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[4 min read] Medicinal cannabis and the entourage effect
The entourage effect is the mechanism in which cannabinoids act synergistically with each other and numerous other compounds within the plant, such as terpenes, flavonoids and resins.
For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Medicinal Cannabis.
The entourage effect was coined in the late 1990s by the famous Rafael Mechuolam, Shimon Ben-Shabat and their group of Israeli researchers.
The discovery of cannabinoids’ ability to enhance and complement each other has led to huge advances in extraction and formulation strategies. While the term ‘entourage effect’ is primarily used in the cannabis industry, this phenomenon is thought to occur in a wide range of botanical medicines.
How does the entourage effect work?
In the realms of recreational cannabis, the entourage effect is touted for its capacity to enhance the effects of THC and contribute to the psychoactive and somatic experiences of cannabis.
However, in the medical setting, the synergistic action of cannabinoids and other plant compounds is appreciated for its propensity to help alleviate symptoms of complex or difficult to treat conditions such as autoimmune, gastrointestinal and mood disorders.
At a physiological level, combinations of cannabinoids, terpenes and flavonoids can increase the activity of endogenous cannabinoids and interact with the body’s endocannabinoid system.
Cannabinoids working together
Additionally, cannabinoids are thought to have a symbiotic action, the most well-known example of this is CBD’s action mitigating the psychoactive effects of THC. Terpenes also have their role in the entourage effect: to name a couple, 𝛽-myrcene as an anti-inflammatory and linalool with anticonvulsant activity. Both of these examples correspond with well-documented actions of CBD oil.
You could imagine the action of the entourage effect to be much like an orchestra. Each musician has great skill individually, their talent can operate in isolation or can have an entirely different impact when combined with other musicians in the orchestra.
Isolated cannabinoids vs formulations: beneficial results and side effects
For medical cannabis patients, the choice between isolated cannabis treatments and full or broad-spectrum formulations primarily is determined by the presenting condition.
The drug Marinol has been on the market since the 1980s used as a potent appetite stimulant in treating anorexia as well as nausea and vomiting associated with cancer therapy. In the case of Marinol, isolated synthetic THC produces the desired effect in increasing hunger, yet is commonly associated with side effects such as paranoia and a subjective high.
When taking formulations or whole-plant extracts, patients are ingesting a range of carefully measured cannabinoids, terpenes and other plant compounds. By choosing formulations, prescribers can select products that are most suitable to the patient’s needs, in doing so utilising the potential benefits of the entourage effect.
Evidence for the entourage effect
In studies relating to human breast cancer cells in vitro, formulated extracts were compared to pure THC, with positive outcomes seen from the formulated treatment, rather than THC-only. The authors believed this may be attributed to the combined action of THC with minor cannabinoids, CBG and THCA.
Other evidence for the entourage effect’s impact in treating skin conditions, bacterial infections, mood and cognitive disorders is beginning to be uncovered. In contrast, a recent study has reported no differences when administering terpenes with phytocannabinoids in the context of activating cannabinoid receptors.
While there is little solid evidence for either side of the debate, a strong appetite for information on the topic continues to fuel clinical research.
Read another article: Nausea and medicinal cannabis
If you are interested in becoming an authorised prescriber of Medicinal Cannabis in Australia, the TGA SAS-B guidelines require you to prove that you have the knowledge necessary to do so. HealthCert’s Professional Diploma of Medicinal Cannabis pathway can serve as part of your documentation showing that you have undertaken education in this field when you decide to become an authorised prescriber.
This article has been provided by our partner, Southern Cannabis Holdings. Southern Cannabis Holdings builds, integrates and operates high-value brands across the cannabis value chain, including FreshLeaf Analytics, Cannabis Access Clinics and Applied Cannabis Research. HealthCert and Southern Cross Holdings have partnered up to bridge gaps in patient and clinician knowledge on medicinal cannabis.
Contact CA Clinics at firstname.lastname@example.org or call 1300 991 477 if you would like more information.