The United States Drug Enforcement Administration (DEA) continues to classify cannabis products as Schedule I controlled substances. This classification indicates that these substances are without medicinal uses (according to the DEA) and have an extreme potential for abuse and the development of dependence. This classification remains in effect by the federal government despite numerous states allowing the legalization of cannabis for medicinal use, personal use, or both.

Marijuana is produced from the cannabis plant (cannabis sativa) by drying of the flowering tops of the plant. Alternate forms of cannabis and cannabis-like products include hashish, BHO, and synthetic cannabinoids or synthetic marijuana.

What Are BHO, Hash, and Synthetic Marijuana?


Hashish is a product that is made from the cannabis plant by extracting the resin from the plant (which is typically done by drying and cooling the plant and then filtering it). The oil that is produced is molded and hardened, and then known as hashish. Hashish has a more potent concentration of delta-9-tetrahydrocannabinol (THC), the major psychoactive ingredient in cannabis.

The process of extracting the resin to produce hashish can be performed in a number of different ways by using different substances. When filtered, it produces a waxy or oily concentrate. Butane-extracted hash oil, or BHO, is produced by running butane over the dried cannabis products to extract the resin.

Synthetic cannabinoids (synthetic marijuana) go by various street names, such as Spice or K2. They are mind-altering chemicals that are added to shredded and dried plant material in order to smoke them or inhale them through e-cigarettes. These chemicals may be related to many of the compounds, such as THC, found in the marijuana plant; therefore, they are considered to be forms of synthetic marijuana. Despite the name similarity, there is nothing “natural” about synthetic marijuana; they are man-made chemicals.



According to the book Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential, the concentration of THC in most marijuana products is 1-5 percent, whereas the concentration of THC in blocks of hashish ranges from 5 percent to 15 percent. Other active ingredients in cannabis are also delivered in more concentrated forms in hashish.

When taken in higher doses (or even in smaller doses for some individuals), other side effects may occur, such as:

  • Decreased reaction time
  • Decreased motor coordination
  • Extreme sleepiness and lethargy
  • Stomach cramps, nausea, and vomiting
  • An increase in appetite that may result in significant weight gain
  • Significantly decreased decision-making abilities and poor judgment
  • Perceptual distortions that may appear as psychosis (hallucinations and delusions) in some cases
  • Depression
  • Anxiety and panic attacks
  • The development of tolerance
  • Withdrawal symptoms when one stops using the drug
  • The potential to develop a cannabis use disorder
  • Mental confusion and the sense of losing control
  • Increases in blood pressure and heart rate (an increase in the potential for heart attack or stroke)



According to information provided by the National Institute on Drug Abuse (NIDA), other potential long-term effects of hashish/BHO abuse may include:

  • Delays in physical growth in adolescents
  • An increase in abnormally developed cells in the body
  • Destruction of lung tissue and issues with the respiratory system
  • Reduced sex hormone production in males
  • Permanent changes in the brain that also may be associated with a lack of motivation, increased vulnerability to depression, and personality changes

According to an article in the journal Substance Abuse, BHO is a highly potent cannabis product that contains a significantly higher concentration of THC than hashish or marijuana. BHO goes by a number of names, including dabs, honey glass, wax, and shatter. Because the THC concentration is extremely high due to the extraction process (estimates range from 40-90 percent), individuals will experience a number of the symptoms associated with hashish use, but they may experience them much quickly or in more intense forms. In addition, negative effects, including issues with potential toxicity, are increased when one uses BHO.

BHO is produced by using butane in the extraction process described above. One puts the dried marijuana flowers in the container and then moves butane through a container that allows the butane to be filtered out but not the plant material. Then, the remaining plant material with the butane mixture is evaporated to eliminate as much of the butane and plant material as possible, leaving a sticky oily substance behind that is high in THC concentration. The substance is then generally either ingested, smoked, or “vaped.”

Because of the increased concentration of THC, the risk of side effects, including issues with psychosis, is much more pronounced in individuals who regularly use BHO. In addition potential long-term effects that occur from chronic use of marijuana, such as issues with attention, memory, judgment, and other areas of cognition, are also increased. Individuals who begin using cannabis products at an early age and continue to do so are also observed to have lower concentrations of white matter in their brains; the white matter in the neurons in the brain, known as myelin, is responsible for the efficiency of neurons to communicate with each other. Finally, increased concentrations of THC found in various forms of hash oil, such as BHO, lead to an increased potential to develop tolerance and withdrawal as well as a cannabis use disorder in individuals who regularly use these products.

Synthetic Cannabinoids (Marijuana)


The use of synthetic cannabinoids often occurs in younger individuals or those who are unable to get “legal” marijuana. NIDA reports that the particular chemicals that are in these substances are cannabinoid-like chemicals; however, they are not THC. This has led to a number of these substances being reported as a legal and safe alternative to cannabis in areas where cannabis remains illegal or hard to get for younger individuals. However, the DEA and certain states have recently classified these substances as illegal.

Many sympathetic marijuana products are produced in the country like Pakistan, India, and China where there are no restrictions regarding the type or potency of chemical that can be included in ingestible substances. This results in individuals not being aware of what they are taking; in many cases, they may be taking potentially dangerous mind-altering substances. The DEA and NIDA report that the overall effects of synthetic marijuana are similar to the effects of marijuana and include:

  • Feelings of euphoria and wellbeing
  • Relaxation and sedation
  • Perceptual changes similar to cannabis
  • Increased potential for issues with anxiety, panic attacks, and even psychosis

The perceptual changes that occur as a result of using these drugs may initially involve the experience of heightening sensory perception. Over time, they may become more dysfunctional and result in psychotic-like experiences, including visual and auditory hallucinations and paranoid delusions.

Individuals who habitually use synthetic cannabinoids are also prone to developing physical dependence on these drugs. The syndrome of physical dependence on synthetic cannabinoids is similar to the physical dependence that occurs with cannabis products, but the withdrawal symptoms are often significantly more intense and prolonged. Symptoms typically include irritability, depression, anxiety, restlessness, and physical symptoms that can include increases in heart rate and blood pressure, nausea, vomiting, headaches, insomnia, etc.

Signs of Abuse


A number of potential signs that a person is abusing hashish, BHO, or synthetic cannabinoids are outlined below.

  • The individual displays problems with controlling use of the drug. These issues with control can include:
    • Using the drug frequently or for prolonged periods of time
    • Spending significant amounts of time recovering from use
    • Frequently using more of the drug than originally intended
    • Expressing a desire to stop or cut down on use but being unable to do so
    • Continuing to use the drug despite problems associated with such use
    • Continuing to use the drug despite physical or mental health issues associated with use
  • Frequent cravings to use the drug
  • Being unable to fulfill important personal obligations as a result of drug use
  • Becoming defensive or even aggressive when asked about drug use
  • Possessing multiple containers for synthetic marijuana or butane, or other drug paraphernalia
  • Needing to use increasingly more of the drug to get the same effects
  • Frequently using the drug in dangerous or potentially hazardous situations
  • Experiencing issues with concentration, irritability, restlessness, nausea, or depression when without the drug

An individual who displays two or more of the above symptoms should be evaluated for a potential cannabis use disorder, as this disorder includes issues with synthetic cannabinoids. An individual who has a formal cannabis use disorder should seriously consider becoming involved in a formal substance use disorder treatment program that includes a physician-assisted withdrawal management program, counseling and therapy for substance use disorders, participation in social support groups like 12-Step groups, and long-term continued participation in treatment in order to avoid relapse. For younger individuals, participation in family therapy is often very useful.

Because individuals who have substance use disorders are often also diagnosed with other co-occurring mental health conditions, such as depression, trauma- or stress-related disorders, attention deficit hyperactivity disorder, etc., it is extremely important to have a qualified mental health professional perform a full assessment in order to identify all areas that require formal intervention. Many comprehensive treatment programs can offer this level of care.