The entourage effect of the phytocannabinoids
The entourage effect of the phytocannabinoids
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植物大麻素的随从效应
作者：
J. Sanchez
最近的一篇社论驳斥了“医用大麻”是娱乐性使用该植物的烟幕弹。当我们已经可以选择开D9-四氢大麻酚（THC; Marinol）时，为什么还要推动医用大麻呢？大多数医生不知道THC单一疗法对许多情况无效，其中含有THC和大麻二酚（CBD）组合的大麻制剂已被证明是有益的。这些治疗效果在I类研究（随机、双盲、安慰剂对照研究）中记录，这些研究针对的是多发性硬化症痉挛患者以及慢性神经性疼痛、癌症疼痛、膀胱多动和急迫性尿失禁患者。大麻制剂作为整个大麻提取物口服，吸烟或蒸发，或通过含有THC和CBD的植物提取物的口腔粘膜喷雾（Sativex）以1：1的比例服用。为什么单独使用THC似乎对这些神经系统疾病无效？口服给药的THC具有非常长的发病潜伏期，并且在某些患者中不能容易地滴定至治疗剂量而不引起不良反应。一个更重要的解释涉及当THC与植物中发现的植物大麻素，特别是CBD和萜烯的“随行物”一起沿着施用时所实现的协同效应。伴随效应首先与内源性大麻素系统有关，其结合了活性和非活性增效剂。Mechoulam对这一概念进行了提炼和限定：“这种类型的协同作用可能在广泛持有的观点中发挥作用，即在某些情况下，植物是比从中分离的天然产物更好的药物。最近对植物大麻素的一项综述支持了一个随行概念，即大麻素的组合在某些情况下比单独的THC或CBD更有效。环境效应并不是植物大麻素所独有的。针对人类疟疾的药物单一疗法是有效的，但由于抗药性寄生虫的不可避免的进化，因此是短暂的。据报道，干燥的整株青蒿在减缓疟疾抗药性的演变方面比青蒿素更有效，青蒿素是从植物中分离出来的纯药物。医学界应该认真研究内源性大麻素系统在健康和疾病中的作用，而不是把医用大麻作为娱乐用途。联邦政府应该重新安排大麻，并允许科学家开发一种合理的大麻素治疗方法，考虑到随从效应。
A recent editorial dismisses “medical marijuana” as a smokescreen for recreational use of the plant. Why push for medical marijuana when we already have the option to prescribe D9-tetrahydrocannabinol (THC; Marinol)? Most physicians are not aware that THC monotherapy is not effective for many conditions for which cannabis preparations containing combinations of THC and cannabidiol (CBD) have been shown to be beneficial. These therapeutic effects were documented in class I studies (randomized double-blind, placebo-controlled studies) in multiple sclerosis patients with spasticity, and patients with chronic neuropathic pain, cancer pain, bladder hyperactivity, and urge incontinence. The cannabis preparations were taken orally as whole cannabis extracts, smoked or vaporized, or by oral–mucosal spray (Sativex) of an extract of the plant containing THC and CBD in a 1:1 ratio. Why is it that THC alone does not seem to be effective for these neurologic conditions? Orally administered THC has very long latency of onset and cannot be easily titrated to a therapeutic dose without eliciting adverse effects in some patients. A more important explanation relates to the synergistic effects achieved when THC is administered along with an “entourage” of phytocannabinoids found in the plant, especially CBD and terpenes. The entourage effect was first brought up in relation to the endocannabinoid system, with its combination of active and inactive synergists. The concept was refined and qualified by Mechoulam: “this type of synergism may play a role in the widely held view that in some cases, plants are better drugs than the natural products isolated from them.” A recent review of the phytocannabinoids supports the entourage concept that combinations of cannabinoids can in certain circumstances be more effective than THC or CBD alone. The entourage effect is not unique to the phytocannabinoids. Pharmaceutical monotherapies against human malaria are effective, but ephemeral, because of the inevitable evolution of resistant parasites. Dried whole-plant Artemisia annua has been reported to be more effective in slowing the evolution of malaria drug resistance than artemisinin, the pure drug isolated from the plant. Rather than cast off medical marijuana as a ploy for recreational use, the medical profession would do well to seriously study the endocannabinoid system in health and disease. The federal government should reschedule cannabis and allow scientists to develop a rational approach to cannabinoid therapeutics that takes into account the entourage effect.
影响因子：
5
作者：
Ben-Shabat, S;Fride, E;Mechoulam, R
通讯作者：
Mechoulam, R