Adolescent Δ8-THC and Marijuana Use in the US

Importance Gummies, flavored vaping devices, and other cannabis products containing psychoactive hemp-derived Δ 8 -tetrahydrocannabinol (THC) are increasingly marketed in the US with claims of being federally legal and comparable to marijuana. National data on prevalence and correlates of Δ 8 -THC use and comparisons to marijuana use among adolescents in the US are lacking. Objective To estimate the self-reported prevalence of and sociodemographic and policy factors associated with Δ 8 -THC and marijuana use among US adolescents in the past 12 months. Design, Setting, and Participants This nationally representative cross-sectional analysis included a randomly selected subset of 12th-grade students in 27 US states who participated in the Monitoring the Future Study in-school survey during February to June 2023. Exposures Self-reported sex, race, ethnicity, and parental education; census region; state-level adult-use (ie, recreational) marijuana legalization (yes vs no); and state-level Δ 8 -THC policies (regulated vs not regulated). Main Outcomes and Measures The primary outcome was self-reported Δ 8 -THC and marijuana use in the past 12 months (any vs no use and number of occasions used). Results In the sample of 2186 12th-grade students (mean age, 17.7 years; 1054 48.9% weighted were female; 232 11.1% were Black, 411 23.5% were Hispanic, 1113 46.1% were White, and 328 14.2% were multiracial), prevalence of self-reported use in the past 12 months was 11.4% (95% CI, 8.6%-14.2%) for Δ 8 -THC and 30.4% (95% CI, 26.5%-34.4%) for marijuana. Of those 295 participants reporting Δ 8 -THC use, 35.4% used it at least 10 times in the past 12 months. Prevalence of Δ 8 -THC use was lower in Western vs Southern census regions (5.0% vs 14.3%; risk difference RD, −9.4% 95% CI, −15.2% to −3.5%; adjusted risk ratio aRR, 0.35 95% CI, 0.16-0.77), states in which Δ 8 -THC was regulated vs not regulated (5.7% vs 14.4%; RD, −8.6% 95% CI, −12.9% to −4.4%; aRR, 0.42 95% CI, 0.23-0.74), and states with vs without legal adult-use marijuana (8.0% vs 14.0%; RD, −6.0% 95% CI, −10.8% to −1.2%; aRR, 0.56 95% CI, 0.35-0.91). Use in the past 12 months was lower among Hispanic than White participants for Δ 8 -THC (7.3% vs 14.4%; RD, −7.2% 95% CI, −12.2% to −2.1%; aRR, 0.54 95% CI, 0.34-0.87) and marijuana (24.5% vs 33.0%; RD, −8.5% 95% CI, −14.9% to −2.1%; aRR, 0.74 95% CI, 0.59-0.94). Δ 8 -THC and marijuana use prevalence did not differ by sex or parental education. Conclusions and Relevance Δ 8 -THC use prevalence is appreciable among US adolescents and is higher in states without marijuana legalization or existing Δ 8 -THC regulations. Prioritizing surveillance, policy, and public health efforts addressing adolescent Δ 8 -THC use may be warranted.