Skunk, Wax, and Edibles: What Marijuana Is Your Child Using?
A Parent’s Guide to Modern Marijuana, Part 1
Posted January 18, 2017
With all the votes counted and the November elections behind us, the U.S. now has 9 states (including the District of Columbia) that have legalized marijuana for recreational use, and 30 that have legalized it for medical purposes. With laws increasingly liberalizing over the past few decades, it’s no surprise that marijuana use is on the rise. Based on surveys of US adults, the reported prevalence of past-year marijuana use increased from 4% in 2001 to 9.5% in 2013, according to National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and from 10% in 2002 to 13% in 2014 according to the US National Survey on Drug Use and Health (NSDUH).1,2
As the country “goes green,” some parents are feeling increasingly anxious about their children being exposed to marijuana, and with good reason. According to the University of Michigan’s Monitoring the Future Study, the reported past-year marijuana use in 2016 among US 8th, 10th, and 12th graders combined was 23%, with over 35% of all high school seniors reporting past-year marijuana use3 – well in excess of rates of adult marijuana use. Meanwhile, the perceived risk of marijuana use is at an all-time low among high school students, with only 31% of 12th graders seeing “great risk” in using marijuana regularly.4
Comparing statistics across studies as a rough approximation, these numbers suggest that 8th graders are about as likely to be using marijuana as adults, 10th graders are twice as likely, and 12th graders are 3 times as likely. If high schoolers are more likely to be using marijuana than their parents, just how concerned should parents be?
The good news is that teenage marijuana use in the US does not seem to have increased substantially over the past two decades and rates of marijuana use disorders (formerly known as “abuse” and “dependence”) appear to be on the decline. According to NSDUH, the past-year prevalence of marijuana use disorders among US adolescents decreased from over 4% in 2002 to less than 3% in 2013.5
The steady rates of marijuana use and declining rates of use disorders among teenagers may reflect the fact that no state has yet seen fit to sanction recreational marijuana use for minors and only a select few have legalized the use of cannabinoids for medical purposes in children. Also, many of the state laws legalizing marijuana use for adults have come packaged with funding for programs aimed at preventing marijuana among children and providing treatment for minors with marijuana use disorders.
And so, despite increasing legalization of marijuana and increasing use in adults, childhood exposure remains discouraged, is for the most part illegal, and has not risen dramatically. But that doesn’t mean that marijuana use in children is “no big deal.” Although teenage marijuana use doesn’t seem to have changed across the nation as a whole, the Monitoring the Future study recently found that marijuana use has increased in 8th and 10th graders in Washington state since the legalization of recreational marijuana in 2012.6 It’s possible that latest round of laws legalizing recreational use of marijuana could have similar effects in other states.
Parents would therefore benefit from keeping up to date about marijuana and its potential risks in children. To begin with, parents should be aware that what marijuana users are now smoking (and eating) has changed significantly since the days when they might have been using it themselves. In Part 1 of “A Parent’s Guide to Modern Marijuana,” we’ll take a look at some of the newer forms of marijuana that have become increasingly common, particularly in states where marijuana has been legalized.
► High potency marijuana
Although the plant marijuana (Cannabis) contains over 70 “phytocannabinoids,” the most prevalent and well-known psychoactive components are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). In general, THC causes the “high” associated with using marijuana, whereas CBD is thought to counteract that effect to some degree while also having other potential medicinal and neuroprotective properties. While the proportion of THC and CBD varies based on the strain or species of plant (e.g. Cannabis indica tends to have a higher THC to CBD ratio than Cannabis sativa) or its anatomy (e.g. the unpollinated flowers of female plants, also known as “sensimilla” or “skunk,” have higher THC than the leaves), the overall trend for the past several decades has been to breed marijuana with increasing amounts of THC and minimal amounts of CBD. In the 1970s, the marijuana typically purchased “on the street” contained less than 1% THC.7 By the 1990s, it had increased to 4% and by 2012, the average concentration of THC in marijuana exceeded 12%.8,9 In states where marijuana has been legalized, it’s now easy to find marijuana containing over 20% THC in medical dispensaries.
The marijuana of 2017 is therefore many times more “potent” (with respect to THC content per dose) than it was when most parents were children themselves. This has led to countless articles in the popular press talking about how marijuana today is “not your father’s marijuana.”
In a forthcoming article in Current Psychiatry and in Part 3 of “A Parent’s Guide to Modern Marijuana,” I’ll be talking about the psychiatric risks of increasingly potent marijuana. In the meantime, suffice it to say that current evidence suggests that higher potency marijuana is associated with a greater risk of addiction, psychosis, cognitive impairment, and structural brain changes.10
► Marijuana “edibles”
“Pot brownies” have been around for decades, but with the legalization and commercial sale of marijuana, “edibles” have become an increasingly profitable part of the industry. A wide range of edibles including baked goods, candy, and beverages are now prominently featured in marijuana dispensaries in states where they’re legal. With much of it packaged to resemble national brand products like Gummi Bears, Pop-Tarts, and Kit-Kats to name a few, it’s hard to avoid the conclusion that if these products aren’t being deliberated marketed to children and young adults, they’re at the very least appealing to that demographic.
Although the sale of edibles to minors isn’t legal anywhere in the US, teenagers report making them or buying them from other students at school and often prefer them over smoking to reduce the chances of being caught using marijuana.11 Young children and even infants are sometimes exposed to marijuana through the unintentional ingestion of edibles in the home. In the wake of marijuana legalization in Colorado, a spike in emergency room visits for children younger than 10-12 years old who have ingested marijuana has been largely attributed to edibles.12 Across the medical literature, reports of toxicity related to edible marijuana consumption in children have included serious cases of respiratory depression, seizure, coma, and even death.12,13,14,15
Marijuana edibles can be more dangerous than smoked marijuana for several reasons. First, edibles often contain high potency forms of marijuana increasing the risk of toxicity at small doses. Second, the THC content in the package labeling of edibles has been found to be extremely unreliable, with products containing as much as 50% more THC than advertised.16 Third, the absorption of edibles by eating is much slower than it is for smoked marijuana, such that a delay in onset of effects can lead to consuming a large amount in a short period of time, with significant accumulation after a few hours. The dosing of marijuana through edibles can often therefore be much greater than was intended, especially in children.
► Cannabis “wax”
The THC in marijuana can be hyper-concentrated through a process called “solvent extraction.” While various chemicals have been used in the past to create “hashish oil,” a recent popular method of extraction has involved the use of butane to produce “cannabis wax,” so-named because of its sticky, hardened appearance. The thick resin is used by heating a “dab” of it and inhaling the resulting vapor, so that using cannabis wax is also known as “dabbing.”
The amount of THC in cannabis wax varies greatly, but has been estimated to contain as much as 90% THC.17 Even more conservative findings of cannabis oil containing 50% THC suggest easy access to marijuana products that are more than 10 times as potent than the average marijuana purchased “on the street” a generation ago.8 Aside from burn injuries related to its production, use of cannabis wax is associated a more intense high as well as less common effects such as “passing out” (often intentionally), confusion, and psychosis.18,19,20 Some have reported that cannabis wax may be associated with greater tolerance and withdrawal (two aspects of physiologic addiction) compared to smoking “regular” marijuana.16
Cannabis wax should not be confused with cannabis oils containing CBD as opposed to THC, which in some states are marketed for medicinal purposes including the treatment of childhood seizures. In Part 3 of “A Parent’s Guide to Modern Marijuana,” I’ll review the potential medical benefits of cannabinoids and whether such marketing claims live up to the hype.
In summary, the THC content of marijuana has increased dramatically over the past two decades, with legalization paving the way for greater availability of novel forms of high potency marijuana that are especially appealing to young people, such as edibles and cannabis wax. Enthusiasm about the potential medicinal applications of marijuana should be tempered by concerns that children today have relatively easy access to marijuana with much greater potency than what was available when their parents were young. As we’ll discuss in Part 4, high potency forms of marijuana appear to increase certain health risks for both children and adults alike.
To read more of this 3-part series on A Parent’s Guide to Modern Marijuana:
- 1. Hasin DS, Saha TD, Kerridge BT, et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry 2015; 72:1235-1242.
- 2. Compton WM, Han B, Jones CM, et al. Marijuana use and use disorders in adults in the USA, 2002-2014: analysis of annual cross-sectional surveys. Lancet Psychiatry 2016; 3:954-964.
- 3. University of Michigan, Monitoring the Future Study. Trends in Annual Prevalence of Use of Various Drugs for Grades 8, 10, and 12 Combined. http://monitoringthefuture.org/data/16data/16drtbl6.pdf
- 4. University of Michigan, Monitoring the Future Study. Trends in Harmfulness of Drugs as Perceived by 12th Graders. http://monitoringthefuture.org/data/16data/16drtbl11.pdf
- 5. Grucza RA, Agrawal A, Krauss MJ, et al. Declining prevalence of marijuana use disorders among adolescents in the United States, 2002 to 2013. Journal of the American Academy of Child and Adolescent Psychiatry 2016; 55:487-494.
- 6. Cerdá N, Wall M, Feng T, et al. Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatrics 2016 (in press).
- 7. Sevigny EL. Is today's marijuana more potent simply because it's fresher? Drug Testing and Analysis 2012; 5:62-67.
- 8. Mehmedic Z, Chandra S, Slade D, et al. Potency trends of ∆9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008. Journal of Forensic Science 2010;55(5):1209-1217.
- 9. ElSohly MA, Mehmedic Z, Foster S, et al. Changes in cannabis potency over the last 2 decades (1995-2014): analysis of current data in the United States. Biological Psychiatry 2016;79:613-619.
- 10. Pierre JM. Psychiatric risks of increasingly potent Cannabis. Current Psychiatry 2017 (in press).
- 11. Friese B, Slater MD, Annechino R, et al. Teen use of marijuana edibles: a focus group study of an emerging issue. Journal of Primary Prevention 2016;37:303-309.
- 12.Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatrics 2013; 167:630-633.
- 13. Wang GS, Le Lait M, Deakyne SJ, et al. Unintentional pediatric exposures to marijuana in Colorado, 2009-2015. JAMA Pediatrics 2016; 170:e160971.
- 14. Appelboam A, Oades PF. Coma due to cannabis toxicity in an infant. European Journal of Emergency Medicine 2006; 13:177-179.
- 15. Hancock-Allen JB, Barker L, VanDyke M, et al. Death following ingestion of an edible marijuana product—Colorado, March 2014. Morbidity and Mortality Weekly Report 2015; 64:771-772.
- 16. Vandrey R, Raber JC, Raber ME, et al. Cannabinoid dose and label accuracy in edible medical cannabis products. JAMA 2015;313:2491-2493.
- 17. Loflin M, Earleywine M. The new method of cannabis ingestion: The dangers of dabs? Addictive Behaviors 2014; 1430-1433.
- 18. Cavazos-Rehg PA, Sowles SJ, Krauss MJ, et al. A content analysis of tweets about high-potency marijuana. Drug and Alcohol Dependence 2016; 166:100-108.
- 19. Pierre JM, Gandal M, Son M. Cannabis-induced psychosis associated with high-potency “wax dabs.” Schizophrenia Research 2016;172:211-212.
- 20. Keller CJ, Chen EC, Bodsky K, et al. A case of butane hash oil (marijuana wax)-induced psychosis. Substance Abuse 2016; 37:384-386.