“There is not enough research!” That is the cry heard around the country as medical marijuana proliferates the states. This is not about the long-running TV show centered on young actors trying to make it big in Hollywood, but the effect of the whole cannabis plant on our health. It’s called the “entourage effect” –a slick name for a simple concept: the whole is greater than the sum of its parts. You may know this as synergy.
When we consume cannabis, we’re ingesting a collection of cannabinoids, terpenes, and flavonoids, making up the group of ingredients sort of like an entourage that follows a celebrity. In the medical cannabis world, the “entourage effect” is widely advocated but narrowly–if at all–formally studied in research projects. That’s why it’s creating buzz in the industry and among our patients.
Many are touting their success by using a broad-spectrum or full-spectrum therapy.
They Work Together
As a patient, you are most likely aware of the two most famous compounds, THC and CBD. Organic Remedies Pharmacist Shannon Ye says, “I start off with the two primary cannabinoids, THC and CBD, and describe their properties and potential synergistic effect.” Then, Ye moves into a deeper realm by discussing strains. “Afterwards, I explain the general differences between sativa, hybrid, and indica strains.”
Starting with strains is just the beginning of delving into the entourage effect of cannabis. Ye’s interest in the effect is helping patients make their way through what can be a daunting first experience and lead to a better overall cannabis therapy. Ye discusses hybrids then moves to terpenes saying, “I explain that cross-breeding over the years has led to many hybrid strains, and that the terpenes, the natural oils that provide aroma and medicinal value, greatly help to distinguish the potential effects and benefits.”
This will be new territory for many first-time medical marijuana patients and going slow with the explanation goes well with the dosing mantra of “start low, go slow.”
Ye walks her patients through a major difference in their new medical therapy. We are working with a natural plant, not a synthetic compound developed in a lab. “With many patients only familiar with single compound synthetic pharmaceuticals and new to plant-based medicine, I distinguish cannabis as the ultimate combination medication.” Ye expands on that crucial difference between medical marijuana and synthetic meds. “Ultimately, I express that the benefits of cannabis do not rely on one component. Rather, there may be a synergy when cannabinoids and terpenes are combined to deliver an enhanced pharmacologic effect.”
How Important is “Anecdotal” Evidence?
Ye agrees more research will help with defining and applying the entourage effect, but in the meantime, she’s seeing more patients benefitting from it. “I have observed from our patients that oftentimes the products containing a more abundant cannabinoid and terpene profile seem to offer greater benefits.”
Ye says the effects of cannabis are highly individualized. So too, are the effects of different products available at Organic Remedies. Ye says, “Many of our Organic Remedies’ extracted products are full spectrum concentrates because the specific cannabinoid and terpene profile of the plant is preserved during the manufacturing process.
Ye says patients can help a pharmacist dial-in a perfect entourage. “For example, one of my patients was having difficulty finding a capsule to help with sleep,” Ye says. “After a distillate 10 mg THC capsule was not effective, trying an indica-dominant full spectrum RSO 10 mg THC capsule finally provided the patient a good night's rest.”
Check Out the Terpenes!
Because of the entourage effect, patients may find that trying products with a different terpene profile creates a very different experience and can improve individual outcomes Ye relies on our lab’s work in extraction and production. “With patients, I often click on the product on our menu to look at the terpene contents obtained from the lab. Our Grape Cake dry leaf is an indica THC-dominant strain that is high in myrcene, a terpene that provides sedative effects.
Fortunately for patients, with the increasing number of strains, the various terpenes and new product forms coming to market, the benefits of the entourage effect can seem endless. “Our AK live crumble was created via an extraction process where the plant is fresh-frozen. It’s abundant in several terpenes. Also, check out strain-specific full spectrum tinctures which often provide a fuller "entourage" effect than our flavored tinctures.”
Research on the entourage effect includes the work of Dr. Ethan B. Russo. You can find his January 2019 study here: The Case for the Entourage Effect and Conventional Breeding of Clinical Cannabis: No “Strain,” No Gain (nih.gov)
An Organic Remedies Patient Care Consultant and Pharmacist are always available to answer your questions!