An exchange between Dustin Sulak, DO, and Bonni Goldstein, MD. Sulak sent the following in reference to Goldstein’s forthcoming article  “Cannabis in the Treatment of Pediatric Epilepsy,” which provided dosages in mg/kg (milligrams of cannabis oil per pound of the patient’s weight). 

This may just be my pet peeve, but can you please help me keep the field on track with mg/kg dosing, not mg/lb? I’m surprised Bonni, a pediatrician, would propagate this terrible habit started by non-clinicians in Colorado. It is found no where else in medicine and its use can only lead to confusion and dosing errors. My opinion is we need to nip this in the bud. Perhaps you could ask Bonni if it could be converted for the full issue, with reports of at least one physician commenting on it. Pediatrics always uses mg/kg, and I’m not aware of any other science mixing the two systems.

Goldstein responded:

We can add the mg/kg dosing in parentheses. 

I had the same pet peeve when I began treating peds patients with CBD, and I tried to get parents to switch over but found significant issues:  firstly, converting to kg is hard for some parents, they get confused; secondly and most importantly, the dosing calculator that Realm of Caring supplies to parents is mg per lb, so parents are using that and again I just confuse them when we talk about changing doses, and lastly, there have been dosing errors made by parents just dealing with converting the mg dose to how many ml to give, again when I tried using per kg dosing it created more confusion. I give a dosing chart but parents still choose to use the ROC calculator despite my instructions.  So I have learned to live with the mg per lb system despite a career of using mg per kg dosing. 

PS: My patients really appreciate the dosing brochure from Project CBD!