Polypharmacology is based on approaching each disease as a system and then treating it by acting on the whole system instead of a specific target as in conventional drug therapy. Nowadays we know diseases are systemic and if we place too much emphasis on just one target, the system will reorganise to offer resistance. This is what happens with antibiotics, just to name the most common example. The new polypharmacology paradigm in cannabis is based on the entourage effect and the way in which the many cannabis components act on multiple targets or disease pathways. Somehow, these many compounds cooperate to achieve a stronger effect while also producing less side effects.
Conventional Therapies vs. Polypharmacology
When used isolated, cannabinoids like CBD show dozens of different mechanisms of action. On the other hand, a single compound offers multiple mechanisms. Pharmacologists consider cannabis as a “dirty” drug because it is not specific in any way, and it has effects on multiple targets. CBD’s “dirtiness” provides multiple effects, including neuroprotective, anti-cancer, anxiolytic, antipsychotic, and anti-inflammatory benefits. According to clinical psychologist and PhD pharmacologist José Carlos Bouso, if the first clinical research revolution in the study of cannabinoids was the discovery of the endocannabinoid system, the second revolution will be the phasing out of the obsolete reductionist approaches to start figuring out how to use different combinations of cannabinoids, terpenes, and other cannabis compounds to increase efficacy and safety in medical treatments.
It is worth noting that some knowledge gaps persist because of the reduced amount of research on cannabis. We must bear in mind that classical pharmacology determines treatments under the premise that molecules must be isolated to target specific symptoms. The application of supplementary cannabis treatments is completely opposed to this idea because it supposes an interaction between the many molecules present in the plant. We have learned that diseases work as teams with many players on the field. If we target just one player, the match does not begin. The same happens with treatments: each time we act on a brain protein, a chain reaction occurs.
As cannabis remains illegal in most parts of the world, patients resort to self-medication. Still, if they could seek medical advice, doctors could work more efficiently towards adjusting the dosage to produce the optimal effect, always providing personalised attention and following up each case responsibly. Fortunately, the introduction of cannabis as a traditional medicine aid may contribute to the development of a new scenario thanks to the very same features of the plant.