Public health considerations about tetrahydrocannabinol-infused beverages

The US cannabis market has evolved to include cannabis-infused beverages; 20% of cannabis consumers in recreational cannabis states have consumed a delta-9-tetrahydrocannabinol (THC)-infused beverage [1]. US sales of THC-infused beverages represented 6% of all edible sales [1]. THC beverages are being sold throughout the United States, regardless of the state cannabis laws, due to the 2018 Farm Bill, which defined hemp as cannabis products with < 0.3% delta-9 THC by dry weight. Due to the heavy weight of liquid, these products can contain high levels of THC and still be under the threshold. Changing the federal definition of hemp could make THC-infused beverages federally illegal. THC beverages are also available in other locations across the globe, including Canada, Germany, Thailand and Laos. However, their legal status and level of regulations differ depending on local laws. For example, while cannabis is illegal in Germany and Laos, THC beverages are still available.

Cannabis beverages can be more rapidly absorbed than THC-infused food due to nanoemulsion, allowing them to have a higher bioavailability, not requiring digestion and metabolization through the liver compared to traditional edibles [2]. This fast-acting onset is one of the major distinguishing marketing claims. Most THC-infused beverages are said to result in effects within 15 minutes and last 60–180 minutes: a much quicker onset but shorter duration than THC-infused food [3].

Many of the largest concerns regarding traditional cannabis edibles relate to not waiting a sufficient amount of time before re-dosing, resulting in extreme effects [4]. Because of their purported rapid absorption, cannabis beverages are marketed as allowing more control over desired effects. However, some brands sell high-dose beverages (e.g. 50 mg of THC in 2 oz). Several cannabis beverages include multiple servings per can (e.g. 10 servings in 12 oz [5]), which may make it difficult to correctly gauge the desired dosage.

Cannabis beverages also often contain a variety of active compounds, including delta-9 THC, delta-8 THC, tetrahydrocannabivarin (THCV), cannabidiol (CBD), cannabinol (CBN), melatonin and caffeine. There may be negative effects resulting from the combination of these various compounds; however, research has yet to examine this extensively [6, 7]. Policies should set maximum THC limits per fluid ounce and which compounds are allowed (e.g. banning caffeine and derived cannabinoids).

Cannabis-infused beverages are available at licensed cannabis dispensaries, on-line [3], some bars/restaurants [8] and at large alcohol retailers (e.g. Total Wine—a large, US-based alcohol retailer). More surveillance is needed, including comprehensive information on their availability across the United States. Restricting their sale to licensed cannabis dispensaries would limit youth access and exposure to marketing, and potentially reduce co-purchase with other substances such as alcohol.

THC-infused beverages in the United States do not contain alcohol, probably because states disallow alcohol products to contain THC. However, well-known alcohol brands are selling THC-infused beverages that mimic alcoholic beverages’ marketing, packaging and flavors. They are often called ‘non-alcoholic THC cocktails’, and are marketed as good options for socially drinking without the negative effects of alcohol. Some alcoholic products are available that incorporate terpenes—non-psychoactive compounds of the cannabis plant that provide a distinct cannabis aroma.

In 2023, Tilray (a large cannabis retailer) acquired several THC-infused drink brands from Molson Coors and Anheuser-Busch (top alcohol companies) [9]. Other alcohol companies may follow into the cannabis market. This is concerning, given the history of the alcohol industry using youth-oriented marketing, limitations to its regulatory oversight and the financial incentives for this industry to lobby for similarly weak regulations on cannabis products [10].

Cassidy R. LoParco: Conceptualization (lead); methodology (lead); writing—original draft (lead). Kayla K. Tillett: Writing—review and editing (equal). Julia Chen-Sankey: Writing—review and editing (equal). Carla J. Berg: Writing—review and editing (equal). Matthew E. Rossheim: Writing—review and editing (equal).

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