Why CBD Is Not Enough: The Entourage Effect

New research shows that cannabis works best as a treatment when interaction between all cannabinoids and terpenoids is allowed.
Jan 30, 2016

Several states have or are in the process of legalizing cannabis extracts, typically oils, high in cannabidiol (CBD) and very low in THC. Because these medicines lack THC (the cannabinoid in marijuana that produces the euphoric high), conservative politicians have been much more willing to embrace this approach to medical marijuana.

However, there are dozens of other cannabinoids and terpenoids (terpenes) in marijuana that have proven to provide medical benefit. New research is pointing toward a synergistic effect of these miraculous molecules, revealing that an isolated cannabinoid (like CBD) may provide benefit for some patients, but only a small minority. The combination of multiple, or all, cannabinoids may work best medicinally.

According to the National Institutes of Health, the delicate interaction of cannabinoids and terpenoids — sometimes called the “entourage effect” — can be used to treat “pain, inflammation, depression, anxiety, addiction, epilepsy, cancer, [and] fungal and bacterial infections.”

With so much potential benefit from whole plant and multi-cannabinoid extracts, why is there such a mad rush to produce single cannabinoid oils for a small percentage of overall patients that might benefit from such limited cannabis therapy? Can states really claim to be helping patients if CBD-only laws are effective in treating only a relatively low number of patients who are suffering?

Helping Only Two Percent?

According to the Marijuana Policy Project (MPP), “…only two percent of the registered patients in both Rhode Island and Colorado report seizures as their qualifying conditions.” Unfortunately, the group reported that “The vast majority of [all medical marijuana] patients have symptoms that benefit from strains of marijuana that include more than trace amounts of THC.”

Cannabis Seedling

The media has focused much attention on children who use CBD oil to combat intractable epilepsy and other severe neurological disorders. Some of these patients gain significant relief from a single-cannabinoid extract. Children who have gone from hundreds of seizures per week to only a couple per month using only CBD oil have gained ample media attention.

One patient, nine-year-old Charlotte Figi of Colorado, experienced a 99 percent decrease in seizure activity using a CBD-only cannabis oil. Figi has been the unofficial poster child of advocates of CBD oil and efforts to legalize it. She is also the inspiration behind a CBD-only oil product called Charlotte’s Web from CW Botanicals in Colorado.

Reports from Parents

Desperate parents of other children with similar conditions have also experimented with CBD oils. Many, unfortunately, have reported that the lack of THC in CBD oils often doesn’t work for their children. Jason David has been treating his seven-year-old son, Jayden, who has Dravet syndrome — a severe form of epilepsy that doesn’t respond to conventional treatments — with medical cannabis since 2011 (Charlotte Figi’s mother learned about CBD oil from David).

Charlotte Figi

“I wish Charlotte’s Web worked for all epileptic kids, but it doesn’t. The worst seizures Jayden ever had on medical cannabis was while we were using Charlotte’s Web,” said David.

Brian Wilson, a former New Jersey resident who moved to Colorado in 2014 because of its liberal medical marijuana law, is another parent of a child suffering from Dravet syndrome. In an interview with Ladybud in 2014, he said:

“CBD is a very important part of the mix, but only part. We saw minor seizure control and developmental progress with CBD alone, but we didn’t see real seizure control until we added measurable levels of THC to the mix.”

Wilson continued:

“Others see great results with THCA added in. Some see very good results with no CBD, like in New Jersey, where there is little to no CBD available. The point is, this is highly individualized medicine. There is no magic bullet.”

Rebecca Hamilton-Brown is the founder of Pediatric Cannabis Therapy, a support group for parents of epileptic children with more than 2,500 members. She has been treating her son with cannabis for two years and gaining feedback from the group’s many members.

“It is ignorance that leads people to believe that CBD only is the way to go.”

said Hamilton-Brown.

“They either have never dosed their children or they are totally naïve when it comes to how the political machine works.”

Are thousands of sick children and adults who would benefit from a multi-cannabinoid or even whole plant extract of cannabis being disregarded by state governments seeking to legalize CBD-only oil?

The miracle story of Charlotte Figi is certainly inspiring; all patients deserve medicine that relieves them of their suffering. However, are paranoid politicians afraid to legalize cannabis extracts containing THC simply because of an 80-year-old stigma? Is the legacy of Reefer Madness — and the perception that euphoria is a sin in some religions — responsible for the passage of state laws that, while helpful for a small number of patients, leave most suffering with no medicine?

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