Education

The Entourage Effect May Help Improve Health

“There is not enough research!” That is the cry heard around the country as medical marijuana proliferates the states. This is not about the long-running TV show centered on young actors trying to make it big in Hollywood, but the effect of the whole cannabis plant on our health. It’s called the “entourage effect” –a slick name for a simple concept: the whole is greater than the sum of its parts. You may know this as synergy.

When we consume cannabis, we’re ingesting a collection of cannabinoids, terpenes, and flavonoids, making up the group of ingredients sort of like an entourage that follows a celebrity. In the medical cannabis world, the “entourage effect” is widely advocated but narrowly–if at all–formally studied in research projects. That’s why it’s creating buzz in the industry and among our patients.

Many are touting their success by using a broad-spectrum or full-spectrum therapy.

They Work Together

As a patient, you are most likely aware of the two most famous compounds, THC and CBD. Organic Remedies Pharmacist Shannon Ye says, “I start off with the two primary cannabinoids, THC and CBD, and describe their properties and potential synergistic effect.” Then, Ye moves into a deeper realm by discussing strains.  “Afterwards, I explain the general differences between sativa, hybrid, and indica strains.”

Starting with strains is just the beginning of delving into the entourage effect of cannabis. Ye’s interest in the effect is helping patients make their way through what can be a daunting first experience and lead to a better overall cannabis therapy. Ye discusses hybrids then moves to terpenes saying, “I explain that cross-breeding over the years has led to many hybrid strains, and that the terpenes, the natural oils that provide aroma and medicinal value, greatly help to distinguish the potential effects and benefits.”

New Approach

This will be new territory for many first-time medical marijuana patients and going slow with the explanation goes well with the dosing mantra of “start low, go slow.”

Ye walks her patients through a major difference in their new medical therapy. We are working with a natural plant, not a synthetic compound developed in a lab. “With many patients only familiar with single compound synthetic pharmaceuticals and new to plant-based medicine, I distinguish cannabis as the ultimate combination medication.” Ye expands on that crucial difference between medical marijuana and synthetic meds. “Ultimately, I express that the benefits of cannabis do not rely on one component.  Rather, there may be a synergy when cannabinoids and terpenes are combined to deliver an enhanced pharmacologic effect.”

How Important is “Anecdotal” Evidence?

Ye agrees more research will help with defining and applying the entourage effect, but in the meantime, she’s seeing more patients benefitting from it. “I have observed from our patients that oftentimes the products containing a more abundant cannabinoid and terpene profile seem to offer greater benefits.”

Ye says the effects of cannabis are highly individualized. So too, are the effects of different products available at Organic Remedies. Ye says, “Many of our Organic Remedies’ extracted products are full spectrum concentrates because the specific cannabinoid and terpene profile of the plant is preserved during the manufacturing process.

Ye says patients can help a pharmacist dial-in a perfect entourage. “For example, one of my patients was having difficulty finding a capsule to help with sleep,” Ye says. “After a distillate 10 mg THC capsule was not effective, trying an indica-dominant full spectrum RSO 10 mg THC capsule finally provided the patient a good night's rest.”

Check Out the Terpenes!

Because of the entourage effect, patients may find that trying products with a different terpene profile creates a very different experience and can improve individual outcomes Ye relies on our lab’s work in extraction and production. “With patients, I often click on the product on our menu to look at the terpene contents obtained from the lab. Our Grape Cake dry leaf is an indica THC-dominant strain that is high in myrcene, a terpene that provides sedative effects.

Fortunately for patients, with the increasing number of strains, the various terpenes and new product forms coming to market, the benefits of the entourage effect can seem endless. “Our AK live crumble was created via an extraction process where the plant is fresh-frozen. It’s abundant in several terpenes. Also, check out strain-specific full spectrum tinctures which often provide a fuller "entourage" effect than our flavored tinctures.”

Research on the entourage effect includes the work of Dr. Ethan B. Russo. You can find his January 2019 study here: The Case for the Entourage Effect and Conventional Breeding of Clinical Cannabis: No “Strain,” No Gain (nih.gov)

An Organic Remedies Patient Care Consultant and Pharmacist are always available to answer your questions!

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What is Cannabis?

Cannabis is a flowering herb believed to have originated in Central Asia but is now found globally. As early as 2700 BC, there is documented evidence that cannabis was used as a safe and effective therapeutic remedy. Between 1840 and 1900, European and American journals of medicine published more than 100 articles on the therapeutic use of cannabis. In fact, cannabis was part of the American pharmacopoeia until 1942, and is currently available by prescription in the Netherlands, Israel, and Germany.

There are several species of cannabis. Those that contain high levels of the psychoactive chemical THC are commonly known as “marijuana” and used in medicinal marijuana. Those with low levels of THC are harvested commercially worldwide as “hemp” for a variety of products, including rope, paper, and clothing.

There are more than 475 chemical compounds in the cannabis plant, including over 80 medicinal cannabinoids. The two most well-known cannabinoids are THC and CBD.

What is THC? (Tetrahydrocannabinol)

THC is the psychoactive chemical in marijuana. It is the one that gives marijuana its mind-altering reputation. However, it also offers numerous medicinal benefits. THC blocks pain signals from the brain, making it a highly effective pain reliever, especially for nerve-related pain.

THC Molecule Diagram

What is CBD? (Cannabidiol)

The best way to describe CBD is to say it is the opposite of THC. And it is. That is because CBD is an anti-psychoactive chemical. It counteracts the mind-altering properties of THC and provides balance. This is one of the reasons why the different forms of medicinal marijuana are so effective.

CBD is also a highly beneficial chemical. It reduces nausea and suppresses epileptic seizures. Arthritis patients gain measurable relief from its anti-inflammatory properties. CBD slows tumor and cancer cell growth in cancer patients, and it has proven to be effective in treatments for anxiety and depression.

Dosage Forms Available

VAPORIZATION

Medical marijuana can be inhaled via vaporization. There are numerous products to help facilitate this process, including portable vapes, stationary vaporizers, and dabbing instruments.

From a health standpoint, many studies comparing the difference between smoking and vaporizing reveal that there are substantial advantages associated with vaporization which include more efficient cannabinoid extraction and a decreased exposure to toxic elements such as carbon monoxide and tar, which are derived from smoking.

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Vaporizing Dry Herb

Vaporizers designed to heat the cannabis in its raw, bud form are known as dry herb vaporizers. Dry herbs of all sorts have been used for centuries for meditation, relaxation and medicinal purposes. Certain flowers and herbs (including cannabis) can be dried, crushed and then inserted into a vape pen that is dry-herb capable. The vape’s oven chamber will heat up the dry herbs which will release a vapor which can then be inhaled. To get the most out of your vaporization experience, be sure to grind your material using an herb grinder to break your material down to create more surface area for the heat to reach.

TINCTURE

Tinctures are oils derived from the cannabis plant and are typically administered sublingually under the tongue with a dropper. This allows the cannabinoids to immediately enter the bloodstream through the vessel-rich tissues within the sublingual cavity. There are a large number of blood vessels under the tongue and within the mouth which can absorb cannabinoids, so that before you swallow, cannabis can also enter the blood stream.

Sublingual delivery through the oral mucosal membranes in your mouth is an effective way to ingest cannabinoids. This method provides for rapid and effective absorption directly into systemic circulation because of the increased bioavailability of the cannabinoids.

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RSO -RICK SIMPSON OIL

RSO is named after its creator, Rick Simpson, who became well-known for professing his passion for this type of product and its medical efficacy. RSO is produced using a vacuum distillation process, which distills out the solvent and reserves terpenes that would otherwise be lost to open air distillation. RSO is a great option for patients who do not want to vaporize or are uncomfortable swallowing capsules. Used orally, RSO can be absorbed through the mouth sublingually, or swallowed and ingested.

RSO

CAPSULES

Infused capsules are swallowed and absorbed through the gastrointestinal tract for slow onset and long-lasting effects. Capsules are precision dosed with a super-critically extracted marijuana concentrate which has been winterized and infused with coconut butter prior to filling. They are available in multiple formulations, giving patients the ability to select the option that is best for them.

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Edibles

Marijuana edibles can be brownies, cookies , pasta, and more. Any recipe that calls for butter or oil can be readily infused with cannabis. Edible cannabinoids are processed differently than inhaled cannabinoids. When it is ingested, cannabinoids enter the bloodstream through the stomach and liver, which increases potency and delays the onset of effects. Dosing should be carefully considered as an edible experience can be much stronger and last longer than other delivery methods. Effects could take up to three hours to absorb into the body.

Edibles

LOTIONS

Cannabinoids can also be absorbed through the skin. Products designed for this are known as cannabis topicals. The skin has a relatively complex absorption process that involves a chemical’s ability to dissolve in H20. Examples of topical products include lotions, creams, and balms. The topical application of cannabinoids has an onset of action within minutes locally (i.e. creams and balms applied to a joint), with duration of these effects lasting approximately one to two hours.

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CONcENTRATES/EXTRACTS

Cannabis concentrates, commonly referred to as cannabis extracts, are significantly more potent than your standard cannabis buds. Their applications as medicine have proven to be effective for patients suffering from many adverse health conditions. A cannabis concentrate is reminiscent of the cannabis strain it was extracted from; the smell, taste, and effects are simply magnified due to a larger concentration by weight.

Due to these products being a concentrated mix, you have the benefit of only needing a very small amount to get the same effect as you would with larger amounts of a less concentrated mix.

While the number of components released depends on the compounds present and the temperature, none of the toxic biproducts of smoking plant matter is present in the vapor. This means that vapor will have a much higher percentage of desired cannabinoid /terpenoid content when compared to smoke.

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Live Sugar – a shimmery crystalline concentrate made using the fresh-frozen material.

Budder – a smooth and creamy concentrate that resembles peanut butter in consistency.

Wax – a concentrate that easily breaks apart into smaller-sized pieces. Easy to work with using only your hands.

Live Budder – a smooth and creamy concentrate made using the fresh-frozen material.

Shatter – a translucent, glass-like concentrate that ‘shatters’ when tapped on a hard surface.

Terpenes

The cannabis plant consists of a wide variety of chemicals and compounds. About 140 of these belong to a large class of aromatic organic hydrocarbons known as terpenes (pronounced tur-peens).

Terpenes have been found to be essential building blocks of complex plant hormones and molecules, pigments, sterols, and cannabinoids. Terpenes are responsible for the pleasant, or not so pleasant, aromas of cannabis and the physiological effects associated with them. Although not permitted in Pennsylvania, patients will often ask to smell the cannabis when selecting their medicine. The idea is that certain aromas help identify different strains and their effects. Strains with relatively high concentrations of specific terpenes are easier to identify by their smell.

For example, the smell of musk or of clove is detected when there is a high level of the terpene myrcene. A piney smell is usually indicative of a high level of the terpene pinene and a lemony smell indicates a high level of the terpene limonene. Our online menu provides the terpene content, if available, of each product which may vary by batch and grower even for the same strain.

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