As Youth Dabbing Increases, Opportunities for Public Health Frameworks Become Apparent

Public health professionals and regulators nationwide have an eye toward Colorado’s cannabis market as a sign of what to expect as other states’ markets mature. The bi-annual Healthy Kids Colorado Survey has confirmed that legalization has had no statistically significant impact on total youth consumption. Public health professionals and regulators alike can celebrate a grand achievement in the social experiment of legal access.

But this win is accompanied by troubling data on dabbing, a way of ingesting high potency THC through concentrated oil. Dabbing has grown among Colorado high schoolers who consume cannabis, from 4.3% in 2015 to 20.4% in 2019. This is on par with national trends, pointing to an overall evolution in cannabis culture.

Make no mistake, youth consumption remaining stagnant is a public health victory. It shows that regulation, enforcement, and prevention campaigns have been effective. These results should be replicated elsewhere, as many states have used and continue to use a copy-and-paste approach of Colorado’s regulatory framework in standing up their own adult use markets.

Even with this positive forecasting, we can’t let our prevalence win overshadow our potency problem. We have a responsibility to allow what little data we have inform our next sets of decision making. Such is the genesis of our profession. Peering beyond prevalence, we see a need for continuous improvement and intervention to prevent use of high potency products. This need is especially important for youth, as high potency use at younger age is the recipe for increasing risk for dependency and addiction.

As public health professionals and cannabis regulators, we have two levers to pull in reacting to this data. The first lever, and often our gut reaction, is tighter regulation. Because a growing body of research shows that dabbing and high potency cannabis use have been climbing at a national level, it is tempting to consider a potency tax. We know from lessons in regulating tobacco and alcohol that high taxes can modify behavior and is effective for youth prevention.

However, taxing potency is a far more complicated challenge with dangerous collateral impacts. For one, the illicit market is notorious for high potency products. Implementing a potency tax may drive consumers to the thriving illicit market, where hash oil extracted with inherently hazardous materials may make dabbing even more dangerous. Additionally, because we lack evidence linking the increase of youth dabbing to the regulated market, a tax on the regulated market may not be effective in reaching our priority population.

So how do we reach our priority population? In the behavioral health field, we start by meeting people where they are. In the case of youth, that is schools, which by no coincidence is where our data comes from. This leads us to our second lever, prevention campaigns.

Prominent substance use researchers Niki Miller and David Centerbar have conducted a review of school and community prevention programs specific to cannabis use in the state of Washington on behalf of the Center for Substance Abuse Prevention. An initial review of outcomes reported by more than 150 programs yielded 21 programs that met criteria across a variety of key disciplines for effectiveness specific to reductions or delays in cannabis use among middle and high school students. The results (listed at the bottom of this post) showed 9 programs that were proven successful in both reduction and delays of use. Each program varied in duration, behavioral health technique, and age group. The most interesting takeaway from this data set is that the secondary and tertiary levels of prevention in older age groups (high schoolers) were most effective. Pairing this with the Colorado results of increased high schooler dabbing, we can see that high school is not only not too late to reach youth at the point of high potency use, it actually may be a very effective time. But we must act quickly. The caveat of using schools as a way to reach youth is that they quickly age out of the system.

These prevention campaigns show promise to curb youth consumption in general. In addition to considering what regulations we can put in place to curtail production and consumption of high potency cannabis, we have to meet regulators at the table to bring the public health framework we know will work: prevention and education. Colorado, acting as our case study and best source of forecasting data, should consider a pilot program specific to high potency risks using best practices in primary, secondary, and tertiary prevention programs as a follow up to this new survey information and let data inform their decisions with both levers.

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