The plant Cannabis sativa is commonly referred to as marijuana in the United States and other countries. Cannabis legalization and the use of cannabis products have probably sparked more debates than any other drug in the United States. Numerous states have now legalized the use of marijuana for medicinal purposes, and a few have gone on to legalize its use for recreational purposes.

Nonetheless, cannabis products are still classified by the United States Drug Enforcement Administration (DEA) as Schedule I controlled substances. This means that the federal government still formally classifies cannabis in all forms as having no medicinal value, not being safe to use even under the supervision of a physician, and as significant potential drugs of abuse that can result in the development of physical and psychological dependence. Despite this stance by the DEA there are numerous research studies that suggest that cannabis products do have some medicinal uses, although they are not the panacea that many users suggest they are.

    According to the Substance Abuse and Mental Health Services Administration (SAMHSA):

  • In 2015, nearly 36 million individuals admitted to using cannabis products.
  • The vast majority of individuals who use cannabis products regularly for recreational purposes also reported that it is their only recreational drug use.
  • Over 75 percent of people who admitted to using other illicit drugs also admitted to using cannabis products at least once.
  • Alcohol, tobacco products, and prescription drugs have higher rates of abuse. The estimated number of users of tobacco and alcohol products runs into the hundreds of millions.

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Dabbing

Numerous concentrated forms of THC exist (delta-9-tetrahydrocannabinol, the major psychoactive ingredient in cannabis). Dabs are highly concentrated extracts of THC that go by numerous names, such as BHO (butane hash oil), honey oil, butter, budder, shatter, wax, and crumble.

Typical marijuana cigarettes have concentrations of THC that range up to 20%, whereas dabs have concentrations of THC that can range from 50% to 80%. The reason for dabbing is obvious; the increased concentration of the THC results in more powerful psychoactive effects with less use. The extraction method can be potentially dangerous due to an increased probability to suffer severe burns or other accidents.

Dabs are made by extracting the THC (and other psychoactive substances referred to as cannabinoids) via use of a solvent, such as carbon dioxide or butane. This results in a sticky oil-like substance that is highly concentrated in THC.

Dabs are most often consumed in a contraption referred to as an “oil rig.”

This device consists of a glass water pipe and a hollow metal rod (referred to as a “nail”). The nail is heated, the dab is placed on the heated surface, and the vapors are inhaled through the pipe. Dabs can also be inhaled through “vape pens,” which are e-cigarette-like devices. Using a vape pen decreases any potential accidents or burn issues associated with heating the metal tube in an oil rig, and users can inconspicuously use the drug without arousing significant suspicion.

Because the use of dabs results in consuming significantly higher amounts of THC than would normally occur with the use of non-concentrated cannabis products, the practice can increase the risks associated with use of marijuana or other cannabis products. The National Institute on Drug Abuse (NIDA) reports that the long-term effects of chronically using concentrated THC products can include:

  • Growth delays in young individuals
  • The development of abnormal cells within the body
  • Significantly reduced sex hormone production, particularly in males
  • Increased potential for destruction of lung tissue
  • An increased potential to develop respiratory conditions
  • Significant damage to the white matter tracts in the central nervous system, particularly in adolescents (White matter tracts are the signaling portion of the neurons, and when these are damaged numerous issues can occur, including a heightened risk to develop diseases like muscular dystrophy and even dementia.)
  • Other permanent changes in the brain that are associated with increased vulnerability to mental health disorders like depression, decreased levels of motivation, issues with attention and concentration, and personality changes

NIDA also reports that dabbing can lead to significant risk for accidents, falls, blackouts associated with cannabis use, and psychosis (the development of hallucinations and/or delusions). Research on long-term chronic use of cannabis products has also suggested that chronic users often have decreased abilities to form new memories, compromised problem-solving abilities, decreased reflexes, and lower levels of life achievement. Moreover, continually consuming increased concentrations of THC can result in a more rapid development of tolerance to the drug, which can lead to more rapid development of a cannabis use disorder.

THC Abuse

Despite legalization of cannabis products in many states, and the ongoing debate of whether or not cannabis products are actual drugs of abuse, organizations such as SAMHSA, NIDA, and the American Psychiatric Association (APA) have provided information from research studies that indicates the following:

  • Chronic abuse of cannabis products can lead to a substance use disorder (the clinical term that encompasses both the notions of abuse and addiction).
  • Chronic abuse of cannabis products can lead to the development of physical dependence (expressing both the syndromes of tolerance and withdrawal).
  • The physical dependence associated with cannabis abuse is not considered to be physically dangerous in the same way that withdrawal from alcohol can be potentially lethal. Nonetheless, individuals undergoing withdrawal are often emotionally distraught and can make errors of judgment that can lead to accidents, or they can become suicidal.
  • It is entirely possible to overdose on THC, although the overdose would most likely not be fatal.
  • APA estimates that the prevalence of cannabis use disorders is about 1.5% percent in people who are over the age of 18 and about 3.5% in individuals between the ages of 12 to 17.

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Individuals who frequently “dab” would be at an increased risk to develop issues with a cannabis use disorder due to the extreme high levels of THC in these products. Only licensed mental health clinicians can formally diagnose substance use disorders, but in general, substance (cannabis) use disorders reflect the following:

  • Significant distress or dysfunction as a result of substance use
  • Significant issues with controlling use of the substance of choice, which can manifest in numerous ways
  • Continued use of the substance despite issues with relationships, performance at work, performance at school, or in other important areas of life
  • Unsuccessful attempts to stop or cut down on using their substance of choice
  • Failure to fulfill major role obligations, such as parenting, obligations at work, family obligations, etc., as a result of use of their substance of choice
  • Significant cravings to use their substance of choice
  • Frequently engaging in more use of their substance of choice than originally intended or using it for longer than originally intended
  • Increasingly spending more time using the substance of choice, recovering from its use, and/or trying to get the substance
  • Continuing to use the substance in spite of knowing that it is causing physical or psychological damage
  • The development of tolerance to the substance of choice
  • The development of withdrawal symptoms after stopping use of the substance of choice

Treatment for Addiction to Dabs

Information provided by APA, NIDA, and numerous other organizations indicates that individuals who develop cannabis use disorders also have high rates of co-occurring mental health disorders. When an individual has a psychological disorder, such as major depression or some other disorder, this increases the risk for relapse, and these individuals need to have all of their issues treated together.

    The approach to treating a cannabis use disorder should include:

  • Medical detox: Placement in a physician assisted withdrawal management program is important if this is deemed necessary by the individual’s treatment providers. Although the withdrawal symptoms associated with recovery from a cannabis use disorder are not severe, some individuals may experience severe issues, such as psychosis, and the potential to relapse during the withdrawal phase is extremely high. Physicians can monitor the individual, prescribe medications to reduce the symptoms of withdrawal, and help the individual to get a solid start on their recovery journey.
  • Medicare care: Medical management for any co-occurring conditions may be needed.
  • Therapy: Psychotherapy for both the cannabis use disorder and any co-occurring conditions is imperative and makes up the backbone of treatment.
  • Strong support from family members and friends: If possible, family members and close friends should become directly involved in the individual’s recovery program.
  • Peer support: Participation in social support groups, such as a 12-Step group, a community health group, or some other similar type of group, can be vital. These groups can facilitate recovery and increase the effectiveness of therapy and medications.
  • Other interventions, as needed in the specific case: These can include numerous interventions that can range from case management services to tutoring at school or vocational rehabilitation.

Commitment and continued participation in treatment-related activities for years following initial abstinence are needed. In addition, abstinence must be maintained.

Individuals in treatment may experience a relapse. Relapse is a very common occurrence for individuals who have any type of substance use disorder, including those suffering from addiction to dabs. When an individual is in a formal treatment program, they can learn to use the experience of a relapse to strengthen their recovery program, whereas an individual who attempts to quit on their own and relapses is less likely to do this.

The use of substance use disorder therapy and social support group participation gives individuals the tools they need to overcome the challenges of recovery. Medications can help with controlling some of the symptoms of withdrawal, cravings, etc., but medications alone cannot teach individuals how to cope with stress, develop a plan of relapse prevention, and seek out support. Thus, the continued use of therapy and social support group participation is essential for successful recovery.