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WASHINGTON -- More than half of all delta-8 cannabinoid (D8) online distributors sold products in kid-friendly packaging and many did not ask customers their age, according to preliminary research presented at the American Academy of Pediatrics annual meeting on Sunday.

An analysis of the top 45 websites selling D8 found that 53% of distributors used eye-catching, kid-friendly packaging. More than a third -- 36% -- did not ask customers their age, and nearly all of the sites (96%) lacked a third-party age verification process.

Distributors also priced their products low enough for minors to afford them: one in three distributors sold D8 products for less than $5, more than half sold them for $10 or less, and three-quarters sold them for $20 or less.

D8 is chemically similar to traditional tetrahydrocannabinol (THC) -- the main psychoactive ingredient in cannabis -- and can produce a similar high. Traditional THC is banned at the federal level, but no clear federal ban exists for D8.

The results are not surprising, researcher Ruth Milanaik, DO, of the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, told MedPage Today. "We have age limits for a reason ... We believe that these types of products should not be sold in colorful, fun-looking packages, because it's misleading."

The analysis also showed:

• 47% of the cheapest products contained ≥51 mg of D8

• 22% contained 41-50 mg of D8

• 2% contained 31-40 mg of D8

• 9% contained 20-30 mg of D8

• 20% of distributors did not report the dosage of D8 their product contained

• 24% of distributors did not include D8 warning or disclosures

Nearly all (98%) of distributors sold D8 edibles, 82% sold D8 smoking or vaping products, and 42% sold D8 tinctures, according to the study.

Milanaik urged clinicians to talk to their patients about the dangers of D8 and advocate for policymakers to do more to regulate online distributors.

"When you look at responsible marijuana distributors in states where it is legal, their package clearly is for adults. They are age verifying. These are responsible adults selling to responsible adults," Milanaik said.

But that isn't happening with many online distributors, she observed. And the kid-friendly packaging is especially harmful beyond the adolescent who might purchase D8 for the experience: the cannabinoids are also being consumed by other young children unwittingly.

Even at the very lowest doses available, the products are still worrying, especially in instances of accidental overdose, Milanaik said.

"Kids come home and they see this lovely little gummy package. They don't read it. They open it. They eat it ... And if you're eating gummies, how many are you gonna eat? Three? Four? Six?" she asked. "If you're talking about a 10-year-old child, that's frightening." Approximately 77% of past accidental D8 exposures involved minors, she noted.

Policy implications of the findings are that more regulation of online communities is needed to ensure the products can't be misused and don't fall into the hands of unwitting children, Milanaik told MedPage Today.

"Our goal as pediatricians is to keep kids out of the ER. And so, stopping this sale online and changing this packaging is going to go a long way to do that," she said.

A limitation of the study is that the researchers did not actually purchase any D8 products, so potential age verification measures during the purchasing stage may have been missed.

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