Delta-8-THC association with psychosis: A case report with literature review

BackgroundCannabis (Delta(9)-THC) is the most commonly consumed illicit drug. The Agricultural Improvement Act of 2018 removed hemp, a strain of Cannabis sativa, as a controlled substance. This law allowed the plant to be processed into its components, which contain <0.3% Delta(9)-THC. As a result, delta-8-tetrahydrocannabinol (Delta(8)-THC), a federally unregulated substance, grew in popularity in 2020. Delta(8)-THC is readily available in most gas stations or head shops and may be considered harmless by patients. However, an increasing number of patients admitted for psychiatric hospitalization report use, with limited literature on the effects. Case presentationsThis case report describes three individual cases of patients who required admission to a university psychiatric hospital after the regular use solely of Delta(8)-THC. All three patients developed psychotic and paranoid symptoms concurrently with the use of Delta(8)-THC, with a severity exceeding their previous historical presentations. The presenting psychotic symptoms were also atypical for all three patients. New-onset violence and visual hallucinations were noted in two of the patients, one patient with no previous psychiatric history and one patient while on a therapeutic dose of his antipsychotic. In the third case, a new onset of bizarre, fixed delusions of puppies dissolving in the bathtub developed. ConclusionThis report adds to the limited body of evidence on Delta(8)-THC documenting a temporal association between Delta(8)-THC use and the development of psychotic symptoms. A strong body of research already correlates the continued use of Delta(9)-THC with psychosis, and Delta(8)-THC acts at the same CB1 and CB2 receptors as Delta(9)-THC. Therefore, it is hypothesized that Delta(8)-THC may have similar adverse psychiatric effects as Delta(9)-THC. These conclusions are not without speculation, due to the need for self or collateral-reporting of Delta(8)-THC use as urine drug screening cannot distinguish Delta(8)-THC from Delta(9)-THC, and the patients' symptoms could be explained by medication non-adherence and primary psychotic disorders. However, physicians should be encouraged to gather a specific history of Delta(8)-THC use and treat patients with Delta(8)-THC-related intoxication and symptoms.