By John Brunstein
7 Apr 2016
Hi Dr. John, I’ve been wanting to try Cannabis for anxiety/stress, but I’m worried about “getting high”. I’m also not interested in smoking. What do you recommend? Thanks! FZ
Let me start by saying that I don’t think you’re alone in those questions – in fact I think some variation of them are concerns shared by a lot of people. Let me deal with your second question – that you’d prefer a route other than smoking – first, as it’s the simpler answer and will underlie an answer to your first question.
Indeed, smoking Cannabis has a lot of drawbacks. Smoking – regardless of what it is you’re smoking – isn’t seen as a socially acceptable (or in many locations, even legal). It’s also intrinsically not good for your airway epithelial cells or your lungs, particularly if it’s prolonged repeated exposure to smoke and other things it contains like carbon monoxide. The biggest disadvantage though may be one that is less immediately obvious: it’s that smoking leads to highly variable dosing. How much of the product gets inhaled as opposed to how much of it floats away is one variable, but so is how big your individual lung volume is, how deeply you inhale, how long you hold the breath, and similar factors. In fact, a common complaint with clinical trials for Cannabis for various medical conditions has been that if it’s administered by “smoking a joint”, the patient to patient (and even dose to dose) actual absorbed dose of active ingredients is quite variable and this makes the results very hard to interpret in a statistically rigorous manner.
The closest alternative to smoking dried flower is use of Cannabis oils in an electronic vaporizer, or “Vaping”. Because the oil can be analytically titrated and the vaporization temperature and vapour density on inhalation is more uniform than smoking flower, this is a more uniform and more reliable dosing format than smoking. It may also have less unwanted or toxic by-products, however some studies have indicated that particular in high temperature vaporizers, unwanted by-products do occur . Vaping is marginally more acceptable than smoking in public settings, although that seems to be increasingly restricted. If vaping is however a route you might want to try, the rest of the following discussion regarding self assessment of dosage titration with input from your doctor will equally apply.
The next most common way to take Cannabis is orally (that is, eat it or something made with Cannabis, or Cannabis oils/extracts). These come in a range of forms, commonly including lozenges, beverages, and baked goods such as cookies. Other edible forms are also available, from chocolates to beer; in fact there’s probably just about no food type that someone, somewhere, hasn’t experimented with incorporating Cannabis in to. In general, any of these would be more socially acceptable to partake of in a public setting than smoking would be, and some are readily transportable much like you might carry any other sort of medicine with you for use as needed. Not all edible forms of Cannabis are equal however; in particular some cannabinoids (active ingredients) such as cannabidiol (CBD) are rather poorly water soluble. This means they are more effectively delivered say in the form of an oil or butter (a lipophilic carrier, where it’s easily dissolved) incorporated in a cookie batter, than in an aqueous (that is, water based and hydrophilic) drink where it’s very poorly soluble without the addition of specialized carrier molecules.
One critical aspect of Cannabis edibles however, regardless of whether a specific edible is an effective carrier or not, is that they can be prepared with very uniform dosages. If you eat X many sections of a chocolate bar, or one lozenge of Y grams, or drink Z ml of a drink, then you can be assured that your net intake of CBD and Δ-9-tetrahydrocannabinol (THC) is Q and R many mg, respectively. So, not only are edibles more convenient and healthier than smoking, but they’re much more reproducible as to effect. That’s going to be important in addressing the first part of your question, and in ensuring that after you titrate your individual effective dose, it’s reliable dose to dose.
Before we move on to that though I want to briefly address one more issue about edibles vs. smoked or vaped Cannabis. That is the pharmacokinetics, or essentially the speed and impact of dosing by these two alternate routes. Smoking or vaping are more effective by about 2.5 times  at raising blood plasma levels of THC per amount used, and have much quicker uptake than edibles. Put another way, edibles have a downside that they will take longer between dosing and having an effect, and more total Cannabis material is needed to get the same end dose in the user. These may be acceptable trade-offs against the downsides of smoking or vaping though, and for an increasing number of users, edibles are preferred.
Figure 1: There are many different types of edibles with varying potency
Be sure to note though that with edibles, because of the slower uptake and action, it is easier to overdose! A person might take some, not notice any effect in 15 minutes, and then take more – then multiple doses reach the bloodstream, and unwanted effects can occur. In fact, the vast majority of Cannabis overdoses relate to edibles rather than smoking exactly because of this. So, a word of caution – don’t exceed recommended doses for edible Cannabis products, and if you don’t notice immediate effects, wait for 1 – 2 hours. It can take that long, depending on format, amount, your body mass, and other factors, before effects become apparent.
So with that out of the way, let’s go back to your first question: you’re looking for relaxant, anxiety suppression / stress release as opposed to feeling “high”, or otherwise impaired. Again, this is a common concern, and a very valid one. As I’ll explain, I can’t give you a definitive answer as to what will work for you or anyone else in that regard, but I can suggest how you can find out what works for you.
Why can’t I just say “oh, take an edible of Strain XYZ, x grams in edibles, with so much CBD and so much THC”? Well, in the first place, under Health Canada regulations, Segra (and thus myself, in this reply) is not allowed to make definitive medical claims for Cannabis in treatment of a specific medical condition. Secondly, I’m a Ph.D., not an M.D., so I can’t prescribe any medication for any condition. Even if I were an M.D., I still wouldn’t be legally allowed to do so. Why? Well, in part it’s because there’s really not a lot of really good medical-evidence level of data, with well controlled clinical trials and statistical power, to be able to make really definitive statements to that effect. We can hope that with increasing use of legalized Cannabis for medical purposes, and the resulting better data and research we will get to that point, but we’re not there yet. Current observational data suggests different people can (and do) report different responses to even the same Cannabis preparation. We don’t yet know enough to understand why this is, and thus be able to tell you what your optimal dose or strain is.
Where does this leave you? Regardless of whether you’re considering the edibles or vaping option, there are multiple publically available sources of information relating to different strains, and individual (anecdotal) reports from users as to how different strains or edibles (with varying THC and CBD levels) impacted them. While these are uncontrolled individual reports, open to many vagaries of interpretation, in the lack of any better resources I’d suggest starting there and seeing what strains, THC/CBD ratios, and doses are most commonly reported by other users as having the calming effects you want, without the intoxicating effect you don’t. Starting from there, I’d look at finding one or more sources of edibles which most closely match what you think you are looking for, and then very carefully try what works for you.
You want to do that safely, so don’t go trying this Monday morning just before getting in the car and tackling work traffic! Try an evening before a day off, or some other time when you can comfortable and safely observe your response. Start off with smallest doses possible for your chosen product and see if it works for you. Try as needed to slowly raise the dose until you get the desired calmative effects. If those come with unwanted intoxication (or worse, the intoxication occurs at a lower dose), then try a different product ideally with a different THC to CBD ratio. (Note that THC is normally associated both with intoxication and relaxation, while CBD is more commonly associated with pain relief, reduction in inflammation, and suppression of seizures; but there are over 80 total cannabinoids present in Cannabis and their total web of interactions with each other and the user’s genetic factors, just aren’t that well characterized yet).
In doing this self-dosing exercise to find what works for you, I can’t stress enough to involve your physician! Particularly if you’re in Canada and this is occurring under the auspices of the MMPR program where your doctor is issuing you your medical Cannabis prescription, discuss the planned approach and your observations with him or her. Although as mentioned above they are limited in what overt prescriptive suggestions they can give, they can assist you in planning a dose testing schedule. They’re used to doing this as it’s done for many other drugs too, because not everyone metabolizes drugs at the same rate. By making your physician your partner in this exercise, not only will you be able to help draw on their expertise, but you’ll be providing them with a case study which they can possibly help apply to the next patient who wants a similar result. If you’re lucky, you may even be that ‘next patient’, and be able to take advantage of their observations.
Finally – what if after all of this, Cannabis just doesn’t seem to do it for you, but you’d still like a natural or herbal-based product to help as a calmative? I’ll point out (not without some admitted bias, since I’m quite excited about it) that there are a number of well documented plant based calmatives with great clinical trials data and a good understanding of their biochemical mode of action. In fact, Segra just received Health Canada approval of Natural Product Number (NPN) 80067446 for Skullcap Serenity specifically for calmative and anxiolytic functions, and we’re currently testing raw material sources prior to release of our first production run of this. You might want to consider this or similar alternatives, as well.
 Pomahacova B. et. al. Cannabis smoke condensate III: the cannabinoid content of vaporized Cannabis sativa. Inhal. Toxicol. 21:1108-1112 (2009)
 Health Canada: Information for Health Care Professionals Cannabis (marihuana, marijuana) and the cannabinoids February 2013. Section 3.2