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Cannabis and the “Entourage Effect”

THC and CBD are just two among many important players working together to produce effects associated with cannabis use. This interactive synergy between cannabis compounds has been coined the “entourage effect,” and once you know what this is, you’ll see why medicines containing only THC or CBD aren’t always sufficient for many medical conditions.

“Whole plant ” is a term used to describe medicines utilizing the full spectrum of therapeutic compounds cannabis has to offer. By full spectrum, I mean the over 100 different cannabinoids your flower contains. You can get a glimpse of the most abundant cannabinoids and terpenes  from articles found in e-magazines like Leafly illustrating the properties and benefits of each individual compound.

For example, each of these therapeutic agents that are processed out of THC- and CBD-only medicines have so much to offer patients treating a wide breadth of symptoms and conditions. Hopefully, we’ll soon start to see strains that not only narrow the gap between THC and CBD profiles, but emphasize other important cannabinoids and terpenes as well.

THC-only medicines primarily refer to man-made renderings of THC, the two most popular being Marinol (dronabinol) and Cesamet (nabilone). These are two legal pharmaceuticals primarily prescribed by most health care providers to treat cancer-related nausea, but their efficacy is questionable. Most studies have found that THC only medicines don’t perform as expected, often not having many desired effects at all. A 2011 survey on forms of consumption found only 1.8% of 953 patients prefer synthetic THC pharmaceuticals over inhaled or infused methods. Furthermore, it can take hours for a THC-only pill to deliver relief whereas inhaled methods take effect immediately.

CBD-only medicines have been gaining momentum in recent years following the media frenzy around Charlotte’s Web, a non-intoxicating cannabis strain that was processed into a CBD-rich oil for an epileptic child. The miraculous remedy prompted several states to adopt CBD-only laws under which THC-rich medicines remain illegal. While CBD-only cannabis medicines have proven to be life-changing for many individuals, these laws mainly exist to help those suffering from seizures.

That is not to say that synthetic, hemp-based, and CBD-only medicines aren’t effective options for many patients, especially as laws limit access to alternatives. These types of products have served a monumental role both as medicine and as a legislative stepping stone. But when it comes to the cannabis plant and its potential, we may be cutting ourselves short, and the question becomes, “what more can patients get from whole plant medicine?”

The diversity in the chemical availability whole plant cannabis medicines is remarkable in its own right, but research looking into how cannabinoids and terpenoids work together adds another level of intrigue. Instrumental in this area of science is Ethan Russo, M.D., a neurologist who has long studied cannabis compounds and their role in the body. In his study “Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects,” he details how cannabis compounds influence each other’s mechanisms. We aren’t just talking about the well-known THC-CBD tag team here – even small amounts of terpenes (fragrant oils that give cannabis its smell) can make a difference.

Some of my favorites are Myrcene, a terpene, that can reduce resistance in the blood-brain barrier, enabling easier passage of other beneficial chemicals and Pinene helps counteract compromised cognition and memory caused by THC. A combination of the terpenes Pinene, Myrcene, and Caryophyllene help unravel anxiety. Mixing terpenes linalool and limonene with the cannabinoid CBG shows promise in the treatment of MRSA, which could be a direct answer to our growing antibiotic resistant bacteria problem. THC plus CBN yields enhanced sedating effects which may improve sedative methods. Linalool and limonene combined with CBD is being examined as an anti-acne treatment, which I’m sure, could be the next skin care miracle product.

These examples only scratch the surface of all possible synergies made available to us by way of whole plant therapies. Think of all the medical possibilities waiting for us as the combinational potential of these compounds are unlocked. The thought of how many lives could be changed for the better by such discoveries is almost overwhelming. Much more research is needed in this field, and until cannabis is federally legalized, the answers to many of these questions will remain unexplored. However, with the limited information we do have, we await with hope and a game plan for the day us scientists can do what we do best.