sleep, natural supplements can be used.
Once medical cannabis is re-started, it’s important that this is gradually built up rather than starting back on the dosage used prior to the tolerance break.
It’s vital that the doctor and patient discuss the tolerance break and agree on a plan. It’s important that patients discuss this with people in their household and those in close proximity as irritability and frustration can occur particularly in the early stages.
A few things to remember:
- A T-break should be planned and measures put in place to ease it as best possible. Decide on a realistic time frame. Doctors and patients need to discuss and agree this also.
- Ensure it happens at a time of fewer stressors but at the same time ensure a good level of activity is taking place to ensure the mind is focused elsewhere.
- Ensure a healthy diet and adequate exercise. Connect with the natural environment.
- Use natural supplements for sleep where required.
- If needs be use CBD oil which is broad spectrum with a good range of terpenes.
- Stay resolute but also realistic. Remember any break above 72 hours will be beneficial.
- Build up the dosage gradually after re-starting.
Find out more about joining the MCCS here
If you’d like to share your experience and insight as a medical cannabis prescriber or patient, we’d love to hear from you. Please email [email protected]
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