David Huggar, PharmD and Jennifer Seltzer, PharmD
August 22, 2016
At present, there are few hotter topics than the legal standing of marijuana. As of 2016, 25 states have legalized medical marijuana, and four states plus Washington DC have legalized recreational use.1 Results from the 2014 National Survey on Drug Use and Health estimate more than 22 million Americans aged 12 years or older currently use marijuana—an increase from the previous year.2 Despite increases in marijuana consumption, potential medical benefits associated with the substance have not been clearly delineated.
The acute psychoactive and sedative properties of marijuana stem from the active ingredient, delta-9-tetrahydro-cannabinol (THC). THC is found as a crystalline substance produced by the buds and leaves of Cannabis sativa plants. Traditionally, marijuana is consumed by smoking the dried plant or via low-yield extraction of active ingredient.6
More recently, higher-yield THC extraction methods have gained popularity. One such method, dabbing, utilizes butane as a solvent for extracting THC resin from marijuana buds. After extracting the THC solute, the butane is purged, leaving a hard, wax-like substance referred to as butane hash oil (BHO), with more specific names determined by the remaining butane content (e.g., “wax”, “shatter”, “budder”). Depending on extraction technique, BHO can yield THC concentrations in excess of 80%, whereas traditional smoking method yields are as low as 5%.7
Risks associated with dabbing are varied. The term ‘dabs’ is derived from the technique of dabbing BHO onto the heated nail and inhaling the resulting smoke. Smoking BHO, or dabbing, often requires use of a water bong outfitted with a titanium nail. The nail is heated, by a butane blow torch commonly, to temperatures hot enough to vaporize BHO upon contact. Explosions due to problems with the extraction process have been reported. Additionally, the process of consuming butane hash oil (BHO) is not without risk itself as “dirty oil” is produced, which exposes users to chemical contaminants with unknown health hazard risks. Also, exposure to higher THC concentrations may lead to overdosing and loss of consciousness.8- 10 Marijuana has been known to potentiate psychological changes, including anxiety, amotivation, hallucinations, memory loss, and underlying psychosis. Physical symptoms are less specific, but include dry hacking cough, xerophthalmia, and impaired coordination.10
Although hazards exist, there are some perceived benefits to “dabbing”: having access to products containing high THC concentrations provides higher doses more quickly.8 Patients with chronic pain or severe nausea, conditions that have evidence documenting THC efficacy, may gain relief more rapidly.8,11
In early 2016, the Drug Enforcement Agency (DEA) received written formal requests from US lawmakers concerning medical marijuana research. Included in the probes was the topic of re-scheduling marijuana as a Schedule II substance from its current Schedule I status.3 A change to Schedule II would concede the substance has acceptable medical use, further increasing access for medicinal and research purposes.4 However, on August 11, 2016, the DEA ruled marijuana would remain a Schedule I substance, citing legal standards outlined in the Controlled Substances Act for accepted medical use.5
Despite the haze of uncertainty surrounding medical marijuana, it remains clear the parameters of use and acquisition in the US is changing, as well as the potency of consumed product. Healthcare professionals must be familiar with such changes in addition to the evolving legal landscape.
- Farber, M. John Kasich signs bill legalizing medical marijuana in Ohio. Fortune. June 9, 2016. Available at: http://fortune.com/2016/06/09/john-kasich-medical-marijuana-ohio/. Accessed: July 31, 2016.
- Center for Behavioral Health Statistics and Quality. Behavioral health trends in the united states: results from the 2014 national survey on drug use and health. Substance Abuse and Mental Health Services Administration 2015. HHS Publication No. SMA 15-4927, NSDUH Series H-50. Available at: http://www.samhsa.gov/data. Accessed: July 26, 2016.
- Rosenberg C, Burwell SM, Botticelli M. Drug Enforcement Agency. Memo from April 4, 2016 to lawmakers. Available at: https://www.washingtonpost.com/blogs/wonkblog/files/2016/04/Response.pdf?tid=a_inl. Accessed: July 26, 2016.
- Drug Scheduling. US Department of Justice: Drug Enforcement Agency. Available at: https://www.dea.gov/druginfo/ds.shtml. Accessed: July 26, 2016.
- DEA Announces Actions Related to Marijuana and Industrial Hemp. US Department of Justice: Drug Enforcement Agency. Available at: https://www.dea.gov/divisions/hq/2016/hq081116.shtml. Accessed: August 14, 2016.
- Drugs of Abuse: Cannabis/Marijuana. US Department of Justice: Drug Enforcement Agency. Available at: https://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf#page=72. Accessed: July 26, 2016.
- Mehmedic S, Chandra S, Slade D, et al. Potency trends of delta-9-THC and other cannabinoids in confiscated cannabis prepatations from 1993 to 2008. J Forensic Sci 2010;55(5): 1209-17.
- Chambers R. What is dabbing and how do dabs work? (10/13/2015) Available at: https://www.leafly.com/news/cannabis-101/is-dabbing-good-or-bad-or-both. Accessed August 16, 2016.
- Nir, SM. Chasing bigger high, marijuana users turn to dabbing. New York Times. May 12, 2016. Available at: http://www.nytimes.com/2016/05/13/nyregion/chasing-bigger-high-marijuana-users-turn-to-dabbing.html. Accessed July 26, 2016.
- Drug Facts: Marijuana. US Department of Justice: Drug Enforcement Agency. Available at: https://www.dea.gov/druginfo/drug_data_sheets/Marijuana.pdf. Accessed: July 27, 2016.
- AltMedDex® System (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. Available at: http://www.micromedexsolutions.com.libproxy.uthscsa.edu/. Accessed August 22nd, 2016.