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Finding the Best CBD:THC Ratios and Products for Pain UPDATE: Starting in January 2022, Leaf411 transitioned to a schedule-based system for our nurse guidance calls. Visit our Services page at In this article, we simplify and summarise the evidence for using a different CBD:THC Ratio for the treatment of a variety of indications

Finding the Best CBD:THC Ratios and Products for Pain

UPDATE: Starting in January 2022, Leaf411 transitioned to a schedule-based system for our nurse guidance calls. Visit our Services page at this link to learn more.

How Different CBD:THC Ratios and Types of Products Can Help with Pain

Medically reviewed by Katherine Golden, RN
Written by Denise Rustning

When it comes to treating pain with cannabis, both the type of product and the ratio of cannabinoids matter. The two primary cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD), though the cannabis plant contains many other cannabinoids, terpenes, plus other compounds that contribute to its therapeutic effect.

CBD: This cannabinoid is the star player in hemp products which are federally legal. CBD hemp products are required to have below 0.3% THC, which is such a small amount that it’s not intoxicating and won’t get you high. You’ll also find CBD in cannabis products that contain higher levels of THC.

THC: The cannabinoid responsible for the “high,” if used in large enough amounts. Cannabis products containing over 0.3% THC remain illegal at the federal level and can only be legally purchased in states that have legalized recreational or medical marijuana.

Understanding the roles that both CBD and THC play in managing pain can help you find the best product for your needs. If you need a quick refresher on the types of pain that CBD and THC work best on, check out our previous post here.

Timing Your Dose: How Different Cannabis Products Reduce Pain

Whether you’re looking at CBD hemp or cannabis containing higher levels of THC (sold legally in dispensaries), you have several different routes of administration to choose between :

  • Inhalation (smoking, vaping): Takes effect immediately and lasts 2-4 hours. This is a great choice for instant relief and for treating breakthrough pain (a flare-up in pain when you’re already taking longer-acting cannabis products). You can also layer inhaled cannabis with a longer-acting method (more on layering below) to help get you through the night.
  • Transdermal (patches, gels): Extended release option that takes effect quickly, since the cannabinoids are absorbed directly into your bloodstream. The time of onset is rapid, sometimes within 20 minutes. Transdermal products provide a consistent dose of medicine for up to 12 hours. The transdermal patch or gel is used on an area where the veins are near the skin’s surface—like the inside of your wrist or on your ankle.
  • Sublingual (placed under the tongue): Sublingual administration can provide rapid relief, but there are few true oromucosal (sublingual) products on the market. Cannabinoids are fat-soluble and, in their natural state, do not absorb well into the oral mucosa. Moreover, cannabis products are often extracted into oils, and these products are not water-soluble. Patients often expect rapid onset when using tinctures, only to wait 1-3 hours for the dose to take effect. Many products marketed as tinctures will end up being swallowed and absorbed via the digestive system, regardless of how long they are held under the tongue. A true sublingual (a product in which the cannabinoids are formulated to be more water-soluble) absorbs rapidly into the mouth. The effects can be perceived in 15-20 minutes and can last 4-6 hours.
  • Edibles (gummies, capsules): Edibles take effect in between 30 minutes and 2 hours. You’ll feel their effects between 5-8 hours. They provide a discreet, portable long-acting option.
  • Topicals (creams, salves): Topicals provide short-term localized relief. They can take effect within minutes, and may last for up to an hour.

Understanding CBD:THC Ratios

Most marijuana flower sold at legal dispensaries is THC-dominant, with very little CBD. Of course there are exceptions, such as The Wife strain or even some CBD hemp flower strains. However, odds are that if you’re using flower, you won’t find ratios connected to the strain.

Once you start looking at other cannabis products, including vapes, you’ll notice ratios on many—but not all—product labels. Common ratios include 1:1, 5:1, 10:1, and even 20:1. What do these numbers mean? And how do they help with your pain?

The ratio indicates the amount of CBD compared to the amount of THC.

  • A 1:1 ratio is when the amount of CBD and THC are the same in each dose.
  • On the other hand, if a product has a 5:1 ratio, that means there’s five times as much CBD as THC in each dose.
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It’s important to note that the ratio is not the same as the amount of CBD and THC. Our supporting member 1906 makes several different products, including their Midnight drops and Genius drops, that are designed to be swallowed. The ratio of each of these recreational products is 1:1—but the amount of CBD and THC in each is different.

  • The 1906 Midnight 1:1 drops have 5 mg of CBD and 5 mg of THC per dose.
  • The 1906 Genius drops are also a 1:1 ratio; however, they have 2.5 mg each of CBD and THC.

What if a product doesn’t list a ratio? In that case, look closely at the product label. The chances are good that the product either contains all CBD, with little or no THC (legal CBD hemp products fall in this category), or the product contains all THC.

What’s the Best CBD:THC Ratio For Your Pain?

The CBD and THC cannabinoids work individually to target different types of pain. By combining them in different ratios, though, you can achieve different effects to fit your specific needs.

While everyone is different, the following guidelines work for most people:

1:1 – Equal amounts of THC and CBD. A good option to try for all kinds of pain, including neuropathic pain. Products with a 1:1 ratio can be uplifting but this ratio will most likely cause impairment if using the suggested serving size. Always start low, go slow, to avoid intoxicating effects.

2:1, 4:1, 5:1 – A balanced product that can provide optimized levels of both CBD and THC for medicinal use, based on the fact that higher doses of CBD are often needed for relief. Can be intoxicating.

10:1 – A high CBD alternative for people who find the 5:1 ratio to be too intoxicating.

20:1 – High CBD levels along with very low THC levels provide a good option for managing inflammation pain. Very rarely intoxicating.

Leaf411’s supporting members offer many different CBD:THC ratios to meet different needs.

Be sure to closely look at the product label to make sure you understand the ratio! While it’s not as common, some manufacturers state the ratio reflecting the THC first and the CBD content second, like our member incredibles 10:1 THC:CBD tincture.

Layering Different Cannabis Products

Have you ever woken up in the middle of the night when your pain medication wore off, and suffered as you re-dosed and waited for the medicine to kick in? Fortunately, with CBD and THC products, you can layer different product types to reduce the changes of this happening.

For example, you might use a shorter-acting sublingual pill or vape to bring instant relief, together with an edible or transdermal patch to get you through the night.

If you’re using products containing THC (the cannabinoid that can be intoxicating and make you feel “high”), you’ll want to be careful with your dosing to make sure you don’t get end up with too much THC. The best approach is to start low and slow.

While you cannot overdose on THC, the feeling of being “too high” can be uncomfortable. Our website provides tips for what to do if you feel too high.

Cannabis as an Adjunct Therapy

Depending on how you use cannabis and other medications, there can be possible medication interactions. Our Leaf411 library offers guidance on specific medication interactions here.

We recommend consulting with a clinician before combining cannabis (which includes CBD hemp products!) with pharmaceuticals or over-the-counter pain medications.

Our Leaf411 cannabis-trained registered nurses can help with questions specific to medications you’re taking, and our service is FREE! Call us at 844-LEAF411 (844-532-3411).

We’re Here to Help!

We realize that it can feel overwhelming when researching cannabis for pain. There are so many options—different types of products and different ratios.

Research on cannabis as a safe alternative for treating pain continues to grow. As nurses, we’ve heard and seen firsthand the power of this plant-based medicine, and we stay up-to-date on the latest findings and clinical guidelines for using cannabis for pain.

Our Leaf411 hotline nurses have both specialized training and experience helping people to find the best option for their particular situation. We’d love to share our expertise with you as well! Reach out to us on our free, anonymous hotline at at 844-LEAF411 (844-532-3411).

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The Leaf411 cannabis nurse hotline provides free, anonymous education and directional support to the general public about the safe use of legal cannabis. We partner with select business members who meet our rigorous standards to extend our education and outreach efforts.

CBD:THC ratio explained

The use of cannabis for medicinal purposes is becoming more and more accepted throughout many countries. With the increased use of these medicines, the CBD:THC ratio is becoming more important. As popularity grows, research is being done to further understand the therapeutic benefits of different combination formulations and doses.

Currently, in New Zealand, only one medicinal cannabis product (Sativex) has been approved by Medsafe. This is for use as an add-on treatment for the symptoms of moderate to severe spasticity due to multiple sclerosis (MS). Sativex contains equal amounts of CBD and THC (a 1:1 ratio).

However, a broader range of CBD:THC combinations are being investigated to treat other indications, such as pain, epilepsy, anxiety, sleep disorders, etc. These combinations range from CBD-dominant to THC-dominant, for example, CBD:THC 20:1 through to CBD:THC 1:10.

Understanding which combination to use on individual patients is challenging. The following sections provide guidance to help understand how the ratio of CBD:THC works so that going forward you can improve the effectiveness of medicinal cannabis.

Understanding CBD and THC

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are both natural compounds found in plants of the Cannabis genus. Although both compounds interact with the body’s endocannabinoid system, the effects of these two compounds are very different. THC binds to CB1 receptors in the brain and causes feelings of euphoria or ‘a high’. CBD binds weakly to the CB1 receptor and only when THC is present. CBD does not produce euphoria or ‘a high’.

CBD and THC can be combined in medicinal products in different ratios to produce different therapeutic effects. Because the use of medical cannabis is a relatively new area in medicine, there is still a lot of research to be done in this area. We are still learning what ratios are best for managing various conditions.

What is a CBD:THC ratio?

The ratio of CBD to THC indicates the amount of CBD compared to the amount of THC in a dose. For example, a ratio of 1:1 would mean that the amount of CBD and THC are the same in each dose. A CBD:THC ratio of 20:1 would mean that there is 20 times the amount of CBD in a dose compared to THC. Changing the ratio of CBD to THC allows for a tailor-made product that utilises the unique effects of either CBD, THC, or both for a particular patient or clinical effect.

What are the most common ratios?

Cannabis cultivars grown for the recreational market have seen a steady increase in THC content, paired with a decrease in CBD. Smoking these varieties will give the user a more potent ‘high’, but this might come at the cost of some therapeutic effects.

Medical use of CBD and THC has changed that, allowing specific ratios of CBD:THC to be selected to provide the greatest clinical benefit for each patient. Now, most medicinal cannabis products are higher in CBD than THC. Pure CBD products are considered to have less than 0.3% THC. The trend has moved towards cultivating plants or producing products that have a higher CBD to THC ratio. Ratios of CBD:THC can range between >20:1 all the way to 1:10. As a general rule of thumb, anything higher than a CBD:THC ratio of 10:1 should not elicit a high.

CBD:THC ratio for pain

By changing the ratio of CBD to THC, you are able to target and manage different types of pain.

Mild to moderate pain due to inflammation (think arthritis-type pain) can be managed well with CBD-dominant products such as CBD:THC 20:1 and 10:1. These ratios will be unlikely to induce any intoxicating effects.

Neuropathic pain, from disease or damage to the nervous system, might be better treated by increasing the ratio of THC towards a balanced ratio, 1:1. The exact ratio will depend on the severity of the condition and how well THC can be tolerated by the patient.

Very severe pain, such as cancer pain, may require THC-dominant medications. It is important to understand that THC-dominant products may induce euphoria and sedation, so care needs to be taken.

CBD:THC ratio for anxiety

Smoking cannabis can induce paranoia or extreme anxiety in certain people, so it seems counterintuitive that you could use medical cannabis preparations for the management of anxiety.

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CBD has demonstrated efficacy in treating various forms of anxiety and is commonly used for this purpose. However, recreational use of high-THC cannabis is associated with increased anxiety, particularly in high doses. Reports suggest that THC has a dose-dependent effect on anxiety, where at low doses THC may be anxiolytic (reduce anxiety) but at higher doses can be anxiogenic (cause anxiety). Therefore, CBD-dominant products (CBD:THC >10:1) are likely to provide the most beneficial treatment, and in some cases, pure CBD with no THC present may be the best product to treat anxiety.

CBD:THC ratio for insomnia

Insomnia is a widespread problem and has been linked to illnesses ranging from depression to cardiovascular disease to dementia. Many allopathic medications used in the management of insomnia have adverse side effects, such as daytime drowsiness or addiction.

THC is well-known to have sedating properties via its action at the CB1 receptor; however, its use alone can cause increased anxiety and lead to other undesirable effects. By adjusting the ratio of CBD:THC, it is possible to block these undesirable effects while still retaining sedating properties. A current study is looking at a CBD:THC ratio of 20:1 in the treatment of chronic insomnia. If you are taking medicinal cannabis for other indications, it may be possible to investigate adding a slightly higher dose of THC at night-time to maximise the sedating effects and reverting to the lower THC ratio for daytime use.

How to pick the best CBD:THC ratio for your patient

This infographic provides ratios of CBD:THC and considerations of which ratio to use for certain conditions.

Currently, the only available medical cannabis in New Zealand contains a ratio of CBD:THC at 1:1; however, going forward you will be able to prescribe your patient other preparations of CBD:THC at a ratio that is optimal for what they want to achieve. The following is a rough guide of what to expect from different ratios:

CBD:THC at a ratio of 1:2

This preparation contains twice as much THC as CBD and will have intoxicating effects, especially for new or naive users. The presence of some CBD in the preparation will dampen some side effects of the higher THC, such as paranoia, but not all. This ratio would be better suited for people who have been using medical cannabis on a chronic basis, e.g., for intractable nausea, poor appetite, or glaucoma, and have developed a high degree of tolerance.

CBD:THC at a ratio of 1:1

This preparation contains equal amounts of CBD and THC and, depending on the dose, is likely to cause symptoms of euphoria or intoxication, especially in people who are naive to cannabis use. If using this ratio, it would be prudent to start with low doses and increase slowly according to tolerance.

CBD:THC at a ratio of between 2:1 and 4:1

Preparations with this ratio of CBD to THC can be psychoactive, especially to people who have poor tolerance for THC. The increased CBD does have beneficial effects and causes some dampening of the effects of THC.

CBD:THC at a ratio of more than 10:1

CBD:THC ratios >10:1 generally produce no intoxicating effects and are ideal for patients that are not able to take THC during the day (e.g., due to driving or work). Where the condition to be treated does not require THC, these products may help provide relief for certain conditions without any intoxication of the patient. This is a really safe dose for those people who want to experience the beneficial effects of CBD without the psychoactive effects of THC.

The bottom line

There is definitely an advantage to being able to adjust the ratio of CBD:THC in your medical cannabis preparation. This will allow you to maximise the particular benefits that you want while minimising any unwanted negative side effects. Currently, the standard preparation contains a fixed ratio of CBD:THC; however, going forward new research may strengthen the argument for flexible dosing.

THC is psychoactive and may impair your ability to undertake certain tasks, such as driving or operating machinery. CBD is non-psychoactive and non-sedating and can be safely used at much higher doses than THC.

With all medicinal cannabis, it is important to start with a low dose and gradually increase it over a few days. This is particularly important for compositions containing THC. Remember: START LOW and GO SLOW.

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