Imagine you suffer from debilitating pain, you try all sorts of remedies but none of them help that much or if they do help they have horrible side effects. Then your doctor prescribes medical cannabis and your symptoms improve. It eases the pain for long periods of time. Finally you can sleep, you can function almost normally. Your prescription runs out, you go to your doctor and get a new one. At your dispensary they tell you that the cannabis that helped you is no longer in stock, they offer you a different one, the pharmacist thinks it’s pretty similar. Similar, but not the same. It doesn’t quite do the job that the previous one did. You need a higher dosage at night to sleep, sometimes the pain breaks through, this cannabis doesn’t seem as strong, you’re not sure how much to take. This is the frustration experienced by so many patients being treated with medical cannabis, and why the need for standardized, targeted treatment formulations is so great.
What researchers, medical practitioners and scientists have discovered over the course of millennia of use and study of the cannabis plant is that it contains within it a world of complexity. Just like the human genome took years and teams of scientists to unravel and code, so the cannabis plant lends itself to a complex process of research and study.
There are basically three chemically active components to the plant. The cannabinoids, the terpenes and the flavonoids. In the medical cannabis field, the cannabinoids have been the most widely studied, while the role of terpenes has been investigated to a lesser degree. Little is known about flavonoids which have been relatively neglected and demand further study. Israel is in a great position to undertake further study, both to further understand the plant itself and to unravel which compounds within it may be most effective in treating various disorders. This is because in Israel it is permitted, indeed encouraged, to carry out research with cannabis, whereas in the USA cannabis is still classified as a schedule 1 drug and it is therefore difficult to be get permission to use it for research purposes.
Cannabis plants vary widely according to each plant’s particular chemical makeup. One of the components that most determines a plant’s chemical attributes and hence its therapeutic effect, is its cannabinoid content. There are 144 cannabinoids that have been identified in the cannabis plant that do not appear in any other plant. These cannabinoids are found in different combinations and strengths in different strains of plant. Michael Cheng, writing in the publication Mass Roots explains it best “ just think of cannabis like ice cream. The plant, like the cold, sweet dessert, comes in many different flavors and combinations. A tart, lemon flavor could cause your tongue to feel tingly and relaxed, while one laced with brownies and thick fudge could leave you feeling full and hazy (like a superior THC strain). But regardless if one is eating a lemon or chocolate-flavored scoop, all flavors and types can still be generally classified as ice cream (just like cannabis).” So imagine going to pick up your lemon ice cream and instead getting fudge brownie flavor, what a disappointment!
It is this experience that makes the need for targeted medical cannabis formulations so apparent. Each cannabinoid and terpene interacts differently with the human endocannabinoid system. If you want a patient to sleep better and you offer a strain of cannabis high in cannabichromene that acts as a brain stimulant, you have not achieved your therapeutic purpose. The medicine must match the ailment. There is some evidence to suggest that the whole plant working together, what has come to be known as the “entourage effect” is better as a treatment than a single extract. Various attempts have been made to extract only THC or CBD and to treat various ailments with these extracts. At the same time, there have been pharmaceutical company attempts to mimic the cannabis plant in synthetic form. These have met with limited success.
The difficulty lies in the infinite number of chemical variations found in the plant itself. So what if we could extract and combine compounds to specifically target different diseases, syndromes or symptoms? The aim here is not to separate out cannabinoids and terpenes, but to combine them in such a way that each compound works in perfect harmony with the others. The active parts of the plant will then be able to formulated to be delivered to the correct part of the body, in the right concentration and at the correct speed. Instead of throwing darts in the dark, there will be a target and a recipe for reaching that target with speed and accuracy.