Curiosity about the therapeutic benefits of cannabis abounds and pharmaceutical companies are capitalizing by isolating and synthesizing cannabinoids, particularly CBD. However, this approach may be negating the effect of the combination of all of the plant’s components – the entourage effect.
Cannabis is a chemically rich plant and its buds are covered in a sticky resin that contains compounds called cannabinoids and terpenoids. These natural components of the plant are believed to interact to create a stronger effect than one component alone. The synergistic effect maximizes the potency and is known as the entourage effect.
Many of us are already familiar with the compounds THC and CBD found in the cannabis plant. The most common chemical found in cannabis is THC, the psychoactive element that produces the “high”.
THC has been created synthetically and used as a medication since the 1980s. One of these drugs, Marinol, is used to reduce the side effects of chemotherapy. People often stop using Marinol because they say it is ineffective and has negative side effects, making them feel anxious. In the experience of many people, the effect of using synthetic THC on its own does not compare with using the whole plant.
CBD accounts for almost 40% of the cannabis extract. It’s plentiful and because it does not produce a “high”, it is now being used widely for medicinal purposes. Some scientists believe that the CBD modulates the effects of THC in the body by blocking some of the receptors.
In most countries, cannabis and THC are illegal while the legal status of CBD is rather unclear. CBD is technically illegal in the US because of its classification as a schedule 1 drug. However, the FDA recently cleared a pharmaceutical form of CBD to be tested on children with epilepsy.
In 2011, Ethen Russo, a psychopharmacologist, and researcher, studied the interactions between the cannabinoids and terpenes found in cannabis. His paper was published in the British Journal of Pharmacology and gave substance to the entourage idea.
Chemicals called Terpenes are found in a number of plants, including cannabis. These chemicals give cannabis its distinctive aroma. Over 200 of these terpenes have been identified and they interact with the THC and CBD. A terpine called Myrcene enables beneficial chemicals to cross the blood-brain barrier more easily. A terpine called Pinene can counteract memory and cognition problems caused by THC.
The scientific literature on the entourage effect of the compounds found in the cannabis plant may be lacking but Russo is one of the scientists who firmly believe it exists.
Dormant chemicals present in cannabis need to be activated. They can only be absorbed by the human body if they go through a process called decarboxylation. Heat is one of the many processes that are necessary for the cannabinoid acids to bind with receptors in the human body.
Without going through this process, the presence of carboxyl atoms would make this impossible. Both THC and CBD need to undergo a process to transform them from the raw state into one that is more available to humans. Once CBD has been through this process, it is usually mixed with a number of cannabis oils.
Medicines containing only CBD have become popular in recent years. When Charlotte’s Web, a particular strain of cannabis, was processed into a CBD oil and used effectively to treat epilepsy in a child, media coverage in the U.S. was extensive. Several states eventually adopted CBD-only laws, with THC-rich medication remaining illegal.
Therapeutic agents made from THC- and CBD-only medicines are used to treat patients with a wide variety of conditions and symptoms. These medicines usually offer patients some relief from pain and other symptoms, as well as increasing their appetite. These products have also pushed boundaries, opening individuals up to possible benefits and forcing changes in legislation.
Cannabis growers (often working illegally) have already experimented with crossing different plants to breed distinctive strains. They have been trying to use genetics to make the whole process more precise and to satisfy specific needs of recreational users. It is possible that experiments like this may also produce plants or products that can be personalized to address the therapeutic needs of patients suffering from a wide range of conditions.
Much of what is known about the efficacy of current products is anecdotal. Double-blind clinical trials still have to be conducted. However, anecdotal evidence has been enough to establish the idea of the entourage effect firmly in the cannabis industry and the minds of consumers.
Studies have been difficult because of the illegal status of cannabis. This has prevented many scientists from obtaining research licenses. However, more studies are currently being conducted and initial data appears to be very promising.
There is some concern about the fact that the value of using the CBD-only products may be overhyped, driven by marketing from those who want to make money. Results of tests done to show that it has an effect on pain and appetite but more studies are essential.
While some patients are experiencing some benefit from using components of cannabis alone, anecdotal evidence and research are pointing out the value of using multiple cannabinoids together. Whole plant extracts, bred to contain similar amounts of THC and CBD as well as the other components, appears to be much more effective than medications made of single compounds.
This was the message promoted by media person and neurosurgeon, Dr. Sanjay Gupta when he changed his mind about cannabis as medicine. He began writing about the entourage effect and created more public awareness.
Scientific understanding of the medical possibilities of the cannabis plant is just beginning to grow. Researchers have an increased desire to study the plant and whole plant medicine options are being developed. This has exciting implications for the future. Discovering all the synergistic possibilities of these components lies ahead and may just make a great difference in the lives of many people.