Emergency department staff are often on the front line when it comes to encountering new street drugs.

In the coming months, butane hash oil — or "dab" as it is more commonly known — is likely to bring many victims of serious explosive accidents to the ER. Users call it dab because it only takes a little dab to get extremely high. New glass pipes that resemble little bongs or fancy crack pipes have been developed to accommodate the market.

Patients showing up in EDs may present symptoms that are a result of either smoking dab or making the substance. They may refer to the drug as "amber," "wax," "ear wax," "hash oil," "budder" or any number of variations of these names. The drug can be any color from gold to tar and can look like oil or a candle.

Butane hash oil was originally manufactured to give a powerful dose of THC to those who could really benefit from it. By forcing a powerful hydrocarbon (usually butane) through marijuana, the levels of THC can be raised to 75 to 90 percent, and it can help patients dealing with extreme nausea or pain — such as cancer patients, those in extreme pain or the near-dying — to get immediate relief.

The product is currently undergoing research, and legal producers are still upgrading their methods.

As with many of the so-called designer drugs, there will always be those who persist in manufacturing in their own backyards, trying to capitalize on the market. Even in legal labs, explosions can occur in the closed extraction systems, so one can imagine the fallout in home labs that do not have the same safety measures.

Dangerous fires can happen in settings similar to methamphetamine labs, and people will be brought to the ED for chemical burns and glass cuts over large areas of their bodies.

Along with this, in smoking illicitly-made dab, there is also the chance of fire when the drug has been hastily made by at-home chemists. Complicating the issue, the patient may present as mildly psychotic.

The high from dab can also be an issue that brings the patient to the ED. Dab users claim that smoking even one whole hit can produce extreme anxiety and even hallucinations. Some users say they feel "cosmically baked," and the effect lasts for several hours. Some people may exhibit psychotic symptoms that can last up to 24 hours. It will be important to differentiate this from other psychotic disorders by attempting to get a full psychosocial history from the patient.

There is little recorded information about whether EDs are treating these patients with anti-psychotic medications, what meds are being used and how effective treatment is. What is known from users and dispensers is that these drugs are treated with surprisingly little alarm despite the serious symptoms.

Dab is even compared to the hash oil from the 1970s, and many claim that it will soon push weed buds out of the market. Be forewarned: This is a dangerous chemical, often prepared in an outdoor, unmonitored lab where toxic residues are a part of the mix.

In at least one case, the drug-produced swelling of the opening to the esophagus that made it difficult to breathe for a short period of time, and the patient had to be treated. It is not known whether patients have displayed other allergic reactions to the drug.

In addition to the physical condition of the patient, monitor for psychosis, anxiety and impulsive behaviors. Understand that there is extremely low awareness/insight on the patient's part of the severity of the drug.

In addition to the problems listed above, be aware that patients might also have possible breathing problems and the potential for other drug issues occurring co-morbidly.