Before the Canadian government chose to legalize cannabis for personal use, it had a medical cannabis program. While far from perfect, this system allowed Canadians access to the plant with a doctorâs approval, offering treatment for a variety of ailments.
As legalization advances and stigma recedes, medical science is looking to understand the medical potential of cannabis. There is however some debate as the best method to develop these treatments.
Should cannabis remain as a whole plant, extracted oil, or the individual compounds isolated and produced as prescription drugs?
According toÂ Dr. Nicco Reggente, a specialist in cognitive neuroscience, cannabis helps â because of one isolated chemical â but rather due to a cocktail of different cannabinoids interacting together. A reaction that has been dubbed the âentourage effectâ by those who study cannabis.
âThe entourage effect is essentially the multivariate combination of all the different cannabinoids and terpenes that are found naturally occurring in cannabis, complimenting each other, making each other more bioavailable in the body and bringing about this rich rounded medical effects,â Reggente said in an interview with Grow.
One of the ways that cannabis â and cannabinoids â function, said Reggente, is by binding with the CB1 and CB2 receptors in the brain. While normally these are part of natural functions of the endocannabinoid system â a system of cannabinoids that already in the body â to control involuntary reactions like hunger or temperature control, with cannabis the receptors allow THC, CBD, or any of the over 80 identified cannabinoids in the plant interact with the body in a variety of ways.
Reggente said our endocannabinoid levels increase during different parts of the day. This includes pain; the body will reduce the feeling â or attempt to â by releasing endocannabinoids, the same thing happens in response to stress. The body will release endocannabinoids to attempt to relieve the condition. However, while the body handles these functions using specific endocannabinoids, Reggente says that itâs the combination of the similar chemicals in cannabis that result in effective treatment.
âA lot of studies that have been done on cannabis have been on isolates, isolating THC, isolating CBD,â he said. âAnd then saying, âjust take this CBD or just take this THC,â or injected into these poor rats that are getting the equivalent of like 20,000 milligrams. A lot of the times what happens is that those studies will yield negative results.â
If peopleÂ understand the entourage effect, he furthered, âyou understand that THC in isolation probably isnât good, CBD in isolation probably isnât even as effective.â
However, the idea that cannabis medicine should involve the plant as a whole is not one shared by everyone working in the field.
Dr. Dan Peer, a professor and the director of the Laboratory of Precision NanoMedicine at Tel Aviv University, isnât interested in cannabis as a whole. A medical traditionalist, he sees the future of the plant being in the isolation of compounds and the development of pharmaceutical drugs.
âOur research is not interested in recreational or medical cannabis, but mostly in registering drugs. We see the full potential of cannabinoids in drug development,â Peer told Grow during an interview. âWe are really interested in cancer, I really think there is some gold there in opportunities. It needs to be done in a careful manner in a controlled manner by doing preclinical an clinical work in the right way.â
Dr. Peer uses pure extracts and isolates to create consistently measurable and quantifiable experiments. Itâs the methods used in traditional drug development. Heâs skeptical of the claims around the entourage effect, but also points out that the data heâs seen doesnât point one way or the other.
Heâs curious, but insists that the way to do things is with long-term study and tempering expectations.
âI apologize in advance to you readers that I donât have a quick fix thatâs wonderful,â he joked. âIf we want to understand the full potential we need to go deep into basic research and then translational research â basically into the clinic in a controlled manner.â
âNot just doing 10 patients and saying this guy respond and this one doesnât and that means itâs great. It needs to be highly regulated, highly controlled, and if itâs also possible double-blinded.
âWithout this we will not be able to really understand where we are going.â