Global expansions to cannabis (i.e., marijuana) legalization have given rise to a growing retail marketplace, with incredible diversity in cannabis products with respect to chemical composition, intended administration route, and formulation. Part of this product expansion includes cannabinoid-infused food and drink products (i.e., edibles) (e.g., baked goods, gummy-, chocolate-, and hard-candies, beverages/drinks) as well as non-food formulations (e.g., oils/tinctures, pills/capsules). Importantly, oral ingestion of cannabis edibles is currently the second most popular route of cannabis administration behind smoked cannabis (Peng and Shahidi, 2021). The predominant cannabinoids found in oral cannabis products are Δ-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), though products that primarily contain other phytocannabinoids (e.g. cannabigerol [CBG]) or isomers of THC (e.g., Δ8-THC) have recently emerged (Spindle et al., 2019). There is some evidence that certain subtypes of oral cannabis products are more popular than others. For example, in focus groups, participants have reported “usually” buying baked goods, hard-candies, and gummy-candies (Giombi et al., 2018). However, updated research is needed considering the evolving cannabis legal landscape and retail marketplace. To help address this need, the current study examined seven different subtypes of oral cannabis products, which included both food- (e.g., “edibles” like baked goods, gummy-, chocolate-, and hard-candies, and beverages/drinks) and non-food based (e.g., oils/tinctures, pills/capsules) formulations.

Oral cannabis products are responsible for the majority of emergency room visits related to over-intoxication from cannabis (Barrus et al., 2016, Monte et al., 2019, Volkow and Baler, 2019, Wong and Baum, 2019), potentially because the acute drug effects are often unpredictable (i.e., either too weak or too strong). The unpredictability of oral cannabis product effects may stem from a lack of knowledge regarding cannabinoid dose (Friese et al., 2017), onset and/or duration of effects (Giombi et al., 2018), inaccurate product labeling with respect to THC (Vandrey et al., 2015, Bonn-Miller et al., 2017, Friese et al., 2017, Giombi et al., 2018, Borodovsky et al., 2017, Peng and Shahidi, 2021) and/or CBD content (Cerino et al., 2021), or other factors (e.g., differences in product formulation or food intake). For example, THC and CBD (Spindle et al., 2020, Bergeria et al., 2022) bioavailability is markedly increased in lipid-based drug formulations (Zgair et al., 2016, McClements, 2020), in the presence of alcohol (Peng and Shahidi, 2021), and following the consumption of food, particularly high-fat meals (Trevaskis et al., 2009, Lunn et al., 2019, Crockett et al., 2020). Research regarding why (i.e., use-motives) individuals consume different oral cannabis products and/or prefer specific oral modes of cannabis delivery (i.e., food- or non-food based) is critically needed to develop a comprehensive understanding of product type choice- and use-behaviors and to mitigate the public health impact of over-intoxication from these products.

Further, as research suggests use of alcohol and cannabis during the same occasion is associated with an increase in social and behavioral consequences (e.g., driving while intoxicated; Yurasek et al., 2017), quantifying alcohol and oral cannabis product co-use is vital. There is currently a dearth of information regarding the simultaneous ingestion of alcohol and oral cannabis products, as previous research has focused predominantly on smoked cannabis and alcohol interactions (Yurasek et al., 2017). It is also largely unknown if those who use oral cannabis products hold beliefs on how to mitigate unwanted effects and, if so, what advice they received and from where. Finally, while previous studies suggest that product formulation and use-behaviors may influence the acute effects of oral cannabis products (Bergeria et al., 2022, Crockett et al., 2020, Lunn et al., 2019, McClements, 2020, Peng and Shahidi, 2021, Spindle et al., 2020, Stott et al., 2013a, Trevaskis et al., 2009, Zgair et al., 2016), few studies have been conducted to understand if such factors impact perceived effects among oral cannabis product-experienced individuals. Because controlled studies generally utilize methodology that may not reflect how these products are consumed in the natural environment (e.g., providing standardized meals), perceived effects are an important component for further examination. Overall, understanding how product choice- and use-behaviors influence oral cannabis product effects, and whether individuals have accurate/inaccurate beliefs on how to alter these effects, is critical to developing appropriate interventions and public health messaging.

The current cross-sectional, web-based survey study aimed to characterize rates of use for seven product types (i.e., baked goods, gummy-, chocolate-, and hard-candies, beverages/drinks, oils/tinctures, pills/capsules) among a convenience sample of adults who reported using oral cannabis products within the past year, as well as examine relevant use motives, self-reported formulation and doses of THC and CBD, perceived impact of food and macronutrients on several subjective effects, use with alcohol, and advice participants had received regarding mitigating acute drug effects.