Three presenters talked about health issues related to semi-synthetic cannabinoids, their marketing and availability, followed by possible actions and approaches to lobbying on the topic.
Here are some observations from the Thursday May 23rd Prevention Technology Transfer Center Network Coordinating Office (PTTC NCO) webinar titled, “Semi-Synthetic Cannabis Products: Public Health Concerns and Policy Solutions!”
My top 4 takeaways:
- Research psychologist Ken Winters talked about “Contemporary health issues in marijuana" and the chemistry of tetrahydrocannabinol (THC) and other cannabinoid analogues, along with information on individuals’ “experience of potency" (audio - 9m, video - PTTC NCO, presentation).
- A clinical psychologist who served as Oregon Research InstituteSenior Scientist, University of Minnesota Department of Psychology Adjunct Faculty, and Smart Approaches to Marijuana Minnesota (SAMn) Research Advisor, Winters remarked that he’d provide an “overview of the semi-synthetics analog world.”
- Having spent years researching cannabis and hemp, he made “two major distinctions of all the various analogues…they could be considered to be semi synthetics,” yet were often “referred to analogues because they're analogous to the so called mothership cannabinoid delta nine” THC. Winters was going to highlight six analogues which had the “distinction of being in the majors, because there's at least some information about them.” He sorted some information about each “based on their strength, potency…legality, whether they're detected in its user and then their primary source.”
- “What do you notice about this grid? There's a lot of question marks.” Winters further noted several other analogues which “don't sit at the main table…because I couldn't find much information about it. There's not much on any of them.”
- The rest of his background touched on the chemical structure and binding affinity of cannabinoids with receptors in the human endocannabinoid system, as well as how analogues needed cannabidiol (CBD) plus “solvents, acid, and other chemical constituents” to be created in significant amounts. This made it “more efficient to grab it from the hemp plant versus the cannabis plant,” commented Winters, but “if the production and the manufacturing isn't careful some of these chemicals and byproducts” could be ingested by the consumer.
- Speaking to the “sparse” research on analogues, Winters found the “information about their impacts, and their effects is mostly anecdotal…but it's not clear that there's even a uniform way to describe the subjective intoxication effects of these various products.” Most concerning to him was that “these analogues are showing up as vapes and edibles sometimes they're used…as a marketing tool.”
- Controlled substance analogues are regulated under the 1986 Federal Analogue Act.
- Winters mentioned the major analogue she’d looked at included delta-8-THC, delta-10-THC, delta-11-THC, hexahydrocannabinol (HHC), tetrahydrocannabinolic acid (THC-A) and delta-9-tetrahydrocannabiphorol (THC-P), reporting that only delta-8-THC—which he nicknamed “diet weed”—had been found to be detectable in the consumer. His presentation touched on the differences between the analogues and he offered a “speculative potency strength continuum” chart to show possible differences in effect intensity based on “where I think they might fall on a stronger-to-lighter continuum” (audio - 7m, video - PTTC NCO).
- Winters added that “it's not clear that there are specific tests, somebody could spike positive if they took delta-10,” but “they would be probably getting a test that was just generic, and falsely saying the person was intoxicated on delta-9.”
- Considering some of the other analogues about which less was known, Winters observed that Cannabinol (CBN) had been shown to act as a neuroprotectant, but he remained skeptical it had a significant effect as some studies “show that it doesn't do any better than placebo if you do double blind studies.”
- Considering the chemistry around cannabis potency, Winters stated it was possible to “alter someone's experience of potency.” He’d evaluated potency “both in terms of how strong a product is,” as well as how it was “impacted by how much you consume the product.” Winters suggested that frequent consumption of delta-8-THC might prove more intoxicating than small amounts of delta-9-THC. He touched on cognitive tests, risks related to first-episode psychosis, and cited a 2022 study which suggested “use of higher potency cannabis, relative to lower potency cannabis, was associated with an increased risk of psychosis” and cannabis use disorder (CUD, audio - 5m, video - PTTC NCO).
- Winters concluded cannabis analogues were a "wild west in the marketplace" whose manufacturing raised concerns about “toxic products being consumed.” Heavy cannabis consumption “likely contribute[d] to more short and long term harms,” he added (audio - 1m, video - PTTC NCO).
- A researcher from Texas reviewed “Marketing and Retail Availability of Semisynthetic Cannabinoids,”including insight into what he’d learned about the Washington state market.
- University of North Texas Health Science Center School of Public HealthAssociate Professor of Health Administration and Health Policy Matthew Rossheim was welcomed as a “leading public health expert on derived intoxicating cannabis products and their marketing” (audio - 1m, video - PTTC NCO).
- Rossheim offered context around “how this problem came to be,” and shared “a few studies about where these products are being sold and what they look like.” He explained the situation emerged following passage of the 2018 Farm Bill which legalized hemp nationwide, even though the legislative “intent was to legalize the non intoxicating part of the cannabis plant hemp.” He elaborated that “the way that they operationalize[d] this” had been based on the delta-8-THC content “by weight…because delta-9-THC is the most naturally abundant, intoxicating compound in the cannabis plant.” Rossheim suggested there’d been a stark difference between “what they envision it looking like and in reality.” He reported that state authorities “tried to respond” once there were “semi-synthetic products hitting the market as well as delta nine edibles being sold.” This led to a “patchwork” of policies between states related to delta-9-THC and other cannabinoids (audio - 1m, video - PTTC NCO).
- The question Rossheim and his research group had confronted was “where can you buy this stuff,” when conducting a study which was being revised for publication in the American Journal of Preventive Medicine. He commented that “most people would think it's…places that have retail cannabis,” but when they “called vape shops across the US and found that in most states, 90 to 100% of the vape shops that we contacted, were selling intoxicating cannabis products.” Rossheim said that “every state except Washington and Alaska, was selling these products in vape shops,” but those two states in particular had both “legalized recreational cannabis and, and bans on these products” (audio - 12m, video - PTTC NCO).
- First, “it seems that more vape shops are selling these in places” without medical cannabis dispensaries, and second “when you add these two up, this means that you can buy intoxicating cannabis products in stores in every state, all 50 States; Washington, D.C.; and Puerto Rico. And so right now we're operating as a recreational cannabis country…with almost no regulations in a lot of states.”
- The wide variety of regulations on hemp and cannabis between states resulted in some types of cannabinoids besides delta-9-THC being banned, he said, and “retailers are counting the weight of the food or beverages in calculating the percent by weight. So they're saying it's hemp, even though chemically it's a THC product.” Rossheim then mentioned the “THC-A issue that's coming up…being one of the closest to delta-9-THC because…when you heat it, either through vaping or smoking or making edibles, it turns into regular delta-9-THC.” But problematically, he indicated “oftentimes, we're just seeing a different type of product that's being sold.” Rossheim offered the example of Florida, where there was a medical cannabis dispensary and “right next to it a CBD store.”
- In contacting vapor retailers in each state, there were “huge discrepancies in what they said were legal and not legal,” Rossheim remarked. In New Hampshire, he noted, “some of them said all THC products were illegal. Some said only delta nine was illegal. Some said they didn't sell any THC, but they sold delta-8. So they didn't even realize what they were selling.” Rossheim added that some locations seemed to “potentially know that they were violating laws. One of them said…’if you're not a cop, yeah, we sell them.’” Retailers in Delaware were all over the place, one said only delta-9-THC was legal, another identified it as the only banned cannabinoid, while a “third one said only [delta-9-THC and HHC] vapes were illegal…so even within-state there's confusion among retailers among what's legal and what's not.”
- Marketing was important to study, Rossheim argued, since it “shapes social norms and perceptions" as well as “in particular, price, availability, and advertising.” Since marketing could have a distinct impact on youth, he felt that made rules “very important policy levers for alcohol, tobacco, cannabis.” Rossheim said marketing regulations were the “best return on investment in terms of policy interventions.”
- In looking at all Fort Worth stores with a "consumable hemp license,” they found “out of the 1200 stores that we called 130 of them reported selling delta-8-THC, almost all of them as either flower or vapes. And more than three fourths sold edibles as well. The edibles tended to be less expensive, on average,” Rossheim noted. Furthermore, “outlets that sold delta-8-THC were also disproportionately located in areas with greater socioeconomic deprivation. And although most of them reported that you had to be 21, 4% said 18, and one of them said there was no minimum age.” When visiting stores in person, Rossheim said researchers had been told at one shop that customers “tend to be 21 but if a kid is having a bad day or something like that, I might sell to them.” Rossheim highlighted that some products with semi-synthetic cannabinoids included were packaged to look like “Willy Wonka's Nerds ropes and chocolate bars with anime characters and HHC and THC-O vapes that are Fruity Pebble flavored.”
- Rossheim stated that he knew “hundreds of kids are getting hospitalized from consuming these.” He pointed to results of the Monitoring the Future youth survey from 2023 which “showed that more than one in ten 12th graders had used delta-8 in the past year. And then for this year, 8th and 10th graders are going to be asked as well about delta-8 use.” Considering online access to cannabinoid products, Rossheim pointed to another study from 2023: “Absence of Age Verification for Online Purchases of Cannabidiol and Delta-8: Implications for Youth Access.” Researchers had concluded “age verification methods are self reported and easily circumvented,” he said. Rossheim claimed this was proof “policies and their enforcement are needed” to reduce online access, and mentioned one school district in Texas where reportedly “65 students were caught with THC vapes, and although most of them wouldn't say where they got it, few of them said that they were using Snapchat and cash apps in order to get access to these products.”
- During the study he’d searched for ‘buy delta THC online’ and “downloaded the top 100 results to Excel” before comparing traffic to the sites, with the top result having “over a million visits in the last month.” With many of the sites selling vapor products and edibles, Rossheim noted there were copyright infringements, along with “cartoon characters and flavors that wouldn't be legal for even tobacco.”
- Blends were also “very common on this online audit, more than half of the products that they sold were blends containing two to eight different types of these intoxicating cannabinoids in a single product,” he stated. While 26 intoxicating compounds had been identified, Rossheim had found THC-P to be the most common addition to give items a “really quick high, and then the other ones…keep it going over time.” The concern for researchers, he suggested, was that after looking at hundreds of products across the three most heavily visited sites there were both compounds that hadn’t been researched individually or in combinations, along with possible known and unknown byproducts.
- In looking at 4/20 specials by vapor retailers, Rossheim and others found “two really distinct kind of types of shops that are carrying these outside of licensed dispensaries.” One was “the gas station convenience stores that may have…an edible or a couple brands of vapes, usually at the point of sale.” But the main supplier “seems to be the vape shops or smoke specialty smoke shops,” which had discounts and promotional events, he remarked. Rossheim observed how at some vapor retailers on 4/20 “you could hit the bongs in the store…to test out the glass before you bought it. And another one had a DJ and food trucks and were handing out edibles for free and things like that.” Rossheim regarded this as evidence of the “very pervasive in terms of online marketing,” like including younger women, and “most of the products were disposable vapes or edibles followed by vape carts, pre rolls, flower, dabs, there were 118 brands.”
- Providing a list of research articles on the topic, Rossheim emphasized the assorted resources available through UNT, mentioning “my former doctoral student, Dr. Cassidy, LoParco, who's really taking this on.” He told the group, “in general, we know what effective regulation looks like. However, the entire purpose of these products is to circumvent regulations intended to protect public health and safety,” concluded Rossheim. In order to effectively regulate them, he felt officials needed an “answer to all of these questions” around prevalence, testing, and health effects. While some states’ leaders “think that a good gray area is just regulating them, but how can you…possibly regulate them for the protection of public health and safety [without an] understanding of the health effects of all of these. So the 2024 Farm Bill reauthorization is a major opportunity to address this. And then also, state laws are needed” (audio - 2m, video - PTTC NCO).
- An anti-drug coalition advocate sounded the alarm about semi-synthetic cannabinoid products and offered approaches to lobby for a federal change to criminalize the items (audio - 13m, video - PTTC NCO).
- Community Anti-Drug Coalitions of America (CADCA) Public Policy Consultant Sue Thau commented that the cannabinoid items in question “gets you high. It's not any CBD crap, you can really feel this.” Echoing the points about inconsistent laws leading to availability of the products, she warned “nobody is enforcing anything when it comes to this. And that's one of the other problems, not only do we have a legal gray area here, but it's not clear to enforcement that if they put any time and effort into this, they're going to get anywhere”
- Thau raised the specter of impairment and driving, and felt “people using this getting high [weren’t] understanding that they really shouldn't be out…doing much in society” afterwards. For kids, she insisted it was impossible to tell the difference between cannabinoid items spoofing popular brands of candies or snacks. Although the “Federal Trade Commission, the FTC has gone after some of these companies recently because of the trademark infringement but honestly,” youth were still “bringing this stuff to school, sharing it with other kids and they're going to the hospital.”
- After calling out a partnership between a Texas alcohol retailer and a hemp-infused beverage manufacturer, Thau echoed the sentiment that the industry was a “total wild west." Although “New York has specifically banned these synthetic cannabinoid products from being sold anywhere in that state,” Thau had spoken with coalition members who reported every “county in New York State had these products, everywhere, gas stations, convenience store, head shops, smoke shops, and there's absolutely no enforcement whatsoever.”
- Thau had lobbied “to totally close the loophole" as her organization believed it was "almost impossible to regulate" chemical conversion of cannabinoids, and "these products should never have existed in the first place." She spoke approvingly of the amendment to the Farm Bill seeking to close the allowance for conversion of legal hemp. “We're praying that it, it passes because it would be amazing to have that in the House bill,” said Thau, before acknowledging comparable language hadn’t been added to the US Senate version. She was complimentary of the amended wording in the House, which she indicated “goes further than we would have thought that it would have gone because it actually deals with the fact that a lot of these products…take the 0.3% dry weight out of the plant and put it in a product and then you end up with products and edibles that have quite a lot of THC.”
- All three presenters fielded attendee questions in between their presentations, addressing chemistry; adult overdoses; state enforcement and marketing towards youth; along with comparative harms and federal policies.
- Winters addressed several questions on cannabinoid chemistry:
- Asked for “a little bit more information on what binding affinity means,” Winters answered that it meant “how well that particular cannabinoid connects to either the [cannabinoid receptor] CB1, CB2, or both receptors” (audio - 1m, video - PTTC NCO).
- Someone wanted to know “which chemical has or which version has double binding.” Winters responded that “double bonds to the carbon apparently occurs throughout all of the cannabinoids,” but scientists had observed “the double bond is located in different spots on the carbon structure” (audio - 1m, video - PTTC NCO).
- Another person was “looking to know what differentiates cannabis from the hemp plant.” Winters replied that “while the hemp plant is, is very different” from cannabis, which he called “rich in, in Delta nine or what we believe to be THC,” he claimed “hemp plants, if they're grown legally, have a very small amount of delta-9 or THC,” but more CBD. “So they're different seeds. They just have a different constitution,” he concluded (audio - 1m, video - PTTC NCO).
- Sourcing seed which consistently produces plants containing 0.3% THC or less by weight had proven difficult. Even Congressman James Comer (R-Kentucky) was involved in the importation of hemp seed for a Kentucky-based wholesale seed provider which ultimately produced many plants that had THC content classifying the plants as cannabis.
- Upon inquiry about which organs had the most CB1 and CB2 receptors, Winters noted they were "rich in the brain,” as well as in the reproductive system, “or [what] I call the swimsuit area of the body” (audio - 1m, video - PTTC NCO).
- When asked about the “legal loophole” behind the rise in semi-synthetic cannabinoid products Winters deferred to the remarks by other presenters (audio - 1m, video - PTTC NCO).
- A question “about overdose with some of these more potent analogues…specifically with adults,” prompted Winters to call attention to the increased number of calls to poison control centers around the country for compounds like delta-8-THC. He believed there was "some nasty data" on the problem, and highlighted an update by SAM staff tracking the trend on March 8th. “Most of the studies I read indicate it's either the delta-9 or the delta-8 is the source. But that doesn't mean some of the other analogues aren’t contributing to that,” in part because Winters believed “people might not know even what they're taking, since things can get adulterated in the manufacturing process” (audio - 2m, video - PTTC NCO).
- Someone curious whether HHC could be safe led Winters to explain how "all intoxicating drugs have harmful effects to a greater or lesser degree.” Arguing there were risks associated with cannabinoids, he acknowledged some compounds were applied medicinally under federal pharmaceutical laws. Winters cautioned people to “be careful [if you use cannabis because it’s] helpful for pain, because the major studies that have looked at it with double blind investigations have not found it to be better than placebo effect” (audio - 2m, video - PTTC NCO).
- Rossheim faced three questions about enforcement and state policies restricting sale, plus the impact of restricting adult cannabis advertising.
- An attendee suggested regulations in Massachusetts weren’t being followed. Rossheim suggested semi-synthetic cannabinoid products were “designed to circumvent regulations” in pursuit of “a massive financial incentive.” He lauded the strong approach, arguing “states that have been able to address this, the most effectively, have just blanket banned” cannabinoid products, “and regulate just regular THC.” Winters felt that whatever policy restrictions were applied “there needs to be enforcement and strong consequence…so it's not just a cost of doing business to get a small fine, but that and those large fines can also help pay for enforcement of related laws” (audio - 2m, video - PTTC NCO).
- When asked for the best state models, Rossheim pointed to Washington and Alaska as states which banned synthetic cannabinoid products but regulated cannabis and THC. Regardless, enforcement and monetary penalties were necessary consequences for non-compliance, he stated (audio - <1m, video - PTTC NCO).
- Someone expressed curiosity about the marketing of legal cannabis, specifically “any proposed policies that could help restrict the marketing tactics that target youth.” Rossheim regarded this as a question more suited for cannabis generally, and “the best way to keep these out of the hands of kids is to not have them on the market” (audio - 1m, video - PTTC NCO).
- One attendee referenced a January 2024 paper authored by University of Washington (UW) researcher and Cannabis Education and Research Program (CERP) Director Bia Carlini “looking at themes presented by cannabis lobbyists in Washington state fighting stronger regulations around high potency THC.” Recounting how the paper argued that cannabis interests used a “playbook…drawn from the alcohol and tobacco industry,” they were curious about “any suggestions about how to address these themes at a legislative level” (audio - 5m, video - PTTC NCO).
- Thau advocated having “trained youth involved” in advocating about what would help their peer group. She viewed it as “ridiculous to put this just on parents when you have…access, availability, very high potency, relatively low cost, a lot of marketing…how do you put that on parents?” Although “societal norms are changing,” Thau claimed legal cannabis was “a gigantic industry with a lot of lobbyists. And there's almost no public health voice in any of this,” alleging the “marijuana industry isn't really being regulated in states that have legalized.” She worried about the impacts to mental health from industry actors whom she accused “are out to make money and to get customers young.” Thau also advocated for parents “who have had children who have had psychotic reactions and breaks from high potency cannabis” to speak up. Lastly, “telling people that you intend to vote not for people who support this,” as well as speaking up through social media were important, she said. Thau also presumed that “I'm sure kids who are in that system, because their parents are chronically using high potency THC,” and that CADCA and others opposed to legal cannabis “have to do a better job…making the case against this being good for anybody and really bad for families and communities.”
- When someone brought up the perspective that “delta-8 is a bathtub gin of these products and can contain lead. Is that the case with most of these…products?” (audio - 5m, video - PTTC NCO)
- Thau insisted “other than delta-8, which actually has been gone through some chemical testing and analysis,” any use of solvents or heavy metals to produce semi-synthetic cannabinoids were “poisonous and they're leftover.” She compared it with “when people were made…meth in soda bottles using harsh solvents.”
- Winters agreed that “claims by producers of some of these analogues, that they are purifying the product after use of these materials” was “hard to know. They can brag about it, but because they probably realize they're under the radar screen of testing, they don't have to really be careful about it.”
- Rossheim said he’d encountered inaccurate lab results, or businesses "cherry picked the findings that were most favorable.”
- Thau added that other coalitions and school officials had reported “kids being taken out daily foaming at the mouth, being taken to the emergency rooms, because they're using these products on school grounds.” She hoped emergency room staff would track the cause of any cases like this, “so that we can have more information about the negative effects, but…anecdotal stuff is every single call.”
- A previous PTTC NCO webinar in August 2023 also delved into contamination risks for CBD and THC unrelated to semi-synthetic cannabinoids.
- Referencing “some slides that showed some products like specifically Doritos and Skittles,” an attendee asked, how “is this not a trademark issue?” (audio - 5m, video - PTTC NCO)
- Thau believed it was a trademark issue and that federal authorities had sent warning letters to several companies marketing CBD and delta-8-THC items in 2022. She wanted to see the products explicitly illegal at a federal level to keep stores from selling them, and relegating cannabis and semi-synthetics to only being found “online from the dark web.”
- Winters expected it would be difficult to prioritize enforcement against the products anywhere they were legal, but felt “regulating the business didn't necessarily mean that we'll have all kinds of wonderful controls and an ability to monitor and to rule out the black market.”
- To Rossheim, trademark infringement was symptomatic of bad actors in the market who would do “everything they can to sell these products without caring about the outcome.”
- When asked if there had been cannabis products laced with the opioid fentanyl in them, Rossheim responded “there have been cases of it” without providing further details (audio - <1m, video - PTTC NCO).
- An attendee wondered about the use of the semi-synthetic nomenclature (audio - 1m, video - PTTC NCO).
- Someone was curious which cannabinoid conversion methods had the highest potential to leave residual contaminants. While none of the panelists knew the answer, Thau stressed the need to involve chemists in researching the topic. Rossheim argued that even with contaminants removed, health implications from cannabinoid use remained. Winters viewed it as merely “a little less dangerous if you take out the contaminants" (audio - 2m, video - PTTC NCO).
- Research on the comparative approaches to cannabinoid synthesis include:
- The final question was whether federal rescheduling of cannabis to Schedule III would impact changes or lobbying on the Farm Bill. None of the presenters believed it would have a notable impact on the discussion, since rescheduling was only focused on delta-9-THC (audio - 1m, video - PTTC NCO).
