Dr Stogner told Medscape Medical News that it is “very important” to start monitoring practices such as dabbing.

“Our past experience, particularly in America, has been to wait for a problem to develop before we start to monitor whether we have an issue at all…. I think it’s a trend we ought to pay attention to and that might become problematic in the near future,” he said.

Dr Stogner believes that one of the driving forces for dabbing is the novelty, based on the idea that users can create something stronger and have a new experience.

“It’s much higher in terms of THC concentration, and it appears to be faster in terms of speed of effect, and I think those are both desirable traits for certain drug users and one of the things they look for,” he noted.

Consequences of Legalization

What does Dr Stogner think can be done to curb the practice? “There is very little that can done,” he said.

“You have got two or three different avenues you can go policy-wise between legalization, decriminalization, prohibition, and so forth. Each one has pros and cons for marijuana use more generally, but each one has pros and cons for dabbing.”

He explained that in jurisdictions where marijuana has been legalized, the risk that people are going to engage in home production is minimized. However, there is an increased likelihood of usage due to the availability of traders.

The opposite effect occurs in areas where there is prohibition, because prohibition may limit the number of people that are dabbing, but it conversely increases the risks of creating the dabs, because more people engage in the practice.

Looking at the wider topic of legalization, where does Dr Stogner feel that the United States is heading in the longer term?

“I think the way that we are, as a country, handling marijuana now is in an interesting and proactive way,” he said.

“It allows you to run natural experiments by setting policies in different states and determining how those states react in terms of the portion of the population using, the health consequences, and the health benefits.”

“So I see some merits in the nonuniversal policy that the United States has at present.”

However, he stated: “I think that, in many cases, the consequences of legalization were not completely thought out. The idea that other forms, stronger forms might be available, and might be available to very young people, wasn’t considered.”

Refreshing Perspective

Commenting for Medscape Medical News, Joseph J. Palamar, PhD, MPH, assistant professor in the section on tobacco, alcohol, and drug use in New York University Langone Medical Center’s Department of Population Health, said that the authors provide a “refreshing perspective” on dabbing.

He told Medscape Medical News that it was particularly important that they mentioned that healthcare providers should provide honest information about the practice and not engage in “scare tactics.”

However, he was concerned about dabbing and the potential risks to users.

“It seems that the process of making this new drug is actually much more dangerous than the drug itself,” he said.

“Marijuana is not known to be one of those harmful drugs. It depends on THC content and so on, but the process of making this [novel] drug is a lot more dangerous than the drug itself.”

He continued: “Most of the time, like with these new drugs, we worry about the drug effect. With this new form of drug, we have to worry more about the manufacturing than the drug itself.”

“But this is all a product of prohibition. If marijuana were regulated, we wouldn’t have kids using blowtorches, possibly blowing themselves up, just for marijuana.”

Dr Palamar explained that if one looks at alcohol prohibition, people were resorting to very high-potency products. “Beer was the big thing before alcohol prohibition in the US, and when alcohol became illegal, people went on to very high-potency liquor,” he said.

“That’s when all the criminal gangs and so on started coming in and overseeing everything. People engaged in riskier alcohol consumption practices underground, in speakeasies, and they were consuming very high - potency products.”

Returning to dabbing, Dr Palamar believes that this high-potency product is being used “because marijuana use is illegal in most of the US,” adding: “You figure, if it’s illegal, you might as well get as much bang for your buck as possible.”

“People turn to harder, more condensed forms of the drug in times of prohibition, and that’s what’s happening with marijuana. People would rather have a small amount of high-potency product than a weaker product that takes up more space and that you’re more likely to get caught with,” he concluded.

The authors and Dr Palamar have report no relevant financial relationships.

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Pediatrics. Published online June 15, 2015. Abstract