The Need for Oversight of Unflavored Cannabis Drink Mixers

Marketed as “an unassuming un-flavor that magically mixes with any drink,” Wims! Unflavored liquid cannabis packet has high potential for misuse,1 raising particular concerns for adolescents and young adults. Wims! is a liquidized form of cannabis sold in pocket-sized packets that can be quickly snapped and poured into beverages. Each packet contains 4 mg delta-9-tetrahydrocannabinol (THC) and 4 mg cannabidiol (CBD).1 THC is the primary psychoactive compound in cannabis, with ingestion or inhalation causing acute alterations in cognitive and motor functioning, such as impaired decision-making and slowed reaction time.2 These effects are exacerbated when combining THC intake with alcohol, as ethanol may increase THC absorption and intensify intoxication.3 In fact, Wims! uses the slogan “any drink, endless fun,” and specifically emphasizes that these flavorless THC packets can be added to cocktails.1 The amount of THC in a singular Wims! packet is comparable to THC levels found in edibles (typically 2.5–10 mg). However, there is potential for multiple Wims! packets to be administered at one time, with higher doses causing more significant impairments. Children, young adults, and other naive users may be particularly impacted by these doses due to minimal tolerance. Wims! currently sells 3 flavors of cannabis drink additives: Lemon Basil, Ginger Lime, and Unflavored. Other brands such as Sprinkle, Cann, and Vibrations also sell flavored drink mixes with 2 to 4 mg of THC. This review will focus mainly on the flavorless product from Wims!, as it poses unique public health concerns. The Unflavored version of Wims! is designed to have no perceptible taste when added to a drink,1 making it virtually undetectable. This quality heightens its potential for nonconsensual administration, particularly in the context of drug-facilitated sexual assault (DFSA). Adolescents and young adults are especially susceptible to the risks posed by unflavored cannabis products. Many in this age group are new to social contexts involving alcohol, which may make them less vigilant about monitoring their drinks and less likely to recognize early signs of THC intoxication due to limited experience with alcohol.In cases of DFSA, alcohol or drugs render an individual unable to consent to or resist unwanted sexual contact. Along with common DFSA-associated substances such as flunitrazepam (Rohypnol), gamma-hydroxybutyrate (GHB), and alcohol, THC’s cognitive and motor effects can contribute to diminished capacity to consent and subsequent increased risk of victimization. In fact, cannabis has been identified as the second most common substance used in DFSA cases.4Its undetectable flavor, concealable form, and ability to administer swiftly render Unflavored Wims! highly susceptible to being used in cases of DFSA. Moreover, because the product is liquid, absorption may occur more rapidly than with traditional edibles, intensifying acute THC effects. In fact, Wims! claims its products take effect in 10 to 15 minutes.1 These characteristics make Wims! a high-risk product, especially when consumed without awareness. This risk is amplified by the ease with which minors can purchase this product, which can be done through the Wims! website with direct delivery to the purchaser’s house. The Wims! website asks purchasers if they are at least 21 years of age but requires no proof of ID. Instead, purchasers simply click a button titled “Yes” to verify their age and enter the website. The products can be purchased at quantities of 3, 10, or 30 packets at $10, $32, or $90, respectively. Online purchase is available across all 50 states, and the website advertises in-person sale at specialty retailers, bottle shops, and forward-thinking grocery stores.1 Despite these risks, Wims! has been gaining attention and popularity, with positive reviews from popular companies such as Forbes.1 With the rise of visibility, it is imperative to promptly assess these products through a pediatric health lens.The global cannabis market is expanding rapidly, with the cannabis beverage sector projected to be a $4 billion industry by 2028. Among past-year cannabis users, 41.7% in states where cannabis is illegal and 18.9% in states where it is legal report weekly use of cannabis beverages, indicating substantial demand.5 Consequently, demand for Wims! liquid cannabis packets, specifically designed to be mixed into beverages, is likely to rise. As the availability of cannabis products increases, intentional and unintentional pediatric exposure also increases. For instance, after recreational cannabis dispensaries opened in Massachusetts, there was a 5-fold increase in pediatric cannabis exposure, which is associated with respiratory depression and hospital admission.6 With the expansion of the cannabis beverage market and products such as Wims!, these health concerns are likely to escalate, posing greater risks of exposure and adverse effects among children and adolescents.Under the Agriculture Improvement Act of 2018 (known as the Farm Bill), hemp-derived THC products such as Wims! were removed from the Controlled Substances Act and placed under Food and Drug Administration (FDA) regulatory authority. However, the bill primarily addressed hemp cultivation, not consumer products; beverages containing hemp-derived cannabinoids were not specifically discussed, creating regulatory confusion. The FDA has maintained that adding THC or CBD to beverages for interstate commerce is unlawful. However, FDA enforcement has been minimal, largely limited to warning letters.7 This regulatory gap poses a serious public health risk.The FDA has previously intervened in the case of e-cigarettes when youth risk and public health concerns became evident. A similar approach is needed here. Specifically, we urge the FDA to: Conduct a formal assessment of the misuse potential of unflavored cannabis drink additives.Require clear and specific warning labels about the risks of covert use.Consider packaging restrictions that minimize portability or concealment.Establish marketing guidelines that prevent the trivialization of potential psychoactive effects.Additionally, pediatricians must reinforce safety measures, especially given that these products may be added to drinks without detection. Clinicians should: Warn patients that unflavored THC can be added to drinks without altering taste or appearance.Counsel patients to never leave their drink unattended and to obtain drinks from reliable sources.Educate patients on the risks of combining THC with alcohol, particularly the risk of impairment when driving and operating machinery.Be aware of signs of acute THC intoxication, and consider this in the differential for patients presenting to the emergency department or urgent care with sudden changes in cognitive function, unusual drowsiness, disorientation, impaired motor control, or unexpected mood changes.Provide young people and their families and friends with the resources necessary to recognize potential signs of THC intoxication. Strategies may include informational flyers for college students, workshops for caregivers, and other educational materials tailored to this audience.Wims! is not the only unflavored THC product available. THC can be formulated as a powder, such as Hometown Hero’s DASH, although powder is more visually detectable. Other brands, including Texas Original, Atlantic Farms, and Nature’s Remedy, produce unflavored THC tinctures sold in drop form, although they are not currently marketed for use in drinks. However, these products present similar risks, including covert administration and DFSA. Given the increased legalization of cannabis products, the THC product market is likely to further expand. As such, we recommend the FDA and pediatricians take early, coordinated action to assess the misuse potential of these products and regulate accordingly to protect the health and safety of adolescents and young adults.Thank you to Dr Ruth Milaniak for her review of the manuscript.