Cannabis Concentrate Use Linked to Cannabis Use Disorder
Over the last decade there has been a slow shift in consumer preferences away from traditional cannabis flower for smoking, and towards the use of cannabis concentrates. These concentrates can take many forms, from cannabis tinctures made for direct oral consumption, to cannabis waxes that can be “dabbed” (a form of flash vaporization) to achieve a high.
At their heart, all of these cannabis concentrates are just different resultant forms of the same process, where cannabinoids are extracted from the plant material into a form with a significantly higher concentration of desired compounds like cannabidiol (CBD) and 9-tetrahydrocannabinol (THC) than the original flower. In states where recreational cannabis is legal, these cannabis concentrates are easily purchased at retail dispensaries and are available in THC concentrations up to around 80%, or four times greater than high-grade cannabis flower.
Cannabis concentrates and public health
Previous studies into concentrate usage have examined cannabis users that obtained concentrates in states that did not have legal cannabis access, or focused on usage statistics between different states, but did not specifically focus on the health effects of the concentrates. Now, researchers from the Institute of Cognitive Science and the Department of Psychology & Neuroscience at the University of Colorado Boulder have set out to explore the public health implications for cannabis concentrate use.
Their study, published in Addictive Behaviors Reports, aimed to create a detailed demographic profile of cannabis users with legal cannabis market access in order to compare the demographics of frequent cannabis concentrate users with other subsets of cannabis users. In addition to comparing the frequency of cannabis use and the potency of cannabis used, various health metrics were also studied, such as self-reports of cannabis dependency, other substance use, occupational functioning, and general health.
The study was carried out using an online anonymous survey that was advertised to cannabis users in California, Colorado, Nevada, Oregon and Washington, using social media and advertisements placed in cannabis dispensaries. All of these states have legal medicinal cannabis programs, and all but California had legal recreational cannabis access, though recreational cannabis use had been decriminalized in California for several years before the study and was legalized shortly after the end of the study.
Participants were asked how frequently they consumed different types of cannabis, including cannabis concentrates and cannabis flower. For each type of cannabis, they reported using more than once per month, the participants were also asked to estimate the average THC and CBD content of that cannabis product.
Lifestyle questions formed the latter part of the questionnaire. These questions asked participants to estimate where appropriate their use of alcohol, cigarettes, prescription opiates, and any recreational use of illicit drugs or abuse of prescription drugs.
The final part of the questionnaire consisted of a series of questions to be answered on a 0-4 point scale. The questions assessed general mental health, physical health, quality of life, diet, and life satisfaction. Worked into these questions were 11 additional questions linked to the 11-item list of Cannabis Use Disorder (CUD) symptoms, as defined in the DSM-5, a manual that aims to help classify and diagnose mental disorders. Similarly, participants were also questioned about their past-week experience of other health issues with links to cannabis use, such as anxiety, depression, post-traumatic stress disorder (PTSD), chronic pain, and sleep disturbances.
Demographics of the study
Respondents to the questionnaire were grouped into three main study groups depending on their cannabis usage statistics. The first group of frequent concentrate users (FC) included people who reported cannabis concentrate use at least 4 days per week. A similar group of frequent flower users (FF) was made up of those who reported using cannabis flower more than 4 days per week but who rarely or never use concentrates. A third, broader comparison group of respondents (NC) was made up of those with any level of non-concentrate cannabis use who reported no current or past use of cannabis concentrates. Statistical analysis of the participants’ questionnaire responses was carried out in order to identify any significant trends or patterns in usage or health data.
Researchers found that FC cannabis users were demographically very similar to NC and FF users. The mean age of respondents did vary from 37.5 years for the FC group, to 46.9 years for FF users and 47.1 years for NC users. Ethnicity, gender, employment status, geographic spread, and the onset age of cannabis use showed little variation between the three user groups. There were no significant differences between the responses of each group to the general health and lifestyle questions, though FC users did show a slight increase in reported anxiety symptoms compared to the FF and NC groups.
Variation in cannabis usage for concentrate users
The most significant difference between the study groups were in direct relation to cannabis usage. FC users on average reported using cannabis concentrates 6.7 days per week with 59.1% reporting using concentrates listed as 80% THC or higher. Additionally, cannabis flower usage was also reported by the FC group an average of 6.04 days per week. In comparison, the NC user group reported cannabis flower use on average 4.16 days per week, although the number of cannabis use sessions per day remained constant between the two groups. FF users reported using cannabis flower 6.7 days per week, but averaged a lower number of cannabis use sessions per day than both the FC and NC groups. The FC user base was most likely to seek out high-THC and low-CBD strains of cannabis flower, with over 20% of users typically using strains with a THC concentration of >30% compared to just 1.8% of NC users.
Analysis of the responses to the Cannabis Use Disorder (CUD) questions revealed that on average FC users reported 2.1 of the recognized symptoms, versus 1.1 and 1.25 for the NC and FF groups. FC users commonly reported feeling a desire to stop, cut down, or control their cannabis intake, and also felt that they needed to use a lot more cannabis in order to get the high that they wanted. There were also trend level indications of using cannabis before engaging in risky behavior and in reported withdrawal symptoms following periods of no cannabis use.
Consequences of the findings
According to the DSM-5 criteria, endorsement of two or more symptoms qualifies for diagnosis of mild CUD. If this study of nearly 300 people holds representative over the US population, this could have worrying implications for the average frequent cannabis concentrate user. Though the authors of this study do note that frequent flower users also endorsed more symptoms than the broader sample group, so further detailed studies are needed to examine the exact dynamic between CUD, frequency of use, and concentrate use.
Other health, lifestyle, and demographic measures that were taken in the survey showed no significant differences between the groups of cannabis users. Additionally, the tendency of frequent concentrate users to choose high-THC strains of cannabis flower didn’t appear to be causing any unusual health effects. It is theorized by the researchers that this tendency is due to the increase cannabis tolerance reported in the CUD section. In response to the lack of health effects observed here, this is put down to only general health questions being asked and a reliance on self-reporting as casual links have been established between high-THC strains and health concerns.