Adolescents “Dabbing” With Marijuana: A Novel Mechanism for Smoking Highly Concentrated Tetrahydrocannabinol

The legalization of marijuana and decriminalization of its possession across America has likely contributed to the public’s view of marijuana as a relatively safe drug (1, 2). Marijuana is still the most widely abused drug among adolescents (1). Yet, public health campaigns depicting the harms associated with adolescent marijuana use, such as increased rates of psychosis in teenagers with a predisposition for schizophrenia and a dose-dependent increase in rates of suicide attempts, have not kept pace with legalization (1). Although epidemiologic data are sparse and inconsistent, there is evidence that the rates of youth marijuana abuse increase postlegalization (1, 3). Given peer pressure and access to drugs in this population, novel mechanisms for ingestion, like dabbing, may be used earlier and more frequently by adolescents.

Dabbing is a mode of marijuana ingestion in which individuals inhale a highly concentrated form of tetrahydrocannabinol (THC) from vaporized butane hash oil (colloquially called dabs, earwax, budder, shatter) created via butane extraction (3). Dabs contain THC concentrations up to 23%–80%, compared to the 3%–6% seen in traditionally smoked cannabis (2, 4, 5). Up to 40% of the THC can be inhaled, based on controlled experiments (4). Recreational users can synthesize dabs at home through a process known as blasting, with directions easily found via Internet search (2, 3).

Dabbing brings up several safety concerns, primarily dangers inherent to blasting, potential contamination of homemade dabs, and an increased risk of addiction and psychosis associated with the highly concentrated THC vapors (2, 4, 5). The safety of at-home blasting has been compared to that of home methamphetamine labs due to butane’s highly flammable and volatile nature (3). Blasting has resulted in several documented cases of fires, explosions, and severe burns (3).

Advocates of dabbing argue that this preparation of THC eliminates dangerous bacteria, mold, fungi, and other toxic compounds found in traditionally smoked cannabis (3). However, a recent study examining 57 dab concentrates available for consumption in the California medical cannabis market found that 80% were contaminated by considerable amounts of residual solvent, most commonly isopentane, and less frequently pesticides, like paclobutrazol and bifenthrin (4).

In 2014, Loflin and Earleywine (2) reported that 357 surveyed dab users, ranging from 18–71 years of age, preferred dabbing over smoking traditional cannabis due to the potency of dabs. The high was described by users as “stronger” and “qualitatively different.” However, the authors also found that dabbing was associated with statistically significant increases in subjective withdrawal and tolerance symptoms, suggesting that dabbing could have a greater addictive potential than traditional smoking (2, 3).

Because of this growing trend, increasing numbers of patients will likely present to emergency room settings with acute marijuana wax intoxication. At least one case of butane hash oil-induced psychosis that did not respond to an antipsychotic has been reported in the literature (5). It is unclear whether dabbing-induced psychosis is transient or could lead to chronic psychotic illness in vulnerable patients. Because dabs can be easily made at home following online tutorials and most adults would not recognize these small, waxy resins as marijuana, adolescents may be at particularly high risk of experimenting with dabbing and subsequently experiencing its negative consequences.