By Melanie Padgett Powers, writer
Synthetically created cannabis products containing delta-8 tetrahydrocannabinol (THC) have been gaining in popularity, and public health professionals are concerned consumers don’t know about their risks.
A chemist and an epidemiologist who study cannabis at the federal level outlined how delta-8 THC works, its potential risks and reported adverse events during the 2022 APHL Annual Conference May 18 session, “Delta: Not Just a COVID Variant! Delta-8 THC and Why Public Health Should Be Concerned,” in Cleveland, OH.
On September 14, 2021, the US Centers for Disease Control and Prevention (CDC) issued a Health Alert Network health advisory to alert public health departments and laboratories to the increased availability of cannabis products with delta-8 THC and the potential for poisonings due to insufficient labeling.
On May 4, 2022, the US Food and Drug Administration (FDA) issued a warning letter to five companies marketing and selling unapproved drugs—the first such warning about delta-8 THC. The FDA followed up with a May 13 consumer alert about the accidental ingestion of food products containing THC. Many of the product packaging mimics real brands of candy and cereal marketed to children, such as Crunch Berries cereal and Nerds candy.
What is delta-8 THC?
Cannabis naturally contains the cannabinoids delta-8 and delta-9 THC, the psychoactive part of marijuana. Any part of the plant with more than 0.3% delta-9 is considered marijuana; less than that, it’s considered hemp. Delta-8, while naturally occurring in cannabis, accounts for less than 0.1% of the plant, explained Cassandra Taylor, PhD, a chemist at the FDA Center for Drug Evaluation and Research. Delta-8 is estimated to be about 50–75% as psychoactive as delta-9 THC, according to CDC.
Delta-8 and delta-9 THC can also be created synthetically by converting the chemical cannabidiol (CBD) in the cannabis plant using a solvent, acid or heat. This is where many of the concerns come in.
Delta-8 THC products are popping up in the marketplace more frequently. Makers of these products are creating quantities of delta-8 THC in much higher quantities than occurs naturally. The legality can be confusing and varies state by state. However, legal or not, there are several risks to consuming delta-8 THC products, as they have not been evaluated or approved by the FDA. They have psychoactive and intoxicating effects and can be particularly dangerous to children and pets, Taylor said.
“The historical use of cannabis cannot be relied upon to establish safety because in the past people have not been taking delta-8 THC in a concentrated way in high doses. This really has not come about until much more recently,” Taylor said.
Delta-8 THC adverse events
Delta-8 THC products are likely created in uncontrolled and unsanitary conditions. To create the higher concentrations of delta-8 THC for these products, makers often use harmful chemicals. They may also add bleach to make the product look more clear, which consumers assume means it’s more pure, Taylor said.
“People are really being exposed to lots of different chemicals, lots of different contaminants, and they are consuming or inhaling these,” she said. “They’re not just getting delta-8 THC; they’re likely getting other byproducts.”
FDA received 104 adverse event reports from December 1, 2020 to February 29, 2022. Of these, 8% were pediatric patients. Adverse events included hallucinations, vomiting, tremors, anxiety, dizziness, confusion and loss of consciousness.
The national poison control centers received notices of 2,362 exposures in 2021, of which 41% were for children younger than 18. Forty percent of the total involved accidental exposure to delta-8 THC.
At CDC, data were collected from emergency departments (EDs) participating in the National Syndromic Surveillance Program, a program in which about 71% of all US non-federal EDs take part. The first suspected reported ED visit involving delta-8 THC was in September 2020, with three more visits that month. By July 2021, there were 48 visits reported.
However, surveillance data are likely a “severe underestimate” because sick individuals have to know that they took delta-8 THC for it to be reported as such, said epidemiologist Brooke Hoots, PhD, MSPH, who leads the Cannabis Strategy Unit in the CDC Division of Overdose Prevention.
Because of the chemical and byproduct ingestion, public health professionals are also concerned about an outbreak of disease similar to the e-cigarette or vaping use-associated lung injury, or EVALI, Hoots said.
“I’m kind of surprised we haven’t [seen this] already. There are unclear effects of consuming or inhaling these chemicals and byproducts,” she said, “and vapes are a popular mode of use of delta-8 THC.”
Delta-8 THC is not the only novel cannabinoid coming to market, Hoots said. Others include delta-10 THC, as well as THC-O acetate, which is not naturally occurring and is considered a lot more psychoactive than delta-9 THC. Another is hexahydrocannabinol (HHC), also derived from CBD, which is said to produce more of a “euphoric high.”
“Really, the question is ‘what’s next?’ because the market is just burgeoning with these THC isomers and analogs,” Hoots said.
Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.
