Consumer Experiences with Delta-8-THC: Medical Use,Pharmaceutical Substitution,and Comparisons with Delta-9-THC

Abstract

Introduction:

Cannabis products containing delta-8-THC became widely available in most of the United States in late 2020 and rapidly became a significant source of revenue for hemp processing companies, especially in states where use of delta-9-THC remains illegal or requires professional authorization for medical use. Scientific research on the use of delta-8-THC is scarce, previous clinical studies included a combined total of 14 participants, leading some state governments to prohibit it until its properties and effects are better understood.

Methods:

Researchers developed an online survey for delta-8-THC consumers addressing a broad range of issues regarding delta-8-THC, including use for the treatment of health and medical conditions. Previous survey studies on the medical use of cannabis and cannabis products informed survey components.

Results:

Patterns of delta-8-THC use had both similarities with and differences from the use of delta-9-THC cannabis and products. Administration methods were primarily edibles (64%) and vaping concentrates (48%). About half of the participants (51%) used delta-8-THC to treat a range of health and medical conditions, primarily anxiety or panic attacks (69%), stress (52%), depression or bipolar disorder (46%), and chronic pain (41%). Participants compared delta-8-THC very favorably with both delta-9-THC and pharmaceutical drugs and reported substantial levels of substitution for both. Most participants did not inform their primary care provider of their delta-8-THC use (78%) and were not confident of their primary care provider's ability to integrate medical cannabis into their treatment (70%). Knowledge of effective dosages was low, and participants' knowledge of delta-8-THC was primarily from the Internet and their own experiences.

Conclusion:

Harm reduction is a central component of public health. Although the legal environment is becoming more restrictive for delta-8-THC in comparison to delta-9-THC, results suggest that delta-8-THC may be equally effective for desired purposes of cannabis use and lower in undesirable or adverse effects. All policies and practices should be informed by empirical evidence. Considerable research will be needed to systematically verify the patterns reported by participants, and collaborations among academic researchers, government, and the cannabis industry may be valuable in developing the knowledge base for delta-8-THC and other cannabinoids.

Introduction

After the passage of the Agriculture Improvement Act of 2018 (“the Farm Bill”) authorizing the production of hemp across the United States, a new cannabinoid emerged on the commercial market, delta-8-THC, Δ8-THC. Delta-8-THC is an isomer or a chemical analog of Delta-9-THC, the molecule that produces the experience of being high when ingesting cannabis.¹ The partial synthesis of delta-8 occurred in 1945,² with complete synthesis occurring in 1965³ earlier literature often referred to delta-8 as delta-6, a term which is no longer used.⁴ Delta-8-THC differs in the molecular structure from delta-9-THC in the placement of a double bond between carbon atoms 8 and 9 rather than carbon atoms 9 and 10 (Fig. 1).⁵ Delta-8-THC has a lower affinity for the CB1 receptor and therefore has a lower psychotropic potency than delta-9-THC, estimated at 50–75%.^5,6 One of the first studies in humans occurred in 1973, where delta-8-THC and delta-9-THC were administrated both orally and intravenously. Although researchers used a small sample size (N=6), they concluded that delta-8-THC was about two-thirds as potent as delta-9-THC, although it was qualitatively similar in experiential effects.^5,6

FIG. 1.

Structures of delta-8-THC and delta-9-THC.

Beginning in late 2020, delta-8-THC attracted the attention of cannabis consumers and processors throughout the United States. Its popularity has grown substantially in the following year. As of early 2021, delta-8-THC is considered to be one of the fastest-growing segments of products derived from hemp.⁷ It is sold by retailers selling CBD products, tobacco outlets, and Internet sources. Delta-8-THC has been sold as an alternative to traditional cannabis (i.e., with >0.3% delta-9-THC), especially in areas where cannabis containing delta-9-THC is illegal or requires physician or other professional health care provider approval for medical use.

The 2018 Farm Bill does not specifically address delta-8-THC, an omission that encouraged the sale of delta-8-THC products, often as edibles, vape cartridges, and tinctures, with no oversight. The Farm Bill allows for products derived in whole from the hemp plant, however, the U.S. Drug Enforcement Administration considers synthetic delta-8-THC a Schedule I compound. In recent months, 14 states—Alaska, Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Mississippi, Montana, New York, Rhode Island, Vermont, and Utah—have taken action to prohibit the sale of delta-8-THC, often citing lack of research into the compound's psychoactive effects.

Previous research has shown that 70–85% of those who used delta-9-stated that they used it to treat a medical condition.^8–10 Very little research has been conducted on delta-8-THC in comparison to delta-9-THC, with just one study on the use of delta-8-THC for medical purposes. In 1995, researchers administered the compound to eight pediatric cancer patients 2 h before each chemotherapy session. Over the course of 8 months, none of these patients vomited following their cancer treatment. The researchers concluded that delta-8-THC was a more stable compound than the more well-studied delta-9-THC,¹¹ suggesting that delta-8-THC could be a better candidate than delta-9-THC for new therapeutics.

It is critical to study experiences with delta-8-THC, as well as other cannabinoids entering the consumer market, to inform policies, regulations, and practices that minimize the costs, risks, and harms and maximize the benefits to individuals and society. We conducted a broad survey informed by previous survey studies on the use of delta-9-THC cannabis and products. Delta-9-THC is used to treat a wide range of health and medical conditions, often including chronic pain, anxiety or panic attacks, depressive symptoms, back problems, and sleep issues,^10,12,13 although not necessarily conditions approved by the U.S. Food and Drug Administration (FDA) or state-level medical cannabis guidelines. This is often associated with the partial or complete substitution of delta-9-THC cannabis and products for a wide range of pharmaceutical drugs.^12–15 Cannabis users report that delta-9-THC cannabis and products are superior to pharmaceutical drugs in terms of effectiveness, side effects, safety, addictiveness, availability, and cost.¹³ Yet, for those who use delta-9-THC for medical purposes, there is often a discrepancy between knowledge and the available evidence.⁹ Primary care providers may only be moderately knowledgeable about the medical use of cannabis,^16–18 and many patients do not reveal this use to their primary care provider,¹² because of perceptions that primary care providers lack knowledge of cannabis and do not support its use.^12,19,20 Thus, primary care providers may be unaware of critical issues such as the substitution of cannabis for pharmaceutical drugs.¹³ Consumer knowledge about the medical use of cannabis is primarily from Internet sources and individuals' own experiences.¹⁰ Consumers often lack knowledge of basic aspects such as effective dosages and substantially overestimate effective dosages and cannabinoid content of cannabis flower strains.¹⁰ We investigated these issues regarding delta-8-THC, as well as consumer comparisons of experiences with delta-8-THC and delta-9-THC.

Methods

Participants

Researchers partnered with Bison Botanics, a manufacturer of delta-8-THC and CBD products in New York State, to recruit participants. Bison Botanics advertised for the study via their social media accounts (Facebook, Instagram), sent advertisements to their email contact list, and posted on the Delta8 Subreddit (Reddit online discussion board). The advertisement read, “Are you a Delta-8-THC consumer? We've partnered with researchers at the University at Buffalo and the University of Michigan to learn more about experiences with delta-8-THC and its impact on public health and safety.” Data were collected between June 12 and August 2, 2021. Delta-8-THC products were legally sold in New York State until July 19, 2021. The survey completion rate was 74%. This study was approved by the Institutional Review Board for Health Sciences and Behavioral Sciences at the University of Michigan prior to data collection (HUM00200303).

Measures

A Qualtrics online survey addressed a broad range of issues regarding delta-8-THC; content was informed by previous survey studies^{8–10,12,13,18} on the medical use of delta-9-THC cannabis and products. Screening questions included whether participants were 18 years of age or older, whether they were currently in the United States, and whether they use or consume products containing delta-8-THC. A 53-item questionnaire (Supplementary Data) collected information on experiences with delta-8-THC, routes of administration, use to treat health and medical conditions, integration of medical use with mainstream health care, comparisons with pharmaceutical drugs, substitution for pharmaceutical drugs, comparisons with delta-9-THC, information sources for delta-8-THC knowledge, knowledge of dosages for delta-8-THC and delta-9-THC, and participants' basic demographics (see Tables 1 –5 and Figures 1 –3).

FIG. 2.

Comparisons of delta-8-THC to pharmaceutical drugs with 95% confidence intervals.

FIG. 3.

Comparisons of delta-8-THC to delta-9-THC with 95% confidence intervals.

Table 1.

Demographics of Survey Respondents (N=521)

Descriptive	Value
Gender
Men	57%
Women	41%
Other	2%
Age in years (M, SD, range)	34, 11, 18–76
Education
Grades 1–8	<1%
Grades 9–11	1%
High school graduate or GED	14%
Some college, no degree	25%
Associate's degree	14%
Bachelor's degree	32%
Master's degree	11%
Doctorate (PhD, MD, etc.)	3%
Other	1%
Currently a student	17%
Races/ethnicities (inclusive)
White/European American	90%
Hispanic/Latino	5%
Black/African American	3%
American Indian or Alaska Native	3%
Asian	3%
Native Hawaiian/Pacific Islander	1%
Other	3%

Participants could select all Race/ethnicities that apply.

SD, standard deviation.

We noted many anecdotes in the popular media stating that delta-8-THC is about half as potent as delta-9-THC, consistent with previous research findings, and investigated participants' beliefs on this topic. For comparison, the Canadian Pharmacists' Association recommends that individuals titrate delta-9-THC dosages starting at 2 mg with gradually increasing dosages.²¹ The recommended adult starting dosage of Marinol (Dronabinol) is 2.5 mg orally twice daily, 5 mg has been proposed as a standard THC unit²² and was recently established by several of the U.S. National Institutes of Health as the Standard Unit for Research for delta-9-THC (NOT-DA-21-049, May 7, 2021). U.S. states either consider 5 or 10 mg of delta-9-THC to be one serving.²³ There are no current guidelines for delta-8-THC dosages.

Analyses

Responses to items comparing delta-8-THC to pharmaceutical drugs were examined by one-sample t-tests with a comparison value of 3 (“About the same”), 95% confidence intervals were calculated (Fig. 2). A Pearson correlation examined the relationship between perceived knowledge of delta-8-THC and accuracy on delta-8-THC dosage.

Results

Participant characteristics

Analyses included only completed surveys (N=521); participant demographics are shown in Table 1. The majority (59%) of participants provided their ZIP Codes; these participants were from 38 U.S. states, with the largest portions from New York (29%), Texas (8%), North Carolina (8%), Pennsylvania (6%), and Georgia (5%). Notably, 90% of geographically identified participants were in states where delta-9-THC cannabis products were not yet available for adult use (i.e., “recreational”) retail sale.

Experiences with delta-8-THC

Delta-8-THC administration methods mainly involved derived products (edibles, concentrates, etc.; see Table 2). About half (51%) of participants used delta-8-THC to treat a health or medical condition, 29% of these participants used delta-8-THC exclusively to treat a health or medical condition (not for recreation). The most common primary conditions treated were anxiety or panic attacks, chronic pain, depression or bipolar disorder, and stress (Table 3). About half of participants also used delta-8-THC to treat sleep issues or insomnia. Only 22% of participants reported that their primary care provider knew that they used delta-8-THC, including 31% of those who used it to treat a health or medical condition. An additional 12% of participants reported that their primary care provider did not always know that they used delta-8-THC. Nearly half (48%) of participants (including 45% who used delta-8-THC to treat a health or medical condition) were not at all confident of their primary care provider's ability to integrate medical cannabis into their medical treatment. Other participants were somewhat confident (22%), moderately confident (16%), very confident (5%), and completely confident (10%).

Table 2.

Cannabis Administration Methods (N=521)

Method	Proportion of participants (%)
Edibles (brownies, gummies, etc.)	64
Vaping concentrates (hash, wax, dabs, oil, etc.)	48
Tinctures	32
Smoking concentrates (hash, wax, dabs, oil, etc.)	23
Smoking bud or flower	18
Vaping bud or flower	9
Topical products (lotion, cream, oil, patch on skin)	9
Capsules	6
Suppositories	1
Other	1

Participants could select all methods that apply.

Table 3.

Health and Medical Conditions Treated with Delta-8-THC (n=246)

Condition	Primary	Other	Total
Anxiety or panic attacks	22	46.7	68.7
Chronic pain	12.2	28.9	41.1
Depression or bipolar disorder	11.8	34.6	46.4
Stress	8.9	43.5	52.4
Headache or migraines	7.3	20.7	28.0
Sleep issues/Insomnia	7.3	40.2	47.5
Back spasms or back problems other than pain	4.9	13.4	18.3
Arthritis	3.3	12.6	15.9
Autism	2.8	2.8	5.6
Fibromyalgia	2.8	3.3	6.1
PTSD	2.4	22.8	25.2
Attention deficit (ADD or ADHD)	2	13.8	15.8
Crohn's disease	1.2	2.0	3.2
Irritable bowel syndrome	1.2	12.6	13.8
Multiple sclerosis	1.2	0.0	1.2
Nausea	1.2	15.0	16.2
Cancer/leukemia	0.8	0.0	0.8
Movement disorder	0.8	1.6	2.4
Chronic fatigue	0.4	8.5	8.9
Diabetes	0.4	0.8	1.2
Endometriosis	0.4	2.0	2.4
Gastrointestinal	0.4	11.8	12.2
Hypertension	0.4	2.4	2.8
PCOS	0.4	2.4	2.8
Sciatica	0.4	5.3	5.7
TMJ syndrome	0.4	5.7	6.1
Appetite or anorexia	0	10.2	10.2
Obsessive-compulsive disorder	0	7.7	7.7
Eating disorder	0	2.4	2.4
Scoliosis	0	1.6	1.6
Osteoporosis	0	1.2	1.2
Kidney problems	0	0.8	0.8
Skin condition	0	0.8	0.8
Other	1.2

Values indicate proportions of participants who use delta-8-THC to treat a health or medical condition. Participants could indicate all conditions that apply for “Other” conditions treated.

ADD, attention deficit disorder; ADHD, attention deficit hyperactivity disorder; PCOS, polycystic ovary syndrome; PTSD, post-traumatic stress disorder; TMJ, temporomandibular joint.

Participants considered delta-8-THC superior to pharmaceutical drugs for treating their health condition(s) in terms of side effects or adverse effects, addictiveness, withdrawal symptoms, effectiveness, safety, and availability, and somewhat better in cost (Fig. 2). Participants did not report a difference in the social acceptance of delta-8-THC products and pharmaceutical drugs. Participants who used other drugs reported high levels of substitution by delta-8-THC, especially for sedatives, opioids, sleep aids, synthetic cannabinoids, muscle relaxers, and alcohol (Table 4). About one-quarter (27%) of participants reported that there was a time in the past 12 months when they needed to see a primary care provider or get health or medical care but could not because of cost, including 32% of those who used delta-8-THC to treat a health or medical condition.

Table 4.

Delta-8-THC Substitution for Other Drugs (N=521)

Drug	Ever used	Past use	Reduced	Stopped	Substitution
Alcohol	93.5	19.5	52.0	16.1	68.1
CBD	80.4	12.2	30.2	12.2	42.4
Delta-9-THC	80.2	12.9	39.6	17.6	57.1
Antihistamines	55.5	23.9	8.6	10.5	19.1
Antidepressants	53.4	31.3	13.6	22.0	35.6
NSAIDs	52.2	15.4	47.4	14.8	62.2
Tobacco	46.4	50.4	23.3	25.0	48.3
Sleep aids	44.7	17.2	40.4	39.9	80.3
E-cigarette/nicotine vape	43.4	27.0	25.5	24.8	50.3
Nonopioid pain relievers	40.1	23.0	53.4	13.0	66.5
Muscle relaxers	38.4	50.5	26.3	42.4	68.7
Opioids	35.9	58.8	27.3	55.8	83.1
Anxiolytics/benzodiazepines	31.9	37.3	31.7	28.8	60.6
Amphetamines	29.9	50.6	26.0	27.3	53.2
Nonamphetamine stimulants	17.3	51.1	11.4	18.2	29.5
Sedatives	15.0	46.2	42.9	40.5	83.3
Antiemetics	13.4	37.1	29.5	27.3	56.8
Steroids	13.2	53.6	9.4	43.8	53.1
Antipsychotics	10.9	47.4	10.0	13.3	23.3
Anticonvulsants	9.0	51.1	8.7	21.7	30.4
Synthetic cannabinoids	8.3	83.7	0.0	71.4	71.4
Prescription cannabinoids	2.1	45.5	50.0	0.0	50.0

Values for Past use indicate proportion of ever users who stopped using the drug before initiating use of Delta-8-THC. Values for Reduced and Stopped indicate proportion of current users who reduced and ended their use of a drug because of delta-8-THC. Values for Substitution indicate proportion of current users who either reduced or ended their use of a drug because of delta-8-THC.

NSAIDs, non-steroidal anti-inflammatory drugs.

Participants who had used delta-9-THC cannabis products (n=431) reported that their experiences with delta-8-THC were equivalent in relaxation, nearly equivalent in pain relief, slightly lower in euphoria, and lower in difficulties with short-term memory, difficulty concentrating, altered sense of time, anxiety, and paranoia compared to their experiences with delta-9-THC (Fig. 3). Participants rated their knowledge of delta-8-THC as excellent (11%), very good (25%), good (36%), fair (25%), and poor (25%). This knowledge was primarily from the Internet and participants' own experimentation and experiences (Table 5). On average, participants considered an effective dose of delta-8-THC to be 67 mg (standard deviation [SD]=179, range=0.1–1500 mg), 37% provided a value between 4 and 25 mg, 33% did not know or left the answer blank. On average, participants considered an effective dose of delta-9-THC to be 48 mg (SD=132, range=0–1500 mg), 13% provided a value between 2 and 10 mg, 57% did not know or left the answer blank. Based on reported dosages, participants on average considered delta-8-THC 56% as potent as delta-9-THC; 9% considered delta-8-THC more potent than delta-9-THC, 29% considered delta-8-THC just as potent as delta-9-THC, and 62% considered delta-8-THC less potent than delta-9-THC. There was no relationship between perceived knowledge of delta-8-THC and accuracy on delta-8-THC dosage (answers ranging between 4 and 25 mg), r(521)=0.017, p=0.701.

Table 5.

Sources of Information on Delta-8-THC

Source	Proportion of participants (%)
The Internet	83
Own experimentation and experiences	82
Employees where products are purchased	46
Delta-8-THC product packaging	38
Friends and/or family	33
Medical cannabis caregiver/dispensary	11
Primary health/medical care provider	4
Other	7

Participants could select all sources that apply.

Discussion

Consumer experiences with delta-8-THC products are both similar to and divergent from experiences with delta-9-THC cannabis and products. As concentrations of delta-8-THC in cannabis flower are relatively low, most consumers administered delta-8-THC through derived products such as edibles, concentrates, and tinctures rather than smoking or vaping bud or flower as is most common with delta-9-THC cannabis.¹⁰ Some companies extract delta-8-THC from large quantities of hemp (or synthesize it from CBD) and then spray it on hemp flower. Consumers are using delta-8-THC products to treat a wide range of health and medical conditions, resembling those treated by delta-9-THC and CBD. Many participants reported using delta-8-THC to treat multiple conditions, and most of these participants reported treating anxiety or panic attacks and stress. About half of participants reporting medical use were treating sleep issues or insomnia and depression or bipolar disorder.

Participants reported considerable substitution for a wide range of pharmaceutical drugs, including sedatives, opioids, sleep aids, synthetic cannabinoids, muscle relaxers, and nonopioid pain relievers. Many participants also reported reducing or ending their use of alcohol, tobacco, e-cigarettes or nicotine vapes, CBD, and delta-9-THC. Participants considered delta-8-THC superior to pharmaceutical drugs for treating their health condition(s) in terms of side effects/adverse effects, addictiveness, withdrawal symptoms, effectiveness, safety, and availability, with somewhat lower cost. Delta-8-THC provided the relaxation and pain relief associated with delta-9-THC, with somewhat less euphoria and less difficulty with short-term memory, difficulty concentrating, altered sense of time, anxiety, and paranoia. Cannabis strains with high concentrations of delta-9-THC produce greater impairments in executive function and motor control.²⁴ Although consumers prefer higher potency (i.e., high delta-9-THC) cannabis in terms of experience and value, they also report more problematic issues with memory, paranoia, and dependence compared to weaker strains.²⁵ Those who use cannabis strains high in delta-9-THC and low in CBD were more likely to experience a psychotic episode than those who used strains lower in delta-9-THC.²⁶

There is a lack of integration of the medicinal use of delta-8-THC and mainstream health care. Most participants did not inform their primary care provider of their delta-8-THC use and were not confident of their primary care provider's ability to integrate medical cannabis into their medical treatment, similar to patterns with medical cannabis use in general.¹² Instead of health care professionals, delta-8-THC consumers are relying in information they can find on the Internet, employees of stores selling delta-8-THC products, and product packaging. Some participants received information from medical cannabis caregivers or dispensaries, as do consumers of delta-9-THC cannabis and products,^27,28 but not as often as they did from sources within the delta-8-THC supply chain. For some, delta-8-THC is a substitute for mainstream health care in general due to financial barriers in accessibility.

Pharmaceutical companies have considerable budgets for research and development necessary to bring products to market. The cannabis industry is largely composed of much smaller companies whose research capacity is limited. Collaborative research partnerships between academic researchers and the cannabis industry may accelerate the development of the knowledge base necessary for appropriate cannabis policies and practices. The FDA sees collaborative partnerships among academics, industry, and government as critical to inform public health decisions related to CBD because of the rapid increase in the interest and availability of CBD products.²⁹ Cannabis is much more complex than many other psychoactive substances; there are over a hundred cannabinoids as well as other compounds that may have differential, synergistic, or opposing effects.³⁰ CBD and delta-9-THC already have far more extensive research literatures than delta-8-THC and other cannabis compounds. Integrating standard academic research practices such as independence, institutional review of ethics and participant protection, and peer-review of studies would be valuable for increasing the trust and utilization of research findings on the diverse array of cannabis content.

Limitations

These results are based on the self-reported experiences of delta-8-THC consumers who were members of delta-8-THC industry contact lists and discussion groups and thus may be more favorable to delta-8-THC than a randomly selected population. The study did not control for the substances used, and noncannabis-based delta-8-THC products have been found to contain varying levels of delta-9-THC, above the 0.3% level allowed in the 2018 Farm Bill.³¹ It is possible that substances other than delta-8-THC contributed to user experiences. For dosages, we did not specify route of administration or intended purpose. Participants reporting very high effective dosages may be basing estimates based on the weight of raw plant material. Reported patterns of findings should be verified with more sophisticated studies, such as double-blind randomized control studies for comparisons with pharmaceutical drugs and delta-9-THC. However, such studies currently face considerable legal barriers.

Implications

Although the legal environment for delta-8-THC is becoming more restrictive compared to policies regarding delta-9-THC, results suggest that delta-8-THC may be equally effective for most desired purposes of cannabis use and lower in undesirable or adverse effects. Harm reduction is a central component of public health, and the fact that delta-8-THC products are ingested or vaped rather than smoked may be consistent with harm reduction.³²

Conclusion

All policies and practices regarding cannabis and its products should be informed by empirical evidence from systematic studies. Participants compared delta-8-THC very favorably with both delta-9-THC and pharmaceutical drugs, findings which will need to be verified by additional research. The medicinal use of delta-8-THC is occurring largely independently of primary health care providers, who are not seen as supportive or knowledgeable. Delta-8-THC may be superior to delta-9-THC in terms of harm reduction; however, educational efforts for both health care providers and consumers are needed, and these educational efforts should be informed by systematic research on delta-8-THC and other cannabinoids.

Footnotes

Author Disclosure Statement

All authors have no competing financial interests to disclose.

Funding Information

No funding was received for this study.

Supplementary Material

Abbreviations Used

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