Research has revealed one of the first snapshots of Americans' use of cannabinoids derived from hemp: A little over one fifth of adults reported using cannabidiol (CBD).
According to the new findings published in JAMA, 25.2% of adults reported past-year use of any emerging cannabinoid, including delta-8 tetrahydrocannabinol (THC). Meanwhile, 21% of adults reported using CBD. Researchers cautioned that the products are not regulated and could put patients at the risk for adverse effects from unknown contaminants.
Other products derived from hemp had lower rates of use: 11.9% of the survey respondents reported using delta-8 THC, 5.2% reported using cannabigerol (CBG), and 4.4% reported using cannabinol (CBN).
The 2018 Farm Bill legalized the cultivation and sale of hemp, leading to a cascade of hemp-derived products sold online and at smoke shops, gas stations, and other retailers. The US Food and Drug Administration does not regulate hemp-derived products; therefore, no federal standards exist for testing ingredients for safety or verification of ingredients as listed on labels.
"If someone is picking up one of these products to use medically, and it ends up having heavy metals and pesticides and it doesn't even have the active ingredient in it, that is not good," said Kevin F. Boehnke, PhD, a research assistant professor in the Department of Anesthesiology and the Chronic Pain and Fatigue Research Center at the University of Michigan in Ann Arbor.
More than 1100 adults were surveyed as part of the National Opinion Research Center AmeriSpeak panel in June 2023.
Participants reported their use of CBD, CBG, and CBN, which do not contain psychoactive components and are commonly marketed to help with sleep, anxiety, and pain problems. Delta-8 THC, also included in the survey, produces psychotropic effects.
Of the emerging cannabinoids, delta-8 THC is of particular concern for Boehnke. The substance has been been associated with psychiatric issues like delusions and paranoia, painful breathing and choking sensations, gastrointestinal issues such as vomiting, and accidental overdose.
Where medical cannabis is legal, residents had 56% lower odds of using delta-8 THC, whereas those in states where recreational marijuana is legal had 55% lower odds of using delta-8 THC than those surveyed in states without legalization.
The findings suggest "cannabis prohibition may unintentionally promote delta-8-THC use," Boehnke and his colleagues write.
Delta-8 products are often sold in the form of vape cartridges, gummies, and chocolates in retailers like supermarkets.
In an advisory published in 2020, the FDA said it tested cannabinoid products, "and many were found to not contain the levels of CBD they claimed. We are also investigating reports of CBD potentially containing unsafe levels of contaminants."
Alice Kuo, MD, PhD, a pediatrician and professor of internal medicine and pediatrics at the David Geffen School of Medicine at the University of California in Los Angeles, said she has observed a large increase in patients who say they use nonpsychotropic cannabinoid products. She said many report viewing the products as "natural."
"My official response to patients who ask me for my opinion is that I don't have enough scientific background to give an opinion: If you think it helps you and you have no side effects, then I'm not going to tell you to stop," Kuo said.
While she has not heard from any patients reporting the use of delta 8-THC, Kuo has concerns about the mental and emotional impact of psychotropic cannabinoids.
Patients generally are reluctant to admitting the use of delta-8 THC or other psychoactive substances like marijuana, and "I have had to be very nonjudgmental and very careful in asking patients because if there is any perception of judgment on my part, I get chastised by my patient," Kuo said.
Various study authors report receiving grants from entities, including the State of Michigan Veteran Marijuana Research Program; the New York State Office of Addiction Services and Support; the Medical Cannabis Research Advocacy Alliance; the Good Samaritan Foundation of Legacy Health; the National Institutes of Arthritis, Musculoskeletal, and Skin Diseases; and Tryp Therapeutics.
The study was partially supported by the National Institute on Drug Abuse of the National Institutes of Health.
Brittany Vargas is a medicine, mental health, and wellness journalist.
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