While many people associate cannabis with the high from a famous compound called tetrahydrocannabinol (THC), that’s not the whole story.
Medical cannabis contains hundreds of compounds, including cannabinoids and terpenes. And now, evidence is emerging of how these compounds work together through a phenomenon known as the entourage effect.
The entourage effect may help us explain why different cannabis strains have different effects. Or why different tincture formulations work for different conditions.
And while it’s not yet fully understood, research suggests that it could enhance the medical benefits of cannabis while minimising side effects.
Medical Cannabis Is a Complex Plant
Medical cannabis comes from the plant Cannabis sativa. Around the world, there are thousands of strains of cannabis sativa, each bred for particular traits and effects. Each strain contains a unique combination of chemical compounds — most importantly, cannabinoids and terpenes.
Cannabinoids are a type of chemical compound that interacts with our endocannabinoid system. They can affect nearly every system in our body, including our nervous system, immune system, metabolism, and cardiovascular system. Cannabinoids occur naturally in our bodies (endocannabinoids) and also in the cannabis plant (phytocannabinoids).
Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the two most common cannabinoids in medical cannabis. But more than 100 cannabinoids have been discovered — you may also hear about cannabinol (CBN), cannabigerol (CBG), and cannabichromene (CBC).
Terpenes are compounds found in every plant. They’re responsible for each plant's unique smell and taste. Terpenes are why lemons smell like lemons, and lavender smells like lavender. There are hundreds of types of terpenes, and each plant has its distinct, complex combination.
The terpenes found in cannabis are also found in other plants, including those used in food, medicines, and alternative therapies. Compounds like limonene, pinene, humulene, and myrcene are very common, but there are hundreds more.
What Is the Entourage Effect?
The entourage effect is a theory that suggests that compounds in cannabis interact in complex ways, leading to different effects on our bodies. For example, vaporising dried leaf containing THC, CBD, and terpenes could offer a greater pain relief effect than a pure THC extract.
The idea of the entourage effect was first proposed in a 1998 study. While research continues, some fascinating results have been published.
For example, there is evidence that full-plant cannabis extracts are more effective at reducing pain than isolated THC, which suggests an entourage effect is occurring. However, researchers are still working on explaining exactly why or how this happens.
The Potential of Cannabinoids and Terpenes in Combination
Doctors and patients alike are excited about the potential of the entourage effect to enhance the medical benefits of cannabis — all while minimising side effects.
The most well-known example of the entourage effect is the interaction between THC and CBD. Prescribing THC and CBD together increases the pain relieving properties of medical cannabis compared to THC alone. For example, one study found that cancer patients receiving a THC: CBD medicine reported lower pain scores than those receiving THC alone.
As far as terpenes are concerned, the picture is hazier. We know that terpenes interact with our cannabinoid system. In 2020, researchers found that terpenes (geraniol, pinene, and humulene) interacted with the CB1 receptors in the endocannabinoid system of mice.
However, other researchers have found that terpenes don’t directly interfere when cannabinoids bind to the endocannabinoid receptors.
In short, more research is needed to fully understand exactly how terpenes and cannabinoids interact with each other and our bodies. With growing interest in medical cannabis worldwide, it’s no surprise researchers are starting to explore these questions too.
What it Means for Medicine: Isolates and Full-Spectrum Options
For medical cannabis users, it's helpful to understand that each cannabis strain and product will have different effects due to its composition of cannabinoids and terpenes. This has led to a wide variety of products, and our doctors can help you find what’s right for you.
You’ll commonly see a distinction between isolates and full-spectrum CBD products. An isolate is a product that contains pure CBD. The cannabinoid has been removed from the plant, purified, and then added to an oil, capsule, or topical.
On the other hand, a full-spectrum CBD product is made from the complete cannabis oil extracted from the plant. It will contain CBD and also other cannabinoids, terpenes, and compounds. Often, a full-spectrum CBD extract will contain very low (0.3%) levels of THC.
Our doctors work closely with you, to identify the right option. Research suggests that full-spectrum CBD extracts may be more effective for some conditions. However, there are several reasons why an isolate may be a better choice, especially if you want to avoid THC altogether.
The Entourage Effect: The Future of Medical Cannabis?
The entourage effect theory has been around for less than 25 years. During that time, medical cannabis has gained widespread acceptance around the world, and researchers have begun to explore the potential of cannabinoids, terpenes, and the entourage effect on our health.
As a medical cannabis patient, it's helpful to understand the complex nature of medical cannabis so you can make an informed choice. Understanding the entourage effect can help you choose the most beneficial product and make the most of your medical cannabis consultation prescription.