Cannabis Concentrates: Green Salvation or a Sticky Mess?

As cannabis regulatory change wafts through major American states and budding entrepreneurs hungry for profit high jack everything green I thought it was time to share the results of the biggest study of Butane Hash Oil (BHO, cannabis concentrates) ever conducted. It was undertaken as part of Global Drug Survey (GDS) 2015. A blog piece published here a year ago was met by a fair bit of moral grandstanding (although I learned quite a bit from the comments). It was suggested that as an addiction specialist anything I had to say was tarnished by the fact that I made money from addiction. I thought that was rather unfair - my interest is to help people use drugs more safely and if they never need to seek help beyond good quality information that is great. I think the accusation reflected the usual polarised nature of the drug debate and cannabis in particular. This unhelpful polarisation remains one of the last taboos that need to be dismantled before drug law reform can proceed. Cannabis is not without risk, dependence is a reality, for the young and those with mental illness it can be seriously problematic and it's not the panacea for every ill. I can say that and in the same breath say getting stoned can be fun, it's not the road to ruin, does not lead people to become heroin users, has huge medicinal potential and drug laws that ruin a person's life for being caught smoking a joint are a joke. No conflict, no mutual exclusion, just the reality of cannabis use in a large population of users. Anyway I digress so back to the point of this piece.

When a game changer of a preparation like BHO comes along, conveniently supported by a flourishing and uber cool vaping industry you have to evaluate what the impact is. And that is what GDS is trying to do with your help. While our study results from last years are currently being prepared for publication there are key findings I can share today that might help inform the trajectory of commercial BHO development and evaluation.

Most BHO is just highly concentrated THC but it does not need to be.

We asked 2500 people to compare the stone from high potency herbal cannabis and their most common BHO preparation. The ratings suggested that they were very similar in effect profile, suggesting most current BHO products are predominantly THC. Based on our previous work (http://youtu.be/m6df_F_ON6Q) manufactures should be offering more balanced preparations with CBD offsetting the negative aspects of a pure THC high (memory impairment, anxiety and paranoia). Potency is not the same as preference.

American cannabis users are the most 'lung smart' in the world.

America has long embraced the fact that cannabis is best and most healthily enjoyed without tobacco. Findings from GDS2014 showed while only 7% of American cannabis users routinely mix their cannabis with the tobacco for most other countries that figure is nearer 80%. The fact that BHO clearly lends itself to non tobacco routes of administration is hugely important from a public health perspective. Our finding from GDS2015 suggested that almost 70% of those using BHO used non tobacco routes of use with just under 50% using some sort of vaping device. With cannabis being the gateway drug to tobacco and combined use being associated with poorer quit rates, worse lung health and higher rates of dependence the opportunity that BHO offers in dissociating cannabis from tobacco globally is hugely important (Winstock et al 2010).

With potency comes problems and we need for an index of risk

Our data from GDS2015 suggested that BHO got people more stoned, more quickly and for longer than high potency herbal. The worry is that people also build up tolerance more quickly and are more at risk of acute unwanted experiences. With 1% of 40,000 cannabis users who took part in GDS2015 reporting seeking emergency medical treatment in the previous 12 months (way higher than I would have guessed and not much higher than the rate for drinkers) more research is needed to quantify whether the use of more potent forms are associated with greater risks of acute harm and dependence. It is not a case on saying one type is safer than the other but sharing the relative pros and cons of each type and route of administration and sharing that data with users so they can make informed decisions.

So what should we do?
Keep an open mind. Keep gathering data. Reflect on what we learn. Share findings so people can make informed decisions around their own health and wellbeing.

If that sounds reasonable to you and you'd like to be part of the words biggest survey of drug use ever conducted please take some time to share your experiences anonymously at www.globaldrugsurvey.com/GDS2016

1) Winstock, Adam R.; Ford, Chris; Witton, John. Assessment and management of cannabis use disorders in primary care.
In: BMJ, Vol. 340, c1571, 2010.