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Background: Products containing delta-8-THC became widely available in most of the USA following the 2018 Farm Bill and by late 2020 were core products of hemp processing companies, especially where delta-9-THC use remained illegal or required medical authorization. Research on experiences with delta-8-THC is scarce, some state governments have prohibited it because of this lack of knowledge. Objective: We conducted an exploratory study addressing a broad range of issues regarding delta-8-THC to inform policy discussions and provide directions for future systematic research. Methods: We developed an online survey for delta-8-THC consumers, including qualities of delta-8-THC experiences, comparisons with delta-9-THC, and open-ended feedback. The survey included quantitative and qualitative aspects to provide a rich description and content for future hypothesis testing. Invitations to participate were distributed by a manufacturer of delta-8-THC products via social media accounts, email contact list, and the Delta8 Reddit.com discussion board. Participants (N = 521) mostly identified as White/European American (90%) and male (57%). Pairwise t tests compared delta-8-THC effect rating items; one-sample t tests examined responses to delta-9-THC comparison items. Results: Most delta-8-THC users experienced a lot or a great deal of relaxation (71%); euphoria (68%) and pain relief (55%); a moderate amount or a lot of cognitive distortions such as difficulty concentrating (81%), difficulties with short-term memory (80%), and alerted sense of time (74%); and did not experience anxiety (74%) or paranoia (83%). Participants generally compared delta-8-THC favorably with both delta-9-THC and pharmaceutical drugs, with most participants reporting substitution for delta-9-THC (57%) and pharmaceutical drugs (59%). Participant concerns regarding delta-8-THC were generally focused on continued legal access. Conclusions: Delta-8-THC may provide much of the experiential benefits of delta-9-THC with lesser adverse effects. Future systematic research is needed to confirm participant reports, although these studies are hindered by the legal statuses of both delta-8-THC and delta-9-THC. Cross-sector collaborations among academics, government officials, and representatives from the cannabis industry may accelerate the generation of knowledge regarding delta-8-THC and other cannabinoids. A strength of this study is that it is the first large survey of delta-8 users, limitations include self-report data from a self-selected convenience sample.
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Krugerand Kruger
Journal of Cannabis Research (2022) 4:4
https://doi.org/10.1186/s42238-021-00115-8
ORIGINAL RESEARCH
Delta-8-THC: Delta-9-THC’s nicer younger
sibling?
Jessica S. Kruger1* and Daniel J. Kruger1,2
Abstract
Background: Products containing delta-8-THC became widely available in most of the USA following the 2018 Farm
Bill and by late 2020 were core products of hemp processing companies, especially where delta-9-THC use remained
illegal or required medical authorization. Research on experiences with delta-8-THC is scarce, some state governments
have prohibited it because of this lack of knowledge.
Objective: We conducted an exploratory study addressing a broad range of issues regarding delta-8-THC to inform
policy discussions and provide directions for future systematic research.
Methods: We developed an online survey for delta-8-THC consumers, including qualities of delta-8-THC experiences,
comparisons with delta-9-THC, and open-ended feedback. The survey included quantitative and qualitative aspects
to provide a rich description and content for future hypothesis testing. Invitations to participate were distributed by a
manufacturer of delta-8-THC products via social media accounts, email contact list, and the Delta8 Reddit. com discus-
sion board. Participants (N = 521) mostly identified as White/European American (90%) and male (57%). Pairwise t
tests compared delta-8-THC effect rating items; one-sample t tests examined responses to delta-9-THC comparison
items.
Results: Most delta-8-THC users experienced a lot or a great deal of relaxation (71%); euphoria (68%) and pain relief
(55%); a moderate amount or a lot of cognitive distortions such as difficulty concentrating (81%), difficulties with
short-term memory (80%), and alerted sense of time (74%); and did not experience anxiety (74%) or paranoia (83%).
Participants generally compared delta-8-THC favorably with both delta-9-THC and pharmaceutical drugs, with most
participants reporting substitution for delta-9-THC (57%) and pharmaceutical drugs (59%). Participant concerns
regarding delta-8-THC were generally focused on continued legal access.
Conclusions: Delta-8-THC may provide much of the experiential benefits of delta-9-THC with lesser adverse effects.
Future systematic research is needed to confirm participant reports, although these studies are hindered by the legal
statuses of both delta-8-THC and delta-9-THC. Cross-sector collaborations among academics, government officials,
and representatives from the cannabis industry may accelerate the generation of knowledge regarding delta-8-THC
and other cannabinoids. A strength of this study is that it is the first large survey of delta-8 users, limitations include
self-report data from a self-selected convenience sample.
Keywords: Medical cannabis, Cannabis, Cannabinoid, Delta-8-THC, Subjective effects
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Background
Among hundreds of cannabinoids, delta-8-tetrahydro-
cannabinol (delta-8-THC, Δ8-THC) has rapidly risen
in popularity among consumers of cannabis prod-
ucts. Delta-8-THC is an isomer or a chemical analog of
Open Access
Journal of Cannabis
Research
*Correspondence: jskruger@buffalo.edu
1 Department of Community Health and Health Behavior, University
at Buffalo, SUNY, 319 Kimball Tower, Buffalo, NY, USA
Full list of author information is available at the end of the article
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Krugerand Kruger Journal of Cannabis Research (2022) 4:4
delta-9-THC, the molecule that produces the experi-
ence of being high when ingesting cannabis (Qamar
etal. 2021). Delta-8-THC differs in the molecular struc-
ture from delta-9-THC in the location of a double bond
between carbon atoms 8 and 9 rather than carbon atoms
9 and 10 (Razdan 1984). Due to its altered structure,
delta-8-THC has a lower affinity for the CB1 receptor
and therefore has a lower psychotropic potency than
delta-9-THC (Hollister and Gillespie 1973; Razdan 1984).
Delta-8-THC is found naturally in Cannabis, though at
substantially lower concentrations than delta-9-THC
(Hively etal. 1966). It can also be synthesized from other
cannabinoids (e.g., Hanuš and Krejčí 1975).
e 2018 Farm Bill did not specifically address delta-
8-THC, but effectively legalized the sale of hemp-derived
delta-8-THC products with no oversight. Its popular-
ity grew dramatically in late 2020, gaining the attention
of cannabis consumers and processors throughout the
United States. As of early 2021, delta-8-THC is con-
sidered one of the fastest-growing segments of hemp
derived products, with most states having access (Richtel
2021). Yet, little is known about experiences with delta-8-
THC or effects in medical or recreational users (Hollister
and Gillespie 1973; Razdan 1984).
In 1973, delta-8-THC and delta-9-THC were admin-
istrated to six research participants. Despite the small
sample size, researchers concluded that delta-8-THC
was about two-thirds as potent as delta-9-THC and was
qualitatively similar in experiential effects (Hollister and
Gillespie 1973; Razdan 1984). In 1995, researchers gave
delta-8-THC to eight pediatric cancer patients two hours
before each chemotherapy session. Over the course of 8
months, none of these patients vomited following their
cancer treatment. e researchers concluded that delta-
8-THC was a more stable compound than the more well-
studied delta-9-THC (Abrahamov etal. 1995, consistent
with other findings (Zias etal. 1993), and suggested that
delta-8-THC could be a better candidate than delta-9-
THC for new therapeutics.
In recent months, 14 U.S. States have blocked the sale
of delta-8-THC due to the lack of research into the com-
pound’s psychoactive effects (Sullivan 2021). All policies
and practices, including those related to substance use
and public health, should be informed by empirical evi-
dence. e current study seeks to better understand the
experiences of people who use delta-8-THC to inform
policy discussions and provide directions for future
systematic research. Because this is the first large sur-
vey of delta-8-THC consumers, we take an exploratory
approach to describe experiences with delta-8-THC. We
combine quantitative rating items with open-ended qual-
itative items enabling participants to provide feedback
which is rich in content.
Methods
Procedures
We developed an anonymous Qualtrics online survey
to assess experiences with delta-8-THC. Bison Botan-
ics, a manufacturer of delta-8-THC and CBD products
in New York State, distributed invitations to partici-
pate in the study via their social media accounts (Face-
book, Instagram), via their email contact list, and via the
Delta8 online discussion board (Subreddit) on Reddit.
com. e invitation read, “Are you a Delta-8-THC con-
sumer? We’ve partnered with researchers at the Univer-
sity at Buffalo and the University of Michigan to learn
more about experiences with delta-8-THC and its impact
on public health and safety.” Screening questions verified
that participants were 18 years of age or older, were cur-
rently in the USA, and used or consumed products con-
taining delta-8-THC. Surveys were completed between
June 12 and August 2, 2021. Delta-8-THC products were
sold legally in New York State until July 19, 2021.
Participants
Completed surveys (N = 521) were included for analy-
ses, the completion rate was 74%. Participants were
men (57%), women (41%), and individuals who reported
another gender identity (2%). e mean age was 34 years
old (SD = 11, range: 18–76). Participants had completed
15 years of education on average (SD = 2, range: 8–20),
17% were currently students. Participants identified
(inclusively) as White/European American (90%), His-
panic/Latino (5%), Black/African American (3%), Ameri-
can Indian or Alaska Native (3%), Asian (3%), Native
Hawaiian/Pacific Islander (1%), and Other (3%). Most
(59%) participants provided ZIP Codes, which ranged
across 38 U.S. States. e largest portion was from New
York State (29%), all other states were below 10%. Nearly
all these participants (90%) were in states where delta-
9-THC Cannabis products were not yet commercially
available for adult (i.e., “recreational”) use.
Measures
Participants reported on the content of their experiences
with delta-8-THC by rating its effects. e question stem
read: “Please indicate how much you experience the fol-
lowing when you use delta-8-THC:” Specific aspects were
altered sense of time; anxiety (unpleasant feelings, nerv-
ousness, worry); difficulty concentrating; difficulties with
short-term memory; euphoria (pleasure, excitement,
happiness); pain relief; paranoia (thinking that other
people are out to get you, etc.); and relaxation. Response
options were not at all, a little, a moderate amount, a lot,
a and great deal.
Two items assessed participants’ comparisons of
experiences with delta-8-THC and delta-9-THC. e
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Krugerand Kruger Journal of Cannabis Research (2022) 4:4
first question read: “How does Delta-8-THC compare
to Delta-9-THC in the intensity or strength of effects?”
[emphasis in original]; with response options: Delta-8-
THC is much more intense, Delta-8-THC is somewhat
more intense, about the same, Delta-9-THC is somewhat
more intense, Delta-9-THC is much more intense, do
not know. e second question read: “How does Delta-8-
THC compare to Delta-9-THC in the duration or length
of effects?” [emphasis in original]; with response options:
Delta-8-THC lasts a lot longer, Delta-8-THC lasts a little
longer, about the same, Delta-9-THC lasts a little longer,
Delta-9-THC lasts a lot longer, do not know.
Participants were asked the open-ended question,
“Do you have any comments about how Delta-8-THC
compares to Delta-9-THC?” after the rating items. is
item was followed by a brief demographic section assess-
ing age, gender identity, education, ethnicity, and ZIP
Code. At the end of the survey participants were asked:
“Do you have any comments about these topics or this
survey?” ere were no restrictions on participants’
responses.
Analysis
Pairwise t tests compared ratings on delta-8-THC
effect items; descriptive statistics, 95% confidence
intervals, and effect sizes were calculated (see Table1
and Fig. 1). Responses to items comparing delta-8-
THC to delta-8-THC intensity and duration were
Table 1 Comparison of effects from Delta-8 THC with item descriptive statistics
Note: Values in columns 2–8 indicate eect sizes for pairwise comparisons, d = .20 indicates a small eect, d = .50 indicates a medium eect, d = .80 indicates a large
eect. ° indicates p = .405, all other comparisons are p < .001
Eect MSD23456 78
1. Relaxation 3.96 0.92 0.45 0.74 1.58 1.60 1.72 2.06 2.26
2. Pain relief 3.41 1.17 0.16 1.04 1.06 1.12 1.44 1.68
3. Euphoria 3.22 0.99 1.08 1.16 1.17 1.49 1.81
4. Altered sense of time 2.00 0.91 0.15 0.18 0.62 0.82
5. Difficulties with short-term memory 1.84 0.95 0.01° 0.44 0.62
6. Difficulty concentrating 1.83 0.85 0.49 0.67
7. Anxiety 1.38 0.70 .027
8. Paranoia 1.22 0.56
Fig. 1 Participant experiences with delta-8-THC. Note: values are means with 95% confidence intervals. Experiences were coded as: 1 = not at all, 2
= a little, 3 = a moderate amount, 4 = a lot, 5 = a great deal
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Krugerand Kruger Journal of Cannabis Research (2022) 4:4
examined by one-sample t tests with a comparison
value of 3 (“About the same”), effect sizes and 95%
Confidence Intervals were calculated (see Fig. 2).
Demographic comparisons were made for partici-
pants’ gender with between-subjects t tests, partici-
pants’ age with Pearson correlations, and participants’
educational levels with partial correlations control-
ling for age. Responses to open-ended questions were
coded as a set to avoid the duplication of codes for the
same participant (see Table2). The coders have been
trained in qualitative methods and an inductive cod-
ing method was used to create a codebook. After the
first coder assigned the codes, a line-by-line coding
was used to then categorize codes. To establish inter-
rater reliability, two coders independently read par-
ticipant responses and identified overall themes. Once
general themes were established, the responses were
coded for theme categories and subcategories. Coding
discrepancies were resolved, coding omissions were
eliminated by adding codes, although no previously
identified themes were deleted. Instances of themes
and subthemes were calculated across participants.
Individual participants could express more than one
subtheme within a thematic category.
Results
Participants mostly consumed delta-8-THC through edi-
bles (64%; brownies, gummies, etc.), vaped concentrates
(48%; hash, wax, dabs, oil, etc.), and tinctures (32%).
Some participants consumed delta-8-THC through
smoking concentrates (23%; hash, wax, dabs, oil, etc.),
smoking bud or flower (18%), vaping bud or flower (9%),
topical products (9%; lotion, cream, oil, patch on skin),
capsules (6%), suppositories (1%), and other methods
(1%). Most participants (83%) also reported consuming
delta-9-THC cannabis and products and reported substi-
tution for delta-9-THC (57%) and pharmaceutical drugs
(59%).
Experiences with delta-8-THC were most prominently
characterized by relaxation, pain relief, and euphoria (see
Table1 and Fig. 1). Participants reported modest levels
of cognitive distortions such as an altered sense of time,
difficulties with short-term memory, and difficulty con-
centrating. Participants reported low levels of distressing
mental states (anxiety and paranoia). ere were large
statistical effect sizes in differences between items in the
first set of experiences (relaxation, pain relief, and eupho-
ria) and items in the second set (cognitive distortions),
and medium statistical effect sizes in differences between
cognitive distortions and anxiety and paranoia.
On average participants reported that the effects of
delta-8-THC were less intense, t(433) = 23.86, p < .001,
Fig. 2 Participant comparisons of delta-8-THC and delta-9-THC experiences. Note: values are means with 95% confidence intervals. Intensity was
coded as: 1 = Delta-9-THC is much more intense, 2 = Delta-9-THC is somewhat more intense, 3 = about the same, 4 = Delta-8-THC is somewhat
more intense, 5 = Delta-8-THC is much more intense. Duration was coded as: 1 = Delta-9-THC lasts a lot longer, 2 = Delta-9-THC lasts a little longer,
3 = about the same, 4 = Delta-8-THC lasts a little longer, 5 = Delta-8-THC lasts a lot longer
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Krugerand Kruger Journal of Cannabis Research (2022) 4:4
d = 1.15, and had a shorter duration, t(421) = 10.08, p
< .001, d = 0.49, than the effects of delta-9-THC (see
Fig.2). Proportionally, participants reported the intensity
of effect as much more with delta-9-THC (36%), some-
what more with delta-9-THC (44%), about the same
(15%), somewhat more with delta-8-THC (4%), and much
more with delta-8-THC (2%). Proportionally, participants
reported the duration of effect as much more with delta-
9-THC (20%), somewhat more with delta-9-THC (27%),
about the same (41%), somewhat more with delta-8-THC
(8%), and much more with delta-8-THC (5%).
Demographic analyses indicated that women perceived
delta-8-THC effects to be somewhat more intense, t(420)
= 3.55, p < .001, d = 0.36, and longer lasting, t(408) =
3.45, p < .001, d = 0.36, compared to delta-9-THC than
did men. Older individuals perceived delta-8-THC effects
to be somewhat more intense, r(429) = .141, p = .003,
and longer lasting, r(418) = .293 p < .001, compared
to delta-9-THC than younger individuals. Controlling
for age, those completing more years of education per-
ceived delta-8-THC effects to be somewhat more intense,
r(383) = .158, p = .003, and longer lasting, r(383) = .139
p = .006, compared to delta-9-THC than those with less
education.
Participants (n = 204) provided text responses in one
or both open-ended questions (see Table2 and S1). e
most common theme was comparisons between delta-8-
THC and delta-9-THC. Participants’ responses contain-
ing this theme included: “Delta 8 feels like Delta 9’s nicer
younger sibling”; “It has all the positives and many fewer
drawbacks/side effects. It is less impairing and much less
likely to cause anxiety or paranoia. It has much milder to
nonexistent aftereffects”; “Delta 8 is not as heavy as Delta
9. With Delta 8, I am able to perform my normal day to
day activities, i.e., no couch lock, paranoia, munchies. I
am able to function well at work under the influence of
Delta 8 whereas under the influence on Delta 9 at work, I
am paranoid and feel less motivated to do work activities.
Delta 8 has more of just a euphoria feeling than any other
feeling for me. I want to do activities and I want to have a
Table 2 Themes in responses to open-ended questions
Theme/subtheme Count
Comparisons between Delta-8 THC and Delta-9 THC 239
Overall similarity of experience 38
Delta-8 THC is less intense or potent than Delta-9 THC 38
Delta-8 THC enables better mental clarity than Delta-9 THC 37
Delta-8 THC produces less anxiety than Delta-9 THC 28
Delta-8 THC produces less paranoia than Delta-9 THC 20
Delta-8 THC has a lower cost than Delta-9 THC 11
Delta-8 THC is more accessible than Delta-9 THC 7
Prefers Delta-8 THC 6
Delta-8 THC has a shorter duration of effect than Delta-9 THC 6
Delta-8 THC produces less sedation than Delta-9 THC 5
Can be more active and/or productive with Delta-8 THC 5
Prefers Delta-9 THC 4
Delta-8 THC is legal so no risk of arrest, job loss, etc. 3
Delta-8 THC is harsher on the lungs when inhaled 3
Delta-8 THC has better social acceptance 3
Delta-8 THC provides better pain relief 3
Delta-8 THC stimulated the appetite less than Delta-9 THC 3
Delta-8 THC generates fewer or no panic attacks 2
Delta-8 THC provides better relaxation 2
Delta-8 THC has lesser (unspecified) adverse effects 2
Therapeutic effect or benefit from Delta-8 THC 62
Relaxation 15
Pain relief 9
Anxiety 9
Sleep aid 6
Maintaining a positive mood 4
Post-traumatic stress disorder (PTSD) 3
Depression 3
Migraines 2
Increasing appetite 2
Comments on the study or researchers 33
Praise for the researchers for conducting a study on Delta-8 22
Feedback and suggestions on the survey content or features 9
Criticism of study design 2
Expressions of concern 22
Concern for continued legal access to Delta-8 THC 17
Concern for the purity of the product 3
General expressions of praise for Delta-8 THC 19
Substitution of Delta-8 THC for other substances 17
Cannabis and cannabis products containing Delta-9 THC 6
Comparisons between Delta-8 THC and pharmaceutical drugs 11
Delta-8 THC is better at pain relief 3
Dual use of Delta-8 THC and Delta-9 THC 8
Delta-8 THC is for working and being active and Delta-9 THC is
for fun, relaxation, and recreation 5
Adverse effects of Delta-8 THC 6
Anxiety (at high doses) 2
Headache 2
Other comments 25
See Supplementary TableS1 for unique responses
Table 2 (continued)
Theme/subtheme Count
Delta-8 THC Edibles or tinctures are more potent than vaping 7
Building tolerance to Delta-8 THC 3
Biochemistry of Delta-8 THC 2
Delta-8 THC is more for medical use than recreational use 2
Recreational use of Delta-8 THC 2
Delta-8 THC is better than alcohol 2
Does not like Delta-8 THC 2
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Krugerand Kruger Journal of Cannabis Research (2022) 4:4
pleasurable time. Whereas if I have too much of Delta 9,
all I want to do is watch TV, eat snacks, distance myself
from the outside world. Delta 9 is better for sleep.
e second most common theme was the therapeu-
tic effect or benefit from delta-8-THC, participants’
responses containing this theme included: “It is like “lite”
Delta 9. I can focus and work more with Delta 8 than
Delta 9. It helps my pains and relaxation and I feel more
able. Depending on the strain it has taken the place of
melatonin for sleep.”; “As with any newer drug with lim-
ited study, care should be taken with its use. But I’ve per-
sonally found it immensely useful and therapeutic, with
management of anxiety and sleep issues. Which nothing
but far more addictive drugs (regarding anxiolytics), have
helped with in the past. I hope lots more studies will be
able to be done.”; “Delta-9 I pretty regularly experience
panic attacks. Delta-8 I do not and it relieves symptoms
of PTSD and anxiety pretty quickly.” e third most com-
mon theme was comments on the study or researchers.
Some examples of this praise are “I’m glad that there’s
more academic research being done on the subject, thank
you for doing it!” and “Keep up the good work. Need
more studies and information on cannabinoids.
e fourth most common theme was expressions of
concern, particularly for continued legal access to delta-
8-THC. Participants’ responses containing this theme
included: “D8 is Great for daytime relief when you need
to get stuff done. It has helped me a lot! I HOPE THEY
DON’T BAN IT!”; “I feel that delta-8-THC is a very effec-
tive alternative to delta-9-THC with less side effects. I
primarily consume it in combination with high CBD or
CBG hemp. I do wish there was regulation purely for
safety concerns; more reliable lab testing, testing specifi-
cally for solvents and reagents used in delta-8-THC pro-
duction, etc. But I do fear that harsh regulation may get
in the way of a wonderful substance that could improve
the lives of many people. I hope against hope that a fear
mongering campaign doesn’t put an end to the golden
age of D8 that we are currently experiencing.
e fifth most common theme was general expressions
of praise for delta-8-THC. Many participants had simi-
lar statements such as “Delta 8 is a great thing. It needs
to stay accessible and affordable for the people that can
really benefit.” e sixth most common theme was sub-
stitution of delta-8-THC for other substances. One par-
ticipant stated: “e therapeutic and medicinal effects of
Delta 8 have significantly improved my life, treating pain
and sleeplessness while not making me feel the high I get
from Delta 9. I have stopped taking pharmaceutical drugs
and my health and wellbeing has improved.
e seventh most common theme was the dual use of
delta-8-THC and delta-9-THC. One representative com-
ment was: “It seems a lot more of a ‘functional’ high, at
my job we call it work-weed. I get too much anxiety to
effectively deal with customers on Delta 9, Delta 8 is just
about perfect for when you gotta actually do things. I still
do prefer Delta-9 after a long day though.” e eighth
most common theme was adverse effects of delta-8-THC,
for example: “I love Delta 8 because I do not need to take
it daily. I’ve never had withdrawals when I did not take it.
What I dislike about Delta 8 is the feeling of always being
cold. I did read the dosage had something to do with this
but unfortunately even reducing the dosage gave me the
same result.” Participants also made comments that did
not fit into the major themes. e most frequent of these
comments was that delta-8-THC edibles or tinctures
were more powerful than when delta-8-THC was inhaled
as a vape: “How Delta 8 is consumed plays a large role
in the effects, when eaten or taken in a tincture it feels
much closer to Delta 9 in effects compared to when vap-
ing/dabbing Delta 8.
Discussion
Participants’ reports were overall supportive of the use
of delta-8-THC. Comparisons reveal that delta-8-THC
experiences are primarily characterized by beneficial
effects and are low in potentially adverse effects associ-
ated with cannabis use. Experiences of relaxation, pain
relief, and euphoria were the most prominent, charac-
terized as between “a moderate amount” and “a lot” on
average. Participants reported “a little” of the cognitive
distortions associated with delta-9-THC and cannabis
use in general. Experiences such as an alerted sense of
time, difficulties with short-term memory, and difficulty
concentrating may not be problematic for consumers in
certain contexts (e.g., relaxation and socialization), how-
ever they may in in others (e.g., operating a motor vehi-
cle). Paranoia and anxiety are distressing mental states
that may result from delta-9-THC ingestion (Freeman
etal. 2015). On average, participants’ experiences of par-
anoia and anxiety were between “not at all” and “a little.
Experiences with delta-8-THC were characterized as less
intense and with somewhat shorter duration than those
with delta-9-THC.
Participant reports included a wealth of other infor-
mation that can inform hypothesis testing and research
questions in future studies. For example, it would be
valuable to conduct systematic studies comparing experi-
ences of delta-8-THC with delta-9-THC and pharmaceu-
tical drugs. Participants viewed delta-8-THC experiences
favorably in comparison, and most participants reported
substitution of delta-8-THC for both delta-9-THC and
pharmaceutical drugs, consistent with comparisons and
substitutions of pharmaceuticals with cannabis products
in general (Kruger and Kruger 2019; Lucas et al. 2016;
Reiman et al. 2017). Participants reported being more
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Krugerand Kruger Journal of Cannabis Research (2022) 4:4
active and productive with delta-8-THC than with delta-
9-THC, and some suggested that delta-8-THC was more
purely therapeutic than delta-9-THC. Participants also
reported notable adverse experiences with delta-8-THC,
most commonly that Delta-8-THC is harsher on the
lungs than delta-9-THC when inhaled.
Some of the variation in experiences across individuals
is likely due to inconsistencies in the products consumed,
particularly in dosage, administration method, and impu-
rities. Manufacturers have adjusted for the lower potency
of delta-8-THC by increasing the dosage (e.g., 25 mg in
edibles) relative to similar delta-9-THC products (where
one dose has been defined as 10 mg) (Sideris etal. 2018;
State of California Senate 2017). e US Cannabis Coun-
cil tested 16 samples of non-cannabis-based products
featuring delta-8-THC in April 2021 and found delta-9-
THC levels ranging from 1.3 to 5.3% (well above the 0.3%
level allowed in the 2018 Farm Bill), as well as heavy met-
als and unknown compounds in some of the samples (US
Cannabis Council 2021). It is possible that substances
other than Delta-8-THC contributed to both beneficial
and adverse experiences in user reports.
Policy considerations
e 2018 Farm Bill (U.S. Agriculture Improvement Act
of 2018) created a legal loophole for the sale of hemp-
derived delta-8-THC products in areas without legal
adult use (i.e., recreational) and where the medical use
of cannabis and cannabis products containing delta-9-
THC requires medical authorization. Manufacturing and
sales of delta-8-THC products skyrocketed due to greater
accessibility to fulfill market demand. Yet, some states
have made Delta-8-THC sales illegal. Paradoxically, of
these 14 states, 6 states allow recreational delta-9-THC
cannabis, 10 allow for medical delta-9-THC cannabis,
and 3 have decriminalized recreational use of delta-9-
THC cannabis.
e current study provides empirical evidence to
inform discussions of delta-8-THC-related policies and
practices. More research is needed to isolate the psycho-
active effects of delta-8-THC and its possible therapeu-
tic benefits, comparisons with pharmaceutical drugs and
other cannabinoids, as well as risks and adverse effects.
Such studies currently face considerable legal barriers,
such as the Schedule I status of delta-9-THC. Banning
delta-8-THC products while allowing the sale of delta-
9-THC products seems inconsistent both in cannabis
policy and in relation to our study results. Current results
suggest that delta-8-THC products have therapeutic ben-
efits and typical administration routes (consumption as
an edible, tincture, or by vaping) may produce less harm
than smoking cannabis flower. Vaping is considered a
harm reduction solution (Fischer etal. 2017).
Harm reduction is a set of practical strategies and ideas
aimed at reducing negative consequences associated
with drug use (Marlatt etal. 2011). It is also a movement
for social justice built on a belief in, and respect for, the
rights of people who use drugs. Harm reduction has been
widely used with various other substances, such as opi-
oids (Rouhani etal. 2019), alcohol (Marlatt etal. 2011),
and tobacco (Parascandola 2011). Interventions based on
harm reduction principles have been successful in reduc-
ing risk behaviors related to cannabis use, for example
driving while under the influence of cannabis (Poulin
and Nicholson 2005). Although our results are largely
descriptive, we provide an initial encouraging assessment
of the suitability of the use of delta-8-THC as a possible
harm reduction practice.
e U.S. Food and Drug Administration (FDA) has rec-
ommended collaborative research partnerships among
academic researchers, government officials, and repre-
sentatives from the cannabis industry to inform public
health decisions related to cannabidiol (CBD), another
cannabinoid with rapidly growing use (Hahn 2021).
Similar research collaborations may accelerate the gen-
eration of knowledge regarding delta-8-THC and other
cannabinoids.
Limitations
is study compiled the self-reported experiences of
delta-8-THC consumers. e patterns of experiences
reported here require verification with carefully con-
trolled studies, such as double-blind and randomized
studies for comparisons of delta-8-THC with delta-
9-THC and pharmaceutical drugs. e current study
assessed participants’ naturalistic experiences, rather
than experiences with a specific delta-8-THC product.
Participants were recruited through the social networks
of a delta-8-THC and CBD product manufacturer and
a delta-8-THC social media interest group. Participant
reports may be more enthusiastic than those of a ran-
domly selected population-representative sample.
Conclusions
Delta-8-THC products may provide much of the experi-
ential and therapeutic benefits of delta-9-THC with lower
risks and lesser adverse effects. Substitution of delta-
8-THC for delta-9-THC may be consistent with harm
reduction, one of the core principles of Public Health.
e current study provided a broad descriptive assess-
ment of self-reported experiences with delta-8-THC.
Further systematic research will be critical in verifying
the favorable reports of delta-8-THC consumers.
Page 8 of 8
Krugerand Kruger Journal of Cannabis Research (2022) 4:4
Abbreviations
THC: Tetrahydrocannabinol; CBD: Cannabidiol; NASEM: National Academies of
Sciences, Engineering, and Medicine; U.S.: United States; PTSD: Post-traumatic
stress disorder.
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s42238- 021- 00115-8.
Additional le1: TableS1. Unique themes in responses to open-ended
questions.
Acknowledgements
We thank Bison Botanics and survey participants for their assistance with this
project.
Authors’ contributions
All authors read and approved the final manuscript.
Funding
Not applicable.
Availability of data and materials
The dataset used and analyzed for the current study are available from the
corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Institutional Review Board for Health Sciences
and Behavioral Sciences at the University of Michigan prior to data collection.
Participants indicated their consent by completing the survey after viewing
the informed consent form.
Consent for publication
All authors approved the submitted manuscript.
Competing interests
The authors declare that they have no competing interests.
Author details
1 Department of Community Health and Health Behavior, University at Buffalo,
SUNY, 319 Kimball Tower, Buffalo, NY, USA. 2 Population Studies Center, Institute
for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI,
USA.
Received: 27 August 2021 Accepted: 15 December 2021
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... Unfortunately, to our knowledge, there are no peer-reviewed publications in the medical literature that specifically address the issue of impairment by ∆ 8 -THC. The available literature does, however, suggest that ∆ 8 -THC and ∆ 9 -THC are pharmacodynamically quite similar (Hazekamp et al. 2010;Abrahamov et al. 1995;Kruger and Kruger 2021;Kruger and Kruger 2022), which is consistent with the findings of the present study. Prior to smoking ∆ 9 -THC in the previous study, the subjects showed no evidence of impairment despite measurable blood ∆ 9 -THC levels, which is consistent with recently published studies showing no significant correlation between impairment and specific blood concentrations of ∆ 9 -THC (Brubacher et al. 2019;Hartman et al. 2016;McCartney et al. 2022;Hubbard et al. 2021;Wurz and DeGregorio 2022). ...
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Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis-∆(9)-tetrahydrocannabinol (THC)-causes paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying paranoia. A randomized, placebo-controlled, between-groups test of the effects of intravenous THC was conducted. A total of 121 individuals with paranoid ideation were randomized to receive placebo, THC, or THC preceded by a cognitive awareness condition. Paranoia was assessed extensively via a real social situation, an immersive virtual reality experiment, and standard self-report and interviewer measures. Putative causal factors were assessed. Principal components analysis was used to create a composite paranoia score and composite causal variables to be tested in a mediation analysis. THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity. The increase in negative affect and in anomalous experiences fully accounted for the increase in paranoia. Working memory changes did not lead to paranoia. Making participants aware of the effects of THC had little impact. In this largest study of intravenous THC, it was definitively demonstrated that the drug triggers paranoid thoughts in vulnerable individuals. The most likely mechanism of action causing paranoia was the generation of negative affect and anomalous experiences.
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An evidence-based approach is needed to shape policies and practices regarding medical cannabis, thereby reducing harm and maximizing benefits to individuals and society. This project assesses attitudes towards and utilization of medical cannabis and the mainstream healthcare system among medical cannabis users. The research team administered brief hard copy surveys to 450 adults attending an annual public event advocating for cannabis law reform. Among usable responses (N = 392), the majority (78%) reported using cannabis to help treat a medical or health condition. Medical cannabis users reported a greater degree of use of medical cannabis and a greater degree of trust in medical cannabis compared to mainstream healthcare. In comparison to pharmaceutical drugs, medical cannabis users rated cannabis better on effectiveness, side effects, safety, addictiveness, availability, and cost. Due to the medical use of cannabis, 42% stopped taking a pharmaceutical drug and 38% used less of a pharmaceutical drug. A substantial proportion (30%) reported that their mainstream healthcare provider did not know that they used medical cannabis. Other issues identified included lack of access to mainstream healthcare, self-initiated treatment of health issues, little knowledge of psychoactive content, and heavy cannabis use.
Article
Background: Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. Objectives: To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. Search methods: We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. Selection criteria: We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. Data collection and analysis: We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. Main results: For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence; (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years); (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products; (4) abstain from using synthetic cannabinoids; (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods; (6) avoid deep or other risky inhalation practices; (7) avoid high-frequency (e.g., daily or near-daily) cannabis use; (8) abstain from cannabis-impaired driving; (9) populations at higher risk for cannabis use-related health problems should avoid use altogether; and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). Authors' conclusions: Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes. (Am J Public Health. Published online ahead of print June 23, 2017: e1-e12. doi:10.2105/AJPH.2017.303818).
Article
Introduction and AimsRecent years have witnessed increased attention to how cannabis use impacts the use of other psychoactive substances. The present study examines the use of cannabis as a substitute for alcohol, illicit substances and prescription drugs among 473 adults who use cannabis for therapeutic purposes.Design and Methods The Cannabis Access for Medical Purposes Survey is a 414-question cross-sectional survey that was available to Canadian medical cannabis patients online and by hard copy in 2011 and 2012 to gather information on patient demographics, medical conditions and symptoms, patterns of medical cannabis use, cannabis substitution and barriers to access to medical cannabis.ResultsSubstituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. Respondents who reported substituting cannabis for prescription drugs were more likely to report difficulty affording sufficient quantities of cannabis, and patients under 40 years of age were more likely to substitute cannabis for all three classes of substance than older patients.Discussion and Conclusions The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches. Further research should seek to differentiate between biomedical substitution for prescription pharmaceuticals and psychoactive drug substitution, and to elucidate the mechanisms behind both. [Lucas P, Walsh Z, Crosby K, Callaway R, Belle-Isle L, Kay B, Capler R & Holtzman S. Substituting cannabis for prescription drugs, alcohol, and other substances among medical cannabis patients: The impact of contextual factors. Drug Alcohol Rev 2015]