I've been prescribed Cesamet for quite some time, on and off depending on how well I've been able to work with their assistance program which is wonderful except that it seems to give absolutely no response or help to patients....either they approve your paperwork and you receive your medication, or they ignore you and you have to figure out for yourself why they might have denied your application.
It has *some* similarity to cannabis, but far less so than Marinol which is itself really not a very good facsimile because it only contains THC, whereas cannabis' most therapeutically beneficial cannabinoids are the others (CBD, CBN, etc). In any case, I'm not trying to discuss cannabis itself, I'm just trying to give you an idea of what Cesamet's expected effects, and its effects for me, are like.
You will gain a tolerance to the lowest dose (taking a single 1mg capsule until it wears off before taking another, or spacing even more widely than that) fairly quickly.....a few days to get past any psychological effects, and you'll barely notice that you've taken it after a while if my experience is any indication. It will just have the benefits, which include very effective anti-emetic properties, and for me, quite a bit of pain relief. Substantially moreso than with Marinol/Dronabinol (the latter being the generic form).
I wouldn't think that discussing Cesamet or Marinol (or Canadian/European pharmaceuticals such as Sativex) is talking about medical marijuana. The two are quite distinct, even though they all provide molecules in the "cannabinoid" class. These are widely accepted prescription medications....whatever one thinks about marijuana, I think these deserve to be evaluated on their merits. They've been approved by the FDA and you can get them at your local pharmacy -- or from the assistance programs of the respective manufacturers.
Cesamet (Nabilone) is a very promising medication. It hasn't yet been approved (AFAIK) for pain relief, but it is very effective for several different kinds and should have *some* benefit for virtually any type of pain. It has not yet been proven to have direct benefits for treating underlying conditions themselves, but several other cannabinoids have shown anti-inflammatory, antibiotic/anti-viral, antinociceptive (pain relieving), and anti-emetic properties among many others. One unique property that some cannabinoids have is to modulate the auto-immune system with little to no negative effects on the ability to fight off infection versus "traditional" immune supressants.
A lot of us with chronic pain have some form of auto-immune condition or another, so I thought that was worth mentioning. It would be good to know whether Cesamet exhibits this property -- it is after all only a single, artificial, cannabinoid. These different properties show up with dozens of different molecules in this class.
To give a short answer: I would suggest patience, and see if you can develop a tolerance to any unwanted effects. Theoretically, with your doctor's knowledge, you could try opening the capsules and putting only a partial dose in a smaller capsule, or add to food, etc....if you really decided you found 1mg to be too much. Personally, Cesamet has helped me with my vomiting, digestive, and severe pain issues more than just about any medication....and there's not all that much tolerance to the beneficial effects, no dependency to speak of....which one can hardly say about opiates or any number of other medication options we're presented with. I have only good things to say about it.
Conditions: Reactive Arthritis (AKA Reiter Syndrome), Crohn's Disease, Chronic Pelvic Inflammatory Syndrome, Sacroiliitis, Costochondritis, As Yet Unknown MS-Like Relapsing/Remitting Neuropathy, and a partridge in a pear tree.
Medications: Currently not that many are taken daily, but there are many at my disposal for part-time use. Low dose pain medication, after years at high doses. Working on innovative ways of taking lesser-known pharmaceuticals and non-prescription supplements to maximum benefit.