Now I know my CBDs; cases of psychiatric admissions after delta-8-tetrahydrocannabinol (delta-8-THC, Δ⁸-THC) product usage

Cannabis contains many chemical entities, including trace amounts of delta-8-tetrahydrocannabinol (Δ⁸-THC). Δ⁸-THC is either naturally extracted from cannabis or synthesized from cannabidiol (CBD) and marketed to consumers over the counter as a legal and “milder” high compared to other THC-containing products. Despite this perception among Δ⁸-THC users, the FDA and CDC have cautioned against Δ⁸-THC ingestion due to reports of serious adverse events, including psychiatric presentations. We describe two patients, aged 19 and 20, who presented with acute psychiatric concerns following reported ingestion of Δ⁸-THC. One patient had manic symptoms only in the context of Δ⁸-THC ingestion and without any previous psychiatric history. The second patient described had impulsive and psychotomimetic symptoms grossly out of proportion to, and more severe than, the symptoms he previously experienced. Both patient's symptoms resolved while abstinent from Δ⁸-THC. These cases demonstrate a potential temporal association between ingestion of Δ⁸-THC containing products and the development of manic or psychotic symptoms, as well as a likely dose-response relationship. They also highlight a growing need for drug-use histories that include specific questions around Δ⁸-THC use. Further investigation is needed regarding the risks associated with Δ⁸-THC use, especially in those with existing psychiatric diagnoses and those at increased risk for psychiatric disorders, and to better understand potential interactions with psychiatric medications.