Based on guidance from the College of Family Physicians of Canada put out in September of 2014, with further affirmations from provincial colleges like the College of Physicians and Surgeons of Ontario, many doctors in Canada have now begun signing 'prescriptions' for medical cannabis with restricted THC levels and/or an emphasis on high CBD strains.
While none of these recommendations are strict rules, doctors do look to these colleges for guidance, especially in terms of controversial medicines like cannabis with which they likely have little familiarity prescribing. The 'start low and go slow' approach applies to all prescription drugs, and cannabis is no different. The College of Family Physicians bases its recommendation of starting with THC levels near 9% on available studies from the WHO, and suggests doctors can increase THC levels over time if lower levels are found to be ineffective.
"Studies of smoked cannabis for neuropathic pain conditions suggest effective doses ranging from one single inhalation from 25 mg of herbal cannabis containing 9.4% THC three times daily using a pipe, 11 to 9 inhalations from a 900 mg “joint” of herbal cannabis containing 7% THC. This translates into current evidence for a daily inhaled dose of 100–700 mg of up to 9% THC content dried cannabis. It is worth noting that in all studies the incidence of adverse events increases with increasing THC levels."
It goes on to mention that if doctors do authorize a higher THC level they must discuss the issue carefully with their patient and monitor their use closely and seek guidance from a colleague experienced with cannabis and THC.
"Furthermore, physicians considering authorizing dried cannabis at doses higher than the current evidence supports (an inhaled dose of 100–700 mg of no more than 9% THC cannabis daily) are strongly advised to; Discuss the decision to increase the dosage, either approaching or exceeding a 3.0 g/day level, with a trusted and experienced colleague, Document in the patient’s record the reasons that support the increased dosage."
The document also recommends low doses of CBD-only strains for people with anxiety.
"If patients with co-existing anxiety and neuropathic pain are authorized for cannabis treatment, i) the dose should be kept low to avoid triggering anxiety, ii) the provider should consider indicating low THC-content or cannabidiol-only (CBD-only) strains on the medical document, and iii) cannabis should be discontinued if the patient’s anxiety or mood worsens."
Lift frequently hears from both patients and doctors impacted by these recommendations. If you would like to share your story with Lift, contact us.
The Family College of Physicians Guidance Document also contains a chart for physicians to see which LP's have strains with these limited levels of THC, but this chart has not been updated since May of 2014. Below is an updated guide for patients to see which LP's currently have available within these recommended ranges. this guide will be updated over time to reflect the changing supply of various Producers.
|Strain Name||THC Levels %||CBD Levels %||Price $|
|Iroquois (Shark Shock)||7||4.28||7.20|
|100% Sativa Shake||4.5||.05||1.75|
|CanniMed||(Prices 25% lower when ordering online)|
|Nebula II CBD||5||8||9.00|
|Nebula II CBD Blend||4||5.6||3.50|
|Original Cheese Blend||11.4||.01||3.50|
|Supreme Formula Blend||8.5||.02||3.50|
|Bubble Gum||8 - 11||5||N/A|
|CBD Skunk Haze||7||5||N/A|
|MariCann||(None currently available, although it lists several options in their 'coming soon)|
|iCann Balanced Moderate||<=12||<=15||N/A|
|iCann Balanced Low||<=8||<=15||N/A|
|AviDekel||0.4 - 1.2||17-20||12.50|
|Midnight||7 - 10||9 - 12||12.50|
|Solveris||8 - 11||0.2 - 0.5||2.50|
|Purple N° 1 (THC Hybrid Trim)||10.37||0.12||3.60|
|Blue No 1||10||15||9.60|
|Green No 1||5.83||11.07||9.60|
|Green No 3 (CBD Hybrid Trim)||2.90||7.38||5.60|
|Yellow No 1 (Available by application only)||0.61||15||9.60|
|OGI CBD Blend||10.7||1.45||N/A|
|Nyce N’ EZ (A milled variety by request)||10.7||N/A||4.50|
|CBD House Blend||4.5||8.1||90 (15 grams)|
|Penelope (CBD Skunk Haze)||7||11||9|
|Devon (CBD Kush)||7||11||9|