08/12/2016 05:35 pm ET Updated Aug 13, 2017

The Dangers of Dabbing: The Health Risks Posed by the Latest Marijuana Trend

Twenty-five states and the District of Columbia have now legalized marijuana in some form. And the trend continues unabated: this year could see marijuana being legalized for recreational use in an additional 10 states and for medical use in an additional six states.

The march toward legalization has brought a dramatic change in attitude. Once perceived as a serious threat to public health and safety - if not a downright evil - marijuana is now considered by most to be safe - on the order of drinking alcohol, but safer. Many even consider it to be good for them. Fifty-four percent of American registered voters support full legalization, and 12.5 percent of American adults use marijuana, including a third of high school seniors.

In some ways, this swing in attitude is understandable given that since 1970 marijuana has been lumped in the same category as heroin and cocaine as a schedule I drug. The drugs placed in this category were defined as drugs that had a high potential for abuse, no accredited medical use, and a lack of accepted safety. This designation was supposed to be based on scientific evidence but in the case of marijuana little research existed. As a schedule I drug, it then became much more difficult for researchers to get funding to research marijuana's potential benefits and dangers. This lack of science left a vacuum between the official government position on marijuana and the common sense of the general public that could see that marijuana did not have the same addictive liability as cocaine or heroin. Not surprisingly, some began to question the strict prohibition of marijuana because of the perceived health benefits of marijuana and harsh sentencing laws that were enacted in the 1980s. This disconnect between policy and conventional wisdom has left many people dubious of claims by government leaders and health professionals that marijuana does pose some health risks. These risks are especially pronounced for young people under the age of 25 whose brains are still maturing and therefore are at an increased risk of the neurologic consequences of marijuana.

These young marijuana users are also more likely to be exposed to newer, more potent forms of marijuana including a dangerous marijuana extract called "dabs" that is rapidly gaining in popularity. The vulnerability to the dangers of dabs is enhanced by the fact that this highly potent, distilled version of marijuana is barely a blip on the radar screens of the health, education and law enforcement authorities who are often the first bulwark of defense against harmful drug trends. This is important because when a young person admits to using marijuana, it is crucial that parents and educators learn more about the type and potency of the marijuana that is being used. In our times, not all marijuana is created equal.

Also known as butane hash oil (BHO), honey oil, budder (or butter), crumble, shatter and wax, dabs are a highly concentrated extract of THC (tetrahydrocannabinol) - marijuana's psychoactive ingredient. While the typical joint is 11 to 21 percent THC, a dab can be 80 percent or more. The result is a high that has been described as "ferocious." And therein lies the danger - or part of it. In fact, dabbing can be dangerous in a number of ways:

• Adverse health effects - Dabbing can lead to rapid heartbeat, blackouts, psychosis, paranoia and hallucinations, as well as to accidents and falls. Some are also concerned about the potential for abuse posed by a drug that delivers such a rapid, potent high. In one study, researchers found that users viewed dabbing as a more dangerous form of cannabis consumption because of the tolerance that is developed - ever-larger doses are required to produce the same effect. Also, although many proponents would repudiate the idea of marijuana as a gateway drug, the immersion in a dabs drug culture holds the potential to lead to the abuse of other substances, especially among the emotionally or genetically vulnerable. Indeed, while dabs are similar to marijuana flowers because they contain the same psychoactive ingredient (THC), they are about as similar in potency as regular beer (~5% alcohol by volume) is to Everclear vodka (95% alcohol by volume).

• Consumption - Dabs are typically consumed in an "oil rig" consisting of a glass water pipe and a hollow metal rod called a "nail." The nail is heated with a blowtorch, the dab is placed on the hot surface and the vapors are inhaled through the water pipe. In addition to the risks associated with inhaling off-gasses from the oil rig and contaminants in the dab, there are the risks associated with heating the nail to hundreds of degrees. One study in experienced users found no increased risk of accident or injury, but John M. Stogner, the co-author of an article on dabbing in "Pediatrics," noted that the situation may be different for novice users who are more likely to be cognitively impaired while using the dangerous equipment.

Dabs can also be consumed in an e-cigarette-like "vape pen." While use of a
vape pen eliminates the dangers associated with an open flame, it increases
the appeal because of the getting-away-with-it factor. Users are
brazenly dabbing on the street, at sporting events and even in school, within
full view of clueless authority figures.

• Manufacture - The production of dabs is a dangerous process in which butane gas is used to extract the THC. The butane is then burned off, leaving only the thick concentrate. Amateurs can accidentally ignite the volatile butane vapors, leading to fires, burns and explosions so severe that they have destroyed homes. Law enforcement authorities are concerned that dabs' increasing popularity will prompt more people to try making their own, especially given the ease with which it is made and the ready availability of instructional videos on the Internet.

While more research is needed on the risks of dabbing, it is likely that the accepting attitudes fostered by the legalization trend are increasing the rate of experimentation with this new form of marijuana. Health, education and law enforcement authorities need to educate themselves about the dangers and get the word out that dabs are not "just pot." Indeed, the increased popularity of dabbing is worrying even the most hardcore of marijuana proponents. In the words of a writer for "High Times," which describes itself as the "definitive source for all things marijuana," "... the fashionability of a form of cannabis consumption that does lead to people passing out and getting wheeled away on stretchers should give us pause."