Ten 2016 studies that defy nz drug policy and the National Party’s determination to continue prohibition of the raw plant.
Ten 2016 studies that defy nz drug policy and the National Party’s determination to continue prohibition of the raw plant.
According to a new survey out of Stanford University, a cannabidiol-rich cannabis extract may be widely effective for children with epilepsy. The survey, published in the December issue of Epilepsy & Behavior, compiled responses from 18 parents who had turned to a special form of cannabis to treat their child’s severe epilepsy. The work begins now to determine which types of epilepsy CBD is going to help, its side effects, and how it interacts with other anti-seizure drugs.
In some cases, parents reported a reduction in seizure frequency of up to 80% and 83% indicated a reduction in their child’s seizure frequency, with little to no side effects of cannabis treatment. Four of the children suffered from Doose syndrome, one had Lennox-Gastaut syndrome, one had idiopathic epilepsy, and thirteen had Dravet syndrome.
Catherine Jacobson, PhD, a postdoctoral fellow who lead the study believes that the results still support CBD-rich cannabis as an effective epilepsy medicine, in spite of the study’s big and obvious caveats and despite the trials of available anti-seizure drugs. Dr. Jacobson reviewed the literature after hearing that some parents were having success using CBD-rich cannabis and found research dating back to the 1970s that supported the anecdotes. She was inspired to conduct the study by her own search for a treatment that could help her epileptic son.
Now part of a team at University of California, San Francisco (UCSF), Dr. Jacobson is leading the clinical investigations on a high-grade CBD extract developed by GW Pharmaceuticals. The company announced that it had received FDA approval to begin experimental treatments with Epidiolex in epileptic children, just last month. Orrin Devinsky, MD at the NYU School of Medicine, and Roberta Cilio, MD, PhD at UCSF are the leading research. Initial results are expected early next year. (Via StT.org)
by Soumya Nala, December 2013
You will find scientific information on most of the studies at Database on Clinical Studies and Case Reports
Neuropathic pain remains a significant clinical problem because it responds poorly to available therapies.
Neuropathic pain is often refractory to conventional pharmacotherapies, necessitating validation of novel analgesics.
Effects of genetic disruption of cannabinoid receptors or enzymes controlling endocannabinoid
degradation on neuropathic nociception are described. Specific forms of allodynia and hyperalgesia modulated by cannabinoids are also considered. In humans, effects of smoked marijuana, synthetic 9-THC analogs (e.g., Marinol, Cesamet) and medicinal cannabis preparations containing both 9-THC and
cannabidiol (e.g., Sativex, Cannador) in neuropathic pain states are reviewed. Clinical studies largely affirm that neuropathic pain patients derive benefits from cannabinoid treatment. Subjective (i.e., rating scales) and objective (i.e., stimulus evoked) measures of pain and quality of life are considered.
Cannabinoids for the Treatment of Neuropathic Pain
Tannia Gutierrez; Andrea G Hohmann
The isolation of Δ9-tetrahydrocannabinol (THC), the major psychoactive ingredient in cannabis, set the stage for the discovery of an endogenous cannabinoid (endocannabinoid) transmitter system. Endogenous signaling molecules for this system were subsequently isolated. Anandamide and 2-arachidonoylglycerol (2-AG), the best characterized endocannabinoids isolated to date, bind to and activate cannabinoid CB1 and CB2 receptors. CB1 is the primary cannabinoid receptor found in the CNS, whereas CB2 is predominantly, but not exclusively, found in the immune system. The discovery of cannabinoid receptors allowed researchers to synthesize cannabinoids and characterize their pain-relieving properties. Anandamide and 2-AG are degraded by the enzymes fatty-acid amide hydrolase and monoacylglycerol lipase, respectively. Enzymes catalyzing endocannabinoid breakdown also represent targets for analgesic drug development. This article will briefly summarize the findings of preclinical and clinical studies evaluating the therapeutic and side-effect profile of cannabinoids as pharmacotherapies for neuropathic pain.
GW Pharmaceuticals announced preliminary results of two Phase III studies of Sativex®, its cannabinoid spray medicine, in peripheral neuropathic pain.
The results of the study in patients with neuropathic pain characterized by allodynia show that patients taking Sativex obtain clinically important improvements in their management of pain and quality of sleep. In comparison with placebo, statistically significant improvements were seen for key outcome measures, including a positive result in the primary analysis of patient response, the outcome measure recommended by regulatory authorities.
The results of the study in patients with painful diabetic neuropathy show that patients taking Sativex obtained substantial improvements in their pain, indeed among the highest level of response seen in the published literature. There was an abnormally large placebo response in this study, which means that the data are more difficult to interpret categorically.
Dr Stephen Wright, GW’s R&D Director, said, “Neuropathic pain is one of the most difficult types of chronic pain to treat. These studies focused on particularly high need patients, who were already taking the best available pain treatments, and yet still suffered severe pain. Even in this most difficult to treat population, Sativex has produced improvements over and above current treatments that are highly meaningful to the everyday lives of patients.”
This multi-centre double-blind, randomized, placebo-controlled parallel group study in 297 patients examined the effect of Sativex in patients with painful diabetic neuropathy. Patients in this study were being treated with a range of currently available analgesics, which were maintained during the course of the study.
In this study, patients taking Sativex showed a thirty percent mean improvement in pain scores, among the highest level of response seen in the published literature. One third of Sativex patients achieved over a fifty percent improvement in pain.
Sativex is approved and marketed in Canada for the symptomatic relief of central neuropathic pain in MS, and is the subject of an ongoing regulatory submission in Canada for the relief of cancer.
Neuropathic pain often does not respond well to pharmacotherapy and medications used in its
treatment often have adverse effect profiles that make it difficult to achieve maximal therapeutic
dosing, resulting in limited symptomatic relief.
At the end of follow-up, the average reduction in pain intensity scores was greater in the
THC:CBD group than in the placebo group (95%).
The authors concluded that THC:CBD had a positive effect on neuropathic pain, when used as an add-on therapy to existing analgesics.
Cannabinoid-mediated Modulation of Neuropathic Pain and Microglial Accumulation in a Model of Murine Type I Diabetic Peripheral Neuropathic Pain.” Molecular Pain.
The new information: This experiment involved inducing diabetes in mice in the presence and absence of cannabinoid agonists and observing the mice over a course of 8 months. There were six main experimental groups, one of which diabetes was induced without cannabinoid treatment, serving as a control. In a second group, diabetes was induced in conjunction with cannabidiol treatment. It was found that in this second group, neuropathic pain did not develop over the course of 8 months and the levels of activated microglia in the spinal cord were greatly reduced compared to the control. Additionally, when cannabidiol treatment was stopped, the mice continued to show reduced microglia as well as no signs of neuropathic pain. A third and fourth group involved the induction of diabetes and treatment with both CB1 and CB2 cannabinoid receptor agonists once symptoms of neuropathic pain started. The results indicated that both CB1 and CB2 agonists inhibited the symptoms of neuropathic pain, but the pain returned after treatment was stopped. The last two groups involved treatment with CB1 and CB2 cannabinoid receptor antagonists, which block the effect of cannabinoids, and no change was seen in the levels of pain compared to the control group.
What this means: This experiment provided more evidence that cannabinoids may be used in the treatment of neuropathic pain. However, the novel information obtained is much more surprising. When treated with cannabidiol at the onset of diabetes, the diabetic mice did not have any symptoms of neuropathic pain even when treatment was stopped. This suggests that treatment with cannabidiol at the onset of diabetes may produce permanent protective changes for nerve cells. Therefore, cannabis could hypothetically be used short-term at the onset of type II diabetes in adults for lifetime or long-term prevention of diabetic peripheral neuropathy.
Cannabis/Cannabinoids/Neuropathic pain (Part 1)
Where ever you look on the internet, the general conclusion regarding effective treatments for neuropathic pain seems to suggest that only three things really work: capsaicin, smoked cannabis and rhNGF (nerve growth factor). The latter has not been approved by the major national organisations and we have discussed capsaicin at length in other posts on the blog. This is the first of two more posts with reasonable explanations supporting Cannabinoids. Legal problems aside, there seems to be a growing cache of evidence supporting the efficacy of cannabis, not only as an analgesic but as something with positive effects on the nervous and other body systems.
Opiates do not have clear indications for neuritis and neuropathy although they are widely prescribed for the pain but marijuana actually has been shown to relieve peripheral neuropathy due to HIV and diabetic neuropathy. THC has been useful for treating phantom pain with amputees, causalgias (another peripheral neuropathy condition), neuralgias, and conditions like trigeminal neuralgia. Medical marijuana has also found success with chronic cancer pain. A study at the University of Iowa found oral THC at 5 to 10 mg was as effective as 60mg of Codeine for terminal cancer pain relief.
One question that is obvious – Does marijuana alleviate pain simply because patients no longer care about it? Do the psychoactive effects of marijuana simply influence a patient’s attitude towards the pain and allow him or her to mask it out?
5/5/2011 – Recent scientific articles reviewed the ability of cannabis and cannabinoids to treat pain, especially neuropathic pain. This may be new hope for doctors who are struggling to treat these conditions. Clinical trials on humans using cannabis in various forms (smoked, extracts, oral THC, synthetic analogues) were reviewed by different research teams. Three recent reviews of those human trials demonstrate that cannabis and cannabinoids are effective for treating certain types of chronic pain with acceptable side effects.
A review on the treatments for HIV neuropathic pain concluded that, “evidence of efficacy exists only for capsaicin, smoked cannabis and rhNGF (nerve growth factor). However, rhNGF is clinically unavailable and smoked cannabis cannot be recommended as routine therapy (Phillips et al).”
Meaning, the only medications that have been shown to effectively alleviate HIV/AIDS neuropathic pain are not available on the market. Notably “smoked cannabis” was shown to be effective for the treatment of HIV neuropathy, a condition that affects more than 40% of the estimated 33 million people currently living with HIV.
A University of Pennsylvania research team published a similar review concluding that, “there is strong evidence for a moderate analgesic effect in peripheral neuropathic and central pain conditions, and conflicting evidence for their use in nociceptive pain. For spasticity, most controlled studies demonstrate significant improvement. Adverse effects are not uncommon with cannabinoids, though most are not serious and self-limiting.”
Last but not least, researchers from Canada concluded, that “overall the quality of trials was excellent. Fifteen of the eighteen trials that met inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared to placebo, several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases (Lynch et al).”
This team from was from Dalhousie University Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto. The researchers go on to say, “this systematic review of 18 recent good quality randomized trials demonstrates that cannabinoids are a modestly effective and safe treatment option for chronic non-cancer (predominantly neuropathic) pain.”
Traumatic pain is scratching your arm, banging your thumb with a hammer or post-operative pain (surgery). But neuropathic pain is something completely different because it is generated by diseases (Multiple Sclerosis, HIV/AIDS, amputation) or as a side effect from medication toxicity. Essentially the brain begins sending pain signals out to the body for no reason. Patients say they experience it as a burning or shooting pain sensation in their hands and feet at first. Neuropathic pain often progresses to become much more intense. Opiates do not seem to have any impact in certain groups.
Jahan Marcu is currently investigating the pharmacology of cannabinoid receptors. He was working at the California Pacific Medical Center Research Institute when exciting discoveries were made showing enhanced anti-cancer effects with THC and CBD from the Cannabis plant. The findings were published in the Journal of Molecular Cancer Therapeutics. In 2009 he received the Billy Martin Award from the International Cannabinoid Research Society (ICRS). Jahan is currently the vice-chair the Medical and Scientific Advisory Board at Americans for Safe Access (ASA).
Medical marijuana (cannabinoids) is an excellent adjunct treatment choice for Neuropathy.
Indica x Sativa hybrid (CBD:THC)
Strains: Herijuana x Trainwreck (I/S), Hog (I), Agent Orange (S/I), Bubba Kush (I), Sweet Cheese (I/S), OG Kush (I), Kandy Kush (H)
Whole plant extracts: Teas, Tinctures, Edibles, Sprays, Vaporizer, Topicals
^ “Peripheral Neuropathy Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS)”. http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm. Retrieved 2008-11-30.
^ “Dorlands Medical Dictionary:mononeuropathy”. http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/five/000067367.htm.
^ “neuritis” at Dorland’s Medical Dictionary
^ Gabriel JM, Erne B, Pareyson D, Sghirlanzoni A, Taroni F, Steck AJ (1997). “Gene dosage effects in hereditary peripheral neuropathy. Expression of peripheral myelin protein 22 in Charcot-Marie-Tooth disease type 1A and hereditary neuropathy with liability to pressure palsies nerve biopsies”. Neurology 49 (6): 1635–40. PMID 9409359.
^ Kiziltan ME, Akalin MA, Sahin R, Uluduz D (2007). “Peripheral neuropathy in patients with diabetes mellitus presenting as Bell’s palsy”. Neuroscience Letters 427 (3): 138. doi:10.1016/j.neulet.2007.09.029. PMID 17933462.
^ Cohen JS (December 2001). “Peripheral Neuropathy Associated with Fluoroquinolones” (PDF). Ann Pharmacother 35 (12): 1540–7. doi:10.1345/aph.1Z429. PMID 11793615. http://fqvictims.org/fqvictims/News/neuropathy/Neuropathy.pdf.
^ Heck AW, Phillips LH 2nd (1989). “Sarcoidosis and the nervous system”. Neurol Clin 7 (3): 641–54. PMID 2671639.
^ Gonzalez-Duarte A, Cikurel K, Simpson DM (2007). “Managing HIV peripheral neuropathy”. Current HIV/AIDS reports 4 (3): 114–8. doi:10.1007/s11904-007-0017-6. PMID 17883996.
^ Wilkes G (2007). “Peripheral neuropathy related to chemotherapy”. Seminars in oncology nursing 23 (3): 162–73. doi:10.1016/j.soncn.2007.05.001. PMID 17693343.
^ Liu N, Varma S, Tsao D, Shooter EM, Tolwani RJ (2007). “Depleting endogenous neurotrophin-3 enhances myelin formation in the Trembler-J mouse, a model of a peripheral neuropathy”. J. Neurosci. Res. 85 (13): 2863–9. doi:10.1002/jnr.21388. PMID 17628499.
^ Skrabek RQ, Galimova L, Ethans K, Perry D (2008). “Nabilone for the treatment of pain in fibromyalgia”. J. Pain 9 (2): 164–73. doi:10.1016/j.jpain.2007.09.002. PMID 17974490.
^ Frank B, Serpell MG, Hughes J, Matthews JN, Kapur D (2008). “Comparison of analgesic effects and patient toleration of nabilone and dihydrocodeine for chronic neuropathic pain: randomized, crossover, double blind study”. BMJ 336 (7637): 119–201.
^ Abrams DI, Jay CA, Shade SB, Vizozo H, Reda H, Press S, Kelly ME, Rowbotham Mc, Petersen KL (2007). “Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trail”. J. Neurology 68 (7): 515–21. doi:10.1212/01.wnl.0000253187.66183.9c. PMID 17296917.
^ Wilsey B, Marcotte T, Tsodikov A, Millman J, Bentley H, Gouaux B, Fishman S (2008). “A randomized, placebo-controlled, crossover trail of cannabis cigarettes in neuropathic pain”. J. Pain 9 (6): 506–21. doi:10.1016/j.jpain.2007.12.010. PMID 18403272.
^ Jin DM, Xu Y, Geng DF, Yan TB (July 2010). “Effect of transcutaneous electrical nerve stimulation on symptomatic diabetic peripheral neuropathy: a meta-analysis of randomized controlled trials”. Diabetes Res. Clin. Pract. 89 (1): 10–5. doi:10.1016/j.diabres.2010.03.021. PMID 20510476.
^ Pieber K, Herceg M, Paternostro-Sluga T (April 2010). “Electrotherapy for the treatment of painful diabetic peripheral neuropathy: a review”. J Rehabil Med 42 (4): 289–95. doi:10.2340/16501977-0554. PMID 20461329.
Latov, Norman; ‘Peripheral Neuropathy: When the Numbness, Weakness, and Pain Won’t Stop; American Academy of Neurology Press Demos Medical Publishing; N.Y., N.Y.; 2007
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Clinical and epidemiological studies suggest an association between cannabis use and psychosis, but this relationship remains controversial.
Clinical High-Risk (CHR) subjects (age 12–22) with attenuated positive symptoms of psychosis (CHR+, n=101) were compared to healthy controls (HC, n=59) on rates of substance use, including cannabis. CHR+ subjects with and without lifetime cannabis use (and abuse) were compared on prodromal symptoms and social/role functioning at baseline. Participants were followed an average of 2.97 years to determine psychosis conversion status and functional outcome.
At baseline, CHR+ subjects had significantly higher rates of lifetime cannabis use than HC subjects. CHR+ lifetime cannabis users (N=35) were older (p=0.015, trend), more likely Caucasian (p=0.002), less socially anhedonic (p<0.001), and had higher Global Functioning (GF):Social scores (p<0.001) than non-users (N=61). CHR+ cannabis users continued to have higher social functioning than non-users at follow-up (p<0.001), but no differences on role functioning. A small sample of CHR+ cannabis abusers (N=10) showed similar results in that abusers were older (p=0.008), less socially anhedonic (p=0.017, trend), and had higher baseline GF:Social scores (p=0.006) than non-abusers. Logistic regression analyses revealed that conversion to psychosis in CHR+ subjects (N=15) was not related to lifetime cannabis use or abuse.
The current data do not support low to moderate lifetime cannabis use to be a major contributor to psychosis or poor social and role functioning in high-risk youth.
The Internet Party recognises that current approaches to cannabis do not work. We will promote an evidence-based approach to cannabis law reform and treat cannabis use as a health issue instead of a criminal issue. We will:
The Internet Party will work towards comprehensive drug law reform to ensure we have a system that is just, and focussed on harm reduction and getting people the help they need. This will involve full public engagement, supported by the best evidence to guide the process.
A sensible approach to cannabis law reform must acknowledge that prohibition has not succeeded in reducing use or abuse.
There is currently a large black market cannabis industry in New Zealand. We seek to shift the regulation of cannabis and the response to cannabis use from the black market and criminal justice system to a sensible regulated system that permits medical use, and non-problematic recreational use.
Reducing problematic use of all drugs, including cannabis and alcohol, is a key aim of the Internet Party policy. A comprehensive evidence-based approach to drug regulation, abuse prevention and the provision of addiction services will be taken to minimise and effectively respond to problematic use.
Medicinal use of cannabis has proven in some cases to be a safe and effective alternative to a number of medicines, including those to treat pain, nausea, and muscle tension and spasms and epilepsy. Natural cannabis and cannabis-based medicines should be available to those who need them for medical reasons.
The Internet Party will:
This will be done by allowing doctors to prescribe tetrahydrocannabinol (THC) and cannabidiol (CBD) in the form of raw cannabis and cannabis products under Section 1 Part 1 of the Medicines Regulations and adding cannabis and cannabis products to the list of controlled drugs that do not require the Minister’s consent to prescribe under Regulation 22 of the Medicines Regulations 1984.
Since there is no current lawful supply of cannabis available, persons will be allowed to apply for licenses to cultivate if they have the support of a doctor. The amount that an individual can lawfully cultivate will be based on international best practice, and may vary from patient to patient.
Those patients who are unable to cultivate their own cannabis due to disability, inappropriate living arrangements or other reasons may nominate an agent to do so on their behalf.
A licensing system will be set up to regulate and administer the cultivation of natural cannabis for medicinal use. Natural cannabis, THC- and CBD-based products will be available to patients on prescription. Organisations that provide natural cannabis for medicinal purposes will be regulated by the Government.
Possession and cultivation of cannabis for personal use will no longer carry a criminal penalty. There is to be no forfeiture of equipment used in relation to cannabis use and this equipment will no longer be unlawful to make, possess, sell or supply.
The amount that can reasonably be considered ‘for personal use’ is to be determined following consideration of research and international best practice. Possession and cultivation for non-medicinal distribution will remain illegal in the first instance. However the ‘presumption of supply’ in reference to possession of cannabis over a certain amount will be removed from law.
This measure will substantially affect the profitability of black market cannabis operations as users cultivating cannabis for their own use will no longer support the illicit drug market.
Smoke-free laws in public places, excluding buildings/events where licenses to smoke cannabis have been obtained, will be maintained. Cannabis will be subject to the same rules and restrictions as alcohol in terms of consumption in public spaces.
The government will develop a model for regulating the legal production and distribution of cannabis for personal use. Such a model would enable the taxation of cannabis and the monitoring of supply. Revenue will be available for education, health promotion, mental health and addiction services for cannabis, alcohol and other drugs.
We recognise that there are many perspectives on this matter. There is common ground on the need to reduce harmful drug use. We should learn from the failure of the current model of alcohol regulation to address harm and the negative and justified community reaction to the legal highs.
The model for natural cannabis regulation will be developed on the basis of evidence and informed community engagement. Supply is currently extensive, un-regulated and un-monitored. Natural cannabis regulation will be informed foremost by health research and strictly adhere to regulations designed to reduce abuse. Controls will include (at least) an R18 limit, banning advertising, plain packaging, a maximum purchase amount, restricting the location of dispensaries based on strict guidelines and the wishes of local communities, and other measures proven to minimise harm according to NZ and international evidence.
Our approach must carefully avoid the negative impacts of commercial drug industries such as the tobacco and alcohol industries.
Harmful cannabis use should be responded to as a health issue, not a justice issue. By decriminalising and potentially regulating cannabis in New Zealand we will free up funds which can be directed into far more effective ways of minimising the harm that cannabis causes – namely proactive health promotion, education and treatment options. Our approach will enable people who need help to access it without exposure to the criminal justice system, which has harmful effects itself.
We propose a massive increase in effective drug education programs in schools which is consistent with the best practices identified by extensive research in this area here and overseas.
“some consider the inability to develop and use illegal drugs like cannabis for medicinal purposes as a particular harm of drug prohibition. Indeed, one of the major adverse side effects of international efforts to control the supply of illegal drugs has been a denial of much needed pain relief to millions of people in developing nations… Given the strong belief of those who already use cannabis for medicinal purposes that it is an effective form of pain relief with fewer harmful side effects than other legally available drugs, we think that the proper moral position is to promote clinical trials as soon as practicable. We recommend that the government consider doing this.”
Its Recommendation 134 stated: “the Government should consider undertaking or supporting clinical trials into the efficacy of raw cannabis by comparison to synthetic cannabis-based products as a treatment for pain relief.”
“Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS. Dronabinol (tetrahydrocannabinol) has been available by prescription for more than a decade in the USA. Other therapeutic uses of cannabinoids are being demonstrated by controlled studies, including treatment of asthma and glaucoma, as an antidepressant, appetite stimulant, anticonvulsant and anti-spasmodic, research in this area should continue. For example, more basic research on the central and peripheral mechanisms of the effects of cannabinoids on gastrointestinal function may improve the ability to alleviate nausea and emesis.”
Given all of this, it is easy to see how CBD and THC can be viewed as being in competition. But the reality is that both compounds, along with as many as 66 other cannabinoids, play important roles in providing the therapeutic benefits associated with cannabis therapy. They work in conjunction with approximately 420 additional compounds (terpenes, flavonoids, etc.) to give cannabis its versatility in treating a multitude of medical ailments.
As good students of the Cannabis Classroom, you are probably familiar with the previous pieces which featured what can simply be described as the Big Six cannabinoids: THC, CBD, CBG, CBN, CBC, and THCV. Each cannabis plant contains these and many other cannabinoids at various percentages as part of the plant’s total chemical profile.
“The chemical profile of the cannabis plant contains other compounds like terpenoids, amino acids, proteins, sugars, enzymes, fatty acids, esters, and flavonoids…”
In addition to cannabinoids, the chemical profile of the cannabis plant contains other compounds like terpenoids, amino acids, proteins, sugars, enzymes, fatty acids, esters, and flavonoids, just to name a few.
Naturally, you consume all of these compounds when medicating with cannabis. The question is how do all of these compounds work together to provide therapeutic relief? The answer can be found in a concept called the “entourage effect.”
First described in 1998 by Israeli scientists Shimon Ben-Shabat and Raphael Mechoulam, the basic idea of the entourage effect is that cannabinoids within the cannabis plant work together, or possess synergy, and affect the body in a mechanism similar to the body’s own endocannabinoid system.
This theory serves as the foundation for a relatively controversial idea within pharmacology community, that in certain cases whole plant extractions serve as better therapeutic agents than individual cannabinoid extractions. The entourage effect theory has been expanded in recent times by Wagner and Ulrich-Merzenich, who define the four basic mechanisms of whole plant extract synergy as follows:
Many studies have demonstrated the effectiveness of cannabis as a therapeutic agent for muscle spasms associated with multiple sclerosis. A study conducted by Wilkinson and colleagues determined that whole-plant extracts were more effective than THC alone.
Researchers compared 1mg THC vs. 5mg/kg cannabis extract with the equivalent amount of THC, and found the whole plant extract to have significantly more antispastic effect.
The researchers attributed this result to the presence of cannabidiol (CBD) within the cannabis extract, which helps to facilitate the activity of the body’s endocannbinoid system.
The entourage effect can also work to improve the absorption of cannabis extracts. Cannabinoids are chemically polar compounds, which makes them at times makes them difficult for the body to absorb in isolation.
“With the assistance of terpenoids like caryophyllene, absorption of cannabinoids can be increased.”
Absorption of topicals provides a prototypical example of this problem. The skin is made up of two layers, also known as a bi-layer, which makes it difficult for for very polar molecules like water and cannabioids to pass through.
With the assistance of terpenoids like caryophyllene, absorption of cannabinoids can be increased and therapeutic benefits achieved.
The entourage effect also accounts for cannabis extracts to be effective in treating various bacterial infections. There are a number of studies which show the antibacterial properties of cannabinoids.
“Whole-plant cannabis extracts have non-cannabinoid constituents which also have antibacterial properties.”
However, bacteria develop defense mechanisms over time to combat the effects of antibiotics ultimately allowing them to become resistant to therapies which were previously effective.
Thus, it is beneficial that whole-plant cannabis extracts have non-cannabinoid constituents that also have antibacterial properties. These molecules attack bacteria through pathways which differ from cannabinoid pathways. Given the attack on multiple fronts, the development of bacterial resistance is limited.
Finally, the entourage effect allows certain cannabinoids to modulate the negative side effects of other cannabinoids. The most fitting example of this is CBD’s ability to modulate the perceived negative effects of THC.
Many patients are have heard about (or experienced) the increased anxiety and paranoia sometimes associated with cannabis consumption. Thanks to the entourage effect, research has shown that CBD can be effective in minimizing the anxiety associated with THC, lowering users’ feelings of paranoia.
As you can see, THC, CBD, and the remaining cannabinoids don’t have to compete with one another – they can work in tandem alongside the other components of cannabis extracts to provide therapeutic relief for a wide variety of ailments.