The Best Recipe for Maximizing the Medical Effects of Marijuana

CBD-only preparations lack the synergies available when marijuana’s other cannabinoids and its terpenes are kept in the game.

 

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By Phillip Smith / AlterNet

March 22, 2017

CBD (cannabidiol) is getting a lot of attention these days as the medicinal cannabinoid in marijuana. CBD-only products are all the rage in the ever-expanding medical marijuana market, and CBD-only medical marijuana laws are becoming a favorite resort of red state politicians who want to throw a sop to those clamoring for medical marijuana, but are hesitant to actually embrace the demon weed.

But is CBD the miracle molecule on its own? Or would users benefit from using preparations made from the whole pot plant? Not to knock CBD, which even by itself clearly provides succor for many people, but advocates of “whole plant medicine” make a strong case.

That case is based on the entourage effect, which posits an interactive synergy between the components of the plant, and not just the major cannabinoids, such as THC and CBC, but also the lesser-known but still therapeutically active cannabinoids, such as CBG, CBN, THC-a, and THC-v, and even the terpenoids, the molecules that make pot plants smell and taste lemony (limonene) or piney (pinene), earthy (humulene) or musky (myrcene). The entourage effect suggests that if people want to unlock the full benefits of medical marijuana, they need to be using whole plant medicine.

“CBD and THC seem to work better together. They lessen each other’s side effects,” said Eloise Theisen, RN, MSN, director of the American Cannabis Nurses Association.

“CBD has value, but its value can be enhanced with the whole plant and we can develop more individualized medicine,” said Mary Lynn Mathre, RN, MSN, and president and co-founder of Patients Out of Time.

And again, it’s not just the cannabinoids.

“THC seems to potentiate all the effects of CBD and conversely, CBD affects THC,” explained Dr. Perry Solomon, chief medical officer for HelloMD. “Dr. Ethan Russo further supports this theory by demonstrating that non-cannabinoid plant components such as terpenes serve as inhibitors to THC’s intoxicating effects, thereby increasing THC’s therapeutic index. This ‘phytocannabinoid-terpenoid synergy,’ as Russo calls it, increases the potential of cannabis-based medicinal extracts to treat pain, inflammation, fungal and bacterial infections, depression, anxiety, addiction, epilepsy, and even cancer,” he said.

“Terpenes act on receptors and neurotransmitters; they are prone to combine with or dissolve in lipids or fats; they act as serotonin uptake inhibitors (similar to antidepressants like Prozac); they enhance norepinephrine activity (similar to tricyclic antidepressants like Elavil); they increase dopamine activity; and they augment GABA (the ‘downer’ neurotransmitter that counters glutamate, the ‘upper’),” Solomon continued.

The entourage effect makes whole plant medicine the preferred means of ingesting therapeutic marijuana, the trio agreed.

“I think that any whole plant medicine is more effective than any CBD-only product,” said Solomon.

“Whole plant medicine is the only way to go,” echoed Theisen.

“It’s safer and more effective, and tolerance will develop more slowly—if at all,” Mathre concurred.

The traditional method of consuming whole plant marijuana has been to smoke it, but that’s not an especially favored route among medical marijuana advocates. And there are other options.

“Vaporization or tinctures of whole plants. Any sort of extraction method that isn’t going to deplete it,” said Theisen.

“Delivery methods vary greatly in terms of their efficiency and their effects. I heard a colleague say that smoking a joint for therapeutic effect is akin to opening your mouth in the rain to get a drink of water,” said Constance Finley, founder and CEO of Constance Therapeutics. “Our preferred methods are buccal (cheek) ingestion or sublingual ingestion, vaping from a vaporizer or vape pen whose hardware is safe to use with cannabis extracts, and topical for additional localized impact.”

With whole plant superior to single-cannabinoid preparations, people living in states that have only passed CBD-only laws are not able to enjoy the full benefits of medical marijuana. That’s a damned shame, said an exasperated Mathre.

“We have lawyers and politicians practicing medicine without a license—they don’t know what they are talking about,” she said. “Clearly there may be some patients who need little to no THC, but the vast majority will benefit from it. Patients should have all of the options open to them and research needs to continue to help determine how to best individualize cannabis medicine.”

Phillip Smith is editor of the AlterNet Drug Reporter and author of the Drug War Chronicle.

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