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

Abstract

Background:

Use 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.

Methods:

Cannabis-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.

Findings:

Among 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).

Conclusions:

Findings 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.

1. INTRODUCTION

The 2018 Agriculture and Nutrition Improvement Act (ANIA) removed hemp with a tetrahydrocannabinol (THC) concentration of ≤0.3% from the US Controlled Substances Act, paving the way for the legal cultivation, sale, and distribution of hemp and its byproducts^1,2. However, the ANIA does not specifically address Delta-8 THC, an isomer of Delta-9 THC, present at low concentrations in most cannabis plants, including hemp³; therefore, ANIA effectively allows for the unregulated distribution of Delta-8 THC products, federally. At the state level, the legal status of Delta-8 THC varies: as of 12/20/2021, 20 US states had imposed some level of restrictions on the sale of Delta-8 THC products^4,5, while the remaining states allowed the unlimited sale of these products online and in retail outlets including marijuana dispensaries, convenience stores, and gas stations⁶.

Media reports indicate that US sales and use of Delta-8 THC products have recently surged^6–11. Although some past studies indicate that the psychoactive effects of Delta-8 THC are weaker than those of Delta-9 THC¹², recent reports indicate that Delta-8 THC is frequently discussed on social media sites (e.g., Reddit) as an alternative to Delta-9 THC in its potency and its psychotrophic effects¹³. Furthermore, recent federal/state reports stipulate that use of Delta-8 THC may cause significant toxicity as its levels in marketed products remain higher than in naturally occurring hemp extracts¹⁴. Additionally, Delta-8 THC products are easily available to consumers, including adolescents, often in packaging with insufficient warning labels^14–16. In fact, the US Centers for Disease Control and Prevention Health Advisory recently issued an alert regarding the unregulated marketing of Delta-8 THC products, and their increasing availability and risk for negative outcomes¹⁷. Similarly, the US Cannabis Council recently issued a position paper¹⁸ stating that unregulated distribution of Delta-8 THC products may pose serious individual and public health risks. Despite the growing distribution of Delta-8 THC, much remains unknown about its use among people who use cannabis.

The current lack of knowledge about Delta-8 THC product use warrants additional research that will provide data regarding patterns of use (e.g., frequency and methods of consumption) and their correlates (e.g., sociodemographic characteristics, reasons for use, ways of obtaining). Such information can shed light on possible risk factors for Delta-8 THC use as well as motivations and perceptions around it. Further, considering reports indicating the potential harmful effects of Delta-8 THC^12,16, there is a need for additional information on how its patterns of use are affected by state-specific Delta-8 THC regulatory restrictions. Moreover, given its federally legal status, it is possible that Delta-8 THC products are in high demand as a licit alternative to cannabis use. Therefore, further information on the effect of cannabis legislation on sales of Delta-8 THC products is warranted.

As an initial effort to learn more about Delta-8 THC and factors influencing its use, we asked about Delta-8 THC use in an online survey of 4,348 US adult cannabis users to determine: 1) awareness of the availability of Delta-8 THC products and their legal status; 2) patterns of past 30-day use of Delta-8 THC; 3) methods of consumption of Delta-8 THC; 4) motivation for use of Delta-8 THC; 5) ways of obtaining Delta-8 THC products. Among cannabis users, we also examined associations between Delta-8 THC use, sociodemographic characteristics, and cannabis use-related correlates (e.g., methods of cannabis).

2. METHODS

2.1. Sample

Potential participants aged ≥18 years living in the US were recruited between 05/25/2021-07/31/2021 using keyword-targeted web-based advertisements (see Supplementary Appendix). Web-based health surveys have emerged as suitable, rapid, and cost-effective methods for population-level data collection¹⁹, particularly among hard-to-reach populations such as substance users^20,21. Participants provided informed consent; procedures were approved by the Dartmouth Committee for Protection of Human Subjects.

2.2. Measures

The anonymous survey, administered through Qualtrics²², included sections covering: 1) sociodemographics (age, gender, state of residence, zip code, education, employment); 2) cannabis use (e.g., lifetime/past 30-day use, method of consumption); 3) Delta-8 THC use (e.g., timeframes of use, reasons for use). Cannabis state law status was coded based on respondents’ report of their state of residence and on whether legislation had gone into effect by the time of the survey. Enactment of recreational cannabis laws (RCL) and medical cannabis laws (MCL) was determined by publicly available state legislative policies^23–25. A 3-level variable operationalized state law status, as done previously²⁶. Participants were categorized as living in a state with an RCL, living in a state with an MCL but no RCL (MCL-only), or living in a state without RCL or MCL (no-CL). Similarly, Delta-8 THC state regulatory restrictions were coded based on respondents’ state of residence and on whether restrictions on use and/or sales of Delta-8 THC products had gone into effect by the time of the survey; this was based on publicly available reports²⁷. A 2-level state Delta-8 THC state regulatory restrictions variable was coded (any restrictions, no restrictions). Two forms of ‘captcha’ verification were used to exclude responses from bots^28,29. Forty-three respondents did not provide consent, were younger than age 18, or failed verification, and were excluded. Data quality was maintained using post-hoc logic checks that excluded respondents with implausible responses (n=53) or that logged out before completing the survey (n=797).

2.3. Statistical Analysis

We calculated frequencies of sociodemographic characteristics in past 30-day cannabis users with and without past 30-day Delta-8 THC use. Adjusted odds ratios (aOR) derived from multiple logistic regression were used to indicate associations between sociodemographic characteristics and past 30-day Delta-8 THC use in two models: 1) unadjusted; 2) adjusted for all sociodemographic characteristics. Analyses were performed using SAS 9.4³⁰.

3. RESULTS

A total of 5,531 individuals initiated the survey, of whom 4,734 (85.9%) completed all questions. Among these, 4,348 (91.9%) reported using cannabis in the past 30 days and comprise the analytic sample in which prevalences of all Delta-8 THC use-related variables are reported. Of all respondents, 2,523 (58%) reported having heard of Delta-8 THC, of which 80.5% first heard about it during the past year, primarily online or via social media (37.1%). Past 30-day Delta-8 THC use was reported by 16.7% of all respondents.

Further characteristics of Delta-8 THC use are provided in Figures 1a–1c. Among participants reporting past 30-day Delta-8 THC use, 51.9% obtained Delta-8 THC products in stores other than cannabis dispensaries. The mean number of days of Delta-8 THC use in the past 30 days was 9.84 (SD=9.87). Regarding methods of consumption, 41.2%, 30.9%, and 14.2% reported vaping concentrates, edibles and smoking as their primary mode of Delta-8 THC consumption, respectively. In terms of the primary reason for using Delta-8 THC products, 30.1% reported use to treat depression, nervousness, or anger, and over a quarter (26.1%) reported use due to the licit status of Delta-8 THC.

Figure 1.

a. Ways of obtaining Delta-8 THC among past 30-day Delta-8 THC users (N=725).

b. Primary reason for using Delta-8 THC among past 30-day Delta-8 THC users (N=725).

c. Primary method of Delta-8 THC consumption among past 30-day Delta-8 THC users (N=725).

Table 1 shows frequencies of sociodemographics, cannabis state laws and Delta-8 state regulatory restrictions, and associations with Delta-8 THC use. Gender and age were significantly associated with past 30-day Delta-8 THC use; compared to females, males and those indicating gender as non-binary, preferred to self-describe, or preferred not to answer (“other”) had higher odds of Delta-8 THC use (adjusted odds ratio[aOR]=1.4, 95% CI 1.18, 1.67; aOR= 1.7, 955 CI 1.18, 2.39, respectively). Delta-8 THC use was more common among younger ages, with the odds of Delta-8 THC use increased monotonically with each decrease in age group; compared to respondents ≥65 years, respondents aged 18-29, 30-44, and 45-64 had higher odds of Delta-8 THC use (aOR=5.4, 95% CI 3.14, 9.21; aOR= 4.0, 95% CI 2.30, 6.84; aOR= 3.2, 95% CI 1.85, 5.48, respectively). Respondents living in MCL-only and RCL states had lower odds of Delta-8 THC use compared to those who lived in no-CL states (aOR=0.6, 95% CI 0.47, 0.68; aOR= 0.4, 95% CI 0.28, 0.45, respectively). Respondents living in states with restrictions on sale of Delta-8 THC products had lower odds of Delta-8 THC use compared to those who lived in states without any restrictions on sale of these products (aOR=0.7, 95% CI 0.50, 0.86).

Table 1.

Association between sociodemographic characteristics, cannabis use variables, and past 30-day Delta-8 THC use among past 30-day cannabis users (N=4,348).

	Delta-8 users (N=725)	Cannabis-only users (N=3,623)	Model 1: Unadjusted	Model 2: Adjusted for sociodemographicsa
	%		Odds Ratio (95% CI)*	Odds Ratio (95% CI)*
Sociodemographic characteristics
Gender
Male	41.4	34.0	1.5 (1.23,1.72)	1.4 (1.18, 1.67)
Female	51.6	61.7	1.0 (reference)	1.0 (reference)
Otherb	7.0	4.3	1.9 (1.4, 2.73)	1.7 (1.18, 2.39)
Age (years)
18–29	42.6	31.2	5.4 (3.18. 9.25)	5.4 (3.14, 9.21)
30–44	27.5	26.9	4.1 (2.37, 6.98)	4.0 (2.30, 6.84)
45–64	27.9	33.7	3.3 (1.92, 5.64)	3.2 (1.85, 5.48)
≥65	2.07	8.2	Reference	Reference
Race/Ethnicity
African American	3.2	3.2	1.0 (0.65, 1.62)	0.8 (0.51, 1.30)
American Indian/Alaska Native	0.8	1.5	0.6 (0.24, 1.32)	0.6 (0.26, 1.43)
Asian/ Native Hawaiian/Pacific Islander	1.0	1.0	0.9 (0.43, 2.17)	0.9 (0.40, 2.10)
White	79.0	80.4	1.0 (reference)	(reference)
Hispanic	4.1	3.8	1.1 (0.73, 1.64)	1.0 (0.65, 1.98)
Other	1.8	1.8	1.0 (0.57, 1.89)	1.1 (0.57, 1.23)
Multiracialc	10.1	8.3	1.2 (0.94, 1.61)	1.1 (0.84, 1.47)
Employment status
Employed (Full/Part time)	59.7	54.8	1.0 (reference)	1.0 (reference)
Not employedd	40.3	45.2	0.8 (0.69, 0.96)	1.0 (0.84,1.19)
Educational level
No high school completion	1.9	2.2	0.9 (0.53, 1.71)	0.9 (0.50,1.63)
Completed high school or GED	49.7	46.3	1.1 (0.97, 1.34)	1.0 (0.85, 1.19)
Completed collegee	48.4	51.5	1.0 (reference)	1.0 (reference)
State CL Status f
None	35.0	20.4	1.0 (reference)	1.0 (reference)
MCL-only	42.4	43.0	0.6 (0.48, 0.69)	0.6 (0.47, 0.68)
RCL	22.6	36.6	0.4 (0.29, 0.45)	0.4 (0.28, 0.45)
State Delta-8 THC restrictions
None	79.9	70.6	1.0 (reference)	1.0 (reference)
Any restrictionsg	20.1	29.4	0.6 (0.50, 0.74)	0.7 (0.57, 0.86)

^*Among past 30-day cannabis users (N= 4,348), odds ratios indicate associations sociodemographic covariates (predictor) and past 30-day Delta-8 THC use (outcome).

^aIncluding gender, age, employment status, educational level, CL status, Delta-8 THC restriction status.

^bParticipants indicating the following responses: non-binary, preferred to self-describe, preferred not to answer.

^cParticipants indicating that they belong to more than one race/ethnicity group.

^dParticipants indicating the following responses: student, retired, disabled, unemployed.

^eParticipants indicating the following responses: associate degree, bachelor’s degree, graduate degree, professional degree.

^fParticipants reported their current state of residence and zip codes. State law status was coded based on whether legislation went into effect by date of survey initiation (05/25/2021). Recreational Cannabis Law (RCL) and Medical Cannabis Law (MCL) enactment was determined by publicly available state legislative policies (https://www.mpp.org/states/; https://ballotpedia.org; https://marijuana.procon.org/legal-recreational-marijuana-states-and-dc/).

All states with RCL also had MCL. A 3-level categorical variable was created to operationalize state law status (living in a state with an RCL [‘RCL’]; living in a state without an effective RCL, but with an effective MCL [‘MCL-only’]; living in a state without an effective RCL or MCL [‘no-CL’]).

^gParticipants reported their current state of residence and zip codes. Delta-8 THC regulatory state restriction status was coded based on whether any form of restriction or bans went into effect by date of survey completion (07/31/2021).

Note: significant associations appear in bold.

4. DISCUSSION

In this large online sample of individuals with past 30-day cannabis use recruited via social media, the prevalence of past 30-day Delta-8 THC use was 16.7%. The likelihood of Delta-8 THC use was higher in male compared to female cannabis users. The prevalence of Delta-8 THC use decreased monotonically with age, in that those in younger age groups were more likely to report past 30-day Delta-8 THC use than those aged 65+ years. These findings suggest that additional research on Delta-8 THC use should target specific populations of cannabis users. Additionally, the prevalence of Delta-8 THC use was higher among participants residing in states without RCLs (MCL-only or no-CL) than among those in states with RCLs, suggesting that Delta-8 THC may be used as a legal alternative to illicit cannabis use. Our finding that respondents who resided in states with some form of restriction on sales of Delta-8 THC products are less likely to use Delta-8 THC suggests that state regulatory restrictions may be effective. Further, 66% of past 30-day Delta-8 THC users who resided in states with restrictions on Delta-8 THC product use were aware of the substance’s legal status in the US. This may point to the successful outreach of such state-specific policies to target audiences.

Most participants who reported Delta-8 THC use purchased these products in stores that were not dispensaries, but instead, bought them in convenience stores, pharmacy and drugstores, and grocery stores, indicating widespread availability. While social media can be a substantial source of information on novel psychoactive substances such as Delta-8 THC, local effective regulation on retail distribution of such products remains necessary.

Nearly a third of past 30-day Delta-8 THC users reported using these products primarily to relieve feelings of depression, nervousness, or anger. This suggests that Delta-8 THC is likely perceived to have mental health benefits, similar to widespread perceptions about Delta-9 THC; considering the lack of knowledge about potential harms and benefits of Delta-8 THC, further research is needed to better understand the impact of Delta-8 THC use on mental health and well-being. Finally, Delta-8 THC users reported that they use this substance primarily through vaping concentrates (41.2%) and consuming edibles (30.9%). This was in contrast to the most common method of using Delta-9 THC, which was smoking (80.6%). Further investigation into differences in users’ preferred methods of consumption of Delta8-THC and Delta9-THC are needed and the factors associated with these preferences, including availability of products on the US market and other factors.

Study limitations are noted. First, use of an online convenience sample limits generalizability; the distributions of some characteristics (e.g., gender) differ from those of cannabis users in nationally representative surveys31. Delta-8 THC studies with nationally representative samples are needed to verify and expand our findings; Studies that report patterns of Delta-8 THC use among adults who are not necessarily regular cannabis users or who do not use cannabis at all are also needed to provide a more complete picture of the population distribution of Delta-8 THC use. Second, we did not question respondents about quantity of Delta-8 THC use, nor about Delta-8 THC use-related intoxication or clinical correlates. Given the increasingly common use of these products, this information is needed. Finally, we did not ask respondents whether the Delta-8 THC products they had used were mixed with other substances. Reports indicate that some products marketed and labeled as Delta-8 THC products sold in the US also contain Delta-9 THC and heavy metal contaminants18. Considering that most states do not require that Delta-8 THC products be tested for potency, pesticides, or adulterants, carefully assessing constituents of Delta-8 THC in marketed products will be important.

5. CONCLUSION

This study provides a snapshot of the current state of Delta-8 THC use among an online-recruited sample of adults who use cannabis in the US, thus adding to the sparse literature on Delta-8 THC use. Considering the lack of high quality data on the potential harms and benefits of Delta-8 THC, there is a serious need for future investigation of the perceived mental health benefits of Delta-8 THC, the role of social media in promoting its use, and the effectiveness of restrictions on Delta-8 THC products; such data would help to guide public health policy and legislation regarding Delta-8 THC.