Can plant-based medicine be personalised?
Plant-based medicine formulations on prescription are just as varied as the delivery methods by which such medicines can be administered. Generally, botanical medicines are infamous in their difficulty to wrangle into the traditional model of standardised conventional medicine and randomised placebo control trials.
While challenges in terms of standardisation of active constituents have largely been overcome in the pursuit of pharmaceutical-grade formulations, variation and concentration of chemical compounds presents a challenge for doctors in terms of discerning the most appropriate dose for patients.
The age of personalised medicine
Personalised medicine is an approach that moves away from a one-size-fits-all healthcare model, towards a system that earnestly looks at the individual, their particular needs, genetics, environmental factors and the manifestation of symptoms.
With so many different cannabinoids and the ability to vary their presence in formulations, this type of plant-based medicine may be able to be personalised to the symptom needs of the patient, if a doctor deems them eligible for this therapy option.
How does your doctor know what’s the right plant-based medicine dose?
The number one guideline followed by doctors that is widely agreed upon with plant-based medicine is “start low, go slow” – in medical jargon, this is called titration. Particularly in relation to medicines containing the psychoactive compound, adverse effects can be experienced if patients are placed on too high a dose, too early in their treatment plan.
While adverse effects from the the non-psychoactive medications may present as relatively mild – drowsiness, dry mouth, increased appetite, nausea – it is still important to avoid the occurrence of these through proper titration. And of course, there is always the risk of unwanted side-effects if taken in conjunction with other medications.
Doctors need to find the appropriate plant-based medicine dose
There are a number of online blackmarket sellers of plant-based medicine, but this is a buy-at-your-own-risk scenario, as you can’t guarantee the pharmaceutical purity or consistency of dosage. It is advised to be prescribed and monitored by a healthcare professional, particularly if you have a serious or complex condition.
As with all medical treatments, the goal is to achieve the greatest alleviation of symptoms with the least amount of dose – therefore hopefully avoiding any adverse effects whilst addressing the potential for building tolerance to the medication. While many patients will not experience therapeutic benefit, regardless of the dose or formulation, if such therapeutic benefit is achieved, this is termed “optimum dose” and is maintained unless symptoms change or the healthcare professional deems the dose should be modified.
Dose optimisation is assessed through preclinical, phase I and II clinical trials and provides physicians with a solid foundation for dosing ranges for a given symptom. Yet with a plant-based medicine, nothing can replace real-world experience. Observing individual patients reactions and applying the tenets of personalised medicines, in conjunction with research-based practice is likely to lead to the better understanding in dosing cannabinoid medicines.
Some of the key factors that play into dosing are the patient’s age, weight and the symptom or condition being addressed. Dosing considerations for children, for example, are very different from an adult.
Comparison of cannabinoids
Firstly, whatever the dose or formulation, many patients will experience no symptom relief at all with plant-based medicine.
However, research so far suggests that, for some patients, higher doses of one cannabinoid may be correlated with increased pain relief. However some other research has shown this cannabinoid, in smaller quantities, has the same effect when combined with another cannabinoid.
It should be noted that, for one cannabinoid in particular, there is deemed a limit for most patients before adverse effects are observed – unless titration is carefully managed.
When combined with equivalent quantities of another cannabinoid that is considered non-intoxicating, some research indicates such formulations to have an effect on pain with a lower dose in a 1:1 ration. So dosing is dependent on the cannabinoids within the medication, and comes down to how and when a patient responds.
What is the Entourage Effect?
Due to the synergism of cannabinoids known as the Entourage Effect, plant-based medicines with a broad spectrum of cannabinoids can exhibit more effect at lower doses than isolated cannabinoids at higher doses.
The therapeutic dose varies greatly given the specific symptoms or disease being targeted. While plant-based medicine may not be suitable or effective for many patients, if it is prescribed, it is of utmost importance that dosing is tailored to the individual patient presentation and modified as required in the long term.