CANNABIS DOSING AND TITRATION RECOMMENDATIONS Children, Elders, and Cannabis, CBD and other cannabinoids

CANNABIS DOSING AND TITRATION RECOMMENDATIONS

Children, Elders, and Cannabis, CBD and other cannabinoids

Primer for parents and other caregivers

NOTE: this is a work-in-progress.  While written with my series of over 40 children with seizure disorder and/or autism in mind, children are part of a larger group of patients: the cannabis-naïve, those new to using cannabis, and the medically-naive, (those who have used cannabis in the past, but now want to see whether cannabis can help some illness or symptom that they have since developed. 

            In that vein, I will be editing these guidelines based on more experience, feedback from patients, caregivers, and other practitioners, and further advances in research and medicine

CBD dosing guidelines

DrFrank's CBD dosing guidelines:

I recommend starting at 0.5 mg/pound of body weight/day into 2 or 3 doses each day, and gradually increasing up to 5 mg/pound/day.

NOTE: 5 mg/pound would be a very large dose for THC, in my opinion.

But these numbers assume mostly CBD, with very low THC levels.

The main side effects to monitor, while increasing dose, are intoxication, sedation, tachycardia, and dysphoria (opposite of euphoria). Fortunately, cannabis has an extremely good safety profile, with no recorded deaths from overdose.

So when assessing the benefits versus risks, we might exceed the “theoretical maximum” of 5 mg/pound/day, and go higher as needed, and as tolerated.

Background info:

I have based my guidelines above on the following 2 sources:

--Dr. Bonni Goldstein, pediatric emergency physician and cannabis expert, who shared her experience at our quarterly meeting of the Society of Cannabis Clinicians in September 2014, and

--GW Pharmaceuticals, who is supplying the CBD-only tincture, Epidiolex, for it’s study on children with certain seizure disorders.

Dr. Bonni Goldstein’s dosing::

0.5 mg/pound/day in 3 doses

increase 0.5 mg/pound/day at weekly intervals, up to 2-6 mg/pound/day.

GW Pharmaceutical's Epidiolex:

5 mg/kilogram body weight/day divided in 2 doses (NOTE that this dosing is in KILOGRAMS (kg) of body weight, rather than POUNDS.

When titrating, it’s Important to know:

Child’s weight

Actual MILLIGRAMS/dose of CBD, THC, and any other cannabinoids (not just ratios), so we can evaluate what we might want to increase or decrease, per volume of tincture or per piece of edible.

Caution/concern:

Some “CBD” sources are steering parents and patients to other products containing significant amounts of other cannabinoids, which may or may not be as useful, but add to the total “cannabinoid load”, and can make it harder to titrate doses of CBD and THC, the two cannabinoids we know the most about.

I feel it is important to see how optimal dosing of CBD affects the patient’s symptoms or illness.  I have concerns about adding too many variables too soon, such as THC-A or CBG.  THC-A is “THC acid” which is the precursor of THC found in raw cannabis.  Apparently it is not psychoactive, which may or may not be a good quality, but I am not sure how pharmacologically active it is for seizure control

I believe that THC, and possibly also THC-A also have their places, especially with some of the behavioral issues of autism, which is a common co-factor in many of the seizure disorders I have seen.  But I recommend that until you have titrated up to near the “theoretical maximum”* dose of CBD and evaluated the effects, that you try to avoid adding other variables, such as other cannabinoids.

DrFrank’s CBD info rap:

CBD vs. THC-Russo GW Tale of Two Cannabinoids article 

I'll try to simplify what I know.

THC is the more psychoactive of the many cannabinoids in cannabis.  There are over 70 identified, most in minuscule amounts.

CBD is of low psycho-activity. I'm not sure I'd say NO psycho-activity though, but much less than THC.  I also think that CBD-rich cannabis would cause less of the anxiety and/or paranoia that some people experience with cannabis.

GW Pharmaceuticals is a company in the U.K. that has extracted THC and CBD from the whole plant, and has been able to market it in Europe and Canada as a 50:50 sublingual spray called Sativex.  It is NOT available in the U.S. at this time

Here is the url for the article by Ethan Russo MD, and Geoffrey Guy MD of GW Pharmaceuticals:

A Tale of Two Cannabinoids

The therapeutic rationale for combining tetrahydrocannabinol and cannabidiol

http://mcforadhd.free.fr/Russo_Tale_of_Two_Cannabinoids_Med_Hypoth_2006.pdf

The salient sentence in the abstract is:

"CBD is demonstrated to antagonise some undesirable effects of THC including intoxication, sedation and tachycardia, while 

contributing analgesic, anti-emetic, and anti-carcinogenic properties in its own right."

More info at:

http://projectcbd.org

a website by Fred Gardner and Martin Lee, our editors at O'Shaughnessy's, the Journal of the Society of Cannabis Clinicians.

State of the Cannabis Union 2014: Sunday, Feb. 23, 2-4pm, a panel of cannabis law experts

State of the Cannabis Union 2014: Sunday, Feb. 23, 2-4pm, a panel of cannabis law experts

Sunday, February 23
2pm-4pm
2300 Durant Avenue
Berkeley, CA 94704
limited parking in our lot / metered street parking / parking garage at Durant & Telegraph

This year, Dr. Lucido is hosting a quarterly series of educational events at his historic office in Berkeley.  The series kicks off on Sunday, February 23 with State of the Cannabis Union 2014: a panel of cannabis law experts (see attached flyer):

Dr. Frank Lucido:
Family Medicine in Berkeley since 1979 and performing Medical Cannabis Consultations in California since Prop 215 passed in 1996, and in Michigan since 2009.

Attorney Omar Figueroa:
criminal defense lawyer since 1998.  His passion is defending human beings facing criminal charges in federal, state, and juvenile courts, specializing in cannabis, counterculture, and cybercrime cases.

Attorney James Clark:
for more than a decade, he has dedicated himself to fighting for the victims of America’s failed “war on drugs” and is devoted to maintaining their constitutional, civil, and human rights against government abuse.  

This is a family-friendly event.
Please RSVP, if possible, by Friday February 21 to danielle@drlucido.com
(510) 848-0958 M-F 9am-1pm & 2pm-5pm
(877) 787-6900 goes straight to voicemail 24/7

Sunday, February 23
2pm-4pm
2300 Durant Avenue
Berkeley, CA 94704
limited parking in our lot / metered street parking / parking garage at Durant & Telegraph

(If you would like to be removed from my mailing list, please reply to let me know and I will be sure to delete you.)

Dr. Frank Lucido's 2nd Annual Open House & Garden Party Sunday August 11, 2013, Berkeley California

Dr. Frank Lucido's 2nd Annual Open House & Garden Party Sunday August 11, 2013

Please join Frank Lucido MD, Maria Mangini PhD FNP, and their staff for an afternoon of food, music, and conversation.
Dr. Lucido has practiced Family Medicine at this location for 34 years, and has been one of the leading cannabis specialists since 1996.
Maria Mangini PhD, FNP has been my trusted colleague for over 15 years, and has extensive experience in women's health, as well as overall family practice.

Sunday, August 11, 2013 from 2pm – 6pm
2300 Durant Avenue in Berkeley, California 94704

Short "formal" program with remarks by Frank Lucido MD and Maria Mangini PhD, FNP

Music line-up:- special performances by:
The Fresh Juice Party, "a politically prejudiced media group"
Michael "Meezy" Marshall, -the Soul of the Bay
Dylan and Lester Chambers (just confirmed!)

Catering by:  Gourmet A Go Go  & by; Cheese 'n Stuff, Berkeley

Questions & RSVPs
Danielle@drlucido.com
(510) 848-0958: M-F 9am-1pm & 2pm-5pm
(877) 787-6900: goes straight to voicemail 24/7

*****EVERYBODY who RSVPs will get a goody bag which will include a mystery CD from my extensive personal collection, which I began giving away at last year's Open House.

Dr. Lucido’s Primary Care Membership Plan As of February 1, 2013

Dr. Lucido’s

Primary Care Membership Plan

As of February 1, 2013

 California only; (My Michigan practice is limited to medical cannabis evaluations only)

Call 510-848-0958 for appointment

Frank H. Lucido MD

Family Practice since 1979

Medical Cannabis Consultation since 1996

Berkeley Ca 94704

https://www.facebook.com/drlucido

info@drlucido.com

This document describes Dr. Lucido’s Primary Care Membership Plan for Primary Care services performed in Dr. Lucido’s office, during office hours.

Annual Membership fee

Sliding Scale:

12-35 years old:          $600/yr

36-64 years old:         $840/yr

65 years old +         $1080/yr

This fee will cover any and all primary care office visits to Dr. Lucido’s office during regular office hours.  No refunds will be given for non-use of these services.  Our patients are strongly encouraged to have an annual health screening exam.

NOTE:

We are an “out-of-network” provider for all insurance plans at this time. If you plan to claim insurance reimbursement for your visits with us, we will provide you with the documents that you need to send to your insurance company to make a claim.   (NOTE: MediCare patients CANNOT bill MediCare for reimbursement of our fees, since we have opted out of MediCare entirely.)  Although we are not participating physicians with any health insurance plans, we will make every effort to make any needed referrals  to specialists, labs, x-ray facilities, hospitals, etc that do participate with your health plan.

Advantages of Membership:

In addition to primary health care by Dr. Lucido  (33 years in practice in Berkeley), and Maria Mangini PhD, FNP (15 years in practice in Berkeley), membership also includes:

1.    Unlimited primary care office visits to our office during regular office hours;

2.    Patient Access to MDConnection’s online Patient Portal, which allows patients to:

3.    Make or change appointments online and to

4.    Communicate online with physicians or staff

OTHER FEES

Depending on your age, gender, and the results of the history and physical exam, we may also order blood, urine and stool tests, as well as other studies. The cost of these tests is not included in the annual membership fee.

Other services, which are subject to additional charges, include, but are not limited to:

1. Hemoccult (test for blood in stool). Currently recommended annually for patients 50 year of age and older

2. Urinalysis -- recommended annually

3. Specimen handling (Pap smears, wound cultures, urine cultures, etc.)

4. Immunizations, TB tests, other medications administered in our office, and medication administration fee

5. Specific procedures performed in the office (i.e., minor surgery, ear irrigation, EKG, diagnostic tests such as vaginal wet mounts and pregnancy tests, sutures and suture removal, incision and drainage of an abscess, etc.)

6. Filling out forms (i.e. DMV forms, camp physicals, jury duty forms, work releases, etc.)

7. All services that occur outside of our Berkeley office (i.e. hospitalizations, home visits, services of outside consultants, lab tests, x-rays, etc.)

8. Regular controlled substance follow-up (including Marinol prescribing)

9. Medical cannabis (marijuana) consultations

Last call: Dr.Lucido's Berkeley Office Open House: Sunday 8/12, 2-6pm! CD collection give-away

Last call: Dr.Lucido's Berkeley Office Open House: Sunday 8/12, 2-6pm!  CD collection give-away

Dr.Lucido's Berkeley Office Open House
Sunday afternoon, August 12,  2pm til 6pm.
2300 Durant Avenue
Berkeley Ca 94704

full invitation at:
http://drfranklucido.blogspot.com/2012/08/drlucidos-berkeley-office-open-house.html

Family Practice since 1979
Medical Cannabis Consultation


4pm: Short formal presentation:
Dr Frank Lucido MD
and Dr. Maria Mangini PhD, FNP
will reflect on our chosen careers
and how a chance encounter at Esalen in 1977 has led to many years of collaboration in and out of the office

RSVP to info@drlucido.com or leave message at 877-787-6900

Light refreshments catered-yum
***CD giveaway: Every person who RSVP's and attends, will be given a surprise CD from DrFrank's personal CD collection of over 500 discs until he runs out!
(((I'm getting excited about giving my CD collection away
Don't miss out!
rsvp AND attend, and get one mystery CD from my collection.
I have ALL of the Beates, Stones, Jackson Brown.
Some Grateful Dead, Neville Brothers, Doors, Leadbelly, Sex Pistols, Santana, Sheryl Crow, Timbuk 3, Sinead, Patti Smith,
Frank Sinatra, Sammy Kaye, Jimmy Durante, Nirvana.  Don't like you mystery pick?  You get to trade with others recipients for the one you want..)))))


Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
2300 Durant Avenue
Berkeley Ca 94704
510.848.0958 (by appointment only)
www.DrFrankLucido.com
www.AIMLegal.org
www.DrFrankLucido.blogspot.com
Michigan office: 877-787-6900
   (24 hr message line)

Repeal Cannabis Prohibition Act of 2014

Full text at:
http://drfranklucido.blogspot.com/2011/10/repeal-cannabis-prohibition-act-of-2012_16.html

Dr.Lucido's Berkeley Office Open House August 12, 2-6pm Sunday! 33 years in practice; CD collection give-away

Dr. Frank H. Lucido Celebrates 33rd Year in Practice
Family and General Practice: Primary Care;
Medical Cannabis Consultant;
Expert Witness

This year, Frank H. Lucido MD celebrates his 33rd year of providing Family Health Care in Berkeley. He began practicing at his current location in 1979.

Open House:
Sunday afternoon, August 12, from 2pm til 6pm.
Dr Frank Lucido is hosting an Open House at his Bekeley office.
Come see our newly refinished hardwood floors, and other improvements,
and celebrate:
Dr Frank Lucido's 33 years in practice (One-third century!!)
and
Dr. Maria Mangini PhD, FNP's 15 years with us!
and meet our wonderful staff!

Light refreshments catered
Every person who RSVP's and attends, will be given a surprise CD from DrFrank's personal CD collection of over 500 discs until he runs out!

RSVP to info@drlucido.com or leave message at 877-787-6900


Dr. Lucido’s practice includes primary care for patients over 12 years of age. Although he no longer does obstetrics, some of the babies he delivered in the early 1980s are still his patients as adults. Solo practitioners such as Dr. Lucido are almost unheard of in an age of large HMOs and PPOs.  Patients of “Dr. Frank” know he will spend as much time with them as their medical condition requires, and he even makes house calls as needed.  Dr. Lucido has been in the forefront of the medical cannabis movement since the passage of the California Compassionate Use Act of 1996 (“Prop 215”). 

Mariavittoria Mangini, PhD, FNP, who has been an integral part of the Family Practice for over 15 years, received her PhD in Nursing from UCSF with an emphasis on Drug Policy. She is associate professor of nursing at Holy Names University in Oakland, as well as a member of the UCSF clinical faculty.


More information about Dr. Lucido, his practice can be found at www.DrFrankLucido.com and by receiving regular blog updates from Dr. Lucido’s blog:  Everyone’s Entitled to My Opinion.”
http://drfranklucido.blogspot.com/


Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
2300 Durant Avenue
Berkeley Ca 94704
510.848.0958 (by appointment only)
www.DrFrankLucido.com
www.AIMLegal.org
www.DrFrankLucido.blogspot.com
Michigan office: 877-787-6900
    (24 hr message line)

Repeal Cannabis Prohibition Act of 2014

Full text at:
http://drfranklucido.blogspot.com/2011/10/repeal-cannabis-prohibition-act-of-2012_16.html

Women's Visionary Congress, Green Aid Benefit this weekend: Dr Frank's Office Open House Aug. 12, 2-6pm

Women's Visionary Congress, Green Aid Benefit this weekend:

Dr Frank's Office Open House Aug. 12, 2-6pm


July 27-29  WOMEN'S VISIONARY CONGRESS Gathers This Weekend
More below

July 28  GREEN AID-WONDERS OF CANNABIS SUMMER PARTY
More below

August 12, 2-6pm: SAVE THE DATE!!
Dr Frank Lucido's office Open House:
Hardwood Floors at office just refinished this week, and furniture now back in place!
Come by for a lovely Sunday afternoon tea and snacks and help celebrate:
Dr Frank Lucido's 33 1/3 years in practice (One-third century!!)
and
Dr. Maria Mangini PhD, FNP's 15 years with us!
and meet our wonderful staff!

RSVP to: info@drlucido.com
More to come soon...


Upcoming: Repeal Cannabis Prohibition Act of 2014: More to come soon on our revised campaign!
Volunteer and donate at:  http://repealcannabisprohibition.org/



WOMEN'S VISIONARY CONGRESS Gathers This Weekend July 27-29

Tickets are still available for the 6th annual Women's Visionary Congress (WVC) http://visionarycongress.org/ which takes place this weekend from July 27 - July 29, 2012 at the IONS Earthrise Retreat Center http://www.noetic.org/earthrise/ in Petaluma, California. Day tickets are $100 which includes all meals. A ticket for the entire weekend is $350. Tickets can be purchased at http://visionarycongress.org/wvc.registration.html. For more information, contact Natalie Engber at info@visionarycongress.org or call +1 707 489 8877.

The WVC is an annual gathering of visionary healers, scholars, botanists, activists and artists who study consciousness and altered states. Visionaries of all genders are welcome. Speakers include Michelle Aldrich, Valerie Corral, Wendy Chapkis, Copperwoman, Dr. Michelle Corbin, Carolyn Ferris, Bob Jesse, Kristina Hunter, Beatriz Labate, Magenta, Mariavittoria Mangini, Natalie Metz, Annie Oak, Carol Randall, Lindsay Robinson, Nicki Scully, Penny Slinger, Joanna Harcourt-Smith, Diana Slattery, Keeper Trout and Berra Yazar-Klosinski.



GREEN AID-WONDERS OF CANNABIS SUMMER PARTY July 28

Green Aid, the Medical Marijuana Education and Legal Defense Fund, a 510(c)(3) non- profit organization, is defending your rights and throwing a fundraiser to support those efforts.
Save the date for the Ed Rosenthal’s Wonders of Cannabis® Summer Party on Sat. July 28th. This will be the fun party of the summer - a great venue, indoors and out. Here are the details:

Music - Comedy By Ngaio Bealum - Unusual Refreshments
Saturday, July 28, 2012  •  3:30 PM-9:00 PM
9 Lake Ave, Piedmont, CA
Fundraiser for:  JOSE GUTIERREZ • DAISY BRAM • EDDY LEPP
Tickets are $20 in advance and $25 at the door. To purchase tickets and for more information you can visit wondersofcannabis.com

Even if you can't attend, please consider purchasing a ticket to support our cause.

This fundraiser is for pivotal cases ranging from the right to protest to protecting mothers and children from abuses by Child Protective Services. For more information about our current cases go to green-aid.com.
kidnapping attacks the very heart of our society. Stopping it now is extremely important. Although Green Aid is going to devote much of its resources to this issue, it is a small organization and we know that we must form a broad task force to change policy.
The first step we are taking is to invite relevant individuals and organizations to a meeting in September to set up a task force. With this group we will be able to use talent and contacts from many organizations to end the heart wrenching policy of state organized kidnapping.
Green-Aid, The Medical Marijuana Education and Legal Defense Fund is a 501(c)3 corporation and all donations are tax deductible. We have no office rent, paid employees and little overhead. Almost all the money you contribute goes to directly fight for your freedom.
Help us fight this human rights violation. No mother should be threatened with the loss of her child over cannabis. This fight will be costly, but we are ingenious and by working cooperatively with other organizations we will end this practice and restore the sanctity of the mother-child bond.
Please be as generous as you can. Think how empty your heart would be if your child were torn from your arms and given to someone else, and the State was the culprit. We need your help now.