The ‘entourage effect’ or ‘hodge-podge hashish’: the questionable rebranding, marketing, and expectations of cannabis polypharmacy

ABSTRACT

Introduction

The concept of a cannabis ‘entourage effect’ was first coined as a hypothetical afterthought in 1998. Since then, multiple scientific reviews, lay articles, and marketing campaigns have promoted the effect as a wholly beneficial manifestation of polypharmacy expected to modulate the therapeutic effects of cannabis and its derivatives. There is reason to wonder at the authenticity of such claims.

Areas covered

A broad definition of the entourage effect is presented, followed by brief summaries of the nature of cannabis polypharmacy and the commonly cited contributing phytochemicals, with special attention to their attendant adverse effects. A critical analysis is then offered of the primary literature that is often portrayed as suggestive of the effect in existing reviews, with further studies being drawn from PubMed and Google Scholar searches. A final discussion questions the therapeutic value of the entourage effect and offers alternate perspectives on how it might be better interpreted.

Expert opinion

Claims of a cannabis entourage effect invoke ill-defined and unsubstantiated pharmacological activities which are commonly leveraged toward the popularization and sale of ostensible therapeutic products. Overestimation of such claims in the scientific and lay literature has fostered their misrepresentation and abuse by a poorly regulated industry.

KEYWORDS:

• Cannabis
• medical marijuana
• entourage effect
• polypharmacy
• tetrahydrocannabinol
• THC
• cannabidiol
• CBD
• terpenes
• synergy

Article Highlights

• The ‘entourage effect’ is a commonly invoked though vaguely defined rebranding of cannabis polypharmacy.

• Literature on the entourage effect is unjustifiably optimistic regarding its presumed benefits and this is commonly translated into unfounded marketing claims.

• Compelling clinical data is lacking to support the notion of an entourage effect as a reliable phenomenon that is predictive of beneficial outcomes.

• Despite common invocations of the entourage effect as an amplifier or augmenter of benefit and mitigator of adverse effects, the polypharmacy of cannabis can in many instances be better framed as a detriment to its proposed therapeutic utility.

• There is a need for more responsible reporting and meaningful regulation of hypothetical therapeutic cannabis claims. Treating the cannabis plant as a source of pharmaceuticals instead of as a schedule I controlled substance will be a good first step of public health advocacy.

Declaration of Interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.