Correlates of Derived Cannabis Product Awareness,Knowledge,Use,and Use Intentions Among Young Adults

Abstract

Derived psychoactive cannabis products (DPCPs) are chemically synthesized and intoxicating. Despite their widespread use, factors associated with DPCP use remain largely unknown. We analyzed 2023 survey data among 4,031 U.S. young adults (48.9% past-month cannabis use per study design). Multivariable regressions examined sociodemographics in relation to DPCP awareness (yes/no) and patterns of DPCP knowledge, derived based on latent class analysis on five questions. Sociodemographics and DPCP knowledge class were assessed in relation to past-month DPCP use and future use intentions. Results indicated 67.1% were aware of DPCPs and 24.4% reported past-month DPCP use. DPCP knowledge classes were all correct (20.5%), mostly incorrect (36.9%), mostly unsure (21.9%), and all unsure (20.7%). Participants more aware of DPCPs were typically White (vs. Asian), male, residing in states where nonmedical cannabis was illegal, and reported past-month cannabis or cannabidiol (CBD) use. Being Black or Asian (vs. White) or Hispanic was associated with knowledge classes of “mostly incorrect” or “unsure” (vs. all correct). Correlates of using DPCPs: all correct knowledge (vs. all unsure), nonmedical cannabis illegal, female, and past-month cannabis or CBD use. Correlates of higher DPCP use intentions: all correct knowledge (vs. all unsure), nonmedical cannabis illegal, older, White (vs. multiracial), and past-month cannabis or CBD use. In sum, White participants were more aware and knowledgeable of DPCPs; participants in the “all correct” knowledge class had higher odds of DPCP use and higher use intentions, despite correctly knowing that DPCPs lacked regulations. Findings highlight the need for targeted prevention and intervention efforts and DPCP bans.

Keywords

cannabis aware knowledge misinformation

In 2018, the U.S. Farm Bill defined hemp as cannabis products with ≤0.3% delta-9 THC (the most naturally prevalent intoxicating cannabinoid) by dry weight (United States Congress, 2019), inadvertently creating a new market for derived psychoactive cannabis products (DPCPs; e.g., delta-8 THC; Rossheim et al., 2023). Use of DPCPs is associated with experiencing effects similar to using traditional cannabis, for example, experiencing euphoria, relaxation, pain relief, anxiety, and paranoia (Kruger & Kruger, 2022).

DPCPs are synthetically derived from cannabidiol (CBD) rather than being naturally grown, often using harsh chemical solvents known to be hazardous to human health (Dubrow et al., 2021; LoParco, Rossheim, et al., 2023). Many retailers claim these products are legally classified as “hemp,” despite most being some form of THC, which is listed by the Drug Enforcement Administration (DEA) as a controlled substance (DEA, 2022). As a result, federal regulations have been weak and largely unenforced. For example, DPCPs are neither Food and Drug Administration (FDA)-approved nor authorized, there is no mandatory testing for safety and, although many are advertised as effective for relieving a variety of ailments, such claims are unsubstantiated with scientific evidence and, therefore, likely constitute deceptive advertising. State regulations vary and are often absent, not comprehensive, or also lacking enforcement (LoParco, Rossheim, et al., 2023). There have been several thousand calls to U.S. poison control related to DPCP use, often involving accidental ingestion and ingestion requiring health care evaluation (FDA, 2022). Due to their relative recent entry in the market, much is unknown regarding DPCP risks, although preliminary research indicates DPCP use is associated with acute psychiatric disorders, psychosis, injuries, and lung, chest and heart disorders (Akpunonu et al., 2021; Bozman et al., 2022; Leas et al., 2023; Miller et al., 2023).

In addition, most research focuses on delta-8 THC, the first DPCP to enter the market (LoParco, Rossheim, et al., 2023; Zawatsky et al., 2024). One national study found that 41% of U.S. adults had heard of delta-8 THC and 12% reported using delta-8 THC in the past year (Wilson-Poe et al., 2023). Some research indicates that use is particularly prevalent among certain sociodemographic groups (e.g., males, younger ages; Livne et al., 2022), whereas other research indicates no significant associations between DPCP use and age, sex, and race/ethnicity (LoParco, Walters, et al., 2023). In addition, those most likely to use tend to have lower risk perceptions and live in states where nonmedical cannabis is not legal (Leas et al., 2022; Livne et al., 2022; LoParco, Walters, et al., 2023).

The general level of awareness of DPCPs (not specific to a compound) and characteristics (e.g., sociodemographic factors including race, ethnicity, sex) of those who are aware of these products warrants research. This is crucial as those who aware of or have access to DPCPs are likely to be those at risk for use. Given the abundance of different marketing tactics, misinformation, and the lack of a centralized authority on these products (LoParco, Olsson, et al., 2023; LoParco, Rossheim, et al., 2023; Rossheim, Tillet, et al., 2024), it is likely that those who have heard of DPCPs may have misconceptions about them, for example, the different effects they may have or their level of regulatory oversight.

As interest and availability of DPCPs continues to grow (i.e., DPCPs are sold in retail stores in at least 47 U.S. states; Leas et al., 2022; Rossheim, LoParco, et al., 2024), research is needed to improve our understanding of these substances to inform policies and related regulations. In this study, we analyzed associations between state cannabis laws, sociodemographic factors, DPCP awareness, knowledge, use, and use intentions among U.S. young adults.

Method

Participants and Recruitment

The current study analyzed data from the Cannabis Regulation, Marketing & Appeal (CARMA) study, which launched in Spring 2022 and examined non-medical cannabis retail, marketing, and consumer impact (Berg et al., 2024). Participants were recruited via ads on Facebook from June to November 2023. Eligibility criteria were (1) 18 to 34 years old, (2) residing in the United States, and (3) English speaking. As part of the larger study aims, purposive quota-based sampling was used to obtain a proportion of ~50% of the sample reporting past-month cannabis use, roughly equal numbers of female and male young adults, and 40% racial/ethnic minorities.

After participants clicked on the study’s advertisement, they were sent a message via a chatbot on Facebook Messenger and asked prescreening questions (i.e., age, state of residence, race and ethnicity, sex, sexual orientation, and past-month cannabis use). Those deemed preliminarily eligible were provided a unique link to the full survey, consented, and administered the baseline survey. The use of the chatbot on Facebook messenger and unique survey links ensured that individuals had active accounts (and therefore were not “bots”) and each only were screened once. Further details on these methods can be found in a published paper (Berg et al., 2024). Participants confirmed their participation via email 7 days after completing the baseline survey and were emailed a $10 Amazon e-gift card; 4,031 were fully enrolled. This study was approved by the University’s Institutional Review Board.

Measures

Participants were provided a table of substances with descriptions and photos of common products in each category. Cannabis was defined as “Marijuana (also known as cannabis, pot, weed, hash, kush) including all forms of the plant and its preparations. Please do not include hemp-derived cannabinoids, like delta-8 THC, delta-10 THC, THC-O, and HHC.” Regarding DPCPs, participants were told “There is a category of hemp-derived cannabinoids, which include delta-8 THC, delta-10 THC, delta-11 THC, THC-O, THC-P, and HHC. Common brands include 3Chi, Cake, Kik, Medusa/Modus, Urb, and Torch. These compounds may have similar effects as marijuana but are assumed to be federally legal by many. They are also distinct from CBD, which does not include THC.” CBD products were specified as cannabis products “not containing THC.”

State Law, Sociodemographics, and Past-Month Cannabis and CBD Use (Independent Variables)

We assessed residential state cannabis laws (non-medical legal vs. not, as of March 2023 to coincide with data collection) and sociodemographics, including age (continuous, 18–34 years), ethnicity (Hispanic/Latino vs. not), race (categorized as White, Black, Asian, multiracial, a different race), birth sex (male, female), sexual orientation (categorized as heterosexual vs. not), education (undergraduate degree yes vs. no), and number of children of their own (categorized as none vs. 1+). Participants were asked about past-month cannabis and CBD use (yes vs. no for each).

DPCP Awareness and Knowledge (Used as Both Independent and Dependent Variables in Different Models)

DPCP awareness was assessed by asking: “Which of the following had you heard of prior to participating in this survey: (Check all that apply.): delta-8 THC, delta-9 THC, delta-10 THC, delta-11 THC, THC-O, THC-P, and HHC.” A variable was also created to represent awareness of any DPCP (yes vs. no). DPCP knowledge was assessed by asking participants to respond “True,” False, or Don’t Know (operationalized categorically) to the following items: “Hemp-derived cannabinoids like delta-8, delta-10, THC-O, and HHC: (1) can get you ‘high,’ (2) are pretty much the same as CBD that doesn’t contain THC, (3) are required to be tested and proven safe to be sold, (4) are required to be approved by the FDA to be sold, and (5) are required to be proven to be effective to be marketed for pain relief, anxiety reduction, sleep, etc.” In this study, we only examined DPCP knowledge among those reporting DPCP awareness.

Past-Month DPCP Use and Future Use Intentions (Dependent Variables)

Participants were asked about past-month DPCP use (yes vs. no) and DPCP future use intentions: “How likely are you to try or continue to use hemp-derived cannabinoids (e.g., delta-8, delta-10, THC-O, HHC) in the next year?” (1 = not at all to, 7 = extremely; continuous).

Data Analysis

First, descriptive analyses were conducted to characterize participants. Second, among those reporting DPCP awareness, a latent class analysis was conducted using the five knowledge questions. We examined latent class solutions for models with 1 to 6 classes. The best-fitting model was determined based on Akaike information criterion (AIC), Bayesian information criterion (BIC), smallest class (>5%), and class interpretability.

Then, Bivariate Analyses Characterized Participants in Relation to DPCP Awareness, Knowledge Class, Use, and Use Intentions

Next, sociodemographics and cannabis and CBD use were examined in relation to: (1) awareness of any DPCP (yes vs. no; logistic regression); and (2) DPCP knowledge class (multinomial logistic regression). Finally, multivariable regressions examined DPCP knowledge class, sociodemographics, and cannabis/CBD use in relation to (1) DPCP use (yes vs. no; logistic regression) and (2) future DPCP use intentions among those reporting non-use (1–7 = extremely likely; linear regression). Analyses were conducted using Stata 18.0 with significance set at p<.05. To adjust for multiple comparison, we also note where variables are no longer significant after making a Bonferroni adjustment (p<.05/6 models = 0.008; Chen et al., 2017).

Results

Descriptives

Refer to Table 1 for participant characteristics. On average, participants were 26.29 years old, not Hispanic/Latino (80.6%), White (62.6%), female (59.8%), heterosexual (72.1%), had less than an undergraduate degree (57.2%), did not have any children (69.1%), and lived in states where non-medical cannabis was illegal (50.4%). Due to purposive sampling, 48.9% of participants engaged in past-month cannabis use; 22.5% had past-month CBD use and 24.4% had past-month DPCP use. Most participants were aware of DPCPs (67.5%). Among those aware of DPCPs, the categories that were most often endorsed included: believing that DPCPs could get you high (62.7%; 24.5% don’t know), were not the same as CBD (42.8%; 32.6% don’t know), had to be tested and proven safe to be sold (42.7%; 38.8% don’t know), and not knowing if they had to be approved by the FDA (43.1%; 32.5% believed they did) or had to be proven effective to be marketed for pain, anxiety, sleep, and so on (42.2%; 34.1% believed they did).

Table 1.

Participant Characteristics.

Variables	Total N = 4,031(100%)
	n (%) or M (SD)
State non-medical cannabis law
Legal	2,001 (49.6)
Not legal	2,030 (50.4)
Sociodemographics
Age	26.29 (4.81)
Ethnicity
Hispanic/Latino	771 (19.4)
Not Hispanic/Latino	3,199 (80.6)
Race
White	2,525 (62.6)
Black	545 (13.5)
Asian	549 (13.6)
Multiracial	167 (4.1)
A different race	102 (2.5)
Sex
Male	1,612 (40.0)
Female	2,394 (59.8)
Sexual orientation
Heterosexual	2,844 (72.1)
Not heterosexual	1,100 (27.9)
Education
<Undergraduate degree	2,305 (57.2)
≥Undergraduate degree	1,726 (42.8)
Number of own children
0	2,784 (69.1)
1+	1,247 (30.9)
Past-month use
Traditional cannabis
Yes	1,968 (48.9)
No	2,059 (51.1)
CBD
Yes	907 (22.5)
No	3,122 (77.5)
DPCPs
Yes	984 (24.4)
No	3,045 (75.6)
DPCP awareness
Yes	2,703 (67.5)
No	1,304 (32.5)
DPCP Knowledge^a (DPCPs . . .)
Can get you ‘high’
True	1,695 (62.7)
False	346 (12.8)
Don’t know	662 (24.5)
Pretty much the same as CBD that doesn’t contain THC
True	665 (24.6)
False	1,157 (42.8)
Don’t know	881 (32.6)
Must be tested and proven safe
True	1,154 (42.7)
False	499 (18.5)
Don’t know	1,050 (38.8)
Must be approved by FDA
True	879 (32.5)
False	660 (24.4)
Don’t know	1,164 (43.1)
Must be proven effective to be marketed for pain, anxiety, sleep, etc.
True	922 (34.1)
False	640 (23.7)
Don’t know	1,141 (42.2)
Knowledge class^a
Mostly incorrect	997 (36.9)
All correct	554 (20.5)
Some correct, some unsure^b	592 (21.9)
All unsure	560 (20.7)

Only among those aware of DPCPs. Correct answers to the DPCP knowledge questions: DPCPs can get you “high” (True), are the same as CBD (False), have to be tested (False), need to be approved by the FDA (False), and need to be proven effective for marketing (False). ^b Participants in this category responded correctly to the first two questions (gets you high, not the same as CBD) and were unsure about the regulation-related questions. Column percent is reported. DPCP = derived psychoactive cannabis product; CBD = cannabidiol; THC = tetrahydrocannabinol; FDA = Food and Drug Administration.

Awareness

Refer to Table 2 for bivariate analyses, which indicated the following correlates were significantly associated with being more (vs. less) aware of DPCPs: living in areas where non-medical cannabis is illegal; being older; being female; not being heterosexual; having less than an undergraduate degree; having one or more children; and engaging in past-month cannabis use, or engaging in past-month CBD use.

Table 2.

Bivariate Associations Among State Non-Medical Cannabis Law, Sociodemographics, Cannabinoid Use, and Derived Psychoactive Cannabis Product (DPCP) Awareness, Knowledge, Use, and Use Intentions.

	DPCP awareness (any)(N = 4,007)			DPCP knowledge class^a (N = 2,703)					Past-month DPCP use(N = 4,029)			Future DPCP use intentions^b (n = 3,045)
Variables	Yesn = 2,703(67.5%)	Non = 1,304(32.5%)		Mostly incorrectn = 997(36.9%)	All correctn = 554(20.5%)	Some correct, some unsuren = 592(21.9%)	All unsure n = 560(20.7%)		Yesn = 984(24.4%)	Non = 3,045(75.6%)
	n (%) orM (SD)	n (%) orM (SD)	p	n (%) orM (SD)	n (%) orM (SD)	n (%) orM (SD)	n (%) orM (SD)	p	n (%) orM (SD)	n (%) orM (SD)	p	M (SD)or r	p
State non-medical cannabis law			<.001					.026			<.001		<.001
Legal	1,223 (45.2)	760 (58.3)		429 (43.0)	257 (46.4)	255 (43.1)	282 (50.4)		426 (43.3)	1,574 (51.7)		1.70 (1.36)
Not legal	1,480 (54.8)	544 (41.7)		568 (57.0)	297 (53.6)	337 (56.9)	278 (49.6)		558 (56.7)	1,471 (48.3)		1.87 (1.52)
Sociodemographics
Age	26.49 (4.70)	25.86 (5.03)	<.001	26.87 (4.67)	26.14 (4.66)	26.43 (4.74)	26.22 (4.71)	.972	26.83 (4.65)	26.11 (4.85)	.105	.08	<.001
Ethnicity			.910					.189			.122		.002
Hispanic/Latino	520 (19.5)	248 (19.4)		199 (20.2)	90 (16.3)	122 (20.9)	110 (20.0)		205 (21.1)	566 (18.9)		1.87 (1.57)
Not Hispanic/Latino	2,145 (80.5)	1,033 (80.6)		784 (79.8)	458 (83.7)	462 (79.1)	441 (80.0)		765 (78.9)	2,433 (81.1)		1.77 (1.42)
Race			<.001					<.001			<.001		<.001
White	1,728 (63.9)	785 (60.2)		589 (59.1)	387 (69.9)	390 (65.9)	362 (64.6)		603 (61.3)	1,921 (63.1)		1.82 (1.48)
Black	400 (14.8)	135 10.4)		199 (20.0)	53 (9.6)	81 (13.7)	67 (12.0)		190 (19.3)	355 (11.7)		2.08 (1.67)
Asian	281 (10.4)	267 (20.5)		109 (10.9)	54 (9.8)	49 (8.3)	69 (12.3)		82 (8.3)	467 (15.3)		1.46 (1.06)
Multiracial	118 (4.4)	48 (3.7)		37 (3.7)	28 (5.1)	25 (4.2)	28 (5.0)		44 (4.5)	123 (4.0)		1.59 (1.29)
A different race	86 (3.2)	16 (1.2)		34 (3.4)	15 (2.7)	20 (3.4)	17 (3.0)		32 (3.3)	70 (2.3)		2.14 (1.54)
Sex			<.001					.181			.997		.350
Male	1,024 (38.2)	569 (43.8)		390 (39.2)	224 (41.0)	208 (35.6)	202 (36.2)		395 (40.3)	1,217 (40.3)		1.77 (1.43)
Female	1,660 (61.8)	729 (56.2)		604 (60.8)	323 (59.1)	377 (64.4)	356 (63.8)		586 (59.7)	1,806 (59.7)		1.80 (1.46)
Sexual orientation			<.001					.001			<.001		<.001
Heterosexual	1,855 (69.9)	972 (76.8)		729 (73.9)	355 (65.3)	384 (66.6)	387 (70.6)		656 (67.6)	2,187 (73.6)		1.74 (1.40)
Not heterosexual	800 (30.1)	293 (23.2)		257 (26.1)	189 (34.7)	193 (33.5)	161 (29.4)		315 (32.4)	785 (26.4)		1.93 (1.56)
Education			<.001					<.001			<.001		<.001
<Undergraduate degree	1,642 (60.7)	658 (50.5)		666 (66.8)	285 (51.4)	372 (62.8)	319 (60.0)		653 (66.4)	1,650 (54.2)		1.92 (1.58)
≥Undergraduate degree	1,061 (39.3)	646 (49.5)		331 (33.2)	269 (48.6)	220 (37.2)	241 (43.0)		331 (33.6)	1,395 (45.8)		1.62 (1.25)
Number of own children			<.001					<.001			<.001		.001
0	1,808 (66.9)	957 (73.4)		602 (60.4)	415 (74.9)	392 (66.2)	399 (71.3)		628 (63.8)	2,155 (70.8)		1.75 (1.40)
1+	895 (33.1)	347 (26.6)		395 (39.6)	139 (25.1)	200 (33.8)	161 (28.8)		356 (36.2)	890 (29.2)		1.88 (1.54)
Past-month use
Traditional cannabis			<.001					<.001			<.001		<.001
Yes	1,702 (63.0)	254 (19.5)		685 (68.7)	351 (63.4)	377 (63.8)	289 (51.7)		898 (91.3)	1,070 (35.2)		2.44 (1.77)
No	999 (37.0)	1,048 (80.5)		312 (31.3)	203 (36.6)	214 (36.2)	270 (48.3)		86 (8.7)	1,972 (64.8)		1.43 (1.08)
CBD			<.001					<.001			<.001		<.001
Yes	811 (30.0)	89 (6.8)		363 (36.4)	167 (30.1)	158 (26.7)	123 (22.0)		574 (58.3)	333 (10.9)		2.56 (1.80)
No	1,890 (70.0)	1,215 (93.2)		634 (63.6)	387 (69.9)	434 (73.3)	435 (78.0)		410 (41.7)	2,711 (89.1)		1.69 (1.37)
DPCPs
Yes	—	—	—	—	—	—	—	—	—	—	—	—	—
No	—	—	—	—	—	—	—	—	—	—	—	—	—
DPCP awareness													<.001
Yes	—	—	—	—	—	—	—	—	—	—	—	2.07 (1.63)
No	—	—	—	—	—	—	—	—	—	—	—	1.39 (1.02)
DPCP Knowledge^a (DPCPs . . .)
Can get you ‘high’								<.001			<.001		<.001
True	—	—	—	708 (71.0)	407 (73.5)	446 (75.3)	134 (23.9)		712 (74.8)	983 (56.2)		2.23 (1.75)
False	—	—	—	153 (15.4)	101 (18.2)	73 (12.3)	19 (3.4)		122 (12.8)	224 (12.8)		2.31 (1.65)
Don’t know	—	—	—	136 (13.6)	46 (8.3)	73 (12.3)	407 (72.7)		118 (12.4)	542 (31.0)		1.68 (1.30)
Pretty much the same as CBD that doesn’t contain THC								<.001			<.001		<.001
True	—	—	—	392 (39.3)	111 (20.0)	143 (24.2)	19 (3.4)		281 (29.5)	384 (22.0)		2.24 (1.74)
False	—	—	—	398 (39.9)	372 (67.2)	387 (65.4)	0 (0)		456 (47.9)	701 (40.1)		2.29 (1.75)
Don’t know	—	—	—	207 (20.8)	71 (12.8)	62 (10.5)	541 (96.6)		215 (22.6)	664 (38.0)		1.74 (1.36)
Must be tested and proven safe								<.001			<.001		<.001
True	—	—	—	883 (88.6)	86 (15.5)	153 (25.8)	32 (5.7)		491 (51.6)	663 (37.9)		2.31 (1.76)
False	—	—	—	53 (5.3)	410 (74.0)	31 (5.2)	5 (0.9)		184 (19.3)	315 (18.0)		2.02 (1.58)
Don’t know	—	—	—	61 (6.1)	58 (10.5)	408 (68.9)	523 (93.4)		277 (29.1)	771 (44.1)		1.88 (1.50)
Must be approved by FDA								<.001			<.001		.010
True	—	—	—	817 (82.0)	19 (3.4)	10 (1.7)	33 (5.9)		371 (39.0)	508 (29.1)		2.21 (1.75)
False	—	—	—	91 (9.1)	524 (94.6)	18 (3.0)	27 (4.8)		246 (25.8)	414 (23.7)		2.07 (1.55)
Don’t know	—	—	—	89 (8.9)	11 (2.0)	564 (95.3)	500 (89.3)		335 (35.2)	827 (47.3)		1.97 (1.58)
Must be proven effective to be marketed for pain, anxiety, sleep, etc.								<.001			<.001		.001
True	—	—	—	745 (74.7)	68 (12.3)	81 (13.7)	28 (5.0)		425 (44.6)	497 (28.4)		2.27 (1.78)
False	—	—	—	107 (10.7)	433 (78.2)	77 (13.0)	23 (4.1)		224 (23.5)	416 (23.8)		2.07 (1.53)
Don’t know	—	—	—	145 (14.5)	53 (9.6)	434 (73.3)	509 (90.9)		303 (31.8)	836 (47.8)		1.94 (1.57)
Knowledge class^a											<.001		<.001
Mostly incorrect	—	—	—	—	—	—	—	—	436 (45.8)	561 (32.1)		2.26 (1.77)
All correct	—	—	—	—	—	—	—	—	204 (21.4)	350 (20.0)		2.08 (1.56)
Some correct, some unsure^c	—	—	—	—	—	—	—	—	200 (21.0)	392 (22.4)		2.19 (1.71)
All unsure	—	—	—	—	—	—	—	—	112 (11.8)	446 (25.5)		1.70 (1.34)

Note. Bold indicates statistically significant. Column percent is reported. DPCP = derived psychoactive cannabis product; CBD = cannabidiol; THC = tetrahydrocannabinol; FDA = Food and Drug Administration. P-values are based on bivariate tests (i.e., Pearson correlation for two continuous variables, chi-square for categorical variables, and t-test or ANOVA for continuous/categorical variables).

Only among those aware of DPCPs. Correct answers to the DPCP knowledge questions: DPCPs can get you “high” (True), are not the same as CBD (False), do not have to be tested (False), do not need to be approved by the FDA (False), and do not need to be proven effective for marketing (False). ^b Among those without past-month DPCP use; 1 = not at all to 7 = extremely. ^c Participants in this category responded correctly to the first two questions (gets you high, not the same as CBD) and were unsure about the regulation-related questions.

Refer to Table 3 for results from adjusted analyses. Findings from the adjusted logistic regression indicated that those who used traditional cannabis (aOR = 5.62, 95% confidence interval [CI] = 4.71, 6.70) or CBD (aOR = 2.93, 95% CI = 2.27, 3.77) had higher odds of being aware of DPCPs. Participants with lower odds of being aware of DPCPs tended to live in states where non-medical cannabis was legal (vs. illegal; adjusted odds ratio [aOR] = 0.55, 95% CI = 0.47, 0.64), be Asian (vs. White; aOR = 0.70, 95% CI = 0.56, 0.88), and be female (vs. male; aOR = 0.84, 95% CI = 0.71, 0.99; no longer significant after Bonferroni adjustment).

Table 3.

Multivariable Regressions Assessing State Non-Medical Cannabis Law, Sociodemographics, Cannabis and CBD Use in Relation to Derived Psychoactive Cannabis Product (DPCP) Awareness, Knowledge Class, Use, and Use Intentions.

	DPCP Awareness (Any)(n = 3,862)			DPCP Knowledge Class* (Ref: All correct; n = 2,616)									Past-month DPCP Use (yes vs. no [ref])(n = 2,615)			DPCP Future Use Intentions^a (n = 1,691)
Variables	DPCP Awareness (Any)(n = 3,862)			Mostly incorrect			Some correct, some unsure			All unsure			Past-month DPCP Use (yes vs. no [ref])(n = 2,615)			DPCP Future Use Intentions^a (n = 1,691)
	aOR	95% CI	P	aOR	95% CI	P	aOR	95% CI	p	aOR	95% CI	p	aOR	95% CI	p	B	95% CI	p
State nonmedical cannabis law
Legal (ref: not)	0.55	[0.47, 0.64]	<.001	0.92	[0.73, 1.15]	.444	0.96	[0.75, 1.23]	.737	1.24	[0.97, 1.59]	.085	0.65	[0.53, 0.79]	<.001	−0.24	[−0.40, −0.09]	.002
Sociodemographics
Age	1.00	[0.99, 1.02]	.689	1.03	[1.002, 1.06]	.032	1.02	[0.99, 1.04]	.293	1.01	[0.99, 1.04]	.315	0.99	[0.97, 1.01]	.331	0.02	[0.001, 0.04]	.036
Hispanic/Latino (ref: non)	0.84	[0.69, 1.02]	.082	1.38	[1.03, 1.85]	.029	1.38	[1.01, 1.89]	.045	1.38	[0.999, 1.90]	.051	1.15	[0.89, 1.48]	.283	0.10	[−0.09, 0.30]	.312
Race (ref: White)
Black	0.94	[0.74, 1.20]	.637	2.49	[1.77, 3.50]	<.001	1.49	[1.02, 2.19]	.041	1.55	[1.04, 2.31]	.030	1.24	[0.95, 1.64]	.119	0.11	[−0.12, 0.34]	.345
Asian	0.70	[0.56, 0.88]	.002	2.13	[1.45, 3.12]	<.001	1.18	[0.76, 1.85]	.454	1.56	[1.03, 2.37]	.035	1.25	[0.86, 1.80]	.246	0.02	[−0.23, 0.27]	.858
Multiracial	1.14	[0.77, 1.69]	.516	0.89	[0.52, 1.51]	.669	0.85	[0.48, 1.50]	.577	1.10	[0.63, 1.92]	.736	1.20	[0.75, 1.93]	.451	−0.37	[−0.73, −0.01]	.044
A different race	1.78	[0.98, 3.24]	.057	1.34	[0.70, 2.58]	.377	1.13	[0.55, 2.33]	.736	1.13	[0.53, 2.41]	.744	0.73	[0.42, 1.28]	.272	0.03	[−0.40, 0.46]	.902
Female (ref: male)	0.84	[0.71, 0.99]	.032	1.09	[0.86, 1.37]	.479	0.88	[0.68, 1.13]	.311	0.82	[0.63, 1.07]	.138	1.24	[1.005, 1.54]	.045	−0.01	[−0.17, 0.15]	.933
Heterosexual (ref: non)	1.04	[0.87, 1.25]	.649	0.70	[0.55, 0.90]	.004	0.95	[0.73, 1.24]	.717	0.82	[0.63, 1.08]	.160	1.07	[0.86, 1.33]	.553	0.04	[−0.13, 0.20]	.682
≥Undergraduate degree (ref: less)	0.97	[0.82, 1.15]	.753	0.49	[0.39, 0.62]	<.001	0.64	[0.49, 0.83]	.001	0.70	[0.53, 0.91]	.007	0.82	[0.65, 1.03]	.083	−0.27	[−0.43, −0.10]	.001
Has children (ref: does not)	0.97	[0.80, 1.18]	.781	1.55	[1.19, 2.03]	.001	1.33	[0.98, 1.79]	.063	1.08	[0.80, 1.48]	.610	1.02	[0.80, 1.29]	.880	−0.13	[−0.31, 0.06]	.170
Past-month use (ref: no)
Traditional cannabis	5.62	[4.71, 6.70]	<.001	1.01	[0.79, 1.29]	.956	0.99	[0.76, 1.29]	.928	0.62	[0.47, 0.80]	<.001	8.29	[6.33, 10.86]	<.001	0.81	[0.66, 0.97]	<.001
CBD	2.93	[2.27, 3.77]	<.001	1.32	[1.03. 1.69]	.026	0.81	[0.61, 1.07]	.143	0.76	[0.57, 1.02]	.069	6.19	[5.02, 7.64]	<.001	0.48	[0.27, 0.69]	<.001
Knowledge class* (ref: All correct)
Mostly incorrect	—	—	—	—	—	—	—	—	—	—	—	—	1.06	[0.81, 1.39]	.674	0.16	[−0.06, 0.37]	.151
Some correct, some unsure	—	—	—	—	—	—	—	—	—	—	—	—	0.85	[0.64, 1.15]	.297	0.07	[−0.16, 0.29]	.558
All unsure	—	—	—	—	—	—	—	—	—	—	—	—	0.45	[0.32, 0.62]	<.001	−0.33	[−0.55, −0.11]	.003

Note. Bold indicates statistically significant. Numbers may not match Table 1 due to missingness. DPCP = derived psychoactive cannabis product; CBD = cannabidiol.

Among those without past-month DPCP use; 1 = not at all to 7 = extremely.

DPCP knowledge is only among those aware of DPCPs.

Knowledge (Among Those Aware)

A four-class structure was determined to be the best fitting (refer to Supplemental Table 1): participants responding incorrectly to most knowledge questions (n = 997, 36.9%), those responding correctly to all of them (n = 554, 20.5%), participants responding correctly to the first two (gets you high, not the same as CBD) and were unsure about the other regulation-based questions (n = 592, 21.9%), and those who were unsure about all of them (n = 560, 20.7%). In bivariate analyses, correlates of knowledge class were state cannabis laws, race, sexual orientation, education, number of children, and past-month cannabis and CBD use.

Findings from the adjusted multinomial logistic regression indicated that compared with being in the class of getting all knowledge questions correct, correlates of being in the class of getting them mostly incorrect were older age (aOR = 1.03, 95% CI = 1.002, 1.06; no longer significant after Bonferroni adjustment), Hispanic/Latino ethnicity (aOR = 1.38, 95% CI = 1.03, 1.85; no longer significant after Bonferroni adjustment), Black (vs. White; aOR = 2.49, 95% CI = 1.77, 3.50) or Asian (vs. White; aOR = 2.13, 95% CI = 1.45, 3.12), not heterosexual (heterosexual vs. not: aOR = 0.70, 95% CI = 0.55, 0.90), less education (undergraduate degree or more vs. less: aOR = 0.49, 95% CI = 0.39, 0.62), having children (aOR = 1.55, 95% CI = 1.19, 2.03), and CBD use (aOR = 1.32, 95% CI = 1.03, 1.69; no longer significant after Bonferroni adjustment). Compared with getting all knowledge questions correct, correlates of getting some correct and being unsure about some were being Hispanic/Latino (aOR = 1.38, 95% CI = 1.01, 1.89; no longer significant after Bonferroni adjustment), being Black (vs. White; aOR = 1.49, 95% CI = 1.02, 2.19; no longer significant after Bonferroni adjustment), and less education (undergraduate degree or more vs. less: aOR = 0.64, 95% CI = 0.49, 0.83); correlates of being unsure about all knowledge questions were being Black (vs. White; aOR = 1.55, 95% CI = 1.04, 2.31; no longer significant after Bonferroni adjustment) or Asian (vs. White; aOR = 1.56, 95% CI = 1.03, 2.37; no longer significant after Bonferroni adjustment), less education (undergraduate degree or more vs. less: aOR = 0.70, 95% CI = 0.53, 0.91), and reporting no cannabis use (use yes vs. no: aOR = 0.62, 95% CI = 0.47, 0.80).

DPCP Use

Significant bivariate correlates of DPCP use included living in a state where nonmedical cannabis was illegal, being Black, not being heterosexual, having less than an undergraduate degree, having at least one child, cannabis or CBD use, and getting most knowledge questions incorrect.

Adjusted logistic regression results indicated that participants with higher odds of engaging in past-month DPCP use tended to: live in states where cannabis was not legal (nonmedical cannabis legal vs. not: aOR = 0.65, 95% CI = 0.53, 0.79), be female (aOR = 1.24, 95% CI = 1.005, 1.54; no longer significant after Bonferroni adjustment), report cannabis (aOR = 8.29, 95% CI = 6.33, 10.86) or CBD (aOR = 6.19, 95% CI = 5.02, 7.64) use, and not be in the unsure knowledge class (all unsure vs. all correct: aOR = 0.45, 95% CI = 0.32, 0.62).

DPCP Use Intentions (Among Those Without Past-Month Use)

In bivariate analyses, correlates of having higher levels of future DPCP use intentions were living in a state where non-medical cannabis was illegal, being older, being Hispanic/Latino, being Black, not being heterosexual, having less than an undergraduate degree, having at least one child, cannabis or CBD use, and getting most DPCP knowledge questions incorrect.

Multivariable linear regression results indicated that the following correlates were associated with having higher future DPCP use intentions: living in states where cannabis was illegal (nonmedical cannabis legal vs. not: B = −0.24, 95% CI = [−0.40, −0.09]), older age (B = 0.02, 95% CI = [0.001, 0.04]; no longer significant after Bonferroni adjustment), White versus multiracial (multiracial vs. White: B = −0.37, 95% CI = [−0.73, −0.01]; no longer significant after Bonferroni adjustment), less education (undergraduate degree or more vs. less: B = −0.27, 95% CI = [−0.43, −0.10]), cannabis (B = 0.81, 95% CI = [0.66, 0.97]) or CBD (B = 0.48, 95% CI = [0.27, 0.69]) use, and being in the class of getting all knowledge questions correct versus being unsure about all of them (all unsure vs. all correct: B = −0.33, 95% CI = [−0.55, −0.11]).

Discussion

In this national sample of young adults (comprising nearly 50% who reported past-month cannabis use due to sampling quotas), two thirds of the sample were aware of DPCPs (67.5%). Among those aware, most individuals did not have accurate regulation-related beliefs (i.e., they believed or were unsure whether DPCPs had to be tested/proven safe, were FDA-approved, and had proven their pain/anxiety marketing claims). Individuals who were in the knowledge class that responded accurately to (vs. were unsure about) all DPCP questions had higher odds of past-month DPCP use and higher use intentions. These findings reflect fewer misconceptions among those who used DPCPs and underscore the need to understand their reasons for use despite knowing that DPCPs are not required to be regulated or proven effective or safe. It may be that DPCPs are more acceptable due to their wide availability, number of brands, or specific packaging/marketing elements, or that individuals have low perceived risk from using these unregulated products.

Past-month cannabis and CBD use were associated with being more aware of DPCPs, past-month DPCP use, and higher DPCP future use intentions. These findings make theoretical sense given exposure to similar marketing and retail locations, and they align with previous research indicating strong associations between cannabis and DPCP use (Harlow et al., 2024; Livne et al., 2022; LoParco, Walters, et al., 2023). There were unique associations observed with regard to cannabis and CBD use and DPCP knowledge class. Specifically, past-month cannabis use was associated with responding correctly to (vs. being unsure about) all DPCP knowledge questions, whereas past-month CBD use was associated with responding mostly incorrectly (vs. all correctly) to the DPCP knowledge questions. These findings suggest unique characteristics of individuals with cannabis versus CBD use, perhaps related to exposures at retail locations. For example, it is likely that individuals using CBD purchase it from specialty retail locations (e.g., holistic medicine, establishments that focus on natural/organic/medicalized products (Bhamra et al., 2021; Leas et al., 2021), meaning they may be less exposed to DPCP-related information, as DPCPs are often used for nonmedical purposes and sold at vape/smoke shops (Rossheim et al., 2022; Rossheim, LoParco, et al., 2024; Rossheim, Tillet, et al., 2024; Satybaldiyeva et al., 2024).

In line with previous research (Leas et al., 2022; Livne et al., 2022; LoParco, Walters, et al., 2023), participants who lived in a state without legalized nonmedical cannabis had higher odds of being aware of DPCPs and reporting past-month DPCP use, as well as reported higher DPCP future use intentions. While state cannabis laws were associated with DPCP knowledge class in bivariate analyses, the association was not statistically significant in multivariable analyses. This is likely because other factors accounted for that association; for example, because cannabis use is highly associated with DPCP knowledge, this may have diminished the association between state law and DPCP knowledge. This could also be due to the amount of diversity in DPCP state laws and related regulations. For example, some states may have implemented DPCP regulations that correspond to some of the knowledge questions asked; this was not assessed in the current study. Future research should examine more nuanced associations between each state’s DPCP-related policies and DPCP knowledge.

Regarding sociodemographic differences, being White was associated with being aware of DPCPs (White vs. Asian), being in the DPCP knowledge class of having all correct answers (White vs. Asian or Black: all correct vs. mostly incorrect; all correct vs. all unsure), and higher DPCP future use intentions (White vs. multiracial). More research is needed to disentangle these findings, given literature indicating racial differences in cannabis use—specifically, highest among American Indian/Alaskan Native and Black populations (Montgomery et al., 2022). Findings from our study indicate potential differences, with White individuals tending to be more aware of DPCPs and having higher DPCP use intentions. There may be DPCP marketing targeting specific groups, which may result in differences to marketing exposure and related information, impacting knowledge.

The current results should be interpreted in light of a few limitations. First, data are cross-sectional and thus causality/temporality cannot be assessed (e.g., does DPCP knowledge predict use, or do individuals who use become more knowledgeable). In addition, the parent study aimed to obtain a sample comprising 50% participants with cannabis use, and thus, findings may not be generalizable to the general population of young adults. Finally, unmeasured confounding factors, such as participants’ exposure to specific marketing practices or social networks, might influence results, and recall bias could affect self-reported cannabis use and knowledge.

Findings indicated that non-medical state cannabis laws and certain sociodemographics (particularly White race) were associated with DPCP awareness, knowledge, use, and use intentions among U.S. young adults. In addition, individuals with greater knowledge about DPCPs were more likely to have engaged in past-month DPCP use and had higher intentions for future use. Implications relate to marketing and retail of these substances, as these factors may be associated with exposure to information and subsequently may impact awareness, knowledge, use, and use intentions. Previous research has found that state-level bans were associated with significantly reduced retail availability of DPCPs (Rossheim, LoParco, et al., 2024). The limited knowledge documented in the current study further supports the need for strong state and federal action, accompanied by targeted interventions reducing misinformation. Without decisive action, the continued widespread availability of these harmful products will likely contribute to rising public health risks, particularly among vulnerable populations.

Supplemental Material

sj-docx-1-heb-10.1177_10901981251374672 – Supplemental material for Correlates of Derived Cannabis Product Awareness, Knowledge, Use, and Use Intentions Among Young Adults

Supplemental material, sj-docx-1-heb-10.1177_10901981251374672 for Correlates of Derived Cannabis Product Awareness, Knowledge, Use, and Use Intentions Among Young Adults by Cassidy R. LoParco, Matthew E. Rossheim, Yuxian Cui, Darcey M. McCready, Yan Wang, Y. Tony Yang, Patricia A. Cavazos-Rehg and Carla J. Berg in Health Education & Behavior

Footnotes

ORCID iDs

Cassidy R. LoParco

Carla J. Berg

Ethical Considerations

This study was approved by the George Washington University Institutional Review Board (NCR224124).

Author Contributions

C.R.L.: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing—Original Draft. M.E.R., Y.C., D.M.M., Y.W., Y.T.Y.: Writing—Review & Editing. P.A.C.: Funding acquisition, Writing—Review & Editing. C.J.B.: Conceptualization, Supervision, Investigation, Resources, Funding acquisition, Writing—Review & Editing.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute on Drug Abuse (R01DA054751, MPIs: Berg, Cavazos-Rehg). Dr. LoParco is supported by the National Institute on Drug Abuse (F32DA060612). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online at .

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