Tolerance is a good thing, right?  It’s good to be tolerant of others’ rights and beliefs.  It’s good to be tolerant of people who are different from you and may want things other than what you want.  Yet, tolerance in medicine is not a good thing.  

In the cannabis world, users, particularly heavy users, often talk about tolerance as though it were a good thing.  Often this is a justification for their excessive use, and has a macho quality to it.  “I have a high tolerance, I need to use 100mg at a time.”  It’s like tolerance has become a badge of courage.  

In reality nothing could be further from the truth.  Excessive use of cannabis, like any medication, can be harmful.  Additionally, this macho “more is more” attitude is pervasive and can mislead other people into misuse as well.  

For example, I recently saw a patient who was already using cannabis for a medical problem.  She had been encouraged to take 100mg at once!  This is a whopping dose (and if you don’t think so, perhaps you should come see me) and thoroughly unnecessary for her.  Yet, her reaction to my informing her of this was instructive:  she said “I didn’t know that.  I thought this was a normal dose.”  And why would she know it was so high?  She wasn’t going to hear that from the dispensary folk who likely use too much as well, and who are making money hand over fist from her excessive use.  

So What’s Wrong With Tolerance, Anyway?

Glad you asked.  If you’ve been reading this blog for any time you’ve probably seen this analogy before.  The chemicals in cannabis (primarily THC) work by binding to receptors in our body.  These receptors are part of a control system called the Endocannabinoid System.  They aren’t there to work with THC, they’re there to respond to internal neurotransmitters as part of this system.  We can use cannabis to enhance the function of this system in people who have certain conditions. 

However, like all transmitter systems, if you flood the system with transmitter, or in this case THC, it’s like we’re SCREAMING in their ear.  It’s not helpful, can be harmful, and the system responds by down-regulating those receptors (removing them).  

Think of those receptors like the little satellite dishes people have on the sides of their homes.  When there’s too much signal (like excessive THC), the cells quiets it down by taking the dishes off the house.  

But here’s the problem:  those dishes (receptors) weren’t there for the THC, they were there to hear the signal from your internal system.  If we take away some or all of those receptors, the “volume” of the THC might be fine, but the volume of the internal signaling is now so quiet it can’t be heard.  This is the basis of tolerance and why it’s a problem.  

If your internal signaling can’t be heard, the system goes out-of-wack and problems arise.  Those problems are called withdrawal symptoms, and in the case of cannabis include insomnia, anxiety, irritability, depression, and poor impulse control.  The quick fix is to put more THC into the system to alleviate those withdrawal symptoms.  Now we don’t just have tolerance, we have dependence.

Dependence means that if  you don’t use the substance, like cannabis, you get sick.  When you get sick, you do what you have to to feel better.  Your behavior changes to avoid getting sick.  This might mean using too much of the medicine or it could mean making other bad decisions in an effort to get the substance and avoid withdrawal symptoms.  This behavioral change is called addiction.  For cannabis this is called Cannabis Use Disorder and recent, well-done but alarming studies have shown it to be on the rise among medical and recreational users alike.  

So Is Cannabis Bad for You?

Not necessarily.  We have to stop thinking about cannabis as a safe recreational drug and acknowledge that all substances have risk.   While cannabis may arguably be safer than alcohol, safer does not mean safe.  Appropriate use of alcohol is safe, and appropriate use of cannabis is likewise.  

All medications have useful and harmful dose ranges and use cases.  Cannabis is no different.  Low doses, in the 5-20mg range, seem to be effective and do not seem to provoke the problems we’re discussing here.  

However, at present, there is little education about what is safe and an enormous industry profiting from people using cannabis indiscriminately.  

How Do We Move Forward Safely?

Stop listening to the self-serving ideas from the industry.  Don’t assume that the government has your back on this one either.  Ideas like it’s ok for physicians to simply hand out cards, and allowing purchases up to 5 ounces per month, demonstrate how broken the cannabis systems (medical and recreational) were from the start.  

The mantra “start low and go slow” sounds like good advice, but isn’t.  What’s low?  How slow?  When should you stop?  How much is too much?  Remember that everyone who is now using too much started with the same mantra.  (More on this topic in my next blog post).

Instead, find a caring, qualified Cannabinoid Specialist physician who you can trust to properly guide you.  They must be able to inform you about risks as well as benefits, dosing and timing, appropriate (and inappropriate) products, and should be readily available to answer your questions so you don’t have to ask at the shop.  If you need help finding such a clinician, visit www.cannaspecialists.org to get a referral.  

Consult with a Qualified Boston 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.

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