Less is More: Why Low-Dose Cannabis is Important

According to Jake Browne, America’s budtender and head strain reviewer at Denver Post’s The Cannabist, most consumers are not looking for strains to get them higher than Snoop Dogg and Willie Nelson trolling KFC at 3:00 a.m. on a weekend bender in Amsterdam.

“If I had cataloged the most common request at dispensaries where I’ve worked,” writes Browne, “it wouldn’t be, ‘What’s going to get me the highest?’ but rather, ‘What can I smoke that won’t knock me out?’”

Nonetheless, since the 1980s growers keep crossbreeding high-octane thoroughbred cannabis strains to steadily drive up THC content while breeding out an essential cannabinoid: CBD. According the National Institute on Drug Abuse, potency has increased from around 4 percent in the 1980s to 15 percent (as of 2012). Peruse a few menus in Denver or San Francisco and you’ll find plenty of strains topping 20, even 30 percent THC. (Notably, after the Netherlands saw THC increase dramatically from 2000 to 2005, THC content has trended downward for the last 10 years.)

For most consumers, “high-octane” THC is ill-suited for them on many levels. High THC is therapeutically less effective. It’s not as enjoyable. And, it’s far more likely to produce adverse — short and long-term — effects. So why do growers keep breeding stronger strains? Good question!

As long as cannabis has been used — nearly 5,000 years — medical practitioners have recognized the importance of moderate dosing. The earliest published volume on Chinese pharmacopoeia (circa 2700 B.C.E.), the Pen Ts’ao (The Herbal), warned consuming too many Ma (marijuana) seeds could cause a person to see demons, while moderate doses would enable users to communicate with the spirits. Of course, too much cannabis is unlikely to cause you to see demons, nor will just the right amount grant you mystical powers to “cross over.” But, the point is that for thousands of years, we’ve known moderate doses are better than high doses.

The Biphasic Effect: Why Less is More

As humans, we’re conditioned to think, “if a little bit is good, then more is better.” Right? Rarely is this the case. Cannabis, like many substances, produces biphasic effects.

What is the “biphasic effect?” Think of alcohol. What happens when you drink a glass (or two) of wine? You feel relaxed, more sociable, the effects are pleasurable. Drink too much, and you can get overly emotional, aggressive, even physically ill. That’s the biphasic effect at work. Low to moderate doses elicit desired effects; high doses do just the opposite.

The biphasic effects of cannabis are subtler than alcohol, but no less consequential. Low doses can make you feel relaxed and happy. Too much THC can impair cognitive function, and even induce intense anxiety or a panic attack.

When it comes to therapeutic use, too much THC can provide diminishing returns, or worse, exacerbate symptoms.

U.C. San Diego researchers conducted a randomized controlled trial and like many studies, confirmed cannabis is effective for pain relief — but within a narrow therapeutic window (the range in which a drug is effective).

Participants found no relief in either the placebo or low dose THC. The medium dose produced the most significant relief, while participants consuming the high THC dose cannabis experienced more pain. One shortcoming was that the study only considered THC (cannabis has numerous other cannabinoids and terpenoids that can influence outcomes). The authors acknowledged “there might be another compound within the cannabis leaf that we did not measure that may be leading to the increased pain at the high dose.”

GW Pharma came to similar conclusions when conducting clinical trials for Sativex, a 1:1 THC/CBD oromucosal spray. Participants were given three daily dose ranges: low-dose (1-4 sprays), mid-dose (6-10 sprays), and high-dose (11-16 sprays). Predictably, low and mid dose groups achieved superior results over the placebo, while high-dose patients experienced more adverse effects (22% dropped out).

The biphasic effect has been documented in numerous studies of various conditions, from depression to multiple sclerosis.

Consumers Prefer Moderate THC Over High THC

Research has validated widespread anecdotal reports that consumers prefer mildly euphoric effects and therapeutic efficacy over getting as “high” as possible.

In a randomized-controlled trial (RCT) of 18 active cannabis users comparing the effects of vaping to smoking, San Francisco oncologist Dr. Donald Abrams and his team measured subjective outcomes like ‘self-reported high’ and how ‘enjoyable’ the experience was.

Participants were given low, medium, and high THC dose cannabis randomly on different days. Of those who expressed a preference, no one preferred the lowest dose, but twice as many people preferred the medium dose over the high dose.

“This is not your parents’ pot,” is a favorite punchline used by prohibitionists to suggest the reputation of cannabis as a relatively benign substance is no longer deserved. No doubt, they fail to consider that higher concentrations aren’t always a bad thing. Anecdotal and scientific evidence suggest — including the Abrams study — that patients self-titrate and inhale more deeply when THC is lower. If a consumer has to inhale less smoke to achieve the desired effect, clearly that is healthier. However, there’s a point of not only diminishing returns, but where THC levels are simply too high to be therapeutically useful or enjoyable for the vast majority of consumers.

As cannabis becomes more mainstream and savvier consumers start to favor strains (like wines) for properties beyond potency —  bouquet, diverse terpenes and aromas, craftsmanship — growers may take note. Instead of growers trying to outdo each other with their obsession to drive up psychoactive potency, they’ll focus their efforts on creating a wider array of complex strains rich in a variety of terpenoids and cannabinoids beyond THC.