A beginner’s guide to tolerance breaks

How does medical cannabis work?

The cannabis plant contains a wide range of active compounds, many of which have been found to possess therapeutic properties. The two most prominent compounds are the cannabinoids cannabidiol (CBD) and delta-9 tetrahydrocannabinol (THC). 

These compounds may be helpful in managing a wide range of conditions and symptoms; however, as with many other medications, long-term use of medical cannabis can lead to the development of tolerance. 

So, how can you manage your treatment regime to compensate for this and ensure optimum outcomes?

Tolerance to cannabis

A number of studies have found that regular cannabis users - whether it's for medicinal or recreational purposes - may develop a tolerance to the effects of cannabis over the long term. It’s believed that this increased tolerance happens because of several neuroadaptive changes. 

For example, regular exposure to cannabis compounds may lead to a down-regulation of CB1 receptors in the body (which THC binds to directly and CBD interacts with indirectly). As a result, cells are less responsive to active compounds such as CBD and THC, and when this happens, higher doses of THC (or other cannabinoids) are often required to achieve the same effect previously demonstrated. 

Studies assessing tolerance in recreational consumers suggest that these neuroadaptations lead to a reduction in impairment during acute cannabis exposure. These effects prompt some consumers to attempt a cannabis tolerance reset, or a “tolerance break”. 

What is a cannabis tolerance break?

A cannabis tolerance break - often referred to as a t-break - is a concept that largely originates from recreational cannabis consumers. In simple terms, it refers to a temporary break from cannabis use with the aim of lowering your tolerance to the effects of active compounds such as THC. During a tolerance break, the consumer will abstain from cannabis to allow any residual cannabinoids to be broken down by the body and for CB1 receptor levels to recover.

As cannabis-based medicines become more accessible, this practice is also becoming increasingly prominent among medical cannabis patients, and in certain circumstances, taking a tolerance break may be recommended by your clinician. 

Taking a tolerance break as a medical cannabis patient

When initiating medical cannabis treatment, it is important to be aware that it can take some time to identify your optimal dosage. At Releaf, our clinicians often guide patients through a titration period, where doses are gradually increased until patients achieve the best outcomes. 

However, over time, you may eventually notice that you require a higher dosage to achieve the same results. If this is the case, it may be time to take a tolerance break from your medication. However, it is essential that this is done under the supervision of a qualified healthcare professional - namely, your prescribing clinician. 

So, what does a tolerance break entail and what precautions should be taken?

How long should a cannabis tolerance break be?

When it comes to medical cannabis treatment, it is important to remember that every patient is different. This also applies when figuring out the best length for a tolerance break. The fact is that there is no official guidance on the optimal length of a t-break. 

However, some evidence indicates that up-regulation of CB1 receptors may begin surprisingly rapidly after the cessation (stopping) of cannabis use. According to the study, a baseline difference in CB1R availability of 15% between non-users and cannabis users was no longer evident after just two days of monitored abstinence from cannabis. This was maintained at 28 days of abstinence. 

Potential side effects of taking a tolerance break

As with many other substances, stopping consumption of cannabis can be associated with some side effects. For example, taking a break from your medical cannabis treatment may trigger symptoms such as:

• Mood changes
• Sleep disturbance
• Appetite changes
• Fatigue
• Restlessness
• Nausea

Your clinician may advise a gradual down-titration in your medical cannabis dose to help mitigate the risk of experiencing these potential side effects. Furthermore, you will be closely monitored to ensure any concerns can be addressed as soon as possible. 

It is also important to consider plans for symptom management during a tolerance break. For example, your clinician may only recommend initiating a tolerance break during periods where your symptoms are under control. In the meantime, alternative medications or supplements (such as to manage sleep disturbances and nausea), alongside a healthy diet and exercise regime, may be recommended. 

Final thoughts

Taking a tolerance break from medical cannabis can be a daunting prospective; however, doing so could help to ensure optimal treatment outcomes over the long term. Moreover, with the guidance of an experienced clinician, there will always be someone on hand to address any concerns or adverse effects. Our Releaf+ patients can book in to discuss their treatment at any time at no extra cost, giving you peace of mind over your medical cannabis regime.

If you’re interested in becoming a medical cannabis patient, you can find out if you could be eligible with just a few clicks. Complete our medical cannabis eligibility checker today to find out more.