Are Retail Sales of Delta-8 THC and Four Loko Associated? Findings from Fort Worth, Texas

Abstract

Objectives: Four Loko is an inexpensive and high-alcohol content product. Across the U.S., Four Loko retailers concentrate in impoverished areas; however, it is unclear whether this geographic patterning exists at a micro level, such as within a city. Delta-8 THC, an isomer of the more common form of the Cannabis plant Delta-9, is an unregulated psychoactive substance that was legalized by the Farm Bill in 2018. It is unknown if retailers that sell risky products like Delta-8 THC may be more likely to sell Four Loko, creating niche stores that sell unregulated or intoxicating substances. Methods: The study sample included 168 retailers in Fort Worth, Texas that had licenses to sell beer off-premise. Stores were contacted in September and October 2021 and asked whether they sold Delta-8 THC. Data regarding Four Loko's availability at each retail site was obtained from the manufacturer's website. Area deprivation index (ADI) scores, a marker of socioeconomic disadvantage (a continuous variable with range 1-10, with higher scores indicating more disadvantage), were linked to each store's zip code. A multivariable logistic regression model was used to examine associations between retail of Delta-8 THC, having a retail tobacco license, ADI scores, and retail of Four Loko. Results: In the overall sample, 55% of stores sold Four Loko and 17% sold Delta-8 THC. Specifically, 41% of stores only sold Four Loko (mean ADI = 6.46, SE = 0.36), 4% only sold Delta-8 THC (mean ADI = 1.67, SE = 0.33), 14% sold both Four Loko and Delta-8 THC (mean ADI = 5.8, SE = 0.71), and 42% did not sell either (mean ADI = 5.18, SE = 0.42). Logistic regression results indicate higher ADI scores (OR = 1.15, 95% CI = 1.03, 1.28) and selling Delta-8 THC products (OR = 8.50, 95% CI = 2.32, 31.17) were associated with increased odds of selling Four Loko. Having a tobacco license was also associated with increased odds of selling Four Loko products, although not statistically significant (OR = 3.41, 95% CI = 0.99, 11.76, p = 0.052). Discussion: Stores that sold Delta-8 THC were 8 times as likely to sell Four Loko. These results suggest that some retail locations may specialize in the sale of high-risk products, including unregulated products. This is important, especially in the context of retail locations, given the rapid development of novel psychoactive substances which future research should focus on. Given associations between type of product sold at each location and ADI scores, residents of socioeconomically deprived neighborhoods may have higher exposures to these dangerous products. Future research should assess the geographic distribution and density of Four Loko and Delta-8 THC sales to determine specific geographic areas that may be at high risk. Additionally, future research should investigate the etiology of health disparities and crimes near these establishments. Implications may suggest supporting the development and implementation of public nuisance laws and/or policies that restrict the sale of unregulated/high-risk substances.