Your Guide To Medical Cannabis Australia

The phrase entourage effect was introduced in 1999 by Professor Mechoulam. Mechoulam theorized that cannabinoids would bind better to our CBD receptors when used in synergy with the fatty acids also found in cannabis. The phrase now commonly refers to the compounds present in cannabis supposedly working in unison to create “the sum of all the parts that leads to the magic or power of cannabis”. Other cannabinoids, terpenoids, and flavonoids may be part of an entourage effect. The entourage effect discovered that by using a range of phytochemicals (chemicals from plants) together synergistically, the user would experience a holistically more positive effect.

The entourage effect is a proposed mechanism by which cannabis compounds other than tetrahydrocannabinol (THC) act synergistically with it to modulate the overall psychoactive effects of the plant. Cannabidiol (CBD) is under preliminary research for its potential to modify the effects of THC, possibly mitigating some of the negative, psychosis-like effects of THC. There are numerous terpenes present in the cannabis plant and variation between strains. Some of the different terpenes have known pharmacological effects and have been studied.

Cannabis plants contain more than 120 different phytocannabinoids. These phytocannabinoids act on your endocannabinoid system, which works to keep your body in homeostasis, or balance.

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are two of the more well-researched and popular phytocannabinoids. People take CBD and THC in a variety of ways, and they can be consumed separately or together. However, some research suggests that taking them together — along with smaller organic compounds in the cannabis plant, known as terpenes or terpenoids — is more effective than taking CBD or THC alone. This is due to an interaction between phytocannabinoids and terpenes called “the entourage effect.”

This is the theory that all the compounds in cannabis work together, and when taken together, they produce a better effect than when taken alone. As research continues to unveil the mysteries of cannabis, the Entourage Effect gains credibility.

Thanks to their efficacy and popularity, THC and CBD have become well-known acronyms among medical professionals and patients alike. Research into their medicinal effects has revealed their usefulness for an ever-expanding list of health issues.

But pure THC and CBD extracts may not offer the best possible therapeutic results. A growing number of researchers believe these substances produce superior results when administered in a more natural form, either together or in combination with other chemical compounds found in cannabis plants like the minor cannabinoids, terpenes, and flavonoids. Such compounds are often referred to as whole-plant or full-spectrum products.

They claim this is the result of a theoretical principle known as the entourage effect. While some still have doubts, experimental and anecdotal evidence has convinced many cannabis consumers and industry professionals that the entourage effect is real.

WHAT IS THE ENTOURAGE EFFECT?

When multiple cannabis compounds are integrated, their medicinal effects may be altered or enhanced. The flavours and psychoactive capacities may also be affected, creating distinct products with varying characteristics.

According to its advocates, the group dynamics of the entourage effect can create emergent properties that would otherwise not be present in pure THC or CBD. Many who work closely with cannabis believe the entourage effect can dramatically increase the medicinal utility of THC and CBD, either by magnifying their known effects or by expanding their menu of therapeutic applications.

The therapeutic effects of cannabis compounds arise from their capacity to bind with naturally occurring endocannabinoid receptors in the brain and throughout the central nervous system. The human endocannabinoid system is designed to link with endogenous cannabinoids produced by the body, but compounds found in cannabis plants can bind with these receptors just as efficiently.

Health benefits abound when high-quality medicinal cannabis is consumed by humans. The entourage effect may be one of the reasons why marijuana is such an effective medicine.

The entourage effect is believed to emerge from the interactions between cannabinoids and between terpenes and cannabinoids. Terpenes are essential oils with distinctive aromas and flavors, and the characteristics of individual cannabis products are often determined by their relative concentrations of specific terpenes.

Currently, most of the research into the entourage effect has focused on the interactions between THC and CBD, and more specifically, on how the latter might affect the former.

“The biggest influence on THC is CBD,” states Ethan Russo, a neurologist who serves as Director of Research and Development at the International Cannabis and Cannabinoids Institute in Prague. Perhaps no one in the industry has gone to greater lengths to prove the existence of the entourage effect than Russo, who has been scouring scientific literature in search of its footprints for decades.

As evidence of CBD’s impact on THC expression, Russo mentions a 2010 clinical trial involving the pain reliever *Sativex, which is prescribed for patients with multiple sclerosis. The drug includes a relatively balanced mixture of THC and CBD.

In a controlled study, Sativex was given to individuals suffering from great pain associated with cancer. Some participants enrolled in the study received a preparation of pure THC extract, while others were given a placebo.  Sativex was found to offer a significant pain-killing effect in 40% of the patients who took it, which made it twice as potent as the THC extract. This difference was observed even though the THC content of each preparation was identical, which could only mean that the CBD was somehow increasing the pain-killing potency of the THC.

Additional research indicates that Sativex does not produce the psychotic side effects that are experienced on some occasions by those who consume pure THC regularly.

Another study, carried out in 2016, compared the experiences of cannabis users who smoked pure THC to those who smoked cannabis products that included both THC and CBD. While those who consumed pure THC experienced memory problems and other cognitive difficulties (typical results associated with that compound), those who smoked THC and CBD together experienced no such troubles.

In analysing the results of these studies, researchers credit the capacity of CBD to either moderate or intensify the binding activity of THC with cannabinoid receptors in the brain.

At present, research into the effects of specific cannabinoid-terpene combinations is limited. One 2018 meta-analysis did reveal that pure CBD extracts were far less effective in reducing the occurrence of seizures in epilepsy patients than extracts that included a mixture of cannabis cannabinoids, including terpenes. While 71% of those who took the mixed preparation had fewer seizures, only 46% of those treated with pure CBD experienced the same result.

Laboratory studies may one day establish the existence of the entourage effect beyond a reasonable doubt. That day has not yet arrived, but the research that strongly suggests the effect is real is starting to accumulate, along with ample anecdotal evidence from users whose experiences with medicinal cannabis vary based on the chemical composition of the products they’ve been consuming.

*Sativex is used when other medicines have not worked to relieve muscle stiffness. Sativex is an oral spray containing the active ingredient nabiximols which consists of cannabis extracts called cannabinoids.

ANECDOTAL EVIDENCE IS STILL EVIDENCE

Researchers who remain skeptical of the entourage effect point to the lack of controlled, double-blind laboratory studies to verify its reality. By its very nature, the entourage effect is a complicated process to trace and identify, but when you have thousands and thousands of people reporting the same thing, it gets hard to ignore.

But the anecdotal evidence is extensive and precise.

The testimony of cannabis consumers is consistent with the thesis that small differences in cannabinoid and terpene mixtures create different user experiences. This would seem to indicate that new and unique properties may emerge from the interaction of various cannabis chemical compounds and that even minuscule alterations in the formula may be enough to produce medically significant differences.

While the anecdotal evidence supporting the reality of the entourage effect may not be conclusive, it should be convincing enough to motivate researchers to continue their quest for the truth.

THE BENEFITS OF THE “ENTOURAGE EFFECT”

Because full-spectrum CBD contains a variety of phytocannabinoids, it produces an “entourage effect” that engages both the CB1 and CB2 receptors in the brain — as well as other cannabinoid and non-cannabinoid receptors throughout your body — for maximum neuroprotective and overall health benefits.

It may help improve the body’s ability to absorb beneficial chemicals through the blood-brain barrier and can help to overcome bacterial defense mechanisms as well as minimizing unwanted side-effects.

CONCLUSION

A 2020 review of research found no entourage effect in most studies, while other reports claimed mixed results, including the possibility of increased adverse effects. The review concluded that the term, "entourage effect", is unfounded and used mainly for marketing.