Natural Care

Understanding the entourage effect

Natural Care medical cannabis entourage effect synergy

Cannabis is more than its most famous ingredients, THC and CBD. It is a complex plant comprised of hundreds of chemical compounds, including hundreds of cannabinoids and terpenes. Science has yet to determine the exact role or mechanism for each of these compounds, but early evidence suggests that they work best together.

This synergy is known as the entourage effect. The term entourage effect has been around since 1998, and is used to describe the combined effect of cannabinoids, terpenes and flavonoids in cannabis. Synergy is another common term used to describe this so-called teamwork effect.

The best known of these interactions happens between THC, the cannabis ingredient famous for creating a marijuana “high” (as well as other effects, like pain relief) and CBD, the one known for reducing anxiety and inflammation. On its own, THC can induce feelings of paranoia; taken with CBD, it is less likely to do so. But this is just a simple picture of two well-known cannabinoids working together.

A more accurate example is the different effects consumers may experience between products. Although two products or strains may contain similar levels of CBD and THC, the experience of the strains can vary significantly. Of course, factors like personal tolerance and time of day play into how we experience cannabis, but many researchers also believe that the sum of a strain’s compounds is more influential than its parts.

Michael Backe’s Cannabis Pharmacy is a well-respected guide to medical marijuana that uses the term ‘entourage effect’ in many of its strain descriptions. In his book, Backe uses the Blue Dream strain as an example of a non-Kush strain that produces an entourage effect similar to OG Kush. Backe notes that Blue Dream’s entourage of cannabinoids, terpenes, and flavonoids makes the strain an excellent option for mitigating nausea, insomnia and gastrointestinal issues.

Scientist and psychopharmacologist Ethan Russo is one of the biggest proponents of the entourage effect, and his work is frequently cited in cannabis research. But the entourage effect is by no means universally accepted, with skeptics citing an overall lack of corroborating evidence and data to support the theory. For instance, Margaret Haney, a cannabis researcher and neurobiologist at Columbia University, believes that the entourage effect is little more than a marketing ploy on the part of marijuana producers. “The cannabis field can say anything, and it does,” Haney told Scientific American. “I’m not against marijuana. I want to study it carefully. We know it can affect pain and appetite, but the large majority of what’s being said is being driven by anecdotal marketing.”

Still, just because there is little scientific evidence to support the theory does not mean that the entourage effect is a myth. Cannabis research is still way behind the times as a result of being prohibited for the majority of the last century, and the effects and properties of most strains have yet to be thoroughly studied.

The same uncertainty applies to the popular idea of whole plant medicines, as well. These are medicines that use the entirety of the plant or its components like whole flower or bud, instead of isolated chemical extracts. The value of whole plant medicine can be inferred from the fact that some licensed producers specifically market their oils as “strain specific” to distinguish them from cannabinoid-specific extractions or blends. (Standardized blends will still produce their own  entourage effects, however.)

Some evidence has shown that whole plant medicines can help patients who struggle with MS spasticity symptoms. Another study showed that medicines composed of CBD-rich plant extracts are more effective anti-inflammatory treatments than purified CBD extractions. But these studies are few and far between. More research is needed for a full understanding of whole plant medicines and their effects compared to single-ingredient extractions.

Until more research is available, we suggest keeping notes when trying new cannabis products, whether they’re strain-specific or not. Record your experiences, jotting down any apparent differences between similar strains and note any similarities that you might discover between vastly different types. Be sure to track variables like time of day, pain levels or symptoms prior to and after ingesting, whether you’ve eaten recently or not, etc. No, it’s not strictly science, but personal experience and anecdote are important precursors to formal research, and have always had an important role giving inspiration and direction for formal cannabis studies.

Share these notes with your Natural Care nurse or prescriber, and he or she will use them to help suggest the most suitable products and doses for your medical needs.

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