THC Products Research Articles

Enhancing Methodological Approaches for Studying Health Effects of High-Concentration THC Products.

For public health protection, informed decision-making relies on having a robust foundation of evidence concerning risks and their prevention. Application of an evidence-based framework depends on the availability of pertinent, scientifically sound data generated by well-directed and valid research endeavors. In this essay, we address the current state of research in humans and the evidential base concerning high-concentration delta-9-tetrahydrocannabinol (delta-9-THC) products, which are readily available in the United States. Furthermore, we explore the intricate challenges faced in carrying out research on these products, which reflect the full range of study design issues: measurement of exposure and outcomes, confounding, selection bias, and the generalizability of findings. We offer recommendations to guide future research toward providing more informative evidence. By following these recommendations, researchers and funders on this emerging topic could move toward generating the valid and comprehensive evidence needed to effectively inform public health initiatives and guide policy decisions regarding high-concentration delta-9-THC products and their use. The urgency of generating such evidence cannot be overstated, given the widespread legalization and increasing availability and use of these products. (Am J Public Health. 2024;114(S8):S639-S644. https://doi.org/10.2105/AJPH.2024.307724).

Methodological challenges and actionable recommendations in studying the health effects of high-concentration THC products.

In conducting a scoping review on the health effects of high-concentration cannabis products, we have uncovered pervasive methodological shortcomings within the cannabis literature. This paper begins by defining the 'causal effect' of interest for public health and delineating the desirable features of study design that can address crucial questions pertaining to public health and policy. We further delve into the methodological complexities inherent in studying the health effects of high-concentration cannabis products, describing challenges associated with the measurement of exposures and outcomes, confounding, selection bias, and the generalizability of findings. We introduce causal inference methods to mitigate potential biases in observational cannabis use studies. We identify specific areas that necessitate further development and investigation to deepen our understanding of this topic. Finally, this paper extends actionable recommendations, serving as a roadmap for upcoming research initiatives in this domain.

Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits

AbstractThe legalization of cannabis for medical and recreational purposes has progressed internationally. Cannabis and cannabinoids are advocated for a plethora of medical indications. An increasing number of medical and nonmedical users regularly consume large doses of delta-9-Tetrahydrocannabinol (THC), the main active component of cannabis. Aim: to summarize the evidence on (1) risks of recreational cannabis use and (2) effectiveness and safety of medicinal cannabis. Findings on recreational use: Cannabis is mostly used to experience its acute rewarding effects. Regular use of high THC products can produce addiction (cannabis use disorder or CUD). Acute consumption of high THC doses (including unintentionally) can cause time-limited mental, gastrointestinal, and cardiovascular problems and motor vehicle accidents. Chronic patterns of cannabis use have been associated with multiple adverse outcomes that are of particular concern among adolescents and young adults, such as, disrupted learning, impaired cognitive performance, reduced educational attainment and an increased risk of CUD, psychosis/schizophrenia, mood and anxiety disorders and suicidal behaviors. There is debate about the extent to which cannabis use is a cause of these adverse outcomes. Physical health risks (e.g., respiratory and cardiovascular, prematurity and restricted fetal growth, hyperemesis syndrome among others) have also been linked with repeated consumption of cannabis with a high THC content. Findings on medical cannabis use: Herbal cannabis, medicines from extracted or synthetized cannabinoids—often used as adjuvants to standard medicines—may produce small to modest benefits. This is primarily the case in treating chronic pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and refractory epilepsy (in the case of cannabidiol, CBD). The evidence is inconclusive on their value in treating mental disorders and other medical conditions. Safety: Cannabis-based medicine is generally well tolerated. There is a risk of mild to moderate adverse effects and CUD.

Pharmacovigilance in the Age of Legalized Cannabis: Using Social Media to Monitor Drug-Drug Interactions Between Immunosuppressants and Cannabis-Derived Products.

A clinical trial of Epidiolex®, the only US FDA-approved cannabis-derived consumer product (CDP), discovered an interaction with an immunosuppressant (tacrolimus) that led to drug toxicity, highlighting the unique intersection of prescription and commonly unregulated consumer products. We aimed to identify if similar drug-drug interactions (DDIs) are occurring among the consumer CDP market, even though they cannot be identified through trials. We searched Reddit for subreddits related to CDPs or health, resulting in 63,561,233 posts. From these, we identified 190 posts discussing both immunosuppressants and CDPs. Two blinded investigators evaluated the following. (1) Was there a concern about a potential DDI between consumer CDPs and immunosuppressants? (2) Was there a unique adverse event attributed to a DDI between consumer CDPs and immunosuppressants? Of these, 66 posts (35%) expressed concern about a potential DDI, such as "Hey, my partner wants to try my edibles … she's on Prograf [tacrolimus] and wants to talk to a stoner who's had a heart transplant." Four posts (2%) reported a unique DDI, such as "I have clinical results that are semi-anecdotal, showing the coordination to my halting substance use … It's the CBD. Shot my prograf to 30 at like 4mg." Two of the four reported DDIs are similar to those first reported for Epidiolex. The remaining two reported DDIs include a potential cannabidiol (CBD)/sirolimus or delta-9-tetrahydrocannabinol (THC)/sirolimus interaction and a THC/tacrolimus interaction, both resulting in drug toxicity. This case study is the first to report on DDIs involving consumer CDPs, including both CBD and THC products, as well as a broader class of immunosuppressants. This demonstrates the risks associated with using consumer CDPs alongside prescription medications while highlighting the need for development of increased surveillance to monitor consumer CDPs for drug safety signals, as well as comprehensive regulations that take into account the unique characteristics of the consumer marketplace.

Dose of Product or Product Concentration: A Comparison of Change in Heart Rate by THC Concentration for Participants Using Cannabis Daily and Occasionally.

Introduction: Studies show that acute cannabis use significantly increases heart rate (HR) and mildly raises blood pressure in the minutes following smoked or inhaled use of cannabis. However, less is known about how the THC concentration of the product or an individual's frequency of use (i.e., tolerance) may affect the magnitude of the change in HR. It is also relatively unexamined how the physical effects of increased HR after acute cannabis use relate to self-reported drug effects or blood THC levels. Aims: To describe the relationship between THC concentration of product used, self-reported subjective intoxication, THC blood levels, and frequency of cannabis use with the change in HR after acute cannabis use. Materials and Methods: Participants (n = 140) were given 15 min to smoke self-supplied cannabis ad libitum, HR was measured at baseline and an average of 2 min post-cannabis smoking. The ARCI-Marijuana scale and Visual Analog Scales (VAS) were administered, and blood samples were taken at both time points. Participants were asked about their frequency of use. Information about the product used was recorded from the package. Linear regression was used to analyze the relationship between changes in HR (post-pre cannabis use) and post-cannabis use HR, blood THC concentration, THC product concentration, frequency of use, and self-reported drug effect. Results: There was a significantly higher HR among those who smoked cannabis compared to the controls (p < 0.001), which did not significantly differ by frequency of use (p = 0.18). Higher concentration THC (extract) products did not produce a significantly different HR than lower concentration (flower) products (p = 0.096). VAS score was associated with an increase in HR (p < 0.05). Overall, blood THC levels were not significantly related to the change in HR (p = 0.69); however, when probed, there was a slight positive association among the occasional use group only. Discussion: Cardiovascular effects of cannabis consumption may not be as subject to tolerance with daily cannabis use and do not directly increase with THC concentration of the product. This is a departure from other effects (i.e., cognitive, subjective drug effects) where tolerance is well established. These findings also suggest that, at least among those with daily use, higher concentration THC products (>60%) do not necessarily produce cardiovascular physiological effects that are significantly more robust than lower concentration (<20%) products.

The impact of recreational cannabinoid legalization on utilization in a pregnant population.

Marijuana potency and utilization both continue to increase across the United States. While the overall prevalence of cannabinoid utilization during pregnancy has been surveyed in various studies, the direct impact of changing governmental policies on pregnancy use is less characterized. Thus, we aimed to investigate how the legalization of recreational cannabinoid products impacted use during pregnancy in the state of New Mexico. Participants who had a live birth during two study epochs were included: pre-legalization (Epoch 1: 1 January 2019-31 March 2021) and post-legalization (Epoch 2: 1 November 2021-30 November 2022). Participants were further divided into case group [prenatal cannabinoid exposure (PCE)] vs. control (no PCE), with cases being identified by documented self-report or a positive laboratory toxicology test for cannabinoid use during pregnancy. A total of 1,191 maternal/infant dyads were included in Epoch 1, and 378 maternal/infant dyads were included in Epoch 2. In Epoch 1, 788 dyads were controls with 403 cases, while Epoch 2 had 292 controls and 86 cases. Interestingly there was a significant decrease in self-report or positive laboratory toxicology tests in Epoch 2 compared to Epoch 1. Infants born following PCE in both Epoch groups were more commonly born via Cesarean section, had significantly smaller birth weight, length, and head circumference as well as significantly lower Apgar scores at 1 and 5 min. The finding of decreased reported cannabinoid use in the post-legalization group is contradictory to previous studies which have shown increased rates of cannabinoid use after legalization. This could be due to multiple factors including changes in screening practices, the COVID-19 pandemic, and lack of commercialization of THC products. Additional studies are needed to further characterize how changing governmental policies impacts utilization during pregnancy.

Commercial Delta-8 THC Products: an Analysis of Content and Labeling.

∆-8 tetrahydrocannabinol (THC) is a psychoactive cannabinoid and structural isomer of ∆-9 THC that is technically legal under United States Federal law. Commercial ∆-8-THC products being sold are currently unregulated. This study aims to (1) describe the advertising and labeling of Δ-8 THC retail products; (2) compare the advertised amount of Δ-8 THC for each product to that found during independent laboratory analysis; and (3) evaluate the presence and amount of other cannabinoids in those products. Twenty ∆-8 THC products were purchased from retail stores in Pittsburgh, PA, USA. Samples were analyzed to determine cannabinoid content using a validated UPLC-MS/MS method. Descriptive statistics were calculated for all variables. Spearman's rank order correlation was calculated for the labeled ∆-8 THC content compared to ∆-8 THC content found on our analysis. Differences in continuous variables were compared using ANOVA, Wilcoxon Rank Sum, or Kruskal-Wallis tests. ∆-8 THC was detected in 95% (N=19) of the sample products. A weakly positive correlation (Spearman's rho =0.40) was found between the advertised ∆-8 THC content and our analysis results. Factors associated with decreased difference in these variables included (1) solid matrix (chocolate, gummies) and (2) absence of a "lab-tested" label. Δ-9 THC was found in 35% (N=7) of the products, and CBD was found in one. A majority of the products analyzed contained ∆-8 THC in amounts that could cause intoxication. The range of ∆-8 THC content on independent analysis was wide and weakly correlated to the advertised content. ∆-8 THC, ∆-9 THC, and CBD were the only cannabinoids detected.

Exploring survey methods for measuring consumption quantities of cannabis flower and concentrate products

ABSTRACTBackground: Researchers need accurate measurements of cannabis consumption quantities to assess risks and benefits. Survey methods for measuring cannabis flower and concentrate quantities remain underdeveloped.Objective: We examined “grams” and “hits” units for measuring flower and concentrate quantities, and calculating milligrams of THC (mgTHC).Methods: Online survey participants (n = 2,381) reported preferred unit (hits or grams), past-week hits and grams for each product, and product %THC. Quantile regression compared mgTHC between unit-preference subgroups. Hits-based mgTHC calculations assumed a universal grams-per-hit ratio (GPHR). To examine individualized GPHRs, we tested a “two-item approach,” which divided total grams by total hits, and “one-item approach,” which divided 0.5 grams by responses to the question: “How many total hits would it take you to finish 1/2 g of your [product] by [administration method]?”Results: Participants were primarily daily consumers (77%), 50% female sex, mean age 39.0 (SD 16.4), 85% White, 49% employed full-time. Compared to those who preferred the hits unit, those who preferred the grams unit reported consuming more hits and grams, higher %THC products, and consequently, larger median mgTHC (flower-hits mgTHC: 32 vs. 91 (95%CI: 52–67); flower-grams mgTHC: 27 vs. 113 (95%CI: 73–95); concentrate-hits mgTHC: 29 vs. 59 (95%CI: 15–43); concentrate-grams mgTHC: 61 vs. 129 (95%CI: 43–94)). “Two-item” and “one-item” approach GPHRs were similar and frequently 50% larger or smaller than the universal GPHR.Conclusion: Allowing respondents to choose “hits” or “grams” when reporting cannabis quantities does not compromise mgTHC estimates. A low-burden, one-item approach yields individualized “hit sizes” that may improve mgTHC estimates.

Potency and safety analysis of hemp delta-9 products: the hemp vs. cannabis demarcation problem

BackgroundHemp-derived delta-9 tetrahydrocannabinol (∆9 THC) products are freely available for sale across much of the USA, but the federal legislation allowing their sale places only minimal requirements on companies. Products must contain no more than 0.3% ∆9 THC by dry weight, but no limit is placed on overall dosage and there is no requirement that products are tested. However, some states—such as Colorado—specifically prohibit products created by “chemically modifying” a natural hemp component.MethodsFifty-three ∆9 THC products were ordered and submitted to InfiniteCAL laboratory for analysis. The lab analysis considered potency, the presence of impurities, and whether the ∆9 THC present was natural or converted from CBD. The presence of age verification, company-conducted testing, and warning labels was also considered.ResultsWhile 96.2% of products were under the legal ∆9 THC limit, 66.0% differed from their stated dosage by more than 10%, and although 84.9% provided a lab report to customers, 71.1% of these did not check for impurities. Additionally, 49% of products converted CBD to THC to achieve their levels, and only 15.1% performed age verification at checkout.ConclusionsDespite some positive findings, the results show that hemp ∆9 THC companies offer inaccurately labeled products that contain more THC than would be allowed in adult-use states. This raises serious issues around consumer safety, and consent when consuming intoxicating products. Steps to boost accountability for companies must be considered by either the industry or lawmakers if intoxicating hemp products are to remain on the market safely.

Youths' cannabis ER visits continued to rise during pandemic

Rates of cannabis‐involved emergency department visits among young people, which already were rising prior to the COVID‐19 pandemic, continued to climb in 2020‐22, a newly published report states. Among the many likely contributing factors to the trend include the use of more highly concentrated THC products and an increased use of cannabis to cope with pandemic‐related stress, particularly among girls.

The Gummies Strike Again: An Emerging Stroke Mimic in New York City’s Unsuspecting Hotel Housekeepers (P12-5.007)

<h3>Objective:</h3> To describe a series of stroke alerts triggered for acute neurological change secondary to inadvertent marijuana toxicity in hotel housekeepers. <h3>Background:</h3> Whilst accidental marijuana ingestion is well described in pediatrics, it is an infrequent cause for ED presentation amongst adults. With the legalization of marijuana, our hospital has witnessed an increase in posterior circulation stroke mimic presentations secondary to inadvertent marijuana ingestion. <h3>Design/Methods:</h3> We retrospectively reviewed the charts of patients who triggered stroke alerts for acute neurological symptoms that were ultimately attributed to inadvertent marijuana edible ingestion. <h3>Results:</h3> Five such women aged 55–79 presented to our hospital between May – September 2022 triggering a stroke alert. All women worked as housekeeping staff in hotels in the catchment area. Indication for stroke alert for all patients was acute onset dizziness concerning for posterior circulation stroke. Additional presenting symptoms included reduced level of arousal, recurrent emesis, dysarthria, anarthria, non-specific visual complaints and unsteadiness. Median NIHSS was 2. One patient displayed central pattern nystagmus and disabling truncal ataxia. Other patients exhibited dry mucous membranes, mydriasis, saccadic pursuits, and sustained clonus. Imaging and bloodwork were unremarkable for all patients. Urine toxicology was positive for THC in all patients, who denied prior THC use. One patient received tenecteplase and was admitted to NeuroICU for disabling vertigo and truncal ataxia. MRI brain was negative. Remaining patients did not receive thrombolysis due to non-disabling symptoms or suspected encephalopathy, and were admitted to the medical or neurological floor for observation. Patients recalled consuming unlabelled candy prior to symptom onset when specifically questioned about the positive toxicology screen. <h3>Conclusions:</h3> Inadvertent marijuana intoxication is increasingly presenting as a mimic for posterior circulation stroke in unknowing adult consumers. This appears to be an occupational hazard for housekeeping staff. Public health campaigns should encourage the proper storage and disposal of THC products. <b>Disclosure:</b> Dr. Alkayyali has nothing to disclose. Dr. Masood has nothing to disclose. Dr. McCarthy has nothing to disclose. Dr. Pyburn has nothing to disclose.

Typical Hits, Grams, or Joints: Evaluating Cannabis Survey Measurement Strategies for Quantifying Consumption.

Aim: Standardized survey measures that capture diverse cannabis consumption patterns are needed to inform public health and policy. Our team is developing a flexible, personalized, low-burden survey item inventory to measure cannabis use patterns and estimate milligrams of THC (mgTHC) consumption in large samples. This study aimed to identify measurement gaps and analysis implications associated with an initial pool of candidate items that assessed use of cannabis flower and concentrate products (smoked and/or vaporized). Methods: Adult cannabis consumers (n=4247) completed an online survey assessing cannabis use frequency, quantity, product types, product potencies (%THC), and methods of administration. Participants chose to report their consumption quantities using one of three units: "hits per day," "grams per week," or "joints per week." Respondents also indicated whether their past 7-day consumption pattern represented their typical pattern. Results: Eighty-one percent had used cannabis daily in the past week. Thirty-two percent, 53%, and 15% chose to report flower and concentrate consumption quantity in hits, grams, and joints, respectively. Approximately 80-90% of responses for the number of hits, grams, and joints consumed were less than the maximum response option-suggesting that response options captured the full range of potential cannabis consumption behaviors. Those who chose grams or joints units were generally more likely to endorse higher risk cannabis use (e.g., morning use, high %THC products) in the past week than those who chose the hits unit (adjusted Odds Ratio range: 1.2-3.9). Among those who reported that the past week represented their typical behavior (83%), past 30-day and past 7-day frequencies were highly correlated (Spearman's Rho=0.77)-supporting the feasibility of using lower burden "typical week" items to extrapolate patterns beyond a 1-week time frame. Conclusion: Results from this online convenience sample of frequent cannabis consumers suggest that the current items yield coherent and expected response patterns. Although additional testing is required, a standardized, flexible survey instrument for large-scale assessment of cannabis patterns and calculation of mgTHC seems within reach.

Medicinal cannabis for Australian patients with chronic refractory pain including arthritis.

To examine the tolerability and effectiveness of medicinal cannabis prescribed to patients for chronic, refractory pain, with a subset analysis on arthritis. This was an interim analysis of the CA Clinics Observational Study investigating self-reported adverse events (AEs) and changes in health-related quality of life (HRQoL) outcomes over time after commencing medicinal cannabis. Patients were prescribed medicinal cannabis by a medical practitioner, containing various ratios of Δ9-tetrahydrocannabinol (THC) and/or cannabidiol (CBD). The overall chronic pain cohort, and specifically the balanced CBD:THC products, were associated with significantly reduced pain intensity scores (p = 0.003, p = 0.025), with 22% of patients reporting a clinically meaningful reduction in pain intensity. Patients in the arthritis subset (n = 199) reported significantly reduced pain intensity scores (p = 0.005) overall, and specifically for those taking CBD-only (p = 0.018) and balanced products (p = 0.005). Other HRQoL outcomes, including pain interference and pain impact scores were significantly improved depending on the CBD:THC ratio. Products that contained a balanced ratio of CBD:THC were associated with improvements in the most number of PROMIS-29 domains. Approximately half (n = 364; 51%) of the chronic pain cohort experienced at least one AE, the most common being dry mouth (24%), somnolence (19%) or fatigue (12%). These findings were similar in the arthritis subset. Medicinal cannabis was observed to improve pain intensity scores and HRQoL outcomes in patients with chronic, refractory pain, providing real-world insights into medicinal cannabis' therapeutic potential.

Delta-8 Tetrahydrocannabinol Product Impurities.

Due to increased concerns regarding unidentified impurities in delta-8 tetrahydrocannabinol (Δ-8 THC) consumer products, a study using Nuclear Magnetic Resonance (NMR), high performance liquid chromatography (HPLC), and mass spectrometry (MS) was conducted to further investigate these products. Ten Δ-8 THC products, including distillates and ready to use vaporizer cartridges, were analyzed. The results yield findings that the tested products contain several impurities in concentrations far beyond what is declared on certificates of analysis for these products. As Δ-8 THC is a synthetic product synthesized from cannabidiol (CBD), there are valid concerns regarding the presence of impurities in these products with unknown effects on the human body. Compounding this problem is apparent inadequate testing of these products by producers and independent laboratories.

Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak

IntroductionIn August 2019, an outbreak of “e-cigarette or vaping product use-associated lung injury” (EVALI) prompted many states and health organizations to warn against the use of electronic cigarettes, or e-cigarettes, due to the presumed link between e-cigarette use and the illness. However, it was later shown that vitamin E acetate, a component of some illicit vaporizable THC products, was the causative agent in this outbreak.MethodsWe conducted a series of cross-sectional surveys of the websites of all state departments of health to determine how they communicated the risk of e-cigarette use during and after the EVALI outbreak. We then paired this analysis with data from the 2016 through 2020 Behavioral Risk Factor Surveillance System to measure changes in cigarette and e-cigarette use.ResultsWebsite data from 24 states was available for analysis at all three time points of interest, and BRFSS data was only available for 8 of these states. We found that by January 2020, a majority of the states surveyed did not list vaporizable THC use as a cause of EVALI; however, differences in state messaging did not appear to be associated with changes in e-cigarette and cigarette use.ConclusionsGiven the number of states that did not appear to update their messaging regarding the cause of EVALI, we believe that states should re-evaluate this messaging to accurately communicate the risks of e-cigarette use.

S2567 Vaping-Induced Duodenal Ulcer

Introduction: Vaping, or electronic cigarette use has tremendously increased. It is estimated a population of five million is involved in vaping each year. While lung injury associated with vaping has gained national attention, the systemic burden of vaping has not been established. To date, there is no current report on the prevalence of gastrointestinal symptoms alone in association with vaping, yet it has been reported that 90% of patients who present with lung injury also have gastrointestinal symptoms. This raises the concern that vaping may also result in gastrointestinal injury such as seen with tobacco smoking and use of nicotine products. To our knowledge, vaping has not been shown to be associated with gastrointestinal ulcers or peptic ulcer disease. Case Description/Methods: We report a case of a 19-year-old male who was admitted to the intensive care unit for concern of hemorrhagic shock after presenting with hematemesis from a duodenal ulcer. The patient had no other medical history or known risk factors for peptic ulcer disease. However, he did report a seven-month history of vaping marijuana and THC products through a vaping pen for several hours per day prior to his onset of gastrointestinal symptoms and eventual hematemesis. Patient gastrin levels were normal. Gastric biopsies were negative for H Pylori. He denied using NSAIDS, including BC powders and goody powders. Discussion: This case emphasizes the need for clinicians to obtain a medical history of vaping when assessing patients with gastrointestinal symptoms. Future research in vaping should evaluate if the various compounds in vaping products or if the different methods of vaping can cause adverse gastrointestinal side effects such as ulcers.

Delta-8-Tetrahydrocannabinol, an emerging NPS and other structurally related cannabinoids

The aim of this presentation is to find answers why delta-8 THC is an emerging NPS and why structurally related analogs like delta-10 THC, tetrahydrocannabivarin and THC-O-acetate are also of concern? From a regulatory point of view, banning delta-8 THC, as has been done with delta-9 THC, will attract people to become interested in other isomers and structurally related analogues. So how to deal with this? We screened the available scientific literature dealing with the biological and chemical synthesis methods of cannabinoids, including their precursors, conversion reactions, types of extractions, relevant by-products and known pharmacological data. Delta-8 THC, differing in the location of a double bond between two carbons from delta-9 THC, is present in very low concentrations in cannabis plants. Like delta-9 THC, it can provoke psychoactive effects such as euphoria, visual and time distortion, relaxation, difficulty in thinking, speaking and reading, and a dream-like state. The dose required to achieve these clinical effects is unclear, as controlled dose-response studies of delta-8 THC in humans are scarce. Delta-8 THC is known to be less potent than delta-9 THC, but a standard human dose has not been set. Several countries have banned or restricted delta-8 THC products, but elsewhere it remains legal and available for sale to individuals of all ages. Where the sale is not restricted, delta-8 THC is often available at tobacco shops and convenience stores in various formulations, such as vape cartridges, dried plants, or candy gummies. Furthermore, as the awareness and popularity of delta-8 THC expands, it is predictable that medical caregivers will encounter increasing numbers of patients who are under the influence of delta-8 THC. Toxicology screening assays for delta-8 THC are also not readily available in most medical facilities and certainly not for law enforcement. Most importantly, a worrying interest is noticed based on the information available on the internet and social media, that deals with the question « How to make delta-8 THC? CBD to delta-8 THC step-by-step ». Given the fact that CBD is legal, not psychoactive, but that it can be used as precursor in the process for converting CBD to delta-8 THC, being psychoactive, is frightening. Even more since the conversion isn’t alchemy or magic; in fact, it's much less complicated than one might expect. The basic process for converting CBD to delta-8 THC simply is: “CBD + acid + time = delta-8 THC”. One by-product commonly found in delta-8 THC products is olivetol, a precursor for the synthesis of THC in the chemical laboratory or manufacturing plant. The Swiss Federal Customs Administration seized a total of 260 kg of olivetol and 260 kg of p-mentha-2,8-dien-1-ol in 2019, an indication that some of the delta-8 THC on the market may be synthetically produced. Another molecule of particular concern is the cannabinoid called THC-O-acetate (the acetyl ester of THC), which seems to be popping up in gummies and vapes. It is basically acetylated THC, which does not occur naturally in cannabis plants and can be called a New Psychoactive Substance (NPS). Interestingly, also heroin was created by acetylating morphine over 100 years ago. No human studies on the effects of acetylated THC are available, illustrating the danger. Many cannabinoids can be obtained from ingredients extracted from hemp and by means of biotechnological processes. We therefore need to inform the public in saying that just because the starting material is legal, it does not make the resulting product(s) legal or safe. We recommend regulatory oversight, uniformity of delta-8 THC's status and its analogues, wide-scale scientific dissemination for law enforcement and the general public, together with sufficient laboratory testing know how and capacity.

Sociodemographic characteristics and correlates of Delta-8 THC use in US adults

Introduction Recent reports suggest that Delta-8 THC use has surged during the past year. Although Delta-8 THC is believed to have relatively low psychoactive potency, its effects are not well characterized and the associated individual and public health risks are unknown.ObjectivesIdentify patterns of Delta-8 THC use among US adult cannabis users and examine associations with sociodemographic characteristics and cannabis use-related variables.MethodsWe surveyed 4,349 US adult cannabis users recruited via online advertisements. We calculated frequencies of sociodemographic characteristics in past 30-day Delta-8 THC users. Odds ratios were used to indicate associations between sociodemographic characteristics and past 30-day Delta-8 THC use.ResultsRespondents aged 45–64 years were significantly more likely than other age groups to have used Delta-8 THC during the past 30 days (odds ratio=1.48, 95% CI 1.04, 2.11). Fifty-eight percent of the sample had heard of Delta-8 THC, 66.8% of which had first heard of it during the last year and 37.1% first heard of it via social media. The most common methods of consumption were vaping concentrates and edibles. We identified motivations for use of Delta-8 THC that potentially indicate a preference for legal options and/or a perception that Delta-8 THC has medical benefits.ConclusionsThis study provides a snapshot of patterns of Delta-8 THC use among US adult cannabis users. Further investigation of the perceived medical benefits of Delta-8 THC, the role of social media in promoting its use, and the effectiveness of restrictions on Delta-8 THC products would provide further information to guide public health policy regarding Delta-8 THC.DisclosureNo significant relationships.

Delta-8 THC use in US adults: Sociodemographic characteristics and correlates

BackgroundUse of novel cannabis products whose primary active compound is Delta-8 tetrahydrocannabinol (Delta-8 THC), an isomer of Delta-9 THC has recently surged. While Delta-8 THC has psychoactive effects and is potentially harmful, little is known about its use. We examined sociodemographic characteristics, motivations, and consumption patterns of Delta-8 THC in US adult cannabis users. MethodsCannabis-using adult online survey participants (N = 4,348) provided information on Delta-8 use, and other characteristics. We assessed frequencies of sociodemographics, patterns, and correlates of Delta-8 THC use. Regression models estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of associations between past 30-day Delta-8 THC use, sociodemographic and other characteristics. FindingsAmong past 30-day cannabis users, 16.7% reported Delta-8 THC use. The most common consumption method was vaping concentrated formulations of Delta-8 THC (41.2%). Primary motivations for use were its legal status and perceived therapeutic benefits. Males were more likely than females to report Delta-8 THC use (aOR = 1.4, 95% CI 1.2, 1.7). Respondents residing in states with restrictions on sales of Delta-8 THC products had lower odds of Delta-8 THC use (aOR = 0.7, 95% CI 0.57, 0.86). ConclusionsFindings provide initial insight into the current state of Delta-8 THC use in the US. Given the limited knowledge on use of Delta-8 THC, and considering emergence of reports indicating its harmful effects, there is urgent need for nationally representative data to investigate correlates of Delta-8 THC use (e.g., effectiveness of state-specific restrictions on its products). Such information can guide public-health policy around Delta-8 THC use.

Observational study of medical marijuana as a treatment for treatment-resistant epilepsies.

ObjectivesMedical cannabis formulations with cannabidiol (CBD) and delta‐9‐tetrahydrocannabinol (THC) are widely used to treat epilepsy. We studied the safety and efficacy of two formulations.MethodsWe prospectively observed 29 subjects (12 to 46 years old) with treatment‐resistant epilepsies (11 Lennox–Gastaut syndrome; 15 with focal or multifocal epilepsy; three generalized epilepsy) were treated with medical cannabis (1THC:20CBD and/or 1THC:50CBD; maximum of 6 mg THC/day) for ≥24 weeks. The primary outcome was change in convulsive seizure frequency from the pre‐treatment baseline to the stable optimal dose phase.ResultsThere were no significant differences during treatment on stable maximal doses for convulsive seizure frequency, seizure duration, postictal duration, or use of rescue medications compared to baseline. No benefits were seen for behavioral disorders or sleep duration; there was a trend for more frequent bowel movements compared to baseline. Ten adverse events occurred in 6/29 patients, all were transient and most unrelated to study medication. No serious adverse events were related to study medication.InterpretationOur prospective observational study of two high‐CBD/low‐THC formulations found no evidence of efficacy in reducing seizures, seizure duration, postictal duration, or rescue medication use. Behavioral disorders or sleep duration was unchanged. Study medication was generally well tolerated. The doses of CBD used were lower than prior studies. Randomized trials with larger cohorts are needed, but we found no evidence of efficacy for two CBD:THC products in treating epilepsy, sleep, or behavior in our population.