Assessing the Dangers of "Dabbing": Mere Marijuana or Harmful New Trend?

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 media Web sites, recreational users have created BHO at home in a process colloquially called "blasting." Blasting involves passing butane through a steel or glass tube packed with dried cannabis trimmings. THC and other hydrophobic compounds in the vegetation's trichomes dissolve within the butane; the butane-THC solution leaves the tube through a filter and is collected in a dish or tray. Because butane is very volatile, it evaporates (or is purged within a vacuum oven), leaving crystalized resins that can have a THC concentration approaching 80%. This product can take many forms depending on heat, pressure, humidity, and other factors. The form most challenging to produce is a clear amber solid referred to as "shatter." Terms such as "honeycomb," "budder," and "earwax" also refer to BHO (a list of colloquial terms that patients may use for dabbing products and devices is presented in Table 1). The process of creating these products is extremely dangerous because butane is flammable and volatile, and a number of fires, explosions, and severe burns have been attributed to home blasting. Fear of incrimination often leads amateur producers to be reticent in seeking medical care and to attribute the damage to some other cause. 3,4 Although blasting may be an appealing project for a young cannabis user, the safety risks have been described as comparable to those of manufacturing methamphetamine.