reading time: 9 minutes
1. Introduction to the concept of entourage effect
Cannabis, while widely known for its primary cannabinoids (Δ9-tetrahydrocannabinol (THC), and cannabidiol ( CBD ), contains a multitude of other compounds, including other cannabinoids, terpenes, flavonoids, and more. The hypothesis The entourage effect suggests that these components work together to create greater therapeutic effectiveness than each of them alone.
2. Cannabis components and their interactions
- More than 100 cannabinoids have been identified in the cannabis plant.
- Each cannabinoid may have distinct therapeutic properties and may interact differently with receptors in the endocannabinoid system (ECS).
- Volatile aromatic constituents produced in the trichomes of the plant.
- More than 200 terpenes have been identified in cannabis, with properties ranging from anti-inflammatory effects to improving blood-brain barrier penetration.
- They contribute to the anti-oxidant, anti-inflammatory, and neuroprotective properties of cannabis.
3. Scientific foundations of the entourage effect
The theory of the entourage effect is based on the observation that the cannabis plant as a whole appears to have therapeutic properties that exceed those of its individual components. This synergy is the result of multiple interactions between cannabinoids, terpenes, flavonoids and other phytochemical compounds.
Studies have indicated that cannabinoids can modulate the effects of each other. For example, CBD, non-psychotropic, is known to modulate the psychoactive effects of THC. CBD may also increase THC's ability to treat pain, inflammation, and seizures. This type of interaction is central to the entourage effect.
Additionally, terpenes , responsible for the distinct aromas of cannabis, also play a crucial role. For example, myrcene , a common terpene, can increase the permeability of the blood-brain barrier, making it easier for cannabinoids to access the brain . On the other hand, linalool , another terpene, has anxiolytic and sedative properties, which, in combination with THC, can enhance the relaxing and sleep-helping effects of cannabis.
Flavonoids , although less studied, have also shown signs of synergy with other cannabis compounds. For example, certain flavonoids can act as inhibitors of the enzyme that breaks down anandamide , a naturally occurring endocannabinoid in the body, thus prolonging its effects.
It is essential to understand that the entourage effect is not simply the sum of the effects of individual components, but a complex interrelationship that can improve the therapeutic effectiveness of cannabis, while minimizing certain adverse effects.
4. Marinol and the illustration of the importance of the entourage effect
Marinol (dronabinol) is a drug approved by the FDA (Food and Drug Administration) in the United States that contains synthetic THC . It was developed and marketed as a legal and “safer” alternative to medicinal cannabis for the treatment of chemotherapy-related nausea and vomiting and AIDS-associated anorexia.
Although Marinol offers some of the benefits of THC, many patients and clinicians have reported that it is significantly less effective than natural cannabis. Several reasons explain this difference:
Lack of entourage effect: Unlike natural cannabis, Marinol contains only THC, depriving users of the synergistic effects offered by the interaction between different cannabinoids and terpenes. This absence could explain why some people find Marinol less effective than whole cannabis for certain symptoms.
Bioavailability and Metabolism: The THC in Marinol is administered orally, which means it must pass through the liver before reaching the systemic circulation. This process transforms much of the THC into a more psychoactive metabolite called 11-hydroxy-THC, which can result in more intense and less predictable side effects than inhaling cannabis.
Varied response: Some patients report that the effects of Marinol are too strong and unpleasant, while others find that it does not provide enough relief. This variability may be due to the absence of other compounds that, in natural cannabis, modulate the effect of THC.
Cost: Marinol is often much more expensive than natural cannabis, making treatment prohibitive for some patients.
In summary, while Marinol was a laudable attempt to medicalize the benefits of cannabis, it clearly demonstrates the importance of the entourage effect and the complexities associated with simplifying a plant with multiple compounds into a medicine. single molecule.
5. Clinical implications
has. Personalization of Treatments Recognizing the entourage effect can help personalize cannabis treatments for different patients and conditions, adjusting THC:CBD ratios and taking terpene profiles into account.
b. Expanded Therapeutic Potential The synergistic combination of cannabis components could be used to treat a broader range of conditions than isolated cannabinoids.
vs. Reduction of Side Effects The entourage effect can also be exploited to minimize the side effects associated with certain cannabinoids, thereby providing a more favorable side effect profile.
6. Challenges and considerations for clinical practice
has. Dosage and Administration Accurate administration and dosage of cannabis preparations requires a thorough understanding of chemical profiles and the entourage effect.
b. Clinical Studies Cannabis clinical trials have often used isolated cannabinoids, which may not fully reflect the effectiveness of whole cannabis due to the absence of the entourage effect.
vs. Regulations With changing laws on medical cannabis in different countries, it is essential that medical specialists are well informed and act in accordance with local legislation.
The cannabis entourage effect has important implications for medical specialists, offering enhanced therapeutic potential but requiring a nuanced approach to maximize benefits while minimizing risks. As research advances, a thorough understanding of this phenomenon will be crucial for the effective clinical use of cannabis.