Cannabis legalization is slowly taking over the country, which is great news for medical cannabis patients looking for access to cannabis’ therapeutic compounds. As states continue to fight against cannabis prohibition, more rigorous scientific research will uncover the mechanisms of action of every chemical compound found in the medicinal plant.
Cannabis flower is covered in tiny, resinous hairs called trichomes, which contain beneficial compounds including cannabinoids, terpenoids, and flavonoids. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most popular cannabinoids for researchers and consumers, but with more than 400 different identified compounds, what else are we missing out on?
What Is the Entourage Effect?
In 1998, the phrase “entourage effect” appeared in medical cannabis research for the first time. Innovative researchers including Raphael Mechoulam, “the father of cannabis research,” adopted the phrase to refer to the unique effects produced by a combination of cannabinoids, terpenoids, and flavonoids, each with their own unique biochemical benefits.
Essentially, some scientists (and a large amount of anecdotal evidence) suggests that cannabis compounds interact synergistically to amplify or mitigate certain effects. Ethan Russo’s 2011 paper on cannabinoid and terpene interaction is widely referenced to express how compounds behave differently in the body when taken in concert.
Isolates vs. Distillates vs. Full-Spectrum Extracts
Many cannabis consumers turn to cannabis isolates, or extracts of a singular cannabinoid compound, for therapeutic relief. Even pharmaceutical companies have developed synthetic cannabinoid extracts, dronabinol and nabilone, but these medications consist of one or two cannabinoids instead of the entire plant’s chemical profile.
A 2011 survey, however, showed that an overwhelming majority of patients preferred inhaled or infused methods than synthetic compounds. It doesn’t help that THC pills can take hours to kick in. CBD isolates, for example, can remove any chance of feeling “high,” but only uses CBD’s medicinal potential.
Distillates, a precursor to cannabis isolates, are made using hydrocarbon, CO2, or ethanol extraction methods. Unlike isolates, distillates may contain other cannabinoids. During these extraction methods, terpenes may be lost in the process. Terpene degradation makes distillates great for cartridges, edibles, topicals, and tinctures to reduce the strong cannabis aroma, but users may lose out on any possible synergistic interaction between terpenes and cannabinoids.
While loosening laws on CBD have opened up access to many patients, there are many more that could benefit from THC-rich cannabis. In fact, Sativex, a THC:CBD medication, is tolerated much better than isolate-based medications. Although not proven, consumers are turning to “full-spectrum” oil that contains the strain’s original cannabinoids and terpenes.
Some users have reported preferring full-spectrum extracts over high THC distillates. Instead of experiencing the unrestrained and highly intoxicating effects of THC, users say they have a more balanced and relaxing experience with full-spectrum concentrates. The elevated experience may be due to the sheer variety of cannabinoids and terpenes working together instead of relying on a single compound.
THC and CBD
While THC and CBD alone hardly represent the complex and beneficial chemical profile of many cannabis cultivars, a combination of both compounds can showcase the effects of the entourage effect. CBD has shown to reduce some of the paranoia and anxiety associated with THC use. THC binds to the endocannabinoid system’s CB1 receptor to provide pain, nausea, and anxiety relief, but can make some users uncomfortable. CBD may temper THC’s side effects.
While CBD can’t bind to cannabinoid receptors like THC, CBD has multiple mechanisms of action that can help increase the body’s amount of cannabinoids, for example. In some cases, however, THC and CBD interactions can reduce the efficacy of some of THC’s medical benefits. For this reason, more medical research is needed to find personalized THC:CBD ratios.
When talking about the entourage effect, it’s important to cover terpenes, a plant’s aroma compounds responsible for cannabis’ pine, fruity, diesel, earthy, citrus, or tropical flavors. There are over 200 terpenes in the cannabis plant, but only a few of them are present in significant amounts to make a difference. Even flavonoids have some benefits but are found in trace amounts rendering them irrelevant.
Terpenes play a vital role in repelling insects and attracting pollinators and also in the entourage effect. Not only do they mitigate THC’s negative effects like CBD, but have also could help boost cannabis’ analgesic, anxiolytic, antiemetic, anti-inflammatory, and antimicrobial characteristics. For example, terpenes beta-caryophyllene and alpha-pinene can dilate blood vessels, which is helpful in reducing inflammatory conditions.
Final Thoughts on the Entourage Effect
The entourage effect exists as a concept that can benefit medical patients in the future, but for now, we don’t have enough information to determine the specific combination of cannabinoids and terpenes that provide repeatable and predictable effects. Until more scientifically-based and personalized extracts are produced for specific ailments, consumers must approach new products with caution and do their due diligence.
We don’t know everything about how the entourage effect actually works, but we do know that a combination of cannabinoid and terpenes have shown promising results for medical patients. Just like drug combinations are used to treat major illnesses, the entourage effect amplifies the efficacy of certain cannabinoids and reduce the side effects of others for a better cannabis experience.