HDCT Frequently asked questions.

Q:  Why should I read all of this FAQ section carefully?

A:  With most drug regimens your doctor is the expert and has quick access to the medical indications and contraindications as well as dosing and safety precautions for the particular medicine they are prescribing.  This is usually not the case with High Dose Cannabinoid Therapy (HDCT) even if your recommending physician is a specialist in cancer and or cannabis medicine.  Post doctoral education in the U.S.A. in particular is driven by big pharma and HDCT is not from that arena although it relies heavily on peer reviewed published medical research is as much as it can at this stage of the game.  Most doctors do not even know what HDCT is and will not be able to help you manage the medication ramp-up and its side effects.  HDCT is not for passive patients.  This medicine is only for patients who take the time to fully inform themselves and their care  team about HDCT BEFORE they begin.  The body of published research on cannabinoids and cancer is broad and getting grander but it is unrealistic of you to expect your physician to read and research the hundreds of articles and studies published on cancer and cannabinoids.

Finally, not a single published study addresses HDCT and cancer.  It is the entire body of work which shines the light in this direction.  HDCT can only be appropriate for those patients for whom big pharma has no good option or more commonly, no good option left.  Sadly, that is the case for a lot of late stage cancer patients and often for earlier stage patients with cancers for which there are simply no other tried and true good options.

Be aggressive in your research and learning.  Do not skim this page of Frequently Asked Questions.  This is likely your life you are playing with, get it together and get reading.  Be sure to read all of the article, “The Limits of High Dose Cannabinoid Therapy” contained elsewhere in this site.

Q:  How is HDCT Ramp-Up different from HDCT Maintenance?  Do I need both?

A:  Yes.  Patients cannot use HDCT Maintenance without first using HDCT Ramp-Up for 14 days.  HDCT Maintenance dose cannot be tolerated without first deliberately and systematically causing your body to adjust to the extremely high levels of THC contained in the regimen.  A very special 14 day graduated dose of THC with 100mg CBD daily is delivered by HDCT Ramp-Up to prevent overuse sickness from the extremely high doses of THC in HDCT Maintenance.

Q:  How long will it take to adjust to the THC so that I’m not so “high”?

A: Most patients reach a steady state of THC in their body around day 27 including the 14 ramp-up days.  At this point most people do not feel high anymore.  In fact some complain that they cannot feel high.  This is approximately 5 half lives for the drug in the regimen that causes the “high” feeling.  It is  the increasing amount of THC in the body and the daily or momentary spike in blood levels of THC which causes patients to feel high not the absolute value of THC in the body which causes this feeling.  For this same reason, a blood tests which shows impairment for drivers is unable to be developed.

Q:  Why is there so much THC and CBD in HDCT Maintenance?

A:  Both CBD and THC, the two main medicines in HDCT Maintenance, have been shown to have antineoplastic (anti-cancer) activity in many studies against many different types of cancer cell lines in the lab.  In almost every single published study the response rate (% of killed cancer cells) is dose dependent and positively correlated with higher dosing.  In plain English, more cannabinoids cause more cancer cell death in the lab experiments published.

Q:  Can I take just the CBD and not the THC in HDCT?

A:  Yes, but its not usually the most promising course.  A few cancers respond just to CBD alone and not THC and vice versa.  In published studies where particular cancer cell lines have been tested for response in the lab, most if not all of these studies suggest that both THC and CBD have different kill mechanisms for the cancer cell lines tested.  Multi-prong approaches to killing these cells is similar to an attack from multiple fronts.  If you provide Evexia Science with your pathology, we may be able to make a suggestion based on the science available but it’s still just a best guess based on what we know at this time.  We believe this is your best course but patients are free to make their own decisions.  It is important to note that not all types of cancer cell lines have been tested and just because these medicines kill cancer cells in some lab and animal studies, they may not work at all in humans.  We don’t know enough yet to make those types of claims.

Q:  Can I stop at anytime or do I have to gradually reduce my dosing down?

A:  Both THC and CBD are self tailing drugs.  You can stop them at anytime and your bodies own elimination cycles will safely tail out the drugs.  There is no need to get fancy about it although stopping before two months of full dose treatment is not recommended.  These drugs are not magic and they need time to work just like other antineoplastic (anti-cancer) agents.

Q:  Will I gain weight from these drugs?

A:  Most cancer patients, especially higher stage patients have trouble keeping weight on.  THC is known to increase appetite and may help patients keep valuable weight on.  During the ramp up phase and while the body adjusts to a steady state some patients may need to be encouraged to eat.  During ramp up patients may be uninterested in preparing food and can be forgetful about hot burners etc.  A caregiver should prepare food with enough nutrients and calories for the patient during this time.

Q:  Will HDCT work for me?

A:  We don’t really know yet.  Here is what we do know.  Various studies with many different cancer cell lines have been done around the world showing that the chemicals in HDCT can and do kill certain cancer cells in the lab and in animals.  The mechanisms of kill vary and are usually positively dose dependent.  That simply means that more of these chemicals are more toxic to the cancer cell lines than less of these chemicals whenever they do kill a particular cancer cell line.  We do not know enough yet to make claims about any particular cancer in humans.

Q:  Will I be able to do all of my normal activities while ramping up and reaching a steady state of THC and CBD in my system?

A:  You should not drive or operate machinery while on HDCT especially in the first month of use.  Even after that we think you should not drive.  You will feel more tired than normal and will spend a lot of time resting and sleeping.  Give you body that chance to adjust.  Most people cannot work during the first month of beginning HDCT and should not plan on doing so.

Q:  Can I take less than the recommended amount of THC in HDCT:

A:  Yes, but in nearly every study of cancer cell lines impacted by THC and CBD the response rate is dose dependent.  This suggests that higher doses may be significantly more effective than lower doses.  The time to reach steady state for higher vs. lower doses is about the same, so it is suggested that patients stick to the suggested dosing in the regimen.

Q:  What happens if I lower the dose of THC as I try to reach the steady state of THC.

A:  This can increase the time it takes to reach a steady state of THC in the system especially if the change occurs later in the process.

Q:  Can I stop the THC for now and start again later.

A:  Yes, but you greatly increase the likelihood of overuse sickness.  You will likely need to start a completely new ramp up period to avoid overuse sickness if skipping more than a couple of consecutive doses.  This also reduces the pressure you are placing on the cancerous cells and may give them time to recover.  This is not what you want.

Q:  Can I just smoke marijuana instead?

A:  The dosing in HDCT is impossible to achieve from inhaled sources of THC and CBD.  The goal of HDCT is not palliative care but is rather to create a cytotoxic state in the body which kills the cancerous cells while leaving healthy cells healthy.  This cannot be achieved through smoking.

Q:  Will my insurance company cover HDCT?

A:  No, HDCT is not approved for treatment or prevention of any disease by the FDA.  Insurance companies in the U.S.A. use this standard to save claims expenses regardless of how much science and research has been done around the world.  This is true even if you have no other options for treatment available.

Q:  I’m taking high doeses of anti-oxidants like vitamin C.  Can I do this while taking HDCT?

A:  You can but it’s not advisable.  CBD has been shown in the lab to induce cell death through the creation of reactive oxygen species in some types of cancer cells.  This is also the secondary way in which radiation therapy works.  These reactive (corrosive) molecules are also known as free-radicals and their production may be limited by high doses of anti-oxidants like vitamin C.  This has not been studied in great detail but this is one dual prong approach that may be counter productive.  Our thinking is that if Vitamin C actually killed cancerous cells no one would actually have it.  Also if you look at the continuing cancer research around the world, we find no one pursing anti-oxidant regimens whereas dozens of studies have and are looking at the promise of cannabinoids.

Q:  How is HDCT different from making and using my own Rick Simpson’s Oil?

A:  HDCT contains very high measured doses of both CBD and THC (100mg/day CBD and 400mg/day THC)  in a consistent formulation in easy to take tablets.  CBD in particular is a very rare cannabinoid produced in only very small amounts by almost all cannabis strains.  Most strains produce none and often what are called “High CBD Strains” are still pathetically low in CBD.  In peer reviewed published research CBD has a very different kill mechanism from THC.  Unless you have access to the very specific strains of ready marijuana which produce virtually only CBD you will not have this quantity of CBD in a backyard chemistry experiment.

HDCT Ramp-Up is also a very carefully dosed ascending regimen of THC that minimizes the very real risk of overuse sickness.  HDCT Ramp-Up ALSO INCLUDES FROM DAY ONE the EXTREMELY high dose of CBD that is contained in maintenance HDCT.  It is there not just for its apparent antineoplastic (anti-cancer) properties.  The CBD in HDCT Ramp-Up also minimizes the “high” from ramping up to maintenance dose.  Even with this you will be way “higher” feeling than you ever wanted to be in the best case scenario offered by HDCT.  The risk of severe over use sickness common with backyard RSO is virtually eliminated by HDCT Ramp-Up when used as directed.  You will be really euphorically high but not sick.  HDCT ramp-up comes in a 14 day punch pack with 4 times/day dosing to keep you on track by gradually pushing your body consistently toward the high dose you want to be able to achieve and tolerate.

Q: Is HDCT legal?

A: No.  HDCT contains all the cannabinoids which are still considered to be schedule 1 drugs by the FDA.  This makes them federally illegal at this time.  California patients with a valid doctor’s recommendation may possess HDCT under state law only but this does not make if federally legal even for them.  The US attorney generals office has generally decided to not prosecute patients who are in compliance with their own state’s medical marijuana laws.  We know of no HDCT patients who have had a legal issue federally.

Q:  Can I use alcohol while on HDCT?

A:  Do not try it at all during the first 45 days and then we recommend using no more than an ounce of alcohol in any day with HDCT. No alcohol is best. Alcohol is about the only drug that does not mix well with HDCT.  The mix can make you quite sick.  If you are an alcoholic and cannot control your drinking do not start or take HDCT.  This is not a good drug regimen for you.  If you ignore this and do get sudden overuse sickness you won’t actually die from the THC or CBD but you will want to for about 8 horrible hours of the sickest agony of your lifetime.  Stay away from alcohol when ramping-up and when on HDCT Maintenance.  HDCT makes you more susceptible to alcohol poisoning which can be fatal.  The safest thing is to not even try mixing the two.  Far too little is known and what we do know is not positive.  just stay away.

Q:  My employer does not allow cannabis use.  Can I take HDCT and not be punished by my employer?

A:  No.  Most state laws including California offer no protections for employees in this situation.  Contact your state congressman and complain.  In most situations this is ridiculous policy and we need a change to the law.

Q:  My mother is on her death bed and the doctors tell me there is nothing left to do.  She has only a few days.  Should we begin HDCT Ramp-Up?

A:  No, no, no.  HDCT is not Harry Potter’s magic wand.  Like any medicine it needs time to work if it is going to work at all.  She has missed the window of opportunity.  We are very sorry.

Q:  We got something from somebody somewhere in a bottle, a vial, a syringe, a brownie,  or a horse terd that somebody somewhere claims has something to do with cannabis, THC, or CBD..  We have no idea what is in it or how potent it is.  Should we try it anyway?  Will it work the same as HDCT?

A:  Really, we get this question almost daily.  No!  We have seen all sorts of concoctions dispensed even by well meaning medical dispensaries and advocates. Some even have fancy lab results attached to them.  This does not mean they contain the combination of medicine you need in the dosing needed to have any chance of having antineoplastic (anti-cancer) effects.  Many will make you high and that is it.  CBD in particular in the doses similar to HDCT are very rare.  If the purveyor cannot cite the peer reviewed published medical science that even suggests the reasons why one might try using it for your very specific cancer pathology, then run.  This is your life.  Talk to the experts.

The Limits of High Dose Cannabinoid Therapy (HDCT)

High Dose Cannabinoid Therapy (HDCT) cannot be tolerated without allowing the body to adjust through repeated exposure to the active compounds.  Developed tolerance is especially required for the quantity of tetrahydrocannabinol (THC) used daily by an individual at the full dose levels of HDCT. (100mg oral THC 4x/day).  Thus, before HDCT can begin in earnest, it is first necessary to complete a course of increasing cannabinoid ingestion over a period of several days.  Not to do so WILL RESULT IN VIOLENT VOMITING, similar to alcohol overdose.

The Rick Simpson’s Oil (RSO) folks warn profusely in countless anecdotal counts that patients are to start with a “grain of rice” sized bit of oil and then instruct them to work their way up to one gram of “oil” per day.  Many of those patients doing their best with such an unscientific, unmeasured, unrepeatable process make themselves exceedingly ill and abandon their attempt at HDCT through no fault of their own.  This is because the cannabinoid content of RSO varies GREATLY from preparation to preparation.

Overexposure sickness and failure does not have to be the case.  Whether you are making your first attempt at HDCT ramp up or if you are one of those patients who failed on RSO you are much more likely to achieve the functional tolerance and long term success you need using the measured tabletized ramp up regimen and HDCT tablets.   Not only is the dosing more accurate, but your ramp up regimen tablets manipulate the ratio of THC to Cannabidiol (CBD) to reduce psycho activity of the THC component in the regimen.1  This is impossible with RSO.  HDCT tablets minimize the psychoactive effects of your treatment during both ramp-up phase and during full HDCT so you can spend more time being your normal self with your family, friends and at work.

Even though the CBD in your regimen (25mg oral CBD 4x/day) will mitigate the “high” of the other cannabinoids,1 all patients should expect to experience some psycho-activity from the medicine in the beginning as well as increased sleep periods.2 Plan accordingly, especially during the initial 2 weeks.  Psycho activity will diminish over time3 as your blood levels increase to the point of saturation where additional THC ingestion no longer creates a significant spike in the patient blood level. It is the spikes in THC blood levels that contribute to the “high” effect or feeling of euphoria, not the absolute quantity of THC in the blood steam which persists for days even after the last dose.4

Be patient, your body will adjust quite easily if you take the tablets as scheduled in your ramp-up package.  Allow extra time for rest as your body adjusts and avoid alcohol use especially during the ramp-up period.  Several patients report being able to tolerate a SINGLE glass of wine or other one ounce alcoholic beverage after they have completed more than a month of HDCT beyond the two week ramp-up period.  We do not however recommend this and definitely do not mix these and drive or operate other machinery.  The combination of alcohol and THC has synergistic negative impacts on driving and motor skills.5,6  Do not attempt it!  This is the time for you to ask for help from all those friends and family members who have absently asked if they could do anything to help you out.

If you are an active alcoholic you may need to be medically detoxed even BEFORE you begin HDCT ramp-up and remain alcohol free during your use of HDCT.  If this is not possible, HDCT is not a good choice.  Consult with your physician.  Excessive use of alcohol during HDCT ramp up and full dose period will certainly result in violent overuse sickness.  AVOID ALCOHOL!

For the first time, this gradual ramp up dosing and subsequent ongoing HDCT is available in a tabletized form reducing the risk of accidental overuse sickness combined with ease of ingestion.  HDCT tablets contain all of the phytocannabinoids in RSO but in a safe and more accurately dosed format that is simple to use.  The tablet granules themselves are prepared using laboratory tested alcohol extracted RSO prepared from special strains of marijuana known to produce very low levels of THC in the case of CBD dominant tablets.  In THC controlled HDCT tablets, a variety of Indica, Sativa, and hybrid strains known for high THC production are used.  The systematic dose increases of the ramp-up tablet package and their combinations virtually ensure successful development of the necessary tolerance.7 The gradually stepped THC content during your ramp-up phase minimizes the chance of overuse sickness and the consistent daily dosing once you reach the full HDCT dose helps to maintain constant blood levels of the cannabinoids.

Each whole extract tablet is controlled for either CBD or THC content, although each type may contain minor amounts of all cannabinoids.  This is by design as we are seeking an entourage effect.  This consistent dosing is important to keep constant pressure on the intracellular processes thought to interrupt the normal survival activity inside cancerous cells.  Consistent dosing is also needed to maintain your tolerance level to the HDCT full dosing levels.  If you stop taking HDCT you will need to repeat an additional ramp-up period.3 Just as your body adjusts quickly to the medicine over a period of days so too it will adjust to its pre-tolerance disposition.  Be prepared and order your refills with plenty of time allowed for delivery.

The final HDCT regimen is a 4:1, THC to Cannabidiol (CBD) ratio which also includes the full array of minor cannabinoids found in the base RSO.  Nothing is removed; only the safety and consistency are increased.  Most HDCT patients are fighting some form of cancer relying on either the anecdotal evidence they have scraped from other patients or forums and or published research showing promise of antineoplastic (anti-cancer) activity of the main active ingredients found in HDCT tablets.  Some of the cannabinoids in your HDCT tablets have even been found to be radio-sensitizing agents in certain cancers in mice,8 so HDCT may offer additional benefit if used during any treatment involving radiation therapy especially Glioma’s.  Some of the cannabinoids in HDCT tablets have also been shown to create synergistic antineoplastic activity when used in combination a certain alkylating and other chemotherapy agents in preclinical trials.9,10

You may also notice improvement in other inflammatory conditions which you have while on HDCT.  Some the cannabinoids contained in HDCT have been shown to possess anti-inflammatory effects.12–15  Cyclooxygenase enzymes are associated with the inflammatory processes in your body, the inhibition of which is the primary function of other non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, acetaminophen and naproxen.  The main cannabinoids in HDCT have been shown to block the production of cyclooxygenase enzymes.  Don’t be surprised if your arthritis, colitis, or any of your “itis” inflammatory conditions improve on this regimen.11


1.
Bhattacharyya S, Morrison PD, Fusar-Poli P, et al. Opposite Effects of Δ-9-Tetrahydrocannabinol and Cannabidiol on Human Brain Function and Psychopathology. Neuropsychopharmacology. 2009;35(3):764-774. doi: 10.1038/npp.2009.184
2.
Gorelick DA, Goodwin RS, Schwilke E, et al. Around-the-clock oral THC effects on sleep in male chronic daily cannabis smokers. The American Journal on Addictions. 2013;22(5):510-514. doi: 10.1111/j.1521-0391.2013.12003.x
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Bass CE, Martin BR. Time course for the induction and maintenance of tolerance to Δ9-tetrahydrocannabinol in mice. Drug and Alcohol Dependence. 2000;60(2):113-119. doi: 10.1016/s0376-8716(99)00150-7 [Source]
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Odell M, Frei M, Gerostamoulos D, Chu M, Lubman D. Residual cannabis levels in blood, urine and oral fluid following heavy cannabis use. Forensic Sci Int. 2015;249:173-180. [PubMed]
5.
Bosker WM, Kuypers KPC, Theunissen EL, et al. Medicinal Δ9-tetrahydrocannabinol (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in Standard Field Sobriety Tests. Addiction. 2012;107(10):1837-1844. doi: 10.1111/j.1360-0443.2012.03928.x
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Perez-Reyes M, Hicks RE, Bumberry J, Robert Jeffcoat A, Cook CE. Interaction between Marihuana and Ethanol: Effects on Psychomotor Performance. Alcoholism: Clinical and Experimental Research. 1988;12(2):268-276. doi: 10.1111/j.1530-0277.1988.tb00193.x
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Russo L. Cannabinoid Poisoning. Medscape. http://emedicine.medscape.com/article/833828-overview. Published June 24, 2016. Accessed October 25, 2016.
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Scott KA, Dalgleish AG, Liu WM. The Combination of Cannabidiol and  9-Tetrahydrocannabinol Enhances the Anticancer Effects of Radiation in an Orthotopic Murine Glioma Model. Molecular Cancer Therapeutics. 2014;13(12):2955-2967. doi: 10.1158/1535-7163.mct-14-0402
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Torres S, Lorente M, Rodriguez-Fornes F, et al. A Combined Preclinical Therapy of Cannabinoids and Temozolomide against Glioma. Molecular Cancer Therapeutics. 2011;10(1):90-103. doi: 10.1158/1535-7163.mct-10-0688
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Nabissi M, Morelli MB, Santoni M, Santoni G. Triggering of the TRPV2 channel by cannabidiol sensitizes glioblastoma cells to cytotoxic chemotherapeutic agents. Carcinogenesis. 2012;34(1):48-57. doi: 10.1093/carcin/bgs328
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Ruhaak L, Felth J, Karlsson P, Rafter J, Verpoorte R, Bohlin L. Evaluation of the cyclooxygenase inhibiting effects of six major cannabinoids isolated from Cannabis sativa. Biol Pharm Bull. 2011;34(5):774-778. [PubMed]
12.
Malfait A, Gallily R, Sumariwalla P, et al. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proc Natl Acad Sci U S A. 2000;97(17):9561-9566. [PubMed]
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Wirth PW, Sue Watson E, ElSohly M, Turner CE, Murphy JC. Anti-inflammatory properties of cannabichromene. Life Sciences. 1980;26(23):1991-1995. doi: 10.1016/0024-3205(80)90631-1 [Source]
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Burstein S, Zurier R. Cannabinoids, endocannabinoids, and related analogs in inflammation. AAPS J. 2009;11(1):109-119. [PubMed]
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Costa B, Colleoni M, Conti S, et al. Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw. Naunyn Schmiedebergs Arch Pharmacol. 2004;369(3):294-299. [PubMed]

Quick Start Guide for HDCT Ramp-Up Tablets

Your new medicine requires you to complete a ramp-up phase where the dosing is gradually increased over a period of days.  It will take 11 days for you to reach the full daily dose and a few more to completely adjust to its affects.   Please read all of the literature provided so you understand your new medicine.  Below are the important bullet points.

  • Your medicine is dosed 4 times per day. It is important to not miss a dose as this would increase your chances of overuse sickness.  Use a caregiver to help with this as you may be quite spacey at first and lose track of time.  Ask for help, have a plan, follow it.
  • Your initial ramp up medicine regimen comes in two packs with 4x/day dosing.   No two days are the same until days 12, 13, and 14 at which point you will have reached the full daily dosing but not the fully saturated blood levels.  Be sure to take them in the order as packaged and at the prescribed time.  Use your plan that you made with your caregiver to be sure you don’t miss doses.
  • AVOID Alcohol use, especially during the ramp up phase.  Alcohol greatly increases the likelihood of overuse sickness.  If you are already alcohol dependent this is likely not a good drug regimen for you.
  • If you do get overuse sickness (very unlikely if you are abstaining from alcohol), skip the next scheduled dose except for the blue CBD tablet.  Resume after 12 hours and call us so we can help you and or your care giver with a plan to make you successful.  Also don’t panic, it will pass in a few hours.  Drink plenty of fluids to stay hydrated.
  • Once you start the Ramp-up, do not stop.  You are manipulating your body so that it builds tolerance to the medicine so that you can reach the blood levels thought to be therapeutic.  If you stop taking the medicine you may have to completely start over with a new ramp-up period.
  • You will be a little “spacey” for the first few weeks.  Do not drive or operate heavy machinery in this state.  Ask for help.  Plan to sleep more than usual.  Most people take midday naps while they adjust.
  • The medicine may make you unstable on your feet especially at night and in the beginning.  Use extra care to avoid falling.  This will improve as your body adjusts.  Be patient.
  • At the end of week 1 be sure to order your next 30 days of medicine so that you do not interrupt your treatment and have to start over.
  • Remember to tell all of your care team that you are using HDCT.  If they have questions please call us so we can talk with them.  Do not expect your care team to be able to provide the best care for you with only partial information.
  • Please consider submitting your pathology report and any pre and post HDCT treatment scans with us for study.  This will help us help you and others.
  • Call us at 530-289-6337 for help from 10am to-6pm 7 days/week if you have questions.  We are here to serve you.