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Cannabis prohibition versus cannabis therapy

This article discusses the topic of cannabis prohibition versus cannabis therapy in light of the “entourage effect” and the use of single versus multiple compounds in modern medicine and therapy. We cover the following topics:

The entourage effect

Over 700 cannabis strains exist, and each strain has its unique natural blend of cannabinoids, terpenes, and phenols. As we know, scientists have found in pre-clinical or phase I clinical trials a number of therapeutic potentials of all three of these cannabis compounds.

Cannabis medicine challenges existing pharmaceutical therapeutic regimens by offering an alternative or a supplement to current therapies.

The term “entourage effect” refers to a cooperation and interaction of a combination of compounds present in the cannabis plant. In such cooperation, compounds increase the therapeutic aspect of each other and at the same time decrease many of the potential side effects.

The “entourage effect” is the complex synergistic relationship between the compounds (cannabinoids, terpenes, and flavonoids) of the cannabis plant.
The entourage effect

For example, a combination of CBD and THC enhances the effectiveness of radiation therapy in glioma (a particular type of brain cancer). Another example is that terpenes offset memory deficiencies that THC might cause.  Additionally, CBD mitigates the effect of THC, because while THC is pro-psychotic and anxiogenic (meaning increases both psychosis and anxiety), CBD is antipsychotic and anxiolytic (meaning reduces psychosis and anxiety).

This also means that high doses of certain individual cannabis compounds might have negative effects, while the combined presence of cannabis compounds results in safer therapy.

Watch this 5:03 minute episode of Weed Easy, by The GrowthOp: “What is the Entourage Effect?”

Single versus combined compounds in therapy

The traditional medicinal use of whole plants (including cannabis) evolved with the breeding of these plants. The breeding of cannabis strains shows a process aimed at having a balanced blend of various cannabis compounds as opposed to having plants with a predominance of a particular compound.

As a matter of fact, clinical studies suggest that medications that are a combination of THC and CBD (Sativex) are more effective for certain conditions than medications containing just one component (Marinol).

This raises the question whether purified compounds might be less effective in therapy than a combination of two or more compounds, or even the whole plant. Unfortunately, however, science and clinical approaches tend to focus on the isolation and therapeutic use of single compounds.

This appears to go against the traditional approach of using for hundreds and thousands of years medicinal plants as whole organisms. As scientific studies indicate, cannabis rich in CBD is safer for people with psychiatric problems than cannabis that has very high THC content.

One additional argument against the preference of single components over a blend of multiple components is that one single component binds to multiple receptors in the body and the brain. Therefore, one component does not have only one effect, but it also has multiple effects – some promoting and others impeding.

Watch this 2:29 minute video by Martha Montemayor of Green Flower: “Understanding Cannabis Terpenes, Strains & the Entourage Effect”

Cannabis prohibition versus cannabis therapy

The prohibition of cannabis can be compared to milk consumption: just because there are people who are sensitive to lactose, milk should not consequently be banned. Instead, there is lactose-free milk available for people who are lactose intolerant.

The prohibition of cannabis and therefore its medicinal use is rooted in media fueled moral panic.

Furthermore, there is also the demonifying of whole organisms: snake venom is poisonous, but purified compounds are medications. However, purified snake venom medications are very dangerous at high doses. As such, it is a false argument that purified compounds are safe.

Additionally, interest groups of pharma companies have been against plant-based medicines, as opposed to single-ingredient proprietary medications. Regulation of plant-based medicine needs to consider social inequalities and regional differences, in order to include players in the illicit market that are usually excluded from regulatory debates.

The future of cannabis therapy

The phyto-therapeutic approach to medicine using psychedelic plants is a successful approach in many countries.  Medical cannabis is legal in a number of countries and in several US states.

On the other hand, purified components are more expensive to produce and therefore the consumer prices are also higher. This makes purified medicines out of reach to many patients with disadvantaged socioeconomic status.

As such, corporate interests have been pushing cannabis therapy towards single-component treatments as opposed to adopting the whole plant.

In the case of medical marijuana, cannabis in natura versus isolated cannabinoids is a billion-dollar question.

Prof. Sidarta Ribeiro

Safe use versus prohibition

Safe use of any substance depends on the:

  • Substance (dose and interactions with other substances)
  • Set (of the mind and body), and
  • Setting (meaning: social context)

As such, prohibition violates all three:

  • Increases dose uncertainty, contamination, and degradation of the substance
  • Prevents free communication about key population sets
  • Promotes violence, marginalization, and stigmatization because of the distorted setting

Prohibition therefore leads to:

  • Unregulated use without harm reduction
  • No scientific control
  • Little to no protection of the society

Having said that, legalization eventually means the safety and protection of people who consume cannabis. It will also give doctors and patients access to a larger number of therapeutic options.

In addition, legalization would also prevent illicit drug trades and the consumption of questionable quality products that has unknown ingredients and purity/concentration. Last, but not least, it would also legitimize in-depth and broad scientific research, dissemination of research data, and best practices in therapeutic use.

Watch this 0:45 minute presentation by Professor Sidarta Ribeiro: “Não existe droga do bem e droga do mal” (“There is no good drug or bad drug”)

The video is in (Brazilian) Portuguese, but here is our translation:

All drugs are birds of a feather. All drugs are potentially good and potentially bad. There is no exchange of good and evil. What is there, is proper or inappropriate or abusive use of a substance. It is important that we understand that for a person a dose can be legal use, and for someone else, the same dose can be lethal. People are different. Wanting to have the same rule for everyone cannot work. It is necessary to regulate understanding the differences.


Ribeiro S. Whole organisms or pure compounds? Entourage effect versus drug specificity. In Plant Medicines, Healing and Psychedelic Science, pp. 133-149. Springer, Cham, 2018.