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Whole-Plant Marijuana ‘Entourage Effect’ Helps Patients More Than Purified CBD, Study Finds

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Patients suffering from epilepsy experience better health outcomes—with fewer adverse side effects—when they use plant-based cannabidiol (CBD) extracts compared to “purified” CBD products, according to a new scientific review.

A team of Brazilian researchers conducted a meta-analysis of studies from 2013 to 2017 that have explored the therapeutic benefits of CBD for epilepsy patients. The results were published in the journal Frontiers In Neurology last week.

While the main purpose of the review was to determine the safety and efficacy of CBD for certain forms of epilepsy, the researchers also distinguished between CBD-rich cannabis extracts and purified CBD products, which contain only trace amounts of other cannabinoids, if any.

Consistent with a growing body of scientific research, the study found that CBD treatment reduces the frequency of seizures, even among patients with treatment-resistant forms of epilepsy. About two-thirds of patients included in studies under review had fewer seizures—and six out of 11 those studies “showed over 80 percent of the patients reporting improvement.”

But in the studies where patients received CBD-rich extracts, that improvement was even greater.

Seventy-one percent of patients treated with CBD-rich extracts reported improvements, compared to just 36 percent of patients who received purified CBD products. 

The researchers didn’t expand on possible reasons for the difference; however, cannabis experts have long promoted a concept called the “entourage effect,” which refers to the cumulative effect that cannabis is believed to have when its many ingredients work together.

“CBD-rich extracts seem to present a better therapeutic profile than purified CBD, at least in this population of patients with refractory epilepsy,” the researchers wrote. “The roots of this difference is likely due to synergistic effects of CBD with other phytocompounds (aka Entourage effect), but this remains to be confirmed in controlled clinical studies.”

In other words, because purified CBD generally contains little to no other cannabinoids such as THC or cannabinol (CBN), these products hypothetically wouldn’t perform as effectively as plant-based CBD in epilepsy treatment.

This isn’t the first study to suggest that marijuana works better as a treatment option when a diverse range of its ingredients is present. There’s research going back to at least 1981 that seems to reinforce the theory.

The theory became especially of interest to scientists following the publication of a 2011 study in the British Journal of Pharmacology, however. That study looked at terpenes, compounds of cannabis that influence the flavor and smell of marijuana—and possibly, according to its findings, even the effects cannabis has on consumers.

As drug companies like GW Pharmaceuticals continue to advance products based on components of marijuana, the results of this and future studies on the entourage effect may help better inform patients about their options as they seek out cannabis therapies.

FDA Warns CBD Medical Marijuana Producers

Marijuana Moment is made possible with support from readers. If you rely on our cannabis advocacy journalism to stay informed, please consider a monthly Patreon pledge.

Kyle Jaeger is Marijuana Moment's Los Angeles-based associate editor. His work has also appeared in High Times, VICE and attn.

Politics

First Senate Marijuana Bill Of 2019 Would Force Study On Medical Cannabis For Veterans

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The first Senate marijuana bill of the new Congress focuses on increasing research on the medical benefits of cannabis for military veterans.

The legislation, introduced by Sens. Jon Tester (D-MT) and Dan Sullivan (R-AK) on Thursday, would direct the U.S. Department of Veteran Affairs (VA) to conduct clinical trials on the effectiveness of medical marijuana in the treatment of conditions common among military veterans.

While the new bill has the same title as a proposal the bipartisan duo filed during the last Congress, its language—which is not yet online but was obtained by Marijuana Moment—much more forcefully directs VA to begin researching medical cannabis than the earlier legislation did.

Whereas last year’s version simply said that the department “may conduct and support research relating to the efficacy and safety of forms of cannabis,” nothing in current federal law actually prevents it from doing so.

This latest version stipulates that the VA, which has been reluctant to engage in marijuana studies, “shall” begin conducting clinical trials on cannabis.

“The VA needs to listen to the growing number of veterans who have already found success in medicinal cannabis in easing their pain and other symptoms,” Tester, the ranking member on the Senate Veterans’ Affairs Committee, said in a press release. “Our bill will make sure the VA takes proactive steps to explore medicinal cannabis as a safe and effective alternative to opioids for veterans suffering from injuries or illness received in the line of duty.”

The proposed double-blind randomized controlled clinical trials are meant to cover the potential therapeutic applications of marijuana for post-traumatic stress disorder and chronic pain.

In particular, the department would have to study areas such as medical marijuana’s effect on opioid, benzodiazepine and alcohol consumption, as well as inflammation, sleep quality, spasticity, agitation, quality of life, mood, anxiety, social functioning, suicidal ideation and frequency of nightmares or night terrors.

Marijuana reform advocates praised the new legislation’s more forceful language as compared to the prior bill.

“The more assertive language is great improvement to this commonsense research bill that could ultimately help veterans with debilitating conditions,” Michael Liszewski, principal of The Enact Group, a lobbying and consulting firm that focuses on cannabis issues, told Marijuana Moment.

“The Department of Veterans Affairs already has the ability to conduct this research and the previous language would have let the Department continue to drag its heels,” he said. “It’s sort of like the difference between a parent telling their child ‘maybe you should clean up your room’ versus ‘you will clean up your room, now.'”

Sullivan said that he’s heard from many veteran constituents who are interested in finding an alternative to prescription painkillers for their pain.

“Many of our nation’s veterans already use medicinal cannabis, and they deserve to have full knowledge of the potential benefits and side effects of this alternative therapy,” he said in a press release.

During the last Congress, the Senate version of the legislation garnered six cosponsors, while 55 representatives ultimately signed onto the House version. The bill became the first standalone piece of marijuana legislation to clear a congressional panel when the House Veterans’ Affairs Committee approved it in May.

Nonetheless, VA leadership remained reluctant about engaging in marijuana research.

“VA is committed to researching and developing effective ways to help Veterans cope with post-traumatic stress disorder and chronic pain conditions,” VA Secretary David Shulkin wrote in a letter to lawmakers last year. “However, federal law restricts VA’s ability to conduct research involving medical marijuana, or to refer veterans to such projects.”

That isn’t true.

Meanwhile, top officials in the Trump administration have talked about pressuring the VA to conduct studies on medical marijuana for veterans, emails revealed, but they expressed concerns about how the Justice Department would react.

Read the full text of the new Senate veterans medical cannabis bill below:

Senate Veterans Medical Mar… by on Scribd

GOP Congressman Talks To Trump About Marijuana And Slams ‘Stupid’ Anti-Cannabis Republican Colleagues

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Politics

Federal Officials Recognize How Marijuana’s Legal Status Blocks Research, Documents Show

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Federal government officials openly acknowledged that cannabis’s restrictive federal classification inhibits progress on necessary medical and public health research during a workshop last month, according to presentation materials obtained by Marijuana Moment.

Representatives from various federal agencies—including the Food and Drug Administration, Drug Enforcement Administration (DEA) and National Institute on Drug Abuse (NIDA)—convened for a December workshop meant to provide guidance on researching cannabis while the plant remains federally illegal. The workshop was explicitly not about “challenging or changing current federal laws, policies or regulations.”

But during at least two presentations, officials with NIDA and the National Center for Complementary and Integrative Health (NCCIH) listed ways that marijuana’s status as a Schedule I drug under federal law complicates research efforts.

NIDA’s director of the division of extramural research, Dr. Susan Weiss, included a slide in her presentation that laid out administrative and scientific “cannabis research barriers.” On the administrative level, that includes the “complex and lengthy registration process” required for researchers interested in studying the plant, the lack of alternative sources for research-grade marijuana and the ongoing Schedule I status of “non-intoxicating components of cannabis” such as CBD.

Via NCCIH.

Dr. Emmeline Edwards, the director of the division of extramural research for NCCIH, echoed some of those points in her presentation.

“Despite marijuana being ‘legal’ in some states, the federal government has not legalized cannabis and continues to enforce restrictive policies and regulations,” one slide states. Edwards also discussed marijuana’s Schedule I status and the limited supply of research-grade cannabis from NIDA, which does “not sufficiently reflect the variety of products used by consumers.”

Via NCCIH.

Outside researchers who were invited to speak at the event also pointed out that the process to study cannabis could be simplified if federal restrictions on the plant were loosened. Dr. Margaret Haney, a professor of neurobiology at the Columbia University Medical Center, included a recent quote about marijuana rescheduling from Surgeon General Jerome Adams in her presentation.

“Our scheduling system is functioning, but not as ideally as it could,” Adams said last month. “Things aren’t static. We have to continue to evolve.”

Via NCCIH.

(Adams later walked back his comments, however, and clarified that he is “not in favor of legalizing marijuana, of rescheduling it, but I do want to make sure we do research so that policy decisions are evidence-based.”)

Haney, during her presentation, said that one piece of federal cannabis reform legislation that was introduced last Congress—the Marijuana Effective Drug Studies (MEDS) Act—is “promising” for researchers and “a hot topic” that could be taken up in 2019. That bill would, among other things, expand sources for research-grade marijuana and require the DEA to register additional cannabis manufacturers and distributers.

All told, the materials reviewed from the federally hosted workshop revealed a surprising amount of candor from government officials about the roadblocks current policy place in front of research, and an intense level of interest in expanding studies into marijuana’s therapeutic potential as well as any public health impacts from state-level reform. And while speakers didn’t seem to directly violate the stated event rule against “challenging or changing” federal marijuana policy, the issues that prohibition present to researchers did not go unacknowledged.

At the same time, agencies like NCCIH have stepped up calls for research into cannabis, including one proposal to fund studies on how terpenes and cannabinoids other than THC affect pain.

Feds Call For Even More Marijuana Research After Hosting Cannabis Workshop

Photo courtesy of Brian Shamblen.

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Science & Health

Most Medical Marijuana Patients Stop Or Reduce Pharmaceutical Use With Cannabis, Survey Finds

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Medical marijuana patients generally have more faith in cannabis than the mainstream health care system—and that’s probably because they’ve found the plant more therapeutically effective compared to traditional pharmaceuticals—according to a new survey.

Researchers distributed about 400 surveys to medical cannabis patients at a pro-reform public event, inquiring about their usage and attitudes toward the U.S. health care system. The results were published this week in the Journal of Psychoactive Drugs.

The participants reported using marijuana for various medical conditions, including chronic pain, muscle spasms, anxiety and post-traumatic stress disorder. Most of them said that cannabis represented an effective and relatively harmless alternative to pharmaceuticals that are conventionally prescribed for their respective conditions.

“In comparison to pharmaceutical drugs, medical cannabis users rated cannabis better on effectiveness, side effects, safety, addictiveness, availability, and cost,” the study found. “Due to the medical use of cannabis, 42 percent stopped taking a pharmaceutical drug and 38 percent used less of a pharmaceutical drug.”

The most common drugs that patients stopped or reduced using were opioid-based painkillers, non-opioid painkillers, benzodiazepines and anti-depressants.

Of course, given the fact that the respondents were participating in a pro-reform advocacy event when they completed the surveys, it could be argued that the results skew in favor of marijuana over pharmaceuticals.

Even so, the surveys reflect trends that have been identified in past studies: access to medical cannabis seems to lead a portion of patients to cut out or reduce their use of prescription medications, some of which can carry serious side effects.

“This study advances knowledge in the evidence-based approach to harm reduction and benefit promotion regarding medical cannabis,” the researchers wrote. “Given the growing use of cannabis for medical purposes and the widespread use for recreation purposes despite criminalization, the current public health framework focusing primarily on cannabis abstinence appears obsolete.”

“Those working in public health and medicine have an obligation to reduce harm and maximize benefits to the health of individuals and society, and thus serious consideration and scientific investigation of medical cannabis are needed,” the study concluded.

New Analysis Explores Relationship Between Medical Marijuana And Opioid Overdoses

Photo courtesy of Brian Shamblen.

Marijuana Moment is made possible with support from readers. If you rely on our cannabis advocacy journalism to stay informed, please consider a monthly Patreon pledge.
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