What is the entourage effect in cannabis?
The entourage effect: One of the great secrets of cannabis
The entourage effect is, so to speak, a concept shrouded in mystery that has kept cannabis researchers around the world busy. They argue that the essence of cannabis' potent effects stems from the complex interplay between its various chemical components. Could cannabis really owe its unique properties to the entourage effect?
What is the entourage effect?
The entourage effect was first described by a renowned Israeli chemist and cannabis researcher Raphael Mechoulam. Mechoulam is considered a leading innovator and pioneer in cannabis research. The term coined by Mechoulam refers to how the various compounds in cannabis work in synergy to affect a wide range of processes in the body. In addition, the entourage effect theory posits that the compounds in cannabis work better together than in isolation. Mechoulam and his team of scientists published their findings in 1998 in European Journal of Pharmacology. In this study, Mechoulam and others describe the complex ways in which different compounds in cannabis work in concert to give the plant its distinctive effects.
Science has now demonstrated the medical potential of various cannabinoids. For example, THC is renowned for its ability to stimulate appetite, suppress nausea and more. For example, the US FDA has therefore approved the sale of Marinol, a pharmaceutical drug made from synthetic THC. While Marinol is used by many patients, studies have shown that its effects are very different from those of cannabis flower, for example. Marinol, unlike regular cannabis, contains Dronabinol, a synthetic compound that mimics the effects of THC. It is currently approved in the US to treat wasting syndrome in HIV/AIDS patients and nausea and vomiting in cancer patients undergoing chemotherapy.
Although the compound in Marinol is very similar to THC, it is not as effective as all the substances from the cannabis plant combined in treating many of the symptoms for which it is prescribed. As a pill, Marinol is very difficult for the stomach to process for patients suffering from nausea/vomiting. In addition, it produces psychoactive effects that are much stronger than those experienced after smoking regular cannabis.
Why is the entourage effect important for medicine?
Since Mechoulam first isolated THC in 1964, we have found that the cannabis plant contains more than 480 natural compounds, including cannabinoids (such as THC, CBD, CBN, CBG, etc.) and various terpenes. Terpenes, unlike cannabinoids, are best described as the fragrant oils in cannabis and many other plants. In addition to imparting aromatic properties to plants, they also have therapeutic effects.
For example, compounds like pinene and caryophyllene are known to be powerful anti-inflammatory agents and also help manage muscle spasms, insomnia and more. These benefits are said to be even stronger when taken together with cannabinoids. Today, most cannabis research focuses on the use of a single cannabinoid (either natural or artificial) in isolation. While this is important to further understanding the properties of each individual compound, the bigger picture tells an even more compelling story. For this reason, the future of medical cannabis seems to lie in the use of the plant as a whole.
When we consume cannabis, whether by smoking or ingesting a tincture, we ingest a unique blend of all the chemicals in the plant, not just THC or CBD alone. Therefore, understanding the effect of the accompaniment is extremely important in order to clearly determine the therapeutic options using the whole plant. It can also reveal why synthetic drugs like Marinol do not provide the same relief as regular cannabis.
It seems logical to want to extract certain useful compounds from the cannabis plant and offer them in a concentrated medicine. However, the science of the entourage effect clearly shows that an approach to the plant as a whole is superior. To use a popular example, the use of the whole plant can be compared to Marinol as one might compare fresh fruits and vegetables to vitamin pills. The latter is simply not as effective.
Does the escort effect really work?
Although research on cannabis is far from complete, studies suggest that Mechoulam's theory is correct. Marinol research has shown that simply extracting a single compound from the plant is not enough to harness the positive effects of medical cannabis. A similar finding emerged with Sativex, a cannabis-based drug developed by GW Pharmaceuticals to treat multiple sclerosis.
CBD and THC
Another simple way scientists have observed the effect of accompaniment is by studying the effects of certain cannabinoids together. For example, CBD is often said to "counteract" the psychoactive effects of THC. For many people, strong doses of THC can induce feelings of paranoia. However, a 1982 study found that CBD can help combat some of these unwanted side effects.
Psychopharmacologist and cannabis researcher Ethan Russo has come up with a very interesting example that suggests the entourage effect is a scientifically sound concept. We have paraphrased his findings below. A dose of 10 mg of pure THC produces toxic psychosis in about 40% of people. However, a dose of Sativex (which contains equal amounts of THC and CBD) equivalent to 48 mg of pure THC produced toxic psychosis in only 4 out of 250 patients.
Critique
While this evidence is not conclusive on its own, it is encouraging for those who support claims of an entourage effect. As is often the case in cannabis research, however, there is still no consensus. In fact, Mechoulam's theory has received its share of criticism. Margaret Haney, a neurobiologist at Columbia University (and cannabis researcher) says there is not enough data to support the existence of an entourage effect.
"The lay public has really embraced the concept of the entourage effect, but there is not enough data to support it," she said in an interview. "The cannabis community can say what it wants, and it does. I am not against cannabis. But I want to study it carefully. We know it can affect pain and appetite, but much of what is said is driven by anecdotal marketing. There are people who are really just trying to make money." Unfortunately, the verdict on the effect of the accompaniment still depends on who you ask about the subject. Hopefully, as more research is done in this area, we will come to firmer conclusions about how cannabinoids and other compounds in cannabis interact with each other.
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