Abstract
Background: Higher potency cannabis products are associated with higher risks of negative physical and psychological outcomes. The US cannabis industry has opposed any restrictions on THC levels, arguing that people titrate their THC doses when consuming higher potency products.Objective: To review research on the degree to which people who use cannabis for recreational purposes can and do titrate their THC doses.Method: A systematic search was conducted for studies published from 1973 to 2020. We included (1) experimental laboratory studies on dose titration of cannabis products that varied in THC content; (2) observational studies on the use of more potent products; and (3) surveys on whether cannabis users titrate when using more potent products.Results: In some experiments, there were inverse associations between the THC content and the amount smoked and smoking topography, while others indicated higher doses consumed and psychological and physiological effects observed. Findings of observational studies of regular cannabis users were more equivocal. In some surveys, cannabis users reported that they use less when using more potent products, but in other surveys, persons who used more potent cannabis had more adverse effects of use.Discussion: There is some evidence from experimental studies that people who use higher potency cannabis for recreational purposes can titrate their THC doses, but less evidence that regular cannabis users do in fact do so. We need much better experimental and epidemiological research to inform the design of regulatory policies to minimize harms from the use of high THC cannabis products.
Highlights
In some states in the USA, the legalization of cannabis for adult and medical use has increased the availability and sales of cannabis products, such as extracts, that have a THC content >70% [1]
This review found mixed evidence on how successful cannabis users were in adjusting their dose of more potent cannabis to achieve the same delivery of THC or the same desired psychoactive effects
More recent experimental studies of ad-libitum cannabis provided some evidence of titration by finding reductions in the amount of THC in blood and plasma when products of different potency were used
Summary
In some states in the USA, the legalization of cannabis for adult and medical use has increased the availability and sales of cannabis products, such as extracts, that have a THC content >70% [1]. The cannabis industry has resisted proposals to cap THC content by arguing that people who use high potency cannabis extracts titrate their doses (e.g., reduce their THC dosage of higher potency cannabis products to achieve the same desired psychoactive effects). Titration Review the amount smoked when using high THC products. We systematically reviewed evidence on the degree to which people who use cannabis for recreational purposes can and do reduce their THC dose when using more potent products. The US cannabis industry has opposed any restrictions on THC levels, arguing that people titrate their THC doses when consuming higher potency products
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