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17 doctor focus cannapatientcare.com july/august 2022 | cannabis patient care disturbances with CBD, I find the best results are usually achieved with THC-dominant cannabis. • Use cannabis throughout the day. • Many patients wait until after work to use canna- bis—this is not ideal in autoimmune disease because some of the anti-inflammatory effects of cannabis are short-lived. • Daytime administration of CBD and cannabidiolic acid (CBDA) combined with approximately one fourth of one's optimal nighttime dose of THC is often well tolerated and effective at reducing symptoms. • Consume acidic cannabinoids. • THCA and CBDA are highly absorbable when taken orally and have profound anti-inflammatory effects. While not usually as rapidly effective as THC in re- ducing symptoms, I've found that most patients who consistently take acidic cannabinoids 2-3 times daily for 2 weeks reports significant improvements in in- flammatory symptoms. • If products containing THCA and CBDA are available, I recommend starting with 10 mg of each per dose and gradually increasing if needed. Some people do well with higher doses of CBDA up to 100 mg per dose. • If you don't have access to such products, simply make cannabis tea. On average, an 8-ounce cup of canna- bis tea made from a ¼ gram of a THC-dominant variety contains approximately 10 mg of THCA and 2 mg of THC, a nice dose for many people. If you add creamer or any oil to your tea, be prepared for a higher dose of THC. • Avoid building tolerance to THC. • THC tolerance occurs via downregulation of the CB1 receptors; CB2 receptors likely also downregulat- ed when this occurs. This means that if you are less able to feel the psychoactive and symptom-relieving effects of cannabis, you are probably also less able to benefit from some of the anti-inflammatory and immune-regulating effects. • Most people who lose the benefits of cannabis over time assume that increasing the dose is going to im- prove efficacy, which it may do temporarily, followed by more tolerance-building. The more effective but counterintuitive strategy, however, is to reduce the dose, allowing upregulation of CB receptors and res- toration of responsiveness to cannabis. • For those who suspect they've developed tolerance to cannabis, Healer.com provides a complimentary protocol, complete with videos and worksheets, to guide people through a cannabis sensitization pro- cess and discover an optimal dose of THC. • Be liberal with CBD and CBDA. • Unlike THC, it's much harder to build tolerance to the benefits of CBD and CBDA. Liberal dosages of both are usually well-tolerated and non-psychoactive, a good choice for daytime treatment. • Explore the perceptual gifts of THC. • While many patients new to cannabis will at first wish to avoid its psychoactive effects, eventual- ly I find the opportunity to introduce them to what might be the most therapeutic aspect of this plant. • People who regularly use oral THC before bed can periodically take their regular dose a few hours early to explore the psychoactive effects of THC while awake. I often encourage them to turn off the screens, put on some music, pick up a journal, or other specific suggestions to increase the likelihood of a therapeutic experience. • For those open to inhaled cannabis, this is usual- ly the best way to appreciate its perceptual gifts be- cause of the rapid onset and easily observable tran- sition of one's perspective of life's stressors. It can support introspection and reflecting on one's day, enhance healing practices like yoga and chi kung, deepen intimacy, and much more. In summary, autoimmune diseases are common and origi- nate in the immune system's (and often one's conscious) dys- functional perception of self and non-self. Cannabis can pro- vide excellent symptom relief for pain, sleep disturbance, itching, spasticity, anxiety, gastrointestinal, and many other symptoms. Some conditions, like MS, have significant clinical trial data supporting the effectiveness of cannabis, while most autoimmune diseases have little data beyond patient surveys, which usually indicate excellent results. Stress is a major factor in the development and progression of autoimmune diseases; cannabis can improve resilience to stress via its acute anti-anx- iety effects and via long-lasting improvements in perceptual flexibility and ability to experience eustress instead of distress. Finally, cannabis also treats many underlying factors of autoim- mune disease, conveying many of the benefits of DMARDs with- out the side effects and likely reducing the progression and damage caused by these conditions. References (1) M.B.A. Oldstone, Monoclonal Antibodies in Immunodiagnosis and Immunotherapy 33(3), 158-165 (2014). (2) Y. Segal and Y. Shoenfeld, Cellular & Molecular Immunology 15(6), 586-594 (2018). (3) G.S. Cooper, M.L.K. Bynum, and E.C. Somers, Journal of Autoimmunity 33(3-4), 197-207 (2009). (4) M. Rojas, et al., Journal of Autoimmunity 95, 100-123 (2018). (5) A. Chan and C. Vila Silván, Neurodegenerative Disease Management 12(3), 141-154 (2022). (6) B.S. Koppel, et al., Neurology 82(17), 1556-1563 (2014). (7) J. Corey-Bloom, et al., Cmaj 184(10), 1143-1150 (2012).