Deriving Dosing Guidelines for MMJ

An interesting article partially written by UofW research Dr. Gregory Carter.
Dosing Medical Marijuana: Rational Guidelines on Trial in Washington State
It could help someone that gets raided for growing over the 15 plant guideline.

C/P

Deriving Dosing Guidelines for Medical Marijuana: Clearing the Smoke
Let us begin with some basic definitions. According to state law, “Medical use of ‘marijuana’ means the production, possession, or administration of marijuana, as defined in RCW 69.50.101(q), for the exclusive benefit of a qualifying patient in the treatment of his or her terminal or debilitating illness” (RCW 69.51A.010, Section 1, emphasis added). In this definition, the concept that is most relevant to the question at hand is the administration of marijuana. This is a technical concept defined in law. The relevant statute cited is RCW 69.50.101(q). The definition there for our purposes is as follows: “Administer” means to apply a controlled substance, whether by injection, inhalation, ingestion, or any other means, directly to the body of a patient...by...(2) the patient." Thus, the “medical use of marijuana” means the administration of a supply of marijuana directly to the body of a qualifying patient by the patient. Route of administration is an important determinant of the pharmacokinetics of the various cannabinoids in cannabis, particularly absorption and metabolism. Typically, cannabis is smoked, which has the advantage of rapid onset of effect and easy dose titration.[19–21] Due to their volatility, cannabinoids will vaporize at a much lower temperature than combustion, allowing them to be inhaled as a warm air mist.[22] This is a much healthier option than smoking.[22] However, there may be differing vaporization points for the individual cannabinoids. Thus, vaporized cannabis may have differing concentrations and ratios of cannabinoids compared with smoked cannabis.[22,23] Cannabinoids in the form of an aerosol in inhaled smoke or vapors are absorbed and delivered to the brain and circulation rapidly, as expected of a highly lipid-soluble drug.[24,25] With smoking, up to 40% of the available cannabinoids may be completely combusted or lost sin sidestream smoke and thus be biologically unavailable.[21]
Cannabis may also be ingested orally, but this delivery route has markedly different pharmacokinetics compared with inhalation. The onset of action is delayed and titration of dosing is more difficult.[14,23] Maximum cannabinoid blood levels are only reached up to 6 hours post ingestion, with a much longer half-life, as long as 20–30 hours.[23] This would apply to dronabinol (Marinol), the pharmacokinetics of which were used as the foundation of our original dosing guidelines.[14] With respect to dronabinol, which is 100% pure, synthetic delta-9 tetrahydrocannabinol (THC), this is converted in the liver to 11-hydroxy-THC, a potent psychoactive agent. This metabolite accounts for the considerable sedation that patients often experience with dronabinol. Despite the persistent warnings from the Drug Enforcement Agency (DEA) that “today's marijuana is stronger,” both the US Food and Drug Administration (FDA) and the DEA agreed to reclassify the scheduling status of dronabinol from a Schedule II (CII) to a Schedule III (CIII) controlled substance, due to its remarkable safety profile (which is inherent to all cannabinoids). The cannabinoids may also be made in to a liniment and absorbed through the skin. This was a common treatment for arthritis around the turn of 20th century. However, this is the least efficient mode of delivery.
The WA DOH must be aware of these common modes of administration and establish a 60-day supply that presumes that any and all of these common methods of administration of medical marijuana are being employed by qualifying patients. Given the inherent variations in strain and phenotype of cannabis, the various routes of administration employed, and the multitude of debilitating or terminal conditions being treated in patients using medicinal cannabis, standards must be set that maximize the potential for symptomatic relief. To do anything less would be unethical.[26] Minimally, this implies setting standards with respect to the use of the least potent strains of marijuana and the most amount-intensive routes of administration.
The logical place to begin with regard to addressing the question of what constitutes a medically reasonable supply range is to investigate current dosing/supply precedents in American cannabinoid medicine. First and foremost, the WA DOH should draw from the experience of the longest running medical marijuana supply program in the United States, this being the ongoing, now 3-decades-old, Compassionate Single Investigational New Drug Program. The National Institute on Drug Abuse (NIDA) and the FDA jointly administer this. This program has supplied enrolled patients with nearly half a ton of marijuana throughout its cumulative history! The cannabis plants are grown at a federally funded farm in Oxford, Mississippi. After curing (air-drying), the cannabis is rolled into cigarettes at the Research Triangle Institute outside of Durham, North Carolina. Grey metal tins are used to package the cannabis cigarettes, which are then shipped monthly to 5 secured pharmacies in the United States for delivery and consumption by the 5 individuals whose healthcare providers long ago attested in writing to the vital health and medical benefits that consumption of cannabis affords them. The director of the Mississippi farm has stated on the public record that they have been able to produce, stock, and supply medicinal cannabis with strengths as high as 14% THC.[27] The marijuana is produced and supplied for consumption with the full financial backing and imprimatur of the US federal government, the NIDA, and the FDA, as part of a program that was reluctantly started 3 decades ago on the order of a federal judge who ruled that “medical necessity” to use marijuana was an unalienable right possessed by one man whose vision was deteriorating from glaucoma, and which the US government is legally obligated to respect, protect, and fulfill.
One of us (Sunil K. Aggarwal [SKA]) can attest to personally meeting with the horticulturalist who has been growing medical marijuana for the federal government's marijuana supply program for nearly 3 decades, Dr. Mahmood El Sohly. In addition, he (SKA) has met with 3 of the qualifying patients in the program who have chosen to go public: George McMahon, who suffers from nail-patella syndrome; Irv Rosenfeld, who suffers from multiple congenital cartilaginous exostoses; and Elvy Musikka, who suffers from congenital cataracts and glaucoma. Russo and colleagues[28] summarized the supply that 4 of the 5 remaining patients in the program are receiving. On the basis of those reported figures, Conrad[29] summarized the average supply for each patient in the federal program, assuming roughly equal strain strength. According to Conrad, the annual dose is between 5.6 and 7.23 lb of cannabis bud mixed with leaf. Thus, the documented federal single-patient dosage averages 8.24 g/day, or about one fourth ounce per day, which amounts to 6.63 lb smoked per year.
Other S