What you need to know before a ‘tolerance break’ from marijuana use

By Madeline Holcombe, CNN

(CNN) — When your tolerance for marijuana goes up, often usage does, too.

That’s a problem many regular users of cannabis products are facing, and some are turning to “T-breaks,” or tolerance breaks, in hopes of getting back to the same high at lower doses. Current research, however, isn’t definitive on whether temporarily abstaining effectively works to recalibrate the body for the desired effect, according to an August study.

Ohio recently became the 24th state to approve legal recreational marijuana use, joining Minnesota, Delaware and Colorado, among others. Despite the fact that cannabis remains federally illegal, the conversation around safe adult usage is ongoing as voters continue to open access at the state level.

With marijuana use putting people at greater risk for bad health outcomes such as heart attack and stroke, reducing usage may sound like a good idea, said Dr. Robert Page, a professor of clinical pharmacy and physical medicine/rehabilitation at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora. But T-breaks come with certain risks, especially when it comes to withdrawal symptoms, he said.

Page spoke to CNN about tolerance breaks and whether or not they are a sound strategy.

This conversation has been edited and condensed for clarity.

CNN: What is a T-break?

Dr. Robert Page: This is a hot topic. This is really all over the internet with very limited — I believe maybe one or two — studies.

T-breaks are temporary periods of abstinence, and the goal is primarily to reduce tolerance so that you can have a smaller amount of cannabis to achieve the same effect. And from a pharmacologic standpoint, that makes sense. When you overstimulate one receptor, it downregulates, and so therefore, you need higher and higher doses in order to achieve the effect.

However, again, there’s not that much data with regard to this (type of break). This is something that is emerging, because the question is, does it reduce poor outcome (such as heart attack and stroke)? And does it lead to hazardous use?

CNN: Do you have any concerns about people taking a T-break?

Page: Number one is withdrawal. While withdrawal in some of these smaller, observational studies hasn’t been seen, I still worry about it.

If you suddenly stop taking a psychotropic medication, you’re going to have withdrawal symptoms, in terms of irritability, you can have nausea, vomiting, nightmares — all these kinds of things. They usually occur the first three days and can last sometimes up to a week or two.

When people take a longer break, like six months or longer, that might suggest a reduction in the risk for things like cannabis use disorder, severity and all those aspects.

However, my major concern is you could undergo withdrawal, and there are some data to suggest that it could lead to potential cannabis use disorder. That means it’s impacting your life: your work, your family, your responsibilities.

CNN: How might going through withdrawals lead to hazardous usage?

Page: If someone is going through withdrawals, they may go right back to using — maybe even a higher dose. They may go to vaping or smoking.

I always tell people here in Colorado that the combustible forms of cannabis create some of the same kind of metabolites and toxic metabolites that are similar to that of nicotine, like smoking tobacco or cigarettes.

CNN: How else can people reduce their usage while avoiding withdrawal?

Page: There is titration (tapering down the dose), which is highly individual. All these (cannabis plant compounds called) cannabinoids, they stay in your body because they’re fat soluble — so they can stay in your body for up to three to four weeks.

Titrating down slowly is the way to go by reducing dosage either in the interval or the frequency.

Typically, you will titrate down over a week or two in order to kind of mitigate those effects. However, again, it’s highly individualistic. And if someone’s having bad side effects and needs to go back up on the dose and then even titrate more slowly. Maybe instead of over a week, it’s over two weeks.

CNN: What is your most important piece of advice for people who are using marijuana?

Page: One of the things that I am really big on from a public health standpoint is transparency, and that is honestly sharing your cannabis use with your health care provider.

They’re not there to arrest. They’re providers, they’re there to help. Having a shared decision-making conversation with regard to this, I think is absolutely critical. Because you need to treat cannabis like you would any other prescription medication.

The reality is that if something does happen — coronary syndrome, heart attack or with regard to stroke — then your provider knows the potential ecology that contributes to that.

Every day we have at least one admission with a positive urine drug screen for cannabis, and having that conversation is very, very important.

I’m not here to judge you. I’m here just to have this open conversation so that you can make an informed decision.

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