Potent cannabinoid use

Adam Winstock

Reinventing cannabis

Why are ‘risky’ and ‘unpleasant’ new versions of cannabis replacing the real thing? Adam Winstock shares findings from the Global Drug Survey.

For the last decade much about harm reduction for cannabis was pretty straightforward. Nothing much had changed apart from the dominance of high potency herbal cannabis and its association with higher rates of paranoia, memory loss and dependence.

Then a few years ago things changed with the reappearance and remarketing of hash oil and the emergence from underground laboratories of myriad synthetic cannabinoid compounds. Both have been driven by the potential for huge financial gain, with hash oil riding on the back of the legitimisation – through medicine – of cannabis and the convenient appearance of vaping technologies, and synthetic cannabinoids exploiting a gap in the market for an unregulated cheap ‘stone’ in the face of very expensive herbal cannabis.

Butane hash oil (BHO, also known as shatter, honey and wax) is a new potent form of cannabis with THC of 60-80 per cent (and varying levels of CBD) that has seen a huge rise in popularity in the USA in recent years, driven by a demand among those with medical conditions for preparations that could minimise smoking-related harms and facilitate easier consumption. So just like the synthesis of opium to morphine, the movement to create a stronger and more potent form of cannabis might have therapeutic value.

These concentrations might also carry harm reduction benefits (eg smoking less combustible product, promotion of oral use, less consumption of unwanted impurities), which could extend to the non-medical use community. The development of a more potent form of drug is often partnered with a more efficient route of delivery. In the case of BHO the rapid evolution in ‘vape’ technology has been the perfect accompaniment.

Global Drug Survey (GDS) has been researching the use of natural cannabis preparations and the emerging issues associated with synthetic cannabis products for the last five years. Since 2012 we have collected data from over 150,000 cannabis users and have used this huge pool of expert knowledge to produce a range of free, peer-led harm reduction and self-assessment tools. These include the cannabis drugs meter www.drugsmeter.com, where you can compare your use with 100,000 others; the highway code, www.globaldrugsurvey.com/brand/the-highway-code (the first guide to talk about the impact of various harm reduction strategies on risk and drug-related pleasure), and the world’s first safe-use guidelines for cannabis at www.saferuselimits.com. All of these tools support our aim of making drug use safer, regardless of its legal status.

More than 2,500 users of BHO took part in GDS2015 and we found that BHO did indeed allow the use of non-tobacco routes of administration. Overall, most effects of BHO were reported to be stronger, last longer, and take effect more quickly than high potency herbal preparations. In terms of risks of dependence and withdrawal, most users reported little difference. As ever, it may be that the risks of harm rest in the unique interplay of drug preparation, individual user and their motivation for use.

CabbinoidsBHO is not the only potent cannabinoid product out there, however. GDS has been fascinated by synthetic cannabis and surprised at how such an ‘unpleasant’ drug has flourished. We’ve been researching them since 2010 and have found that synthetic cannabis (SCs) products are far less desirable (93 per cent prefer the real thing) and more risky than natural high potency weed, with the risk of seeking emergency medical treatment at least 30 times higher.

But this doesn’t take account of the massive profits to be made in flogging a cheap high. With emergency room presentations in some US states exceeding that of traditional drugs, and many UK prisons reporting high rates of inmate use and severe complications, it is fair to say that SCs are going to be more than a little challenge to regulators, law enforcement and health providers.

Unlike THC, SCs are full receptor agonists – meaning that there is no ceiling on how stoned you get. Manufactured with varying quality control, dosing is with varying amounts of active product being found on each gram of inert herbal material. Many SCs are much more potent (sometimes hundreds of times more) than THC, and SC products contain no counter-balance such as CBD.

The laws of common sense and basic economic theory (there are lots of natural weed supplies in the world) would suggest that the market for SC products should be dying. And yet they represent the fastest growing group of novel psychoactive drugs reported to international monitoring agencies like the EMCDDA. One reason is that when one set of synthetic cannabinoids is regulated, there’s a whole truck full waiting to be dissolved in acetone and sprayed on damiana and lettuce leaf, dried, packaged and sold for huge profits with no need for elegant hydro set-ups, electricity and water.

But why is there still demand? Why use a less desirable product when a preferable one is usually available? At least in some cases, it will be to avoid workplace drug screens. Working in a prison, I know these products have had real currency, and the same could be said for those in transport, mining and other risk-critical areas. But it’s not just avoidance of detection that can be an issue – it’s also price, potency and bang for buck, because over the last decade, high potency weed has increased in price relative to other drugs in many parts of the world. At a mean price of around €10/gram (and most people getting three to four joints out of gram), pot smoking has become an expensive habit.

For some people, using a more potent but less desirable product might just be down to economics. I bumped into a guy in a head shop in London, who was buying 3gm of cherry bomb for £25. I asked ‘wouldn’t you rather smoke some nice weed?’ ‘Yeah,’ he said, ‘I’m a weed man, but I only get three spliffs from a gram. I can get 25 spliffs out of this. I use it to sleep – saves on my use ofnice weed.’

Two minutes later in walked a mother in her mid-30s with her nine-year-old son: ‘I’ll have the usual – three blueberry bags please.’ So it is out there and people are using it. And sometimes users end up in the ER room, agitated, sweaty, paranoid and psychotic.

I also worry that, given all we know about the harms of early onset cannabis use impacting on the developing brain and increasing the risk of schizophrenia, use of SCs by young people might be a real public health issue. I have to remind them, ‘before you try and expand your brain, you have to let it grow.’

This year GDS is continuing its assessment of synthetic cannabis products. We’ll be looking at the risks of getting dependent, whether or not people get withdrawal, and whether vaporisers and potent new preparations are leading to a whole new range of health risks – or benefits.

Dr Adam Winstock is the founder of Global Drug Survey and a consultant psychiatrist, addiction medicine specialist and researcher, based in London.

To contribute experiences to GDS2015, visit https://www.globaldrugsurvey.com/GDS2015

More information at the GDS YouTube channel: http://bit.ly/1OBLjxW