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Do you know about the dangers of ‘dabbing’?

A more harmful way of preparing marijuana known as “dabbing” appears to be quickly spreading among users, according to an opinion article released today in Pediatrics.

A more harmful way of preparing marijuana known as "dabbing" appears to be quickly spreading among users, according to an opinion article released online today from Pediatrics. Dabbing is the inhalation of concentrated tetrahydrocannabinol (THC) – the primary intoxicant in marijuana – created through butane extraction.

In the article, "Assessing the Dangers of 'Dabbing': Mere Marijuana or Harmful New Trend?", two professors of criminology discuss why they believe this relatively new method of preparing cannabis is dangerous:

  1. The preparer can either start a fire or cause an explosion.

  2. The very concentrated end product may itself be more dangerous than other methods of using marijuana to become intoxicated.

The article attempts to makes adolescent and children's medical providers aware of this relatively new agent. (I found the first news reports on this process in the "underground" press go back less than three years.) It also provides a list of the many names used for the end product, which can be almost pure crystallized THC.  These include BHD, Shatter, Budder, Wax, Earwax, Honeycomb, Dab, and Honeybuds.

The authors want primary care pediatricians to discuss this process with their patients and warn them  because there are increasing injuries from the relatively simple process of dabbing. (One can also buy all the equipment one needs on for under $200 dollars and even get free shipping.)  But butane has always been dangerous to use. In April 2014, the Los Angeles Times reported four separate explosions or fires with injuries from dabbing in a week. Some of the people making the THC concentrates may also be intoxicated which would not lead to careful working habits.

Dabbing is attractive to marijuana producers and users because it is very "green." The source material that is processed is all the trimmings and low quality material that is often thrown away. One takes normally unused material and makes an end product that is 80 percent or more THC.

In addition, the article worries about the effects of the high dose THC. But the only authenticated death from concentrated THC ingestion that I could find was a man who lost consciousness and fell down hitting the back of his head so hard that he had a fatal subdural hematoma. The long-term effects of chronic high doses of marijuana in adolescents with losses of white brain matter, disorganized thinking and loss of inhibitions is well reported. Use of these new products would probably cause more long-term damage, but there is no actual data at this time, only conjecture.

As a pediatrician, I have several issues with this article. First, the title says "Mere Marijuana," which assumes that marijuana is safe.  Casual use in adults may be safe, but any use in young children and heavy use in adolescents is clearly not safe. However, the same can be said of cigarettes and liquor, and both are legal.

Secondly, I have a very few minutes with my adolescent patients during their yearly visits and I am going to hit on subjects that are actually injuring them: texting while driving, alcohol binging, unprotected sex, and diverted prescription opiate pain medications.

Although I disagree with the article's approach, "dabbing" is a real problem and the next big thing in drug abuse. It's something parents should discuss with their children. My roommate from college, Mark Kleiman, PhD, a Professor of Public Policy at UCLA, who is advising the State of Washington on legalizing marijuana says the end product is very strong. "Dabbing has a different risk, comparable to chugging a bottle of vodka," he said.

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