If you are a daily medical cannabis user and have been for some time, you may have already faced the issue of tolerance. You may be finding that you require greater amounts of dried flower or oil to feel the desired effects.

While this is not dangerous, it may reflect a self-imposed imbalance in your endocannabinoid system — and an unnecessary drain on your bank account as well. Tolerance does not occur with all medical cannabis users, but it is common enough to be a frequent question asked of our doctors and educators.

What is THC tolerance?

Cannabis tolerance is the brain’s mechanism to maintain balance in the system, and it is a dynamic (always changing) process. One of the safest qualities of THC, the primary cannabinoid in cannabis, is the natural limit the body places on THC’s effects.

Our bodies interact with the components of cannabis in fascinating ways. It’s built for balance and optimal function. We have receptors (called CB1 and 2) into which phytocannabinoids such as THC fit perfectly.

When we use significant amounts of cannabis, tolerance develops as CB1 and CB2 receptors respond to the presence of THC. Our bodies like balance and cannabis helps create that balance. When we first introduce cannabis, our bodies respond with “Oh! There you are! I’ve been looking for you!” and fills up our CB receptors with the cannabinoid puzzle pieces that are essential for balance and regulation.

When those receptors are all regularly full, then the body says, “Well, let’s cover up a few of these, since we seem to have too many plugged in now and are getting off-balance again.” At this point, our bodies down-regulate some of those receptors and make them unavailable. It has effectively closed some tills at the grocery store.

Finding your ideal cannabis dosing levels can help keep you from building a tolerance to its calming and pain-reducing effects. When you exceed your optimal dose, you may find that you quickly lose those benefits. Most people automatically increase their use to regain those desired side effects. In doing so, at certain levels, benefits can decrease even more.

Resetting allows the body’s endocannabinoid receptors to efficiently tackle the job once again. You will find that you will be able to use less cannabis while feeling more benefits and with fewer side effects.

“… many see it as a spiritual plant and have great respect for its varied effects and how it communicates within our bodies to help bring things back to balance.”

Tolerance is not necessarily a bad thing

Some medical cannabis users prefer to have a baseline tolerance to some of the effects of THC, such as dizziness, so that they can dose more comfortably while still functioning in their daily life. Each medical cannabis user will have their unique sweet spot to control symptoms while balancing other daily responsibilities. Please be aware that Health Canada’s guidelines around THC use and driving still apply for safety.

Tolerance should not be confused with addiction since cannabis itself is not addictive. The use and abuse of cannabis is a function of behaviour, with interrelated psychological and environmental factors at play. When you stop using cannabis for a short time to reset your tolerance, you will not experience a dependence-related withdrawal. You may, however, experience those same symptoms that you treated initially. For example, there may be a re-appearance of sleeplessness, pain, or anxiety until you start medicating with cannabis again.

What can I do to reset my tolerance?

1. Microdose

Microdosing, or consuming a minimal amount of cannabis on a regular basis, is a popular method of use for medical purposes. In this way, you can get the benefits of THC without developing a tolerance to its effects. By microdosing, you can be medicated all day without overwhelming your CB1 receptors with larger doses.

2. Switch to CBD-rich strains

Both psychoactive THC and non-impairing CBD engage the endocannabinoid system. However, these two compounds work in fundamentally different ways. We know that CBD works on many receptors, and not just on our CB receptors. For this reason, it is much harder to become tolerant to the effects of CBD. Opting for a high-CBD strain may be helpful to those looking to decrease their tolerance to THC, but who still require the relaxation and pain relief cannabis offers.

3. Mix things up

Rotate strains or try using new consumption methods such as vaporizing, oils, or making edibles. Change up your routine. For example, skipping consumption in the morning may encourage the onset of stronger effects during evening use.

4. Try a fast partial resensitization

Used to drop the amount of cannabis needed to achieve desired medical effects, this method only requires a few days’ break. Use no cannabis at all for two full days. On the third day, take one puff and then wait for five minutes. If you feel any effect of the cannabis at all, put down your cannabis and do not use anymore that day. If you don’t, however, feel anything in the five minutes of after first puff, then take one more puff and wait another five minutes. Continue this process until even the smallest effect is felt.

Once you hit that point, stop for the day. Continue this process of one puff, waiting, and ceasing as soon as you feel any effect, for the next three days. On the fourth day, resume your regular use and timing. You should find that your body requires much less, even up to only one-half, of the cannabis that you previously needed to achieve the same medical effects.

5. Do a complete tolerance break.

This method has a double effect of both increasing the amount of added receptors and restoring your baseline receptors to normal function. It requires stopping all cannabis use for at least two days and up to four weeks. CB1 downregulation begins to reverse surprisingly rapidly upon termination or decrease of cannabis use. Studies show that tolerance can start to change within two days of abstaining from using cannabis.

Enjoy your tolerance break by staying active as much as possible, and make sure to hydrate often. Engaging in rewarding physical activities will help make resetting your endocannabinoid system more effective. Eating well and focusing on proper nutrition will also give more positive results. Try going for a run, cooking a healthy meal, or taking on a hobby that will offer some positive reward or self-satisfaction.

Cannabis has an interesting and noble effect — it provides comfort, care, and treatment for genuine needs, at the level the user needs. As such, many see it as a spiritual plant and have great respect for its varied effects and how it communicates within our bodies to help bring things back to balance. Take this time to focus on the benefits of cannabis and make an effort to be mindful and thankful for what this plant has to offer.

Keep in mind that a tolerance break means your dosage will change when you start your treatment again. When re-starting your medical cannabis, start with a lower dose than you were using previously. Keep doses low until you get an idea of how it will affect you with your new lower levels of tolerance.

Enjoy the renewed full benefit and pleasure of a balanced, working endocannabinoid system again.

— Written by Shawna Zylenko, RN, clinical assistant and educator with Natural Health Services

For further insight into all things cannabis, don’t forget to check out The Cannabis Show (new episodes every Wednesday), and connect with us through FacebookTwitter and Instagram. The Cannabis Show is also available as an audio podcast, subscribe on iTunes, Google Play, Stitcher, and Overcast.

References:

Billy R. Martin, et al. “The Effects Of Δ9-Tetrahydrocannabinol Physical Dependence On Brain Cannabinoid Receptors.” European Journal Of Pharmacology (2003): 139.
D’Souza. “Rapid Changes in CB1 Receptor Availability in Cannabis Dependent Males after Abstinence from Cannabis. Biol Psychiatry Cogn Neurosci Neuroimaging. (2017): 60-67.
Gerhold Kauert, et al. “Tolerance And Cross-Tolerance To Neurocognitive Effects Of THC And Alcohol In Heavy Cannabis Users.” Psychopharmacology (2011): 391-401.
Gorelick, David, et al. “Tolerance To Effects Of High-Dose Oral Δ9-Tetrahydrocannabinol And Plasma Cannabinoid Concentrations In Male Daily Cannabis Smokers.” Journal Of Analytical Toxicology (2013): 11-16.
Rafael Maldonado. “Study of cannabinoid dependence in animals.” Pharmacology & Therapeutics (2002): Volume 95, Issue 2, 153-164.
Ramaekers, Johannes, et al. “Neurophysiological Functioning Of Occasional And Heavy Cannabis Users During THC Intoxication.” Psychopharmacology (2012): 341-350.
Sulak, Dr. Dustin. “Clinical Applications for Cannabinoids.” NORML http://norml.org/pdf_files/NORML_Clinical_Applications_for_Cannabis_and_Cannabinoids.pdf

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