As a patient researching medical medical cannabis, you have certainly read of the
entourage effect. If you have used cannabis, you have probably noticed the differences
in symptom control, side effects and generally how cannabis makes you feel when
using different strains. Why does one strain with 17% THC and 0.5% CBD affect you
differently than a different strain having the same labeled cannabinoid percentages?
There is obviously something else going on here.
Raphael Mechoulam is an Israeli natural products organic chemist, known as "The
Father of Cannabis Research,"; discovered ∆-9-THC present in cannabis in 1964. This
led to the subsequent discovery of the naturally produced ";endocannabinoids" in the
human body and later to the discovery of the endocannabinoid system, the complex
network of cannabinoid receptors and endocannabinoid production, in 1992. It is the
endocannabinoid system on which the phytocannabinoids, cannabinoids produced by
plants (interestingly only by the cannabis genius), exert their effects.
Professor Mecholam’s research later led him to findings that the interaction of two
endocannabinoids resulted in the effects of one being increased. This is referred to as
"potentiation" in pharmacology. He coined the term "entourage effect" in the July 1998
paper: "An entourage effect: inactive endogenous fatty acid glycerol esters enhance 2-
arachidonoyl-glycerol cannabinoid activity." Since then, clinical experience as well as
additional research has proposed that it is the interaction of the various
phytocannabinoids as well as that of aromatic compounds called terpenes present in
cannabis result in the effects produced in humans. This theory, which I subscribe to and
on which my advice is based, is that the various differences in the effects of the different
strains is related to the relative cannabinoid and terpene content and ratios.
The pharmaceutical industry's research has been centered on isolating the various
cannabinoids (primarily THC) identifying their effects and then synthesizing them for
production. Indeed, synthetic versions of THC are produced and prescribed in the
United States. Marinol (dronabinol), for example, is one synthetic analogue of THC that
has been in use for many years. Clinical experience has shown it to have more side
effects and be less effective in treating cachexia and poor appetite than cannabis. It has
not found to be effective for other conditions that respond positively to cannabis.
Experience with other synthetic analogues has also shown the whole plant to be better
tolerated and more effective. So far, the industry can't beat nature. The entourage
effect, although incompletely understood, is quite real.
What does all this mean to you?
Almost every patient who tries medical cannabis sees some improvement in their
symptoms. Most patients stop there. With careful strain selections, taking the entourage
effect into consideration, patients can go from some improvement in in their symptoms
to a marked improvement in the quality of their life. Cannabis is a very safe medication
to use. It is a somewhat complicated medication from which to get the great results.
Make the extra effort in learning how to best use cannabis. I hope that by providing you
with my perspectives and experience in managing medical cannabis patients that you
can achieve the best possible results in improving the quality of your life.
Brian Nichol MD