Ask Dr. Leigh: what is the entourage effect?

scientist examining cannabis oil entourage effect

Using cannabis can have a big impact on your physical and mental health—for better, and once in a while, for worse. That’s why it’s important to consult a healthcare provider before experimenting.

Here at GreenState, cannabis clinician Dr. Leigh Vinocur is here to answer your questions on healthy living with cannabis.

Editor’s Note: The answer to this question is meant to supplement, not replace, advice, diagnoses, and treatment from a healthcare provider.  Always consult a medical professional when using cannabis for medicinal purposes, and do not disregard the advice of your healthcare provider because of anything you may read in this article.

RELATED: Ask Dr. Leigh: cannabis and immunotherapy for cancer

Q: What is the entourage effect?

Cannabis is a very complex plant with a myriad of diverse chemical constituents. While CBD and THC are the main cannabinoids in cannabis, there are over 100 other plant cannabinoids present. 

These so-called minor cannabinoids have potential therapeutic properties. In fact, the National Institutes of Health (NIH) is creating research grants to investigate any medical benefits. 

What are some of the compounds in cannabis aside from THC and CBD?

Cannabigerol (CBG) is one of the cannabinoids present in the cannabis plant to a lesser extent than CBD. It has been found to be biologically active, interacting with our cannabinoid receptors. It has anti-inflammatory activity as well as antibacterial and antifungal activity too. 

Another example is THC-A, the acidic precursor molecule of THC that is present in the fresh flower, but decarboxylates to its neutral non-acidic form THC when heated or dried. Like THC, it has anti-inflammatory activity, but it is not intoxicating in the same way that THC is.

Additionally, there are over 550 other compounds found in cannabis. Just like many other plants, cannabis also has many botanical essential oils found in its flowers, fruits, leaves, and sap; these are called secondary metabolites. 

These chemicals are used as a defense system to prevent predators from eating them, to protect the plant from damaging UV light, to attract pollinators, and even have a role in plant-to-plant communication. 

One example of these secondary metabolites is terpenes. They give the plant its scent because the chemical formulas have a ring structure called an aromatic ring.  

Additionally, they have their own potential healing properties. For example, myrcene, also found in lemongrass, hops, and cardamom, is one of the more common terpenes found in cannabis. It can activate pain-relieving receptors, called TPRV1, in the brain. 

And there are also flavonoids in cannabis which are the plant pigments. At present, these are under-researched for medicinal benefits in cannabis. But we know that eating richly colored fruits and vegetables, which have anti-oxidant flavonoids, is very healthy! 

How do the different compounds in cannabis work together?

All the chemical compounds in cannabis can work together synergistically, creating an enhanced effect. This notion of this “entourage effect” was first speculated and coined in 1998 by the “father of modern cannabis research,” Dr. Raphael Mechoulam, who was also the first to discover and isolate the intoxicating molecule THC in the hashish. 

The term was further popularized in 2011 by another famous cannabis researcher, Dr. Ethan Russo. In this article, he discussed further research on how selective breeding of cannabis with varying ratios of all the different cannabinoids, along with differing profiles of terpenes and the other compounds, could provide a “treasure-trove” of potential therapeutic benefits. 

In a more recent study from 2019, Russo reviewed other research and found that whole plant extracts (meaning they have all the cannabinoids as well as terpenes, flavonoids, and other chemical substances found in cannabis), work together in concert to create superior benefits and therapeutic effects when compared to purified THC or CBD isolate. 

In fact, many anecdotal reports from patients have corroborated this theory. Prior to medical cannabis laws passing here in Maryland, the only cannabis option for cancer patients who suffered from nausea and vomiting, or anorexia from chemotherapy was a synthetic form of THC called Marinol. Many oncology patients that I spoke with stated after the law passed, they had much better symptom relief using whole plants and their extracts than with THC alone, due to this entourage effect.  

Got cannabis questions? Ask Doctor Leigh. Send your questions to GreenState’s Editor at and keep an eye out for new answers from Dr. Leigh Vinocur every month.

Dr. Leigh Vinocur is a board-certified emergency physician who also has a cannabis consulting practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a graduate of the inaugural class, with the first Master of Science in the country in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.

The response to this question was not written or edited by Hearst. The authors are solely responsible for the content.