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Teens are using delta-8 THC—a cannabinoid that’s closely related to the psychoactive chemical in marijuana—in high numbers.

From February through June 2023, researchers surveyed 2,000 high school seniors about delta-8 and marijuana use to gain a better understanding of their attitude toward the substances. According to a study published Tuesday in the Journal of the American Medical Association, more than one in 10, or 11.4%, of high school seniors reported using delta-8 in the past year. Meanwhile, 30.4% reported using marijuana. Among those who had used delta-8 in the past year, 35.4% had used it 10 or more times.

While delta-8 is legal in 22 states, it’s highly understudied. And this latest research, led by investigators at the Keck School of Medicine at the University of Southern California, is one of the first to examine how widely it’s being used among teens.

The paper’s senior author and a professor of population and public health sciences, Adam Matthew Leventhal, said teens’ use of delta-8 follows “the same pattern” we’ve seen in the past.

“When a new addictive drug hits the market and is commercialized, youth are the first to be affected if public health protections are not in place,” he said. “We saw this with nicotine e-cigarettes and should not let history repeat itself with delta-8 THC or the other hemp products.”

The substance is also typically synthetic, given high amounts of delta-8 cannot be found in the cannabis plant. But the manufactured form isn’t regulated by the Food and Drug Administration (FDA). And according to the FDA’s website, the organization has received 104 reports of adverse events in patients who consumed delta-8 THC products between December 1, 2020 and February 28, 2022, including medical events like hallucinations, vomiting, tremors, anxiety, dizziness, confusion, and loss of consciousness.

Calls to poison control centers were much greater, totaling 2,362 cases of exposure to delta-8 THC products between January 1, 2021 (the date this product code was added to the database) and February 28, 2022.

Recreational marijuana use has been legalized in 24 states, but that’s largely excluded in the South and Midwest. Unsurprisingly, the study found that delta-8 usage among teens was higher in areas where marijuana is not legal.

In states where delta-8 is banned or severely restricted, it has lower rates of use among teens. But beyond the 22 states that legally sell delta-8, it’s also widely available online in various forms—from drinks to gummies and more—and ordering the substance, often despite location, is fairly cut-and-dried.