Cbd oil for pain october 9 2022

What Is CBD Oil?

This cannabis extract may help treat nerve pain, anxiety, and epilepsy

Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman’s World, and Natural Health.

Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.

Meredith Bull, ND, is a licensed naturopathic doctor with a private practice in Los Angeles. She helped co-author the first integrative geriatrics textbook, “Integrative Geriatric Medicine.”

Cannabidiol (CBD) oil is an extract from hemp plants called Cannabis indica and Cannabis sativa . You might be more familiar with cannabis plants because they are grown for marijuana. However, CBD is not the same thing as marijuana.

CBD oil contains CBD that’s mixed with a base (carrier) oil, like coconut oil or hemp seed oil. These are called tinctures. You can get tinctures in different concentrations. The oil can also be put into capsules, gummies, and sprays.

People who support using CBD oil say that it can treat pain and anxiety; can help stimulate appetite and may help manage some types of seizures.

This article goes over what CBD is used for, the possible side effects, and what you should look for if you choose to buy CBD.

CBD vs. Marijuana

CBD is one component (called a cannabinoid ) that’s found in a hemp plant. Marijuana is a separate plant but it’s from the same species that hemp belongs to. Marijuana has CBD and hundreds of other compounds in it.

The main difference between hemp plants and marijuana plants is how much of a compound called tetrahydrocannabinol (THC) is in them. Hemp is grown to have less than 0.3% THC, while marijuana has more.

THC is what’s responsible for the psychoactive effects of cannabis—in other words, it’s what makes you feel “high.”

CBD oil generally does not have THC in it; however, a very small (trace) amount might be in products sold in certain states.

What Is CBD Oil Used For?

We’re not sure exactly how CBD works. Unlike THC, CBD doesn’t have a strong connection with the molecules in the brain that THC binds to create psychoactive effects. These are called cannabinoid receptors.

Instead, CBD works on other receptors, like the opioid receptors that help control pain. It also affects glycine receptors that control a brain chemical called serotonin which helps control your mood.

People that support the use of CBD claim that CBD oil can treat a variety of health problems, including:

  • Acne
  • Anxiety
  • Chronic pain
  • Depression
  • Drug use and withdrawal
  • High blood pressure
  • Muscle spasms
  • Poor appetite

As CBD has gained popularity, researchers have been trying to study it more. Still, there has not been a lot of clinical research to look for evidence in support of these health claims.

CBD is not a safe option for everyone. Talk to your healthcare provider if you want to try it for managing a health condition.

Anxiety

A 2015 review of research that was published in the journal Neurotherapeutics suggested that CBD might help treat anxiety disorders.

The study authors reported that CBD had previously shown powerful anxiety-relieving effects in animal research—and the results were kind of surprising.

In most of the studies, lower doses of CBD (10 milligrams per kilogram, mg/kg, or less) improved some symptoms of anxiety, while higher doses (100 mg/kg or more) had almost no effect.

The way that CBD acts in the brain could explain why this happens. In low doses, CBD might act the same as the surrounding molecules that normally bind to the receptor that “turns up” their signaling.

However, at higher doses, too much activity at this receptor site could produce the opposite effect.

There have not been many trials to look at CBD’s anxiety-relieving effects in humans. However, one was a 2019 study published in the Brazilian Journal of Psychiatry.

For the study, 57 men took either CBD oil or a sugar pill with no CBD in it (placebo) before a public-speaking event.

The researchers assessed the participants’ anxiety levels using measures like blood pressure and heart rate. The researchers also used a reliable test for mood states called the Visual Analog Mood Scale (VAMS).

The men who took 300 mg of CBD oil reported less anxiety than the men who were given a placebo; however, the men who took 100 mg or 600 mg of CBD oil did not experience the same effects.

Addiction

CBD oil might help people with substance use disorder, according to a 2015 review published in the journal Substance Abuse.

The review looked at the findings from 14 published studies. Nine of the studies looked at the effects of CBD on animals, and five studies looked at the effects on humans.

The researchers reported that CBD showed promise for treating people with opioid, cocaine, or psychostimulant use disorders.

However, the effects of CBD were quite different depending on the substance. For example, CBD without THC did not decrease withdrawal symptoms related to opioid use.

On the other hand, it did reduce drug-seeking behaviors in people using cocaine, methamphetamine, and other similar drugs.

Some experts suggest that CBD could help treat cannabis and nicotine dependence, but more research is needed to provide this theory.

High Blood Pressure

A 2017 study found that CBD oil may reduce the risk of heart disease because it can lower high blood pressure in some people.

For the study, nine healthy men took either 600 mg of CBD or the same dose of a placebo. The men who took CBD had lower blood pressure before and after experiencing stressors like exercise or extreme cold.

The study also looked at the amount of blood remaining in the heart after a heartbeat (stroke volume).

The stroke volume in the men who took CBD was lower than in was in the placebo group, meaning their hearts were pumping more efficiently.

The study suggested that CBD oil could be a complementary therapy for people with high blood pressure that is affected by stress and anxiety.

However, there is no evidence that CBD oil can treat high blood pressure on its own or prevent it in people at risk. While stress can complicate high blood pressure, it does not cause it.

Seizures

In June 2018, the U.S. Food and Drug Administration (FDA) approved a CBD oral solution called Epidiolex.

Epidiolex is used to treat two rare forms of epilepsy in children under the age of 2: Dravet syndrome and Lennox-Gastaut syndrome. These are very rare genetic disorders that cause lifelong seizures starting in the first year of life.

Other than for these two disorders, CBD’s effectiveness for treating seizures is not known. Even with Epidiolex, it’s not clear if the anti-seizure effects are from CBD or another factor.

However, there is some evidence that CBD interacts with seizure medicines like Onfi (clobazam) and raises their concentration in the blood. That said, more research is needed to understand the link.

Possible Side Effects

Clinical research has shown that CBD oil can cause side effects. The specific side effects a person has and how bad they are varies from one person to the next and from one type of CBD to another.

Some common side effects people report from using CBD include:

  • Anxiety
  • Changes in appetite
  • Changes in mood
  • Diarrhea
  • Dizziness
  • Dry mouth
  • Nausea
  • Vomiting

CBD oil may also increase liver enzymes, which is a marker of liver inflammation.

People with liver disease should talk to their healthcare provider before taking CBD oil. They may need to have their liver enzymes checked regularly if they are using CBD.

Can You Use CBD If You’re Pregnant?

You should not use CBD oil if you’re pregnant or breastfeeding. Even though the effects of CBD are not fully understood, it does pass through the placenta.

The American Academy of Pediatrics (AAP) further states that pregnant people should not use marijuana because of the potential risks to a developing fetus.

Do not drive or use heavy machinery when taking CBD oil—especially when you first start using it or switch to a new brand. Remember that some products do contain THC, even in small amounts.

Interactions

CBD oil can interact with medications, including many that are used to treat epilepsy. One of the reasons for this has to do with how your body breaks down (metabolizes) drugs.

Cytochrome P450 (CYP450) is an enzyme your body uses to break down some drugs. CBD oil can block CYP450. That means that taking CBD oil with these drugs could make them have a stronger effect than you need or make them not work at all.

Drugs that could potentially interact with CBD include:

  • Anti-arrhythmia drugs like quinidine
  • Anticonvulsants like Tegretol (carbamazepine) and Trileptal (oxcarbazepine)
  • Antifungal drugs like Nizoral (ketoconazole) and Vfend (voriconazole)
  • Antipsychotic drugs like Orap (pimozide)
  • Atypical antidepressants like Remeron (mirtazapine)
  • Benzodiazepine sedatives like Klonopin (clonazepam) and Halcion (triazolam)
  • Immune-suppressive drugs like Sandimmune (cyclosporine)
  • Macrolide antibiotics like clarithromycin and telithromycin
  • Migraine medicine like Ergomar (ergotamine)
  • Opioid painkillers like Duragesic (fentanyl) and alfentanil
  • Rifampin-based drugs used to treat tuberculosis

Always tell your healthcare provider and pharmacist about all the medicines you take, including prescription, over-the-counter (OTC), herbal, or recreational drugs.

The interactions between these medications and CBD are often mild and you might not have to change your treatment.

However, in some cases, you might have to change medications or space out your doses to avoid a reaction. That said, never change or stop medication without talking to your provider.

Dosage and Preparation

There are no guidelines for using CBD oil. Each product works a bit differently, depending on the form.

For example, putting the oil under your tongue can produce effects more quickly than swallowing a capsule that needs to be digested.

Here are a few ways that you can take CBD oil:

  • Placing one or more drops under your tongue and holding it there for 30 to 60 seconds without swallowing. You can also use a spray that is spritz in your mouth/under your tongue.
  • Taking a capsule or chewing a gummy
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There’s no “correct” dose of CBD oil. How much you take and the form you choose will depend on your needs and what you hope to get for effects. The average dose range is from 5 mg to 25 mg.

Most oils come in 30-milliliter (mL) bottles and include a dropper cap to help you measure.

That said, it’s hard to figure out the exact amount of CBD per milliliter of oil. Some tinctures have concentrations of 1,500 mg per 30 mL, while others have 3,000 mg per mL or more.

How to Calculate CBD Dose

To determine an exact dose of CBD, remember that each drop of oil equals 0.05 mL of fluid. This means that a 30-mL bottle of CBD oil will have about 600 drops in it.

If the concentration of the tincture is 1,500 mg per mL, one drop would have 2.5 mg of CBD in it. The math to figure that out looks like this: 1,500 mg ÷ 600 drops = 2.5 mg

What to Look For

CBD oil comes in different forms: isolates, broad-spectrum, and full-spectrum.

  • Isolates contain only CBD
  • Broad-spectrum oils nearly all of the components of the plan (e.g., proteins, flavonoids, terpenes, and chlorophyll), but does not have THC oils have all the compounds including THC (up to 0.3%)

Alternative medicine practitioners believe that the compounds provide more health benefits, but the is a lack of evidence to support these claims.

Remember that CBD oils are unregulated. There’s no guarantee that a product is what it claims to be on its packaging. You also can’t know for sure that it’s safe and effective.

A 2017 study reported that only 31% of CBD products sold online were correctly labeled. Most had less CBD in them than was advertised, and 21% had significant amounts of THC.

If you are interested in buying CBD products, here are a few tips to keep in mind:

  • Buy American: Domestically produced CBD oil might be a safer option than those that have been imported.
  • Go organic: Brands certified organic by the U.S. Department of Agriculture (USDA) are less likely to expose you to pesticides and other harmful chemicals.
  • Read the product label: Even if you choose a full-spectrum oil, don’t assume that every ingredient on the product label is natural. CBD products can also have preservatives, flavorings, or thinning agents in them. If you don’t recognize an ingredient, ask the dispenser what it is or check online.

Summary

Hemp plants can be grown for different purposes. Some species are made for marijuana but others are used to make CBD products.

Unlike marijuana, CBD oil does not “get you high.” Instead, it may help relieve stress, anxiety, drug withdrawals, and nerve pain.

While there are many claims about the health benefits of using CBD oil, the evidence is lacking. A lot of studies were done with animals, not humans.

If you want to try CBD oil, you should learn about the different dosages and preparations first.

You should also know that the products are not regulated, which means you can’t know for sure that a product will work and be safe.

Before you use CBD oil, talk to your provider. If you take certain medications or have a health condition, you may not be able to use these products.

Frequently Asked Questions

It would be hard to overdose on CBD oil. Research has shown that human tolerance for CBD is very high. One study reported the toxic dose would be about 20,000 mg taken at one time.

It depends on where you live, the type of product, how it was sourced (e.g., is it from hemp or marijuana), and its intended purpose (medical or recreational). In many states, you must be 18 or 21 to buy CBD oil. Check your state’s laws.

Not necessarily. While the names are sometimes used interchangeably, hemp oil can also refer to hemp seed oil, which is used for cooking, food production, and skincare products.

CBD oil is made from the leaves, stems, buds, and flowers of the Cannabis indica or Cannabis sativa plant. It should contain less than 0.3% THC.

Hemp oil is made from the seeds of Cannabis sativa and does not have TCH in it.

Clinicians’ Guide to Cannabidiol and Hemp Oils

Cannabidiol (CBD) oils are low tetrahydrocannabinol products derived from Cannabis sativa that have become very popular over the past few years. Patients report relief for a variety of conditions, particularly pain, without the intoxicating adverse effects of medical marijuana. In June 2018, the first CBD-based drug, Epidiolex, was approved by the US Food and Drug Administration for treatment of rare, severe epilepsy, further putting the spotlight on CBD and hemp oils. There is a growing body of preclinical and clinical evidence to support use of CBD oils for many conditions, suggesting its potential role as another option for treating challenging chronic pain or opioid addiction. Care must be taken when directing patients toward CBD products because there is little regulation, and studies have found inaccurate labeling of CBD and tetrahydrocannabinol quantities. This article provides an overview of the scientific work on cannabinoids, CBD, and hemp oil and the distinction between marijuana, hemp, and the different components of CBD and hemp oil products. We summarize the current legal status of CBD and hemp oils in the United States and provide a guide to identifying higher-quality products so that clinicians can advise their patients on the safest and most evidence-based formulations. This review is based on a PubMed search using the terms CBD, cannabidiol, hemp oil, and medical marijuana. Articles were screened for relevance, and those with the most up-to-date information were selected for inclusion.

Copyright © 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Comment in

Scharf EL, Ward AM, Ebbert JO. Scharf EL, et al. Mayo Clin Proc. 2020 Jan;95(1):200. doi: 10.1016/j.mayocp.2019.10.026. Mayo Clin Proc. 2020. PMID: 31902417 No abstract available.

VanDolah HJ, Bauer BA, Mauck KF. VanDolah HJ, et al. Mayo Clin Proc. 2020 Jan;95(1):200-201. doi: 10.1016/j.mayocp.2019.10.025. Mayo Clin Proc. 2020. PMID: 31902418 No abstract available.

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Delta-8-THC: Delta-9-THC’s nicer younger sibling?

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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Background

Among hundreds of cannabinoids, delta-8-tetrahydrocannabinol (delta-8-THC, Δ 8 -THC) has rapidly risen in popularity among consumers of cannabis products. 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 (Qamar et al. 2021). Delta-8-THC differs in the molecular structure 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).

The 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 popularity 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 considered 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 administrated 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. The 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 compound’s psychoactive effects (Sullivan 2021). All policies and practices, including those related to substance use and public health, should be informed by empirical evidence. The 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 survey 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 qualitative 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 Botanics, a manufacturer of delta-8-THC and CBD products in New York State, distributed invitations to participate in the study via their social media accounts (Facebook, Instagram), via their email contact list, and via the Delta8 online discussion board (Subreddit) on Reddit.com. The invitation 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.” Screening questions verified that participants were 18 years of age or older, were currently in the USA, and used or consumed products containing 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 analyses, the completion rate was 74%. Participants were men (57%), women (41%), and individuals who reported another gender identity (2%). The 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%), Hispanic/Latino (5%), Black/African American (3%), American 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. The 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. The question stem read: “Please indicate how much you experience the following when you use delta-8-THC:” Specific aspects were altered sense of time; anxiety (unpleasant feelings, nervousness, 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. The 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. The 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. This item was followed by a brief demographic section assessing 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?” There 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 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 participants’ gender with between-subjects t tests, participants’ age with Pearson correlations, and participants’ educational levels with partial correlations controlling 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 coding 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 interrater reliability, two coders independently read participant 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.

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

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

Results

Participants mostly consumed delta-8-THC through edibles (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 substitution 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 concentrating. Participants reported low levels of distressing mental states (anxiety and paranoia). There were large statistical effect sizes in differences between items in the first set of experiences (relaxation, pain relief, and euphoria) and items in the second set (cognitive distortions), and medium statistical effect sizes in differences between cognitive distortions and anxiety and paranoia.

Participants (n = 204) provided text responses in one or both open-ended questions (see Table 2 and S1). The most common theme was comparisons between delta-8-THC and delta-9-THC. Participants’ responses containing 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 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.”

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The second most common theme was the therapeutic 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 limited study, care should be taken with its use. But I’ve personally 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.” The third most common 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.”

The 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 effective 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 specifically for solvents and reagents used in delta-8-THC production, 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.”

The fifth most common theme was general expressions of praise for delta-8-THC. Many participants had similar statements such as “Delta 8 is a great thing. It needs to stay accessible and affordable for the people that can really benefit.” The sixth most common theme was substitution of delta-8-THC for other substances. One participant stated: “The 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.”

The seventh most common theme was the dual use of delta-8-THC and delta-9-THC. One representative comment 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.” The 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. The 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 vaping/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 associated with cannabis use. Experiences of relaxation, pain relief, and euphoria were the most prominent, characterized 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), however they may in in others (e.g., operating a motor vehicle). Paranoia and anxiety are distressing mental states that may result from delta-9-THC ingestion (Freeman et al. 2015). On average, participants’ experiences of paranoia 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 information that can inform hypothesis testing and research questions in future studies. For example, it would be valuable to conduct systematic studies comparing experiences of delta-8-THC with delta-9-THC and pharmaceutical 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 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 impurities. 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). The US Cannabis Council 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 metals 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

The 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.

The current study provides empirical evidence to inform discussions of delta-8-THC-related policies and practices. More research is needed to isolate the psychoactive effects of delta-8-THC and its possible therapeutic 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 benefits 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 opioids (Rouhani et al. 2019), alcohol (Marlatt et al. 2011), and tobacco (Parascandola 2011). Interventions based on harm reduction principles have been successful in reducing 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.

The U.S. Food and Drug Administration (FDA) has recommended collaborative research partnerships among academic researchers, government officials, and representatives 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 generation of knowledge regarding delta-8-THC and other cannabinoids.

Limitations

This study compiled the self-reported experiences of delta-8-THC consumers. The patterns of experiences reported here require verification with carefully controlled studies, such as double-blind and randomized studies for comparisons of delta-8-THC with delta-9-THC and pharmaceutical drugs. The 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 randomly selected population-representative sample.

Conclusions

Delta-8-THC products may provide much of the experiential 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. The current study provided a broad descriptive assessment of self-reported experiences with delta-8-THC. Further systematic research will be critical in verifying the favorable reports of delta-8-THC consumers.

Availability of data and materials

The dataset used and analyzed for the current study are available from the corresponding author on reasonable request.