A recent blog from another cannabis expert led with this headline above: 5 Signs You Need a Tolerance Break. This left me shaking my head. It’s exceeding rare that I would ever recommend a tolerance break for a patient. I’ll explain in a minute.
However, I want to lead with this firm statement: If you are a patient and need a tolerance break, you’re doing it all wrong!
That’s not to say that some cannabis users aren’t using too much cannabis, and that using too much cannabis isn’t a problem. It is! A tolerance break is just rarely the right solution.
What is Tolerance and What is a Tolerance Break?
Tolerance is a medical term that means your body adapts to a substance and requires more of that substance to get the desired effect. Lots of medications and substances can cause tolerance. However, most of the examples are things that should concern you, for example opioids and benzodiazepines. Cannabis does this too, albeit at a lower rate and with less dire outcomes.
The cause of tolerance is the real problem here. As we put a substance into our bodies, we often do so at levels higher than our bodies like. As a result, our bodies remove some or all of the receptors for that substance. In essence, flooding our body with a substance is like screaming at our body and our body reacts by turning down the volume, by removing those receptors.
The problem is that our bodies need those receptors. They’re not excess – they’re the amount that we need. Their job is not to listen to the substance we’ve taken, but to our body’s internal signals (like neurotransmitters). If we remove receptors to turn down the volume on the ingested substance, we then don’t have enough receptors to hear the internal signals. When that’s the case, we become dependent on the external substance to trigger the response that ordinarily comes from the internal signal.
Dependence is a bad thing because it means we need the external substance and will get sick if we don’t get it. This is called Withdrawal (or withdrawal syndrome). In the worst case scenario, dependence leading to withdrawal is so debilitating that it changes our behavior – usually in ways that are unhelpful overall – and that is called Addiction. We’d like to avoid that.
A tolerance break makes use of the fact that if you stop using the external substance for a period of time (weeks to months in the case of cannabis), your body will slowly put back the receptors that it had previously taken down. Once that happens, dependence gets better, withdrawal symptoms stop, and resuming use of the substance at much lower doses will lead to the desired effect.
However, this just re-starts the cycle. Unless there is some conscious intervention, likely the doses will simply start to escalate again and we’re right back where we were.
Why a Tolerance Break is the Wrong Idea
At low doses, cannabis will cause a small degree of tolerance but will remain stable (not increasing). Hence, when you find a therapeutic dose (in the safe range) it will be stable, effective, and unchanging. At excessive doses we see the continued escalation of doses that leads to runaway tolerance and all the consequences of that that we discussed above.
So, finding the minimum effective dose and sticking to it religiously is the safest, most effective way to get best benefit and avoid these problems. Your cannabinoid specialist clinician is the person to rely on to guide you to that safe and effective dose, and also to help you monitor your use-patterns to avoid escalation and problems. If you’re not seeing your physician regularly and frequently, this is where problems go unnoticed and become larger problems.
OK, you say, I’ll work closely with my cannabinoid specialist to avoid these problems. What do I do if I’m already having an escalating tolerance or any of the subsequent problems?
If you are a recreational or non-medical user (in other words, not using it to treat a problem), then a tolerance break is a fine approach to getting back on track. But, if you are using cannabis as a treatment, stopping that treatment leaves the medical condition untreated. This is not fair to a patient and it’s not the best approach to their care overall.
Instead, your cannabinoid specialist should see you frequently to prescribe and monitor a slow, long-term process of weaning down the dose. This may also include changing the way in which you take cannabis, as some methods are more habit-promoting than others. By weaning over a relatively long period of time, the symptoms that need treatment can continue to be treated while still reducing the dose and tolerance.
Patients who come to me already behind the eight-ball are often surprised when, after weaning, they are using less, getting better benefit for their illness, and are also saving money. The keys to success are being willing to believe that excess use is a problem, being willing to accept the guidance of the doctor, and the availability of the doctor to guide and monitor the process.
Consult with a Qualified Massachusetts Medical Marijuana Expert Today
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically.
Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at inhaleMD stand ready to assist patients in determining whether medical marijuana is right for them.
For more information, or to set up a virtual consultation with the team at inhaleMD, call us at (617) 477-8886 today.