Why dosing guidance exists at all
Cannabis dosing is less improvised than the retail environment suggests. There are published clinical protocols, and they agree with each other more than they disagree.
The published protocols
The 2021 modified Delphi consensus — 20 experts across 9 countries — set out three protocols for oral preparations in chronic pain.
- • Routine: start 5 mg CBD twice daily, titrate by 10 mg every 2 to 3 days up to 40 mg/day. At that plateau, consider adding THC at 2.5 mg, titrating by 2.5 mg every 2 to 7 days up to 40 mg/day.
- • Conservative (frail, elderly, comorbid, cannabis-naive): start 5 mg CBD once daily, same CBD titration, then initiate THC at 1 mg and titrate by 1 mg once per week.
- • Rapid (experienced users, severe pain): start 2.5 to 5 mg of each cannabinoid once or twice daily, titrate by 2.5 to 5 mg of each every 2 to 3 days.
The practical bedtime protocol
MacCallum and Russo set out a simpler THC-predominant schedule: 2.5 mg THC-equivalent at bedtime on days 1 to 2 (1.25 mg if young, elderly, or otherwise cautious), then increase by 1.25 to 2.5 mg every two days until you reach the effect you want.
For daytime use they suggest 2.5 mg once daily, then twice daily, increasing as tolerated to a divided total of about 15 mg per day.
The ceiling
This is the part most consumer content omits. MacCallum and Russo note that doses exceeding 20 to 30 mg of THC per day may increase adverse events or induce tolerance without improving efficacy, and suggest limiting total daily THC to 30 mg or less.
More is not better past that point. It is just more.
What we do not know
The Delphi authors were explicit about their limitations: few randomised controlled trials exist, the evidence base for cannabis in chronic pain is low to moderate, and the panel could not reach consensus on a minimum age for THC. A published critique argued that a Delphi process is not a substitute for randomised trials, and that criticism is fair.
Use these numbers as a starting framework, not a prescription. Anyone on other medication should involve a pharmacist or physician.