The practice now known as “dabbing” appears to be quickly proliferating as a fashionable way to use marijuana in the United States.1 Dabbing is the inhalation of a concentrated tetrahydrocannabinol (THC) product created through butane extraction. The use of butane hash oil (BHO) products and the modification of cannabis more generally are not new phenomena, but dabbing has recently moved from relative obscurity to the headlines, leaving cannabis aficionados, adolescents, and parents curious about its effects. Physicians and other health care professionals need to be prepared for discussions about the effects of dabbing to minimize potential harms, particularly because recent marijuana policy changes likely has facilitated youth access to “dabs.”
BHO is made from cannabis and in many instances may be used to salvage less potent portions of the plant.2 Because BHO production is uncomplicated, requires few resources, and is the subject of countless instructional videos on social...
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For Youth, There Is No 'Mere Marijuana'
For Youth, There Is No 'Mere Marijuana'
The "Perspectives" piece by John M. Stogner and Bryan Lee Miller, "Assessing the Dangers of 'Dabbing': Mere Marijuana or Harmful New Trend?" valuably alerted this journal's readers about the potential risks as well as unknown effects of newly popular practices of creating and inhaling high-potency cannabis extracts. While I appreciate the importance of pediatricians alerting families about the dangers of "dabbing," there was no mention of the dangers of "ordinary" marijuana for youth, and one would be left with the impression that use of the drug by more mainstream methods presents no appreciable risks for young people's health and safety. It is well established by science that this is not the case.
The use of the phrase "mere marijuana" in the title reflects the radical shift in public perceptions around marijuana in recent years. Many now see it as a benign substance, and students asked about their drug use and perceptions in the annual Monitoring the Future survey increasingly see marijuana as safe. Yet considerable research clearly shows that, for adolescents, frequent or heavy marijuana use may have adverse consequences for brain development and related life outcomes.
In one prospective study, persistent, heavy use of marijuana starting in adolescence was associated with a loss of up to 8 points in IQ, which were not recovered even after a person quit. Probably because of the involvement of the body's endocannabinoid system in synaptic development, marijuana is in a unique position to severely alter brain development trajectories when it is used regularly before the brain finishes maturing in a person's mid-20's. Regular marijuana use (at least several times a week) by teens is associated not only with poorer cognitive outcomes but also with increased risk of psychosis in individuals with a genetic predisposition. And although causality here is sometimes harder to ascertain, numerous studies have also linked marijuana use with adverse life outcomes, such as lower educational attainment, income, and life satisfaction.
The National Institute on Drug Abuse works with other federal agencies as well as a multitude of private-sector partners to educate the public and clinicians on the adverse effects of marijuana and other substance use in young people. We also want to help pediatricians talk to their adolescent patients about drugs with abuse potential as part of a standard practice of screening. Clinicians should be reminded of the risk of addiction for young people (about 1 in 6 among those who start using as a teen). In addition, the potential for impaired driving is an immediate concern and should also be discussed with adolescents. To this end, we are partnering with the American Academy of Pediatricians to develop a Continuing Medical Education course to facilitate just these kinds of clinical conversations.
Pediatricians play a unique and important front-line role in giving teens and their families information about the dangers of using drugs while the brain is still developing. I agree it is critically important to keep abreast of new and risky drug trends like dabbing, but it is also crucial that we not lose sight of the fact that no marijuana use is harmless for pediatric populations. The science is quite clear on this. For youth, there is no "mere marijuana."
Nora D. Volkow, M.D. Director National Institute on Drug Abuse
Conflict of Interest:
None declared