By Michael Backes, member of MGT Science & Medical Advisory Board
Author of Cannabis Pharmacy, The Practical Guide to Medical Marijuana

 

Entourages are one of my favorite topics because they provide the best explanation for the complex medicinal effects produced by cannabis.

 

The idea of an entourage effect first arose during the 1960s when Israeli scientist Dr. Raphael Mechoulam, who discovered structure of THC, investigated the plant’s medicinal chemistry and observed that THC and CBD together could produce effects greater than the sum of their individual effects. 

Dr. Mechoulam began his cannabis studies with Lebanese hashish cannabis resin from seized material provided to him by the Israeli state police.  Lab tests revealed this hashish contained equal amounts of CBD and THC.  When Mechoulam separated THC from CBD, he tested both compounds on animals and humans.  THC was euphoric, while CBD was not.  But when THC and CBD were combined, CBD modified the effects of THC, reducing THC’s ability to cause anxiety at higher doses. Mechoulam coined the term “entourage effect” to explain this observed synergy between THC and CBD.  

 

THC is the best known cannabinoid because it’s a euphoriant; CBD is increasingly well-known, but for years it was ignored because its effects are much more subtle.

CBD modifies some of the less desirable effects of THC. For example, THC can make some people anxious at moderate doses, but simultaneous administration of CBD reduces that anxiety. CBD is working like a “seat belt” to protect against some of the unwanted effects of THC.  CBD in an entourage can also lengthen the effects of THC, allowing patients to use a smaller dose that lasts longer. 

Dispensaries offer products in which CBD and THC can be taken together, but you can also take them separately. Pre-treatment with CBD, (taking it before THC) can dramatically reduce the likelihood of experiencing negative THC side effects. I often recommend patients take a pure CBD tincture about an hour before taking a pure THC tincture.  The CBD will diminish anxiety and provide mild pain relief. The latter dose of THC will provide additional, stronger pain relief and CBD will modulate its potential unwanted effects. 

Another potentially useful entourage candidate is the cannabinoid CBG. 

CBG is what the plant uses to make its CBD and THC.  But CBG is also pharmaceutically active as an analgesic, so combining CBG, CBD and THC provides the broadest spectrum of pain relief available from cannabis formulations.  

Another interesting cannabinoid is CBN, which is formed as THC breaks down.  CBN has mild sedative effects, so an entourage comprised of THC, CBG and CBN may encourage restful sleep for many patients.  However, I avoid using CBD in entourages intended for sleep, since CBD can keep some patients wide awake.

 

Cannabinoids are odorless, so it is the plant’s terpene essential oils that are responsible for the smell, flavor, and “personality” of cannabis strains. By paying close attention to the smell of cannabis flowers, it will you help to predict likely effects on your own body.

 

Your nose knows, when it comes to predicting the effects.

 

Citrus aromas are linked to limonene and terpinolene which are mood-elevating. Woody and lavender-like aromas are associated the terpenes myrcene and linalool, and promote pain relief and relaxation. Linalool inhaled with THC is one of the most effective entourage components to promote relaxation and sleep. 

Peppery-scented caryophyllene is an incredibly important terpene because it is a powerful anti-inflammatory that is excellent for conditions like IBS, IBD, Crohn’s Disease, rheumatoid arthritis, or inflammation-based pain. Used in combination with THC and/or CBD, caryophyllene is a cornerstone entourage member to alleviate inflammation.

You can design entourages for anxiety, sleep, pain, appetite, mood, inflammation and more. The benefits of using entourages are consistent outcomes and more predictible effects.   

Most terpenes are destroyed in the digestive tract, so inhalation is the best method of administration. Because fragile terpenes are lost through the high heat of smoking, the best way to benefit from these essential oils is with a flower vaporizer. 

When designing your own entourages, begin with what you know works for you. Talk to your Patient Education Specialist to identify the cannabinoids and terpenes found in your favorite cultivar.

Understanding the interaction between cannabinoids and terpenes allows you to customize entourages that deliver desired effects and consistent outcomes while reducing unwanted side effects.

Learn more about this topic by watching Maui Grown Mana`0 with Michael Backes. Episode Two (Below) specifically explores the Entourage Effect with medical cannabis, in modern applications.