Co-authored by Mallory J Loflin, M.A.
Messing With Mother Nature
I live in London. And to my knowledge, butane hash oil (BHO), shatter, honey, wax has not yet made a significant mark on the UK or European cannabis market. It is here for sure. The occasional patient I see in clinic, the off-the-cuff remark from the police, even the odd report of a corner street explosion. But to my knowledge we are not anywhere close to the US when it comes to this new potent form of cannabis with THC percentages running at 60 to 80 percent. It's for this reason I asked Mallory Loflin to co-author this piece with me because I wanted to make sure we knew what we were talking about.
As a general rule, anytime "man" starts messing with Mother Nature, the outcomes when related to drugs is generally not good. From a public health perspective it is rarely an improvement on the original. I'm not saying drug purification and distillation does not make a drug more fun (well, I guess chewing coca leaves and running up the mountain after your goat is hardly fun compared to what some people get up to on cocaine), but messing with nature does come at a cost. And as GDS2015, which has a huge focus on BHO and is set to become the biggest drug survey ever, launches, we thought it might be worth speculating whether the reinvention and promotion of hash oil and the explosion of vaping devices is going to turn out to be good, bad or rather ugly.
Learning From the Past
The history of drugs suggests that nature tends to restrict the potential of psychoactive substances to create large scale dependence and social unrest. Leave most compounds in their natural state, place some culture bound rituals around them, don't package and distribute them, avoid laborious processes to permit consumption through routes other than swallowing and most of all give purification/distillation a wide berth and many of the most troublesome drugs of the 21st century would be less problematic. And whilst we look toward technology and invention for the next great leaps in making drug use safer for people (commonsense drug regulation would be rather helpful but less easy to market!), recent history suggests that technological advances tend to undermine nature's inherent harm reduction strategies and make the use of most drugs more dangerous and risky.
From the isolation and purification of cocaine and morphine from their plant based origins to the distillation of alcohol from fermented fruits, arecoline and other psychoactive alkaloids from areca nut into Pan Masala and the methylation of amphetamine to methamphetamine -- almost without exception the development of a more potent form of a drug is associated with greater addiction potential and consequently risks of harms. The development of a more potent from of a drug is often partnered with a more efficient/rapid route of delivery. For cocaine hydrochloride and morphine, it was the ability for the drug to be injected leading to rapid reinforcement whilst for crack cocaine and methamphetamine subtle molecular alteration allowed the drug to be smoked leading to a more rapid onset of action with a shorter, more intense high.
But that is not the whole story. What's missing is the "why." Historically, the drive to isolate, modify and purify was not, we assume, to increase the harms associated with the use of the drug, but was "a byproduct" of scientific advancement and well intentioned medical and pharmaceutical interests in broadening the therapeutic efficacy and availability of these plants' "healing" properties. And in a similar fashion the context for the rise of many of these new, potent forms of cannabis, such as BHO and other concentrates, was the demand by those with medical conditions for preparations that could minimize smoking-related harms and facilitate easier adoption of oral consumption. So just like the synthesis of morphine, leading to greatly improved therapeutic application compared to the poppy's original derivative, opium, the movement to create a stronger and more potent form of cannabis might be a good thing. And these potential harm reduction benefits (through having to smoke less combustible product or the use of a vape pen and promotion of oral use) could extend to the non-medical use community.
So what does the evidence say? Early research conducted by Mallory Lofflin and her co-author Mitch Earleywine (1) suggests recreational users did indeed prefer BHO to traditionally smoked flower cannabis because the effects were stronger and onset more rapid. For a medicinal user who relies on cannabis to alleviate symptoms, this is a very desirable property. But their study of about 350 users of BHO does suggest that some concerns might be warranted. Although their analyses revealed that using "dabs" created no more problems or accidents than using flower cannabis, users did report that "dabs" led to the development of higher tolerance and withdrawal, suggesting that the practice might be more likely to lead to the development of dependence.
The Future?
As parts of the world drift into revising the regulation of cannabis, the appearance of butane hash oil in parts of US raises concerns about whether history is about to repeat itself. We worry that cannabis purification and reformulation combined with the commercialization of the cannabis industry in partnership with a new generation of vaporizers ("safe delivery devices") might lead to greater cannabis harms. We worry that the cannabis industry might start to think like the tobacco industry where CEOs embraced (then buried) the realization that users dependent on your product are good for profits. We worry that edibles coming in the form of chocolate bars with 16 segments where each one is a dose are going to lead to all sorts of "white-outs." Really, who ever had one piece of chocolate? So while we don't have much evidence for this, we at least wanted to give it a bit of thought before we punch the numbers from the responses we get in from GDS2015.
There's a reason that almost all medications carry warning labels and why medical doctors and pharmacists discuss ways to reduce dependency risk with their patients. We see no reason why the cannabis industry should not follow suit. Being cognizant of safety when making recommendations to cannabis patients and consumers is not antithetical to the goals of the cannabis industry. In fact being fully up front that some people become dependent and that the use of cannabis especially heavy, regular use and consumption by the young, those with mental illness and those who are pregnant can be harmful is totally essential and will only create respect within the wider community. Guidelines are needed for cannabis use in exactly the same way they are needed for alcohol (2) For a movement that needs to distinguish itself from the tobacco and alcohol industries, dispensaries would be well served by advocating for the establishment of risk indexes to inform recommendations for use and best practices for safety such as the GDS Highway Code (3). Where does BHO fall in that index? That's what we're trying to find out.
Take part in Global Drug Survey 2015 here. Everything is anonymous and confidential. Please take the time to share what your experience anytime up until Dec. 20, 2014.
References
1) Loflin, Mallory, and Mitch Earleywine. "A New Method of Cannabis Ingestion: The Dangers of Dabs?." Addictive Behaviors (2014).
2) Winstock, Adam. "Cannabis regulation: the need to develop guidelines on use."BMJ 348 (2014).
3) http://www.globaldrugsurvey.com/wp-content/uploads/2014/04/High-Way-Code_Cannabis1.pdf
About the authors: Dr Adam Winstock MBBS, BSc, MSc, MRCP, MRCPsych, FAChAM, MD, is the founder of Global Drug Survey and a Consultant Psychiatrist, Addiction Medicine Specialist and researcher based in London. Mallory J Loflin, M.A, is a graduate student and doctoral candidate, Department of Psychology, University at Albany, SUNY.