This question was posed to an audience of over 800 stakeholders at the spring FDA conference on CBD regulation. The ultimate answer was that we do not have enough human clinical evidence to nail down exact dosages for any one condition and a plea was put out to the scientific community to provide the answers the FDA sought.
So, the dosage question is still not validated by clinical evidence. One thing is clear, there is no “correct” CBD dosage as of yet and even when established by studies, these values will be affected by numerous variables such as concentration, product form, presence of food, tolerance or other such confounders.
What is CBD?
Cannabidiol (CBD) is a type of phytocannabinoid found in the hemp plant that interacts with our own natural endocannabinoid system to regulate various physiological and cognitive functions. When CBD is taken internally it promotes equilibrium, having positive effects on such conditions as pain, epilepsy, psychotic symptoms, anxiety, mood disorders, nausea, inflammation.
Does CBD make you high?
Because CBD’s sister molecule, tetrahydrocannabinol (THC) does create psychoactive effects, many people confuse CBD with THC in thinking CBD might be psychoactive too. It’s not, CBD will not make you “high” even though it may positively affect your mood state it does not alter your thought processes. Also, CBD comes from the hemp plant which contains less than 0.3% THC by its genetic makeup. Hemp was decriminalized in 2018 by the Farm Bill act and is therefore legal to include in products in all 50 states. The FDA has not given the green light on CBD in supplements yet and this remains a grey area. The primary reason for this is not a safety issue as much as it is a lack of scientific evidence for dosages and uses for CBD.
It is important to know that long term studies on CBD have not been conducted and will take time to discern long term effects of this wonderful little molecule. However, most experts agree that CBD is safe even in high doses and lacks addictive properties. Even though CBD does not get you “high” and is seemingly harmless, measured doses are still recommended and are currently taken mostly from small clinical studies or anecdotal evidence.
Important dosage considerations
Dosages of CBD have a unique U shaped, or biphasic action. When CBD interacts with our endocannabinoid system at low levels it stimulates wakefulness and alertness while at high levels people feel sedated and calm. This effect has been seen in animal studies and now is repeated in clinical studies on humans. This type of biphasic action is common with other drugs such as caffeine where a little bit increases wakefulness but too much causes irritability or with alcohol where it is a stimulant until it reaches .05% in our blood where it causes sedation.
Dosages are also affected by the following major variables:
The strength of a given product is measured in milligrams (mg). This is different from dosage, which indicates the amount of CBD per serving. For example, let’s say we have a bottle of CBD oil with a concentration of 1500 mg in a 30 ml bottle with 1 ml as a standard serving size. This means that each 1 ml dropper contains 50 mg of CBD. You get this amount by taking 1500 mg divided by 30 ml to equal 50 mg per ml or serving size.
Because of the biphasic response of CBD, the effect you want to achieve will drive the dosage level with more activating responses requiring a lower dose while more sedating results will require a higher dose. Someone with severe and chronic inflammation will require a larger dose than someone with a minor inflammatory condition.
CBD is lipophilic meaning it is absorbed better in a fatty environment. A greater amount of CBD will be absorbed if taken with a fatty meal than if taken on an empty stomach.
How much you weigh determines how much of a dosage you need. Generally speaking, heavier people will need a larger dose to achieve the same effect that a smaller dose would have on a lighter individual. You will see this later in the dosage by weight table.
As with any drug, we develop a tolerance to its effects. The more often and longer one uses CBD the greater the dose needed to achieve the same effect. Higher doses may increasingly be required to achieve the desired outcome.
These are by no means all the factors that can throw a dosage off. A person’s genetics, metabolism, environment, product composition, product application all can affect absorption and bio-availability.
How to calculate CBD dosages?
A good place to start with dosages is by using one’s weight. Comparing a weight chart with a condition chart may guide you in determining how much of a difference your weight will make in calculating dosages.
CBD dosage chart: calculating the dose based on weight
Table 1. Calculating Your Dose by Weight per Pound of Body Weight
|Weight Group||Mild Effects||Moderate Effects||Strong Effects|
|Light: <130 lbs.||≤11 mg||12-14 mg||15-17 mg|
|Medium: 130-230 lbs.||≤18 mg||19-23 mg||24-27 mg|
|Heavy: >230 lbs.||≤23 mg||24-30 mg||31-45 mg|
This chart may be used as a launching point for those who don’t know what dosage to start on. Again, the condition being treated, and the desired effects will be the main determining factors. Let’s take an example. Say you have a woman who weighs 125 lbs. The woman is having severe inflammation and wants relief. According to the chart we use 15 (for strong effects and a light body) so someone 125 lbs would be in the light category and should start with a dosage of 15 mg and wean up as tolerated.
CBD dosage chart: calculating CBD dose based on pain level and inflammation
Table 2. Common Starting Doses for Pain Management in Milligrams Per Pound of Body Weight
|<25 lbs.||25-45 lbs.||46-85 lbs.||86-150 lbs.||151-240 lbs.||>240 lbs.|
|Mild||4.5 mg||6 mg||9 mg||12 mg||18 mg||22.5 mg.|
|Medium||6 mg||9 mg||12 mg`||15 mg||22.5 mg||30 mg|
|Severe||9 mg||12 mg||15 mg||18 mg`||27 mg||45 mg|
A review of the clinical literature shows that CBD appears to only be effective in pain associated with inflammatory conditions. CBD is a well-known anti-inflammatory and these particular actions are what is associated with the reduction in pain levels.
Pain chart # 2 includes the answer to “where do I start my dose for rheumatoid arthritis”? Dosages for pain should start low and go slow until titrating to the effective dose. When in doubt, contact your physician for guidance.
CBD dosage chart: Calculating dose based on condition
Table 3. Calculating Dosage Based on Condition and Clinical Study
|Insomnia||Sedation||Pain from Inflammation*||Anxiety||Psychosis|
|160 mg||300-600 mg||4.5- 45 mg||400-600 mg or 25 mg||300 mg|
*taken from pain chart and clinical study using transdermal patches
The dosage chart for conditions used “achieved results” such as “how much CBD oil do I need to take for anxiety” as an endpoint. A weight chart was not used in these studies. It is not clear why the clinical studies on humans need to use such high doses to achieve effective results in their subjects, but clearly more research is needed. For example, on 60 mg CBD, insomniacs would go to sleep but not stay asleep. It took 160 mg for them to achieve at least seven hours of sleep.
How much oil is in a dropper?
Here is a good example on how to do this calculation: If a bottle has 1500 mg in it and it is a 30 ml bottle then the amount in a 1 ml or 1 gm drop would be 1500 divided by 30 = 50 mg in 1 dropper or 1 ml. 1 ml is equivalent to 1 gram of water or liquid. How much is a gram of CBD oil? 1 ml is 1 gram.
Why are doses for certain conditions higher than others?
There are many reasons why the dosage for these conditions may seem higher than those given for weight. First, most of these conditions noted in Table 3 are those that require a sedating dose which would be much higher than one used for an activation condition due to the biphasic dose-response noted in animal and human studies.
An activating response might be a calmer mood or mental clarity. For example, someone might need a lower dose for an irritable mood, but a higher dose for anxiety. At this point, studies are sparse and often contradictory. Websites contain products that are not consistent in following their labels as to the actual content of CBD and may vary from brand to brand. Don’t be afraid to consult a professional if caught in a maze of confusion.
Navigating the maze of CBD products
Thanks to a multi-billion-dollar industry, consumers have a plethora of products containing CBD to choose from. The industry has literally exploded! Because of the number of products to choose from, calculating a proper dosage can be even more challenging.
CBD Oil and tincture dosages
Oils and tinctures typically come in 15 ml or 30 ml bottles and are concentrated forms of the product. These products vary significantly in terms of concentration having anywhere between 100 – 5000 mg per bottle. We discussed earlier how to figure out the concentration in a bottle.
First-time users should start low and go slow. Tinctures do not take effect as quickly as other CBD products such as vape oils and the feelings may not be felt right away. It is worthwhile to note though that effects can last for up to three or four hours. Sublingual medicines should be held under the tongue for 60 seconds for maximum absorption.
Vape oils dosages
Vape oil is CBD oil extracted from the hemp plant that is combined with another agent such a propylene glycol or vegetable glycerin. A vape pen is used to extract the oil in the form of smoke that is inhaled into the lungs and thus into the bloodstream almost immediately.
The effects of vaping are almost instantaneous with a calming effect felt almost immediately. The length of time the effects are felt depends on how much vape oil is consumed and how long the smoke is held in the lungs.
With respect to concentrations, tinctures and vape oils are very similar. Most vape oils come in 30 ml bottles with the same 1 ml serving size and concentrations ranging from 200-1500 mg meaning that the serving size for most oils will vary from 6.6 mg to 550 mg. A vape pen will hold a cartridge of oil with the size ranging from 0.5 – 1.5 ml.
Care should be taken that the product is reputable and has been tested. Many products haunt the shelves of unsuspecting dispensaries that contain contaminants or undesirable additives. Even testing does not guarantee quality as one test showed 26% of tested products contained less CBD than labeled, which could affect any potential clinical outcome to the use of the product.
CBD also comes in lotions, creams, salves, and bath balms. These topicals are applied directly to the skin and the CBD attaches to cannabinoid receptors in the epidermis and never enter the bloodstream or interact with the endocannabinoid system directly. People may use CBD topicals to relieve muscle or joint pain or alleviate discomfort from burns, stings and other injuries.
CBD topicals have shown anti-acne activity from its actions on the sebaceous glands making it a therapeutic treatment for dermatological conditions. Many topicals are combined with synergistic essential oils such a menthol, capsaicin, camphor or peppermint. The oils may all work together to create a dynamic change in tissue healing or inflammation and pain. The result, nevertheless, is soothing to the tissues.
Calculating a dosage for topicals is even trickier than for orals. The serving size depends almost completely on the amount that is applied to the skin. Most CBD topicals are sold with a concentration between 250 mg – 1500 mg and most of the studies done have been on animals. If the pain or discomfort is severe, choose the higher concentration.
Topicals have already shown medical use in such conditions as Epidermolysis bullosa, a rare blistering skin disorder that is challenging to manage because skin fragility and repeated wound healing cause itching, pain, limited mobility, and recurrent infections. In a preclinical trial, for example, all 3 patients treated with the CBD cream were able to wean off their opioid medications and exhibited significant healing of their lesions.
Is CBD safe to use?
CBD is generally well tolerated with a good safety profile. Reported adverse effects may be as a result of drug-drug interactions between CBD and patients’ existing medications. According to the World Health Organization, there is no evidence of a public health problem with CBD or the potential for dependence or abuse. High doses have been well tolerated with few if any, side effects. It is not psychoactive and will not cloud one’s judgment.
There are high hopes for future medicinal uses for the CBD molecule for several ailments for which we yet have no effective treatments. Further study is needed to nail down dosage recommendations for various conditions, a feat proven difficult because of its biphasic dosage response.