Stronger Than Ever

As medical and recreational cannabis legalization sweeps the country, so does the increased availability of new and unique products available for purchase in dispensaries. As the variety of products continues to grow, so does their strength and potency. The increased potency has become a point of contention for many legalization opponents, health care professionals, and law enforcement officials. The primary concern isn’t more potent CBD, CBG (cannabigerol), or other cannabinoids, but THC due to its intoxicating abilities.

Opponents of increased potency question whether there are severe health risks associated with long-term high THC dosages and whether states should limit how concentrated a product can be. Additionally, there’s a concern for adolescents and medical cannabis users who may unknowingly consume high dosages and face unwanted side effects, especially when using an oral administration method.

On the other side of the argument, legalization advocates and other health care professionals argue that placing a cap on THC percentages doesn’t help curb its use and will instead lead to the sustained growth of the illicit market.

‘Old’ Cannabis vs ‘New’ Cannabis

There’s no question that the strength of cannabis plants and products—and their THC concentrations—has steadily increased, especially over the past three decades. This has happened through the manipulation of plant genetics and various horticulture practices. Sinsemilla—a variety of female cannabis plants that hasn’t been pollinated and doesn’t contain seeds, which increases the density of cannabinoids and terpenes in the plant—is one common product of such methods.

These practices, along with selective breeding, have helped increase the yield of trichomes on the plant and alter the composition of the cannabinoids inside the trichomes, mainly to produce higher amounts of THC.

As reported in Biologic Psychiatry, samples of cannabis examined in 1995 by the Drug Enforcement Administration averaged roughly 4% cannabinoid potency; samples the Administration obtained nearly 20 years later averaged roughly 12% cannabinoid potency. Along with the sharp increase in overall cannabinoid potency came lower CBD concentrations and greater THC concentrations.1

Another study, published in the European Archives of Psychiatry and Clinical Neuroscience, examined samples from 2008–2017 and found a similar trend of increased potency, reporting an average THC concentration of 17.1% in 2017 vs 8.9% in 2008.2

Beyond cannabis plants with increased potency, highly concentrated prepared cannabis products are available for purchase in dispensaries. Most often called cannabis concentrates, these highly potent products can range from 50% to 99% THC. These are often named shatter, wax, badder, budder, hash, rosin, crumble, distillate, live resin, full extract cannabis oil, Rick Simpson Oil, and more. They’re often “dabbed” (a form of inhalation) but can also be used sublingually or topically or consumed orally in edibles.

What This Means for Consumers

Due to short-term safety concerns and potential long-term health effects, medical cannabis consumers must learn as much as possible about increased-potency products to use them in a way that’s beneficial to their health and needs. This is especially true for older adult users, who may be expecting products with the lower cannabinoid concentrations of the past, and young users, who may be more susceptible to long-term health consequences.

The most significant risk of high-potency cannabis comes from the potential to overconsume THC. Overconsumption isn’t deadly, but it can be uncomfortable, with patients experiencing disorientation, dizziness, drowsiness, short-term memory issues, slow reaction times, anxiety, heart palpitations, and tachycardia.3 Such unwanted symptoms can be exacerbated when high amounts of THC are consumed orally, as the liver converts delta-9-THC into the significantly more potent 11-hydroxy-THC.4 It’s suspected that very high concentrations of THC consumed over long periods of time can be damaging to various aspects of health and may lead to long-term addiction.5

In addition, there is a substantial concern about children and adolescents using these potent products; introducing cannabinoids, primarily THC, to developing brains can dysregulate essential mechanisms that are still forming.5 Therefore, it’s essential to educate patients on abstaining from high-THC products until after age 25 and to help ensure those products stay out of the hands of minors.

Beyond the drawbacks, there are some potential benefits of high-potency cannabis for medical consumers. As clinicians, it’s important to remember that bodies process chemicals differently, and THC is no exception. Some consumers have exceptionally high tolerance to THC, whether they inhale or ingest it. Cannabis concentrates can help these individuals find relief by delivering high concentrations of THC as needed. In addition, many consumers find the steep price tag at the dispensaries to be a strain on their wallets. Teaching patients how to use high-potency cannabis concentrates in small amounts can help them receive the doses they need more affordably. Finally, many cannabis consumers who make their own edibles at home prefer to use cannabis concentrates. The reason for this preference is two-fold: Concentrates are relatively mild-tasting compared with flower, and it’s easier to dose the final product when the input value in milligrams is already known.

What This Means for Clinicians

In most cases, educating patients on the benefits and drawbacks of high-potency cannabis is the safest, most thoughtful approach. Regardless of whether you approve of high-concentration products, your patients should have access to products that meet their needs and accurate information to make educated decisions.

As we’ve learned from the past, prohibition doesn’t keep patients from using or consuming cannabis; it only leads them to the illicit market where they may not have access to products that have the quality and safety standards of those found in dispensaries. Caps on THC content would prove to be no different. In addition, it’s becoming increasingly easier to make cannabis concentrates at home. While the old-school methods of making butane extractions and bubble hash still are used, new extraction methods involving the use of high-proof alcohol allow consumers to make concentrates at home with simple ingredients and equipment. Patients can’t be stopped from making these at home, but clinicians can teach them how to use them safely.

It’s vital for clinicians to discuss with patients the potential uncomfortable and/or dangerous effects of consuming too much THC both in the short and long term. Clinicians can advise clients on finding their minimum effective doses and appropriate products to meet their needs. Patients also should know that high-potency cannabis can increase their tolerance over time. While increased tolerance can often be counteracted with a short tolerance break, it’s still an unwanted side effect for most. Note that repeated, long-term exposure to THC may trigger cannabis hyperemesis syndrome, although the epidemiology and natural course of this condition remains limited and requires further investigation.6

Finally, clinicians should empower patients to advocate for themselves. Practitioners can provide information for making educated choices, offer help and suggestions for what to do if too much THC is accidentally consumed (such as taking a separate dose of CBD, chewing on black peppercorns, and finding a safe and calming space to wait it out), and encourage them to use a cannabis journal daily to correlate their dosages with their symptoms.

— Emily Kyle, MS, RDN, HCP, is a registered dietitian nutritionist and certified holistic cannabis practitioner. As a three-time published cookbook author, she combines the medicinal, nutritional, and culinary aspects of cannabis use through the creation of detailed cannabis-infused recipes. She advocates for responsible adult-recreational cannabis use and shares her published resources at EmilyKyleNutrition.com and on Instagram at @EmilyKyleNutrition.

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