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Petrilli K, Lawn W, Lees R, Mokrysz C, Borissova A, Ofori S, Trinci K, Dos Santos R, Leitch H, Soni S, Hines LA, Lorenzetti V, Curran HV, Freeman TP. Enhanced cannabis timeline followback (EC-TLFB): Comprehensive assessment of cannabis use including standard THC units and validation through biological measures. Addiction 2024; 119:772-783. [PMID: 38105033 DOI: 10.1111/add.16405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
AIMS The aims of this study were to present an enhanced cannabis timeline followback (EC-TLFB) enabling comprehensive assessment of cannabis use measures, including standard tetrahydrocannabinol (THC) units, and to validate these against objectively indexed urinary 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH) concentrations. DESIGN We used cross-sectional baseline data from the 'CannTeen' observational longitudinal study. SETTING The study was conducted in London, UK. PARTICIPANTS A total of 147 participants who used cannabis regularly took part in the study (n = 71 female, n = 76 male; mean age = 21.90, standard deviation = 5.32). MEASUREMENTS The EC-TLFB was used to calculate frequency of cannabis use, method of administration, including co-administration with tobacco, amount of cannabis used (measured with unaided self-report and also using pictorial aided self-report) and type of cannabis product (flower, hash) which was used to estimate THC concentration (both from published data on THC concentration of products and analysis of cannabis samples donated by participants in this study). We calculated total weekly standard THC units (i.e. 5 mg THC for all cannabis products and methods of administration) using the EC-TLFB. The outcome variable for validation of past week EC-TLFB assessments was creatinine-normalized carboxy-tetrahydrocannabinol (THC-COOH) in urine. FINDINGS All measures of cannabis exposure included in this analysis were positively correlated with levels of THC-COOH in urine (r = 0.41-0.52). Standard THC units, calculated with average concentrations of THC in cannabis in the UK and unaided self-report measures of amount of cannabis used in grams showed the strongest correlation with THC-COOH in urine (r = 0.52, 95% bias-corrected and accelerated = 0.26-0.70). CONCLUSIONS The enhanced cannabis timeline followback (EC-TLFB) can provide a valid assessment of a comprehensive set of cannabis use measures including standard tetrahydrocannabinol units as well as and traditional TLFB assessments (e.g. frequency of use and grams of cannabis use).
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Affiliation(s)
- Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Anya Borissova
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| | - Shelan Ofori
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Katie Trinci
- Clinical Psychopharmacology Unit, University College London, London, UK
| | | | - Harry Leitch
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Shilpa Soni
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Lindsey A Hines
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Programme, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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2
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Chesney E, Lawn W, McGuire P. Assessing Cannabis Use in People with Psychosis. Cannabis Cannabinoid Res 2024; 9:49-58. [PMID: 37971872 PMCID: PMC10874830 DOI: 10.1089/can.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Introduction: Cannabis use is common in people with psychotic disorders and is associated with the exacerbation of symptoms, poor treatment adherence, and an increased risk of relapse. Accurate assessment of cannabis use is thus critical to the clinical management of psychosis. Discussion: Cannabis use is usually assessed with self-report questionnaires that were originally developed for healthy individuals or people with a cannabis use disorder. Compared to these groups, the pattern of cannabis use and the associated harms in patients with psychosis are quite different. Moreover, in people with psychosis, the accuracy of self-reported use may be impaired by psychotic symptoms, cognitive deficits, and a desire to conceal use when clinicians have advised against it. Although urinary screening for delta-9-tetrahydrocannabinol is sometimes used in the assessment of acute psychotic episodes, it is not used in routinely. Cannabis use could be assessed by measuring the concentration of cannabinoids in urine and blood, but this is rarely done in either clinical settings or research. Conclusion: Using quantitative biological measures could provide a more accurate guide to the effects of use on the disorder than asking patients or using questionnaires.
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Affiliation(s)
- Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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3
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Larsen SF, Johnson AJ, Larimer ME, Dager SR, Kleinhans NM. Self-report methodology for quantifying standardized cannabis consumption in milligrams delta-9-tetrahydrocannabinol. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:723-732. [PMID: 37506343 DOI: 10.1080/00952990.2023.2232525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Background: There is currently no format-independent method to determine delta-9-tetrahydrocannabinol (THC) in milligrams for self-report studies.Objectives: Validate self-report method for quantifying mg THC from commercially available cannabis products using product labeling, which includes both net weight and product potency.Methods: 53 adult cannabis users (24 M, 29F), 21-39 years of age (M = 28.38, SD = 4.15), were instructed to report daily use via a weekly survey for two consecutive weeks, provide product label photographs, abstain from use for 24 h, submit a urine sample and complete the Cannabis Use Disorder Identification Test - Revised (CUDIT-R) and the Marijuana Craving Questionnaire - Short Form (MCQ-SF). Milligrams of THC were determined by multiplying quantity of product used by its THC concentration. Urine was analyzed for the urine metabolite 11-nor-carboxy-THC (THC-COOH) via liquid chromatography mass spectroscopy. THC and THC-COOH values were log10 transformed prior to correlational analyses.Results: Median daily THC consumption was 102.53 mg (M = 203.68, SD = 268.13). Thirty-three (62%) of the 53 participants reported using two or more formats over the 2-week period. There was a significant positive correlation between log10 THC-COOH and log10 THC mg (r(41) = .59, p < .001), log10 THC mg and MCQ-SF score (r(41) = .59, p < .001), and log10 THC mg dose and CUDIT-R score, (r(41) = .39, p = .010).Conclusion: Our label-based methodology provides consumption information across all modalities of cannabis use in standard units that can be combined across products for calculation of dose. It is a viable and valid method for quantifying mg of THC consumed and can be utilized in any region where cannabis is legal, and labeling is regulated.
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Affiliation(s)
- Sarah F Larsen
- Department of Radiology, University of Washington, Seattle, WA, USA
- Integrated Brain Imaging Center, University of Washington, Seattle, WA, USA
| | - Allegra J Johnson
- Department of Radiology, University of Washington, Seattle, WA, USA
- Integrated Brain Imaging Center, University of Washington, Seattle, WA, USA
| | - Mary E Larimer
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Stephen R Dager
- Department of Radiology, University of Washington, Seattle, WA, USA
- Institute on Human Development and Disability, University of Washington, Seattle, WA, USA
- Department of Biomedical Engineering, University of Washington, Seattle, WA, USA
| | - Natalia M Kleinhans
- Department of Radiology, University of Washington, Seattle, WA, USA
- Integrated Brain Imaging Center, University of Washington, Seattle, WA, USA
- Institute on Human Development and Disability, University of Washington, Seattle, WA, USA
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4
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Tervo-Clemmens B, Schmitt W, Wheeler G, Cooke ME, Schuster RM, Hickey S, Pachas GN, Evins AE, Gilman JM. Cannabis use and sleep quality in daily life: An electronic daily diary study of adults starting cannabis for health concerns. Drug Alcohol Depend 2023; 243:109760. [PMID: 36638745 PMCID: PMC10015315 DOI: 10.1016/j.drugalcdep.2022.109760] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/07/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Real world patterns of cannabis use for health concerns are highly variable and rarely overseen by a physician. Pragmatic effectiveness studies with electronic daily diaries that capture person-specific patterns of cannabis use and health symptoms may help clarify risks and benefits. METHODS As part of a larger, randomized trial (NCT03224468), adults (N = 181) seeking cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately (MCC) or a waitlist control (WLC) and completed 12-weeks of daily web-based surveys on cannabis use and sleep, pain, and depressive symptoms. RESULTS Completion rates of daily surveys were moderate to high (median completed: 72 out of 90 days). Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The MCC group increased cannabis use frequency in the 12 weeks following randomization, while WLC did not. Among the MCC group, self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The MCC group displayed long-term sleep improvements, consistent with increasing cannabis frequency. No improvements were found for pain or depressive symptoms. CONCLUSION Cannabis use is associated with same day improvements in self-reported sleep quality, but not pain or depressive symptoms, although sleep improvements occurred in the context of increased frequency of cannabis use, raising the risk for cannabis use disorder. Daily web-based assessments of cannabis appear valid and feasible in adults seeking cannabis for health concerns, providing a flexible, complementary method for future real-world effectiveness studies with expanded and objective measures.
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Affiliation(s)
- Brenden Tervo-Clemmens
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - William Schmitt
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Wheeler
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Megan E Cooke
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Randi M Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Hickey
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gladys N Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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5
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Huang W, Czuba LC, Manuzak JA, Martin JN, Hunt PW, Klatt NR, Isoherranen N. Objective Identification of Cannabis Use Levels in Clinical Populations Is Critical for Detecting Pharmacological Outcomes. Cannabis Cannabinoid Res 2022; 7:852-864. [PMID: 34793254 PMCID: PMC9784609 DOI: 10.1089/can.2021.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction: Cannabis is widely used for recreational and medical purposes, but its therapeutic efficacy remains unresolved for many applications as data from retrospective studies show dramatic discrepancy. We hypothesized that false self-reporting of cannabis use and lack of differentiation of heavy users from light or occasional users contribute to the conflicting outcomes. Objective: The goal of this study was to develop an objective biomarker of cannabis use and test how application of such biomarker impacts clinical study outcomes and dose-response measures. Methods and Analysis: Population pharmacokinetic (PK) models of (-)-trans-Δ9-tetrahydrocannabinol (THC) and its metabolites 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (11-COOH-THC) were developed based on published studies reporting cannabinoid disposition in individual subjects following intravenous administration or smoking of cannabis. Plasma 11-COOH-THC concentration distributions in different cannabis user groups smoking cannabis were generated via Monte Carlo simulations, and plasma concentration cutoff values of 11-COOH-THC were developed to differentiate light and heavy daily cannabis users in clinical studies. The developed cutoff value was then applied to a retrospective study that assessed the impact of cannabis use on T cell activation in subjects with HIV who self-reported as either nonuser or daily user of cannabis. Results: The developed population PK models established plasma 11-COOH-THC concentration of 73.1 μg/L as a cutoff value to identify heavy daily users, with a positive predictive value of 80% in a mixed population of equal proportions of once daily and three times a day users. The stratification allowed detection of changes in T cell activation in heavy users which was not detected based on self-reporting or detectability of plasma cannabinoids. A proof-of-concept power analysis demonstrated that implementation of such cutoff value greatly increases study power and sensitivity to detect pharmacological effects of cannabis use. Conclusions: This study shows that the use of plasma 11-COOH-THC concentration cutoff value as an objective measure to classify cannabis use in target populations is critical for study sensitivity and specificity and provides much needed clarity for addressing dose-response relationships and therapeutic effects of cannabis.
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Affiliation(s)
- Weize Huang
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Lindsay C. Czuba
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Jennifer A. Manuzak
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
- Division of Immunology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Jeffrey N. Martin
- Department of Medicine and University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Peter W. Hunt
- Department of Medicine and University of California San Francisco, San Francisco, California, USA
| | - Nichole R. Klatt
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nina Isoherranen
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
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6
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Sullivan RM, Wallace AL, Stinson EA, Montoto KV, Kaiver CM, Wade NE, Lisdahl KM. Assessment of Withdrawal, Mood, and Sleep Inventories After Monitored 3-Week Abstinence in Cannabis-Using Adolescents and Young Adults. Cannabis Cannabinoid Res 2022; 7:690-699. [PMID: 34678051 PMCID: PMC9587800 DOI: 10.1089/can.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Among adolescents and young adults, cannabis use is prevalent. Prior studies characterizing withdrawal effects in this age range have primarily included treatment seeking or comorbid psychiatric samples; these studies have identified several affected domains, especially sleep, mood, and anxiety. The present study compared a community (i.e., nontreatment seeking) sample of cannabis-using and control participants on mood, anxiety, sleep, and withdrawal inventories during the course of a monitored 3-week cannabis abstinence period. Materials and Methods: Seventy-nine adolescent and young adult participants (cannabis-using group=37 and control group=42) were recruited from the community to undergo 3 weeks of confirmed abstinence (i.e., urine and sweat patch toxicology) and completion of Cannabis Withdrawal Symptom Criteria, State-Trait Anxiety Inventory, Beck's Depression Inventory, and Pittsburgh Sleep Quality Index across the study period. Repeated measures and cross-sectional regressions were used to examine main effects of group and interactions with time (where appropriate), while accounting for recent alcohol use and cotinine levels. Results: Cannabis-using participants reported higher mood (p=0.006), overall withdrawal (p=0.009), and sleep-related withdrawal (p<0.001) symptoms across abstinence compared to controls. Overall withdrawal severity (p=0.04) and sleep-related withdrawal symptoms (p=0.02) demonstrated a quadratic trajectory across the monitored abstinence periods, with an increase from baseline and subsequent decreases in symptom severity. No differences of anxiety scores (p=0.07) or trajectories (p=0.18) were observed. By study completion, groups did not differ among sleep quality components (all p's>.05). Conclusions: These findings revealed that nontreatment-seeking cannabis-using adolescents and young adults reported heightened total withdrawal symptoms during a 3-week sustained abstinence period relative to controls. Cannabis-using participants demonstrated an increase in withdrawal symptom trajectory during the first week followed by decreased symptoms from weeks 2 to 3, which contrasts with prior linear decreases observed in cannabis-using adolescent and young adults. More mood symptoms were observed in the cannabis-using group even while excluding for comorbid psychopathologies-along with significantly more sleep problems during the abstinence period. Implications include the necessity to provide psychoeducation for recreational, nontreatment-seeking cannabis-using individuals about cannabis withdrawal, mood symptoms, and sleep quality difficulties when cannabis cessation is attempted, to improve likelihood of long-term sustained abstinence.
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Affiliation(s)
- Ryan M. Sullivan
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Alexander L. Wallace
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Elizabeth A. Stinson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karina V. Montoto
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Christine M. Kaiver
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Natasha E. Wade
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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7
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Vomer R, York E. It’s high time for a change. Br J Sports Med 2022; 56:1267-1268. [DOI: 10.1136/bjsports-2022-106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
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8
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Connor JP, Stjepanović D, Budney AJ, Le Foll B, Hall WD. Clinical management of cannabis withdrawal. Addiction 2022; 117:2075-2095. [PMID: 34791767 PMCID: PMC9110555 DOI: 10.1111/add.15743] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ9 -tetrahydrocannabinol (THC). This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research. METHODS Narrative review of literature. RESULTS Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications. CONCLUSIONS The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.
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Affiliation(s)
- Jason P. Connor
- National Centre for Youth Substance Use ResearchThe University of QueenslandSt LuciaQLDAustralia,Discipline of Psychiatry, Faculty of MedicineThe University of QueenslandHerstonQLDAustralia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use ResearchThe University of QueenslandSt LuciaQLDAustralia
| | - Alan J. Budney
- Center for Technology and Behavioral HealthGeisel School of Medicine at DartmouthLebanonNHUSA
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthUniversity of TorontoONCanada,Departments of Family and Community Medicine, Psychiatry, Pharmacology and ToxicologyUniversity of TorontoONCanada
| | - Wayne D. Hall
- National Centre for Youth Substance Use ResearchThe University of QueenslandSt LuciaQLDAustralia,Queensland Alliance for Environmental Health SciencesThe University of QueenslandWoolloongabbaQLDAustralia
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9
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Lorenzetti V, Hindocha C, Petrilli K, Griffiths P, Brown J, Castillo‐Carniglia Á, Caulkins JP, Englund A, ElSohly MA, Gage SH, Groshkova T, Gual A, Hammond D, Lawn W, López‐Pelayo H, Manthey J, Mokrysz C, Pacula RL, van Laar M, Vandrey R, Wadsworth E, Winstock A, Hall W, Curran HV, Freeman TP. The International Cannabis Toolkit (iCannToolkit): a multidisciplinary expert consensus on minimum standards for measuring cannabis use. Addiction 2022; 117:1510-1517. [PMID: 34590359 PMCID: PMC9298052 DOI: 10.1111/add.15702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. METHODS A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. RESULTS The expert-based consensus agreed upon a three-layered hierarchical framework. Each layer-universal measures, detailed self-report and biological measures-reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. CONCLUSIONS Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation.
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health SciencesAustralian Catholic UniversityMelbourneAustralia
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Jamie Brown
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
| | - Álvaro Castillo‐Carniglia
- Society and Health Research Center and School of Public HealthUniversidad MayorSantiagoChile
- Department of Population HealthNYU Grossman School of MedicineNew YorkNYUSA
| | | | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Mahmoud A. ElSohly
- National Center for Natural Products Research, School of PharmacyUniversity of MississippiUniversityMSUSA
- Department Pharmaceutics and Drug Delivery, School of PharmacyUniversity of Mississippi, UniversityMSUSA
| | - Suzanne H. Gage
- Department of Psychology, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Teodora Groshkova
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Antoni Gual
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - David Hammond
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Will Lawn
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
| | - Hugo López‐Pelayo
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Rosalie Liccardo Pacula
- USC Sol Price School of Public PolicyUSC Leonard D. Schaeffer Center for Health Policy & EconomicsLos AngelesCAUSA
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Elle Wadsworth
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Adam Winstock
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
- Global Drug SurveyLondonUK
| | - Wayne Hall
- National Addiction Centre, King's College LondonLondonUK
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - H. Valerie Curran
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Tom P. Freeman
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
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10
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Frei P, Frauchiger S, Scheurer E, Mercer-Chalmers-Bender K. Quantitative determination of five cannabinoids in blood and urine by gas chromatography tandem mass spectrometry applying automated on-line solid phase extraction. Drug Test Anal 2022; 14:1223-1233. [PMID: 35187817 PMCID: PMC9543167 DOI: 10.1002/dta.3241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
Cannabis is the most frequently consumed illegal substance worldwide. More recently, an increasing number of legal cannabis products low in psychoactive Δ9‐tetrahydrocannabinol (THC) but high in non‐intoxicating cannabidiol (CBD) are being more widely consumed. While the detection and quantification of THC and its metabolites in biological matrices is an important forensic‐toxicological task, additional detection of CBD is also important, for example, when examining the plausibility of consumer's statements. This report describes the method validation for the quantitative determination of THC and its two major metabolites, 11‐hydroxy‐THC (OH‐THC) and 11‐nor‐9‐carboxy‐THC (THC‐COOH), as well as CBD and cannabinol (CBN) in whole blood and urine. The method employs automated on‐line solid phase extraction coupled to gas chromatography tandem mass spectrometry (GC–MS/MS). The method was fully validated according to guidelines of the Swiss Society of Legal Medicine (SGRM) and the Society of Toxicological and Forensic Chemistry (GTFCh). The method fulfilled the validation criteria regarding analytical limits, accuracy and precision, extraction efficacy, and sample stability. The limits of detection (LODs) in whole blood and urine were 0.15 ng/mL for THC, OH‐THC and CBD, 0.1 ng/mL for CBN, and 1.0 ng/mL for THC‐COOH. The limits of quantification (LOQ) in whole blood and urine were 0.3 ng/mL for THC, OH‐THC and CBD, 0.2 ng/mL for CBN, and 3.0 ng/mL for THC‐COOH. The fully validated and automated method allows sensitive and robust measurement of cannabinoids in whole blood and urine. Detection of CBD provides additional information regarding consumed products.
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Affiliation(s)
- P Frei
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - S Frauchiger
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - E Scheurer
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - K Mercer-Chalmers-Bender
- Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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11
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Abstract
The rules of fair play in sport generally prohibit the use of performance-enhancing drugs (PEDs). The World Anti-Doping Agency (WADA) oversees global antidoping regulations and testing for elite athletes participating in Olympic sports. Efforts to enforce antidoping policies are complicated by the diverse and evolving compounds and strategies employed by athletes to gain a competitive edge. Now between the uniquely proximate 2021 Tokyo and 2022 Beijing Olympic Games, we discuss WADA's efforts to prevent PED use during the modern Olympic Games. Then, we review the major PED classes with a focus on pathophysiology, complexities of antidoping testing, and relevant toxicities. Providers from diverse practice environments are likely to care for patients using PEDs for a variety of reasons and levels of sport; these providers should be aware of common PED classes and their risks.
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Affiliation(s)
- C James Watson
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Genevra L Stone
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel L Overbeek
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare, Ōtawara, Japan
| | - Michele M Burns
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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12
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Prevalence of marijuana use in pregnant women with concurrent opioid use disorder or alcohol use in pregnancy. Addict Sci Clin Pract 2022; 17:3. [PMID: 34991713 PMCID: PMC8734065 DOI: 10.1186/s13722-021-00285-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A quarter of pregnant women use alcohol, 6.5/1000 deliveries are affected by opioid use disorder (OUD), and the prevalence of cannabis use in pregnant women is increasing. However, marijuana co-exposure in polysubstance-using women is not well described. METHODS The well-characterized ENRICH-1 cohort (n = 251), which focused on the effects of two primary exposures of interest-opioids and alcohol, was used to (1) estimate the prevalence/frequency of marijuana use in those with OUD and/or alcohol use, and (2) examined correlates of marijuana use. Participants were classified into an OUD group (n = 125), Alcohol group (n = 69), and concurrent OUD and Alcohol (OUD + Alcohol) group (n = 57). Self-report and biomarkers ascertained substance use. Multivariable logistic regression identified correlates of marijuana use. RESULTS The prevalence of any marijuana use in pregnancy was 43.2%, 52.6%, and 46.4% in the OUD, OUD + Alcohol, and Alcohol groups, respectively. Correspondingly, weekly or daily use was reported by 19.4%, 21.0%, and 24.6% of participants. In the OUD and OUD + Alcohol groups, the proportion of women using marijuana was significantly higher in those taking buprenorphine (45.8% and 58.3%, respectively) compared to women using methadone (37.5% and 42.9%, respectively). Mean maternal age was lower in women who used marijuana in all three groups compared to non-marijuana users. Independent correlates of marijuana use (controlling for group, race/ethnicity, education, and smoking) were maternal age (adjusted Odds Ratio (aOR) per 5-year increment 0.61; (95% CI 0.47, 0.79)), and polysubstance use (aOR 2.02; 95% CI 1.11, 3.67). There was a significant interaction between partnership status and group: among women who were not in a partnership, those in the OUD and OUD + Alcohol groups had lower odds of marijuana use relative to the Alcohol group. For women in the Alcohol group, partnered women had lower odds of marijuana use than un-partnered women (aOR 0.12; 95% CI: 0.02, 0.68). CONCLUSIONS Results indicate a relatively high prevalence and frequency of marijuana use in pregnant women being treated for OUD and/or women consuming alcohol while pregnant. These results highlight the need for ongoing risk reduction strategies addressing marijuana use for pregnant women receiving OUD treatment and those with alcohol exposure.
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13
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Lappas NT, Lappas CM. Cannabinoids. Forensic Toxicol 2022. [DOI: 10.1016/b978-0-12-819286-3.00026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Blandino A, Cotroneo R, Tambuzzi S, Di Candia D, Genovese U, Zoja R. Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues. Forensic Sci Int Synerg 2022; 4:100224. [PMID: 35330981 PMCID: PMC8938866 DOI: 10.1016/j.fsisyn.2022.100224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022]
Abstract
Driving under the influence of alcohol has been shown to increase the risk of involvement in road traffic collisions (RTCs) however, less is known about the effects of illicit drugs, and a clear correlation between drug concentrations and RTC risk is still debated. The goal of this narrative review is to assess the current literature regarding the most detected psychoactive drugs in RTC (ethanol, amphetamines, cannabis, opioids and cocaine), in relation to driving performance. Evidence on impaired driving due to psychoactive substances, forensic issues relating to the assessment of the impact of drugs, blood cut-off values proposed to date as well as scientific basis for proposed legislative limits are discussed. At present there is no unequivocal evidence demonstrating a clear dose/concentration dependent impairment in many substances. Per se and zero tolerance approaches seem to have negative effect on drugged driving fatalities. However, the weight of these approaches needs further investigation. Driving under the influence of psychotropic substances has become a widespread phenomenon. Only a few substances have been reported to have a clear dose/concentration dependent impairment. Statistically significant differences should not be considered as clinically significant per se There is wide variability in legislative cut-offs. Detection limits seems to be the most public safety-oriented legislative approach.
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15
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Abstract
OBJECTIVE Cannabis Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of intractable emesis associated with heavy use of cannabis. Recognition of CHS can be problematic due to the lack of specific biomarkers, which can point the clinician to the diagnosis. We present, retrospectively, a series of adolescent/young adult patients who presented to a pediatric gastroenterology (GI) service with acute on chronic nausea and vomiting, subsequently found to have CHS with associated elevated urinary cannabis metabolite concentrations. METHODS We describe 15 patients referred to our pediatric GI division for intractable emesis with spot urinary cannabis metabolite carboxy-THC (THC-COOH) concentrations from January 1, 2018 through April 20, 2019. Urinary testing was performed using gas chromatography mass-spectrometry (GC-MS) in a manner consistent with Clinical Laboratory Improvement Amendments (CLIA) requirements at Mayo Clinic laboratory (Rochester, MN). The laboratory cutoffs were 3.0 ng/mL. Data was extracted via chart review and analyzed via online statistical application. RESULTS Fifteen patients (seven females, eight males) were studied with an average age of 17.7 years. All patients reported frequent cannabis use for at least 1 month and exhibited intractable, non-bilious emesis for at least 2 weeks. Twelve patients also reported weight loss. Two patients had underlying gastrointestinal disease (one with Crohn disease and one with irritable bowel syndrome). All patients had essentially normal GI workup including laboratory tests, imaging studies and endoscopies.Fourteen of 15 patients had urinary THC-COOH concentrations >100 ng/mL, with seven individuals exhibiting levels >500 ng/mL. One patient had a urinary TCH-COOH concentration level under 100 ng/mL had not used cannabis for 2 weeks. Most other patients had used cannabis within 2 days of providing a urine sample. The Binomial test for CHS patients with urinary THC-COOH levels over 100 ng/mL was significant with a P-value of <0.0005 (one tail test). CONCLUSION CHS is associated with an elevated urinary THC-COOH level usually exceeding 100 ng/mL, which is indicative of significant chronic cannabis exposure. In patients with a history consistent with CHS, urine THC-COOH testing may help guide the diagnostic evaluation of these patients and decrease the need for further workup.
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16
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The effects of marijuana use prior to traumatic brain injury on survival. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Breindahl T, Kimergård A, Leutscher PDC, Hindersson P. Implementation of Mathematical Models to Predict New Cannabis Use by Urine Drug Testing: It Is Time to Move Forward. J Anal Toxicol 2021; 45:e15-e19. [PMID: 33876828 PMCID: PMC8272527 DOI: 10.1093/jat/bkab037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Torben Breindahl
- Department Clinical Biochemistry, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark
| | - Andreas Kimergård
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB London, UK
| | - Peter D C Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark.,Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Peter Hindersson
- Department Clinical Biochemistry, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark
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18
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Sullivan RM, Wallace AL, Wade NE, Swartz AM, Lisdahl KM. Cannabis Use and Brain Volume in Adolescent and Young Adult Cannabis Users: Effects Moderated by Sex and Aerobic Fitness. J Int Neuropsychol Soc 2021; 27:607-620. [PMID: 34261557 PMCID: PMC8288486 DOI: 10.1017/s135561772100062x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Studies examining the impact of adolescent and young adult cannabis use on structural outcomes have been heterogeneous. One already-identified moderator is sex, while a novel potential moderator is extent of aerobic fitness. Here, we sought to investigate the associations of cannabis use, sex, and aerobic fitness levels on brain volume. Second, we explored brain-behavior relationships to interpret these findings. METHODS Seventy-four adolescents and young adults (36 cannabis users and 38 controls) underwent 3 weeks of monitored cannabis abstinence, aerobic fitness testing, structural neuroimaging, and neuropsychological testing. Linear regressions examined cannabis use and its interaction with sex and aerobic fitness on whole-brain cortical volume and subcortical regions of interests. RESULTS No main-effect differences between cannabis users and nonusers were observed; however, cannabis-by-sex interactions identified differences in frontal, temporal, and paracentral volumes. Female cannabis users generally exhibited greater volume while male users exhibited less volume compared to same-sex controls. Positive associations between aerobic fitness and frontal, parietal, cerebellum, and caudate volumes were observed. Cannabis-by-fitness interaction was linked with left superior temporal volume. Preliminary brain-behavior correlations revealed that abnormal volumes were not advantageous in either male or female cannabis users. CONCLUSIONS Aerobic fitness was linked with greater brain volume and sex moderated the effect of cannabis use on volume; preliminary brain-behavior correlations revealed that differences in cannabis users were not linked with advantageous cognitive performance. Implications of sex-specific subtleties and mechanisms of aerobic fitness require large-scale investigation. Furthermore, present findings and prior literature on aerobic exercise warrant examinations of aerobic fitness interventions that aimed at improving neurocognitive health in substance-using youth.
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Affiliation(s)
| | | | - Natasha E. Wade
- Department of Psychiatry, University of California, San Diego
| | - Ann M. Swartz
- Department of Kinesiology, University of Wisconsin-Milwaukee
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19
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Preliminary Evidence for Cannabis and Nicotine Urinary Metabolites as Predictors of Verbal Memory Performance and Learning Among Young Adults. J Int Neuropsychol Soc 2021; 27:546-558. [PMID: 34261558 PMCID: PMC8288450 DOI: 10.1017/s1355617721000205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Verbal memory deficits are linked to cannabis use. However, self-reported episodic use does not allow for assessment of variance from other factors (e.g., cannabis potency, route of consumption) that are important for assessing brain-behavior relationships. Further, co-occurring nicotine use may moderate the influence of cannabis on cognition. Here we utilized objective urinary measurements to assess the relationship between metabolites of cannabis, 11-nor-9-carboxy-∆9-tetrahydrocannabinol (THCCOOH), and nicotine (cotinine) on verbal memory in young adults. METHOD Adolescents and young adults (n = 103) aged 16-22 completed urinary drug testing and verbal memory assessment (RAVLT). Linear regressions examined the influence of THCCOOH and cotinine quantitative concentrations, and their interaction, on RAVLT scores, controlling for demographics and alcohol. Cannabis intake frequency was also investigated. Secondary analyses examined whether past month or recency of use related to performance, while controlling for THCCOOH and cotinine concentrations. RESULTS THCCOOH concentration related to both poorer total learning and long delay recall. Cotinine concentration related to poorer short delay recall. Higher frequency cannabis use status was associated with poorer initial learning and poorer short delay. When comparing to self-report, THCCOOH and cotinine concentrations were negatively related to learning and memory performance, while self-report was not. CONCLUSIONS Results confirm the negative relationship between verbal memory and cannabis use, extending findings with objective urinary THCCOOH, and cotinine concentration measurements. No moderating relationship with nicotine was found, though cotinine concentration independently associated with negative short delay performance. Findings support the use of both urinary and self-report metrics as complementary methods in substance use research.
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20
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Foppe KS, Kujawinski EB, Duvallet C, Endo N, Erickson TB, Chai PR, Matus M. Analysis of 39 drugs and metabolites, including 8 glucuronide conjugates, in an upstream wastewater network via HPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1176:122747. [PMID: 34052556 PMCID: PMC8271266 DOI: 10.1016/j.jchromb.2021.122747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/17/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023]
Abstract
Pharmaceutical compounds ingested by humans are metabolized and excreted in urine and feces. These metabolites can be quantified in wastewater networks using wastewater-based epidemiology (WBE) methods. Standard WBE methods focus on samples collected at wastewater treatment plants (WWTPs). However, these methods do not capture more labile classes of metabolites such as glucuronide conjugates, products of the major phase II metabolic pathway for drug elimination. By shifting sample collection more upstream, these unambiguous markers of human exposure are captured before hydrolysis in the wastewater network. In this paper, we present an HPLC-MS/MS method that quantifies 8 glucuronide conjugates in addition to 31 parent and other metabolites of prescription and synthetic opioids, overdose treatment drugs, illicit drugs, and population markers. Calibration curves for all analytes are linear (r2 > 0.98), except THC (r2 = 0.97), and in the targeted range (0.1-1,000 ng mL-1) with lower limits of quantification (S/N = 9) ranging from 0.098 to 48.75 ng mL-1. This method is fast with an injection-to-injection time of 7.5 min. We demonstrate the application of the method to five wastewater samples collected from a manhole in a city in eastern Massachusetts. Collected wastewater samples were filtered and extracted via solid-phase extraction (SPE). The SPE cartridges are eluted and concentrated in the laboratory via nitrogen-drying. The method and case study presented here demonstrate the potential and application of expanding WBE to monitoring labile metabolites in upstream wastewater networks.
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Affiliation(s)
- Katelyn S Foppe
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Elizabeth B Kujawinski
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA; Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, Woods Hole, MA 02543, USA
| | - Claire Duvallet
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Noriko Endo
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Timothy B Erickson
- Division of Medical Toxicology, Department of Medical Toxicology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02411, USA; Harvard Humanitarian Institute, Cambridge, MA 02139, USA
| | - Peter R Chai
- Division of Medical Toxicology, Department of Medical Toxicology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02411, USA; The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA; The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02142, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Mariana Matus
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA.
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21
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Marín J, Pérez de Mendiola X, Fernández S, Chart JP. Cannabis withdrawal induced brief psychotic disorder: a case study during the national lockdown secondary to the COVID-19 pandemic. J Addict Dis 2021; 39:579-584. [PMID: 33884940 DOI: 10.1080/10550887.2021.1910473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cannabis Withdrawal Syndrome (CWS) is a key feature of Cannabis Use Disorder (CUD). The CWS causes significant distress and disability. While the relationship between CUD and psychosis has been extensively studied, the potential connection between CWS and psychosis has not received as much attention. CASE PRESENTATION The CARE guideline's methodology is followed in the presentation of this case report. During the national lockdown decreed by the Spanish government for the containment of the CoronaVirus Disease 19 (COVID-19) pandemic, a 29-year-old man suffers a CWS and a subsequent psychotic episode. He is admitted to a psychiatric unit, obtaining a rapid and complete response to treatment. DISCUSSION Clinical and pathophysiological data that support the hypothesis of CWS-induced psychosis are discussed. Due to the increasing use of cannabis worldwide, we believe that more research is needed on the mental disturbances associated with CUD, including CWS and psychosis. On the other hand, the confinement and social distancing measures adopted in the face of the current COVID-19 pandemic could have restricted the availability and consumption of certain drugs, precipitating the emergence of withdrawal syndromes such as CWS.
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Affiliation(s)
- Julen Marín
- Department of Psychiatry, Araba University Hospital (OSI Araba), Osakidetza (Basque Health Service), Vitoria-Gasteiz (Spain)
| | - Xabier Pérez de Mendiola
- Department of Psychiatry, Araba University Hospital (OSI Araba), Osakidetza (Basque Health Service), Vitoria-Gasteiz (Spain)
| | - Sergio Fernández
- Department of Psychiatry, Araba University Hospital (OSI Araba), Osakidetza (Basque Health Service), Vitoria-Gasteiz (Spain)
| | - Juan Pablo Chart
- Department of Psychiatry, Araba University Hospital (OSI Araba), Osakidetza (Basque Health Service), Vitoria-Gasteiz (Spain)
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22
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Moral J, Hundl C, Lee D, Neuman M, Grimaldi A, Cuellar M, Stout P. Erratum To: Implementation of a Blind Quality Control Program in Blood Alcohol Analysis. J Anal Toxicol 2021; 45:e15. [PMID: 33792720 DOI: 10.1093/jat/bkab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jackeline Moral
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Callan Hundl
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Dayong Lee
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Maddisen Neuman
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA.,Center for Statistics and Applications in Forensic Evidence (CSAFE), 613 Morrill Road, Ames, IA 50011, USA
| | - Aimee Grimaldi
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
| | - Maria Cuellar
- University of Pennsylvania, Philadelphia, McNeil Office 554, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Peter Stout
- Houston Forensic Science Center, 500 Jefferson Street, 13th Floor, Houston, TX 77002, USA
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23
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Kul A, Sagirli O. Determination of Enzymatic Hydrolysis Efficiency in Detection of Cannabis Use by UPLC-MS/MS. J Anal Toxicol 2021; 46:257-263. [PMID: 33543758 DOI: 10.1093/jat/bkab017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/14/2022] Open
Abstract
Cannabis is still the most widely used illegal plant in the world. However, cannabis use is prohibited in many countries. After cannabis use, Δ9-tetrahydrocannabinol is metabolized in the liver to 11-nor-9-carboxy-Δ9- tetrahydrocannabinol (THC-COOH) and most undergo glucuronidation. THC-COOH and THC-COOH glucuronide are excreted in the urine. The total concentration of THC-COOH in the urine sample is measured to determine cannabis use. The total concentration is determined after enzymatic or alkaline hydrolysis. In this study, comparing enzymatic hydrolysis efficiency is presented comprehensively together with the method developed for the determination of total 11-nor-9-carboxy-Δ9-tetrahydrocannabinol in the urine. Also, the method was validated according to the European Medicines Agency (EMA) Guideline on bioanalytical method validation. The method has rapid hydrolysis time (20 min), rapid analysis time (5 min), and simple sample preparation. The lower limit of quantitation of the developed method was 1 ng/mL for 11-nor-9-carboxy-Δ9- tetrahydrocannabinol. The calibration curve of 11-nor-9-carboxy-Δ9- tetrahydrocannabinol was between 1-2000 ng/mL with a correlation coefficient>0.99. Also, the method was applied to real patient's urine. We think that the results will provide a new perspective on enzymatic hydrolysis optimization studies.
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Affiliation(s)
- Aykut Kul
- Department of Analytical Chemistry, Faculty of Pharmacy, Istanbul University, 34452, Istanbul, Turkey
| | - Olcay Sagirli
- Department of Analytical Chemistry, Faculty of Pharmacy, Istanbul University, 34452, Istanbul, Turkey
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24
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Claus BB, Specka M, McAnally H, Scherbaum N, Schifano F, Bonnet U. Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor? Front Psychiatry 2020; 11:598150. [PMID: 33343424 PMCID: PMC7744589 DOI: 10.3389/fpsyt.2020.598150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background: For cannabis-dependent subjects, the relationship between cannabis withdrawal syndrome (CWS) severity and the urine cannabinoid concentrations are unclear; we investigated this using a commercial point-of-care (POC) enzyme immunoassay detecting 11-nor-9-carboxy-Delta-9-tetrahydrocannabinol (THC-COOH). Methods: Observational study of 78 adult chronic cannabis-dependent subjects assessed over a 24-day inpatient detoxification treatment, with 13 serial measurement days. Repeated Measures Correlation and Multilevel Linear Models were employed. Results: Absolute urinary THC-COOH levels significantly correlated with Marijuana Withdrawal Checklist (MWC) scores across the entire study duration (r = 0.248; p < 0.001). Correlation between serial creatinine-adjusted THC-COOH ratios and serial MWC scores emerged as significant only in the sample with higher MWC scores (>11 points) at admission (n = 21; r = 0.247; p = 0.002). The aforementioned significant relationships have persisted when replacing the absolute THC-COOH-levels with the (relative) day-to-day change in urinary THC-COOH levels. MWC scores were significantly correlated with the Clinical Global Impression-Severity (CGI-S; r = 0.812; p < 0.001). Females showed a significantly slower decline in urine THC-COOH levels and prolonged CWS course characterized by substantial illness severity (per CGI-S), occurring in nearly 30% of cases. Conclusion: Urine cannabinoid levels (THC-COOH) determined by POC assay significantly predicted CWS severity (moderate correlation), guiding detoxification treatment duration. In patients with MWC > 11 points upon admission, creatinine-adjusted THC-COOH ratios also significantly predicted CWS severity-again with moderate effect size. Females showed prolonged urinary THC-COOH elimination and cannabis withdrawal.
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Affiliation(s)
- Benedikt Bernd Claus
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heath McAnally
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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25
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Leskovan JJ, Patel PD, Pederson J, Moore A, Afaneh A, Brown LR. The combined effects of alcohol and marijuana use prior to traumatic brain injury on mortality. Ann Med Surg (Lond) 2020; 60:639-643. [PMID: 33304579 PMCID: PMC7718113 DOI: 10.1016/j.amsu.2020.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background Alcohol (ETOH) intoxication is a common comorbidity in traumatic brain injury (TBI), and marijuana (THC) has been implicated as a major risk factor for trauma. The objective this study was to investigate the combined effects of ETOH and THC on mortality after TBI. Materials and methods A retrospective review of patient data was performed to assess adult (>18 years) patients with brain injuries between January 2012 and December 2018. Included patients sustained TBI (Abbreviated Injury Scale (AIS 1-6)) and were divided into two groups: No Substances and THC + ETOH. Results 1085 (median age 52 years [range: 18–97 years]; 33.5% female (364/1085)) patients met the inclusion criteria. Significant differences for mortality at discharge were found between groups (p = 0.0025) with higher mortality in the No Substances group. On multiple logistic regression, a positive test for both ETOH + THC was found not to independently predict mortality at discharge, while age, Glasgow Coma Scale, intensive care unit stay, Injury Severity Score, length of hospital stay, and days on ventilator were independent predictors. Conclusions After controlling for confounding variables, positive ETOH + THC screens were not found to be independent predictors of mortality at discharge. Therefore, our results indicated no survival benefit for TBI patients with concomitant ETOH and THC use prior to injury. No survival benefit of alcohol and marijuana for all traumatic brain injury levels Glasgow Coma Scale predicts mortality for all traumatic brain injury levels Length of stay predicts mortality for all traumatic brain injury levels
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Affiliation(s)
- John J. Leskovan
- Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, OH, USA
- Corresponding author. Department of Trauma Surgery Mercy St. Vincent Medical Center 2213 Cherry St, Toledo, OH, 43608 ,
| | | | | | - Aaron Moore
- Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Amer Afaneh
- Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Laura R. Brown
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA
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26
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Huestis MA, Sempio C, Newmeyer MN, Andersson M, Barnes AJ, Abulseoud OA, Blount BC, Schroeder J, Smith ML. Free and Glucuronide Urine Cannabinoids after Controlled Smoked, Vaporized and Oral Cannabis Administration in Frequent and Occasional Cannabis Users. J Anal Toxicol 2020; 44:651-660. [PMID: 32369162 DOI: 10.1093/jat/bkaa046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023] Open
Abstract
Total urinary 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH) concentrations are generally reported following cannabis administration. Few data are available for glucuronide and minor cannabinoid metabolite concentrations. All urine specimens from 11 frequent and 9 occasional cannabis users were analyzed for 11 cannabinoids for ~85 h by liquid chromatography with tandem mass spectrometry following controlled smoked, vaporized or oral 50.6 mg Δ9-tetrahydrocannabinol (THC) in a randomized, placebo-controlled, within-subject dosing design. No cannabidiol, cannabinol, cannabigerol, tetrahydrocannabivarin (THCV), THC, 11-OH-THC and Δ9-tetrahydrocannabinolic acid were detected in urine. Median THCCOOH-glucuronide maximum concentrations (Cmax) following smoked, vaporized and oral routes were 68.0, 26.7 and 360 μg/L for occasional and 378, 248 and 485 μg/L for frequent users, respectively. Median time to specific gravity-normalized Cmax (Tmax) was 5.1-7.9 h for all routes and all users. Median Cmax for THCCOOH, THC-glucuronide and 11-nor-9-carboxy-Δ9-THCV (THCVCOOH) were <7.5% of THCCOOH-glucuronide Cmax concentrations. Only THC-glucuronide mean Tmax differed between routes and groups, and was often present only in occasional users' first urine void. Multiple THCCOOH-glucuronide and THCCOOH peaks were observed. We also evaluated these urinary data with published models for determining recency of cannabis use. These urinary cannabinoid marker concentrations from occasional and frequent cannabis users following three routes of administration provide a scientific database to assess single urine concentrations in cannabis monitoring programs. New target analytes (CBD, CBN, CBG, THCV and phase II metabolites) were not found in urine. The results are important to officials in drug treatment, workplace and criminal justice drug monitoring programs, as well as policy makers with responsibility for cannabis regulations.
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Affiliation(s)
- Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.,Currently at The Lambert Center for the Study of Medicinal Cannabis and Hemp, Institute on Emerging Health Professions, Thomas Jefferson University, 683 Shore Road, Severna, Park MD 21146, USA
| | - Cristina Sempio
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.,Currently at Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Laboratory IC42, Aurora, CO 80045, USA
| | - Matthew N Newmeyer
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.,Currently at Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Maria Andersson
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.,Currently at Cepheid AB, Inc., Rontgenvägen 5, 171 54, Solna, Sweden
| | - Allan J Barnes
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.,Currently at Quest Diagnostics Nichols Institute, 14225 Newbrook Dr., Chantilly, VA 20151
| | - Osama A Abulseoud
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224
| | - Benjamin C Blount
- Center for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Tobacco and Volatiles Branch, 4770 Buford Highway, NE, Atlanta, GA 30341
| | - Jennifer Schroeder
- Office of the Clinical Director, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd., Baltimore, MD 21224
| | - Michael L Smith
- Huestis & Smith Toxicology, LLC, 683 Shore Road, Severna Park, MD 21146
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27
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Zarei S, Salimi Y, Repo E, Daglioglu N, Safaei Z, Güzel E, Asadi A. A global systematic review and meta-analysis on illicit drug consumption rate through wastewater-based epidemiology. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:36037-36051. [PMID: 32594443 DOI: 10.1007/s11356-020-09818-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/19/2020] [Indexed: 05/06/2023]
Abstract
Wastewater-based epidemiology (WBE) is a complementary, well-established comprehensive, cost-effective, and rapid technique for monitoring of illicit drugs used in a general population. This systematic review and meta-analysis is the first to estimate the rank and consumption rate of illicit drugs through WBE studies. In the current study, the related investigations regarding the illicit drug consumption rate based on WBE were searched among the international databases including Scopus, PubMed, Science direct, Google scholar, and local database, Magiran from 2012 up to May 2019. The illicit drug consumption rate with 95% confidence intervals was pooled between studies by using random effect model. The heterogeneity was determined using I2 statistics. Also, subgroup analyses were conducted to examine the possible effects of year and location of studies on observed heterogeneity. Meta-analysis of 37 articles indicates that the overall rank order of illicit drugs according to their pooled consumption rate can be summarized as tetrahydrocannabinol or cannabis (7417.9 mg/day/1000 people) > cocaine (655.7 mg/day/1000 people) > morphine (384.9 mg/day/1000 people) > methamphetamine (296.2 mg/day/1000 people) > codeine (222.7 mg/day/1000 people) > methadone (200.2 mg/day/1000 people) > 3,4-methylenedioxymethamphetamine (126.3 mg/day/1000 people) > amphetamine (118.2 mg/day/1000 people) > 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (33.7 mg/day/1000 people). The pooled level rate was 190.16 mg/day/1000 people for benzoylecgonine (main urinary cocaine metabolite), 137.9 mg/day/1000 people for 11-nor-9-carboxy-delta9-tetrahydrocannabinol (main metabolite of cannabis), and 33.7 mg/day/1000 people for 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (main metabolite of methadone). The I2 values for all selected drugs were 100% (P value < 0.001). The results of year subgroup indicated that the changes of heterogeneity for all selected drugs were nearly negligible. The heterogeneity within studies based on continents subgroup just decreased in America for drugs like 11-nor-9-carboxy-delta9-tetrahydrocannabinol (I2 = 24.4%) and benzoylecgonine (I2 = 94.1%). The outcome of this meta-analysis can be used for finding the illicit drugs with global serious problem in view of consumption rate (i.e., cannabis and cocaine) and helping authorities to combat them.
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Affiliation(s)
- Shabnam Zarei
- Students Research Committee, Department of Environmental Health Engineering, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Salimi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Eveliina Repo
- Department of Separation Science, School of Engineering Science, LUT University, Mikkeli, Finland
| | - Nebile Daglioglu
- Department of Forensic Medicine, School of Medicine, University of Cukurova, 01330, Adana, Turkey
| | - Zahra Safaei
- Department of Separation Science, School of Engineering Science, LUT University, Mikkeli, Finland
| | - Evsen Güzel
- Department of Basic Sciences, Faculty of Fisheries, University of Cukurova, 01330, Adana, Turkey
| | - Anvar Asadi
- Department of Environmental Health Engineering, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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28
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Leskovan JJ, Patel PD, Pederson JM, Moore A, Afaneh A, Brown LR. The effects of alcohol and marijuana on survival after severe traumatic brain injury: A retrospective cohort study. Ann Med Surg (Lond) 2020; 57:201-204. [PMID: 32793339 PMCID: PMC7406975 DOI: 10.1016/j.amsu.2020.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 02/03/2023] Open
Abstract
Background Alcohol (ETOH) and marijuana (THC) use have previously shown to improve outcomes after Traumatic Brain Injury (TBI). However, whether TBI severity impacts outcomes among patients tested positive for both ETOH and THC remains unclear. Materials and methods A retrospective review from the Northern Ohio Regional Trauma Registry, which includes deidentified data from six regional hospitals, including three Level 1 and three Level 3 trauma centers, was performed to assess adult (>18 years) patients with severe TBI (head Abbreviated Injury Score ≥ 3) between January 2012 and December 2018 having an alcohol and drug toxicology screen and data regarding outcome at discharge. Patients were divided into two groups: 1) patients with a negative ETOH and drug test, and 2) patients positive for ETOH + THC. Mortality at discharge was the primary outcome measure and multiple logistic regression was used to assess predictors of mortality at discharge. Results A total of 854 (median age: 51 years [range: 18–72]; 34.4% female [294/854]) patients were included. On multiple logistic regression, age (p = 0.003), days in intensive care unit (ICU) (p < 0.001), Glasgow Coma Scale (GCS) (p < 0.001), Injury Severity Score (ISS) (p < 0.001), length of stay (LOS) (p < 0.001), and days on ventilator support (p = 0.032) were significant predictors of mortality at discharge. Blood alcohol content (BAC), cause of TBI, drug class, and sex were not significant predictors of mortality at discharge. Conclusions After severe TBI, positive THC and BAC screening did not predict mortality at discharge after controlling for confounding variables, indicating no survival benefit for patients with severe TBI. No survival benefit of alcohol and marijuana for severe traumatic brain injury. Glasgow Coma Scale predict mortality for severe traumatic brain injury. Injury Severity Score predict mortality for severe traumatic brain injury.
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Affiliation(s)
- John J Leskovan
- Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | | | | | - Aaron Moore
- Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Amer Afaneh
- Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Laura R Brown
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA
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29
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Kapur BM, Aleksa K. What the lab can and cannot do: clinical interpretation of drug testing results. Crit Rev Clin Lab Sci 2020; 57:548-585. [PMID: 32609540 DOI: 10.1080/10408363.2020.1774493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Urine drug testing is one of the objective tools available to assess adherence. To monitor adherence, quantitative urinary results can assist in differentiating "new" drug use from "previous" (historical) drug use. "Spikes" in urinary concentration can assist in identifying patterns of drug use. Coupled chromatographic-mass spectrometric methods are capable of identifying very small amounts of analyte and can make clinical interpretation rather challenging, specifically for drugs that have a longer half-life. Polypharmacy is common in treatment and rehabilitation programs because of co-morbidities. Medications prescribed for comorbidities can cause drug-drug interaction and phenoconversion of genotypic extensive metabolizers into phenotypic poor metabolizers of the treatment drug. This can have significant impact on both pharmacokinetic (PK) and pharmacodynamic properties of the treatment drug. Therapeutic drug monitoring (TDM) coupled with PKs can assist in interpreting the effects of phenoconversion. TDM-PKs reflects the cumulative effects of pathophysiological changes in the patient as well as drug-drug interactions and should be considered for treatment medications/drugs used to manage pain and treat substance abuse. Since only a few enzyme immunoassays for TDM are available, this is a unique opportunity for clinical laboratory scientists to develop TDM-PK protocols that can have a significant impact on patient care and personalized medicine. Interpretation of drug screening results should be done with caution while considering pharmacological properties and the presence or absence of the parent drug and its metabolites. The objective of this manuscript is to review and address the variables that influence interpretation of different drugs analyzed from a rehabilitation and treatment programs perspective.
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Affiliation(s)
- Bhushan M Kapur
- Clini Tox Inc., Oakville, Canada.,Seroclinix Corporation, Mississauga, Canada
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30
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Sangmo L, Braune T, Liu B, Wang L, Zhang L, Sosnoff CS, Blount BC, Wilson KM. Secondhand marijuana exposure in a convenience sample of young children in New York City. Pediatr Res 2020; 89:905-910. [PMID: 32403116 PMCID: PMC7882144 DOI: 10.1038/s41390-020-0958-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/24/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Biomarkers of exposure to marijuana smoke can be detected in the urine of children with exposure to secondhand marijuana smoke, but the prevalence is unclear. METHODS We studied children between the ages of 0 to 3 years who were coming in for well-child visits or hospitalized on the inpatient general pediatric unit between 2017 and 2018 at Kravis Children's Hospital at Mount Sinai. Parents completed an anonymous survey, and urine samples were analyzed for cotinine and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (COOH-THC), a metabolite of Δ9-tetrahydrocannabinol. RESULTS Fifty-three children had urine samples available for analysis. COOH-THC was detectable in 20.8% of the samples analyzed and urinary cotinine was detectable in 90.2%. High levels of tobacco exposure (defined as cotinine ≥2.0 ng/ml) were significantly associated with COOH-THC detection (p < 0.01). We found that 34.8% of children who lived in attached housing where smoking was allowed within the property had detectable COOH-THC compared to 13.0% of children who lived in housing where smoking was not allowed at all. CONCLUSIONS This study adds to the growing evidence that children are being exposed to marijuana smoke, even in places where recreational marijuana use is illegal. It is critical that more research be done on the impact of marijuana smoke exposure on children's health and development. IMPACT We found that 20.8% of the 53 children recruited from Mount Sinai Hospital had detectable marijuana metabolites in their urine. Children with household tobacco smoke exposure and children who lived in attached housing where smoking was allowed on the premises were more likely to have detectable marijuana smoke metabolites. This study adds to the growing evidence that children are being exposed to marijuana smoke, even in places where marijuana remains illegal by state law. As states consider marijuana legalization, it is critical that the potential adverse health effects from marijuana exposure in children be taken into account.
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Affiliation(s)
- Lodoe Sangmo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tanya Braune
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Zhang
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Connie S. Sosnoff
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin C. Blount
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen M. Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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31
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Spindle TR, Cone EJ, Schlienz NJ, Mitchell JM, Bigelow GE, Flegel R, Hayes E, Vandrey R. Urinary Excretion Profile of 11-Nor-9-Carboxy-Δ9-Tetrahydrocannabinol (THCCOOH) Following Smoked and Vaporized Cannabis Administration in Infrequent Cannabis Users. J Anal Toxicol 2020; 44:1-14. [PMID: 31095692 DOI: 10.1093/jat/bkz038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/24/2019] [Accepted: 04/18/2019] [Indexed: 12/27/2022] Open
Abstract
As cannabis has become more accessible, use of alternative methods for cannabis administration such as vaporizers has become more prevalent. Most prior controlled pharmacokinetic evaluations have examined smoked cannabis in frequent (often daily) cannabis users. This study characterized the urinary excretion profile of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH), the primary analytical outcome for detection of cannabis use, among infrequent cannabis users following controlled administration of both smoked and vaporized cannabis. Healthy adults (N = 17), with a mean of 398 (range 30-1,825) days since last cannabis use, smoked and vaporized cannabis containing 0, 10, and 25 mg of Δ9-tetrahydrocannabinol (THC) across six outpatient sessions. Urinary concentrations of THCCOOH were measured at baseline and for 8 h after cannabis administration. Sensitivity, specificity, and agreement between three immunoassays (IA) for THCCOOH (with cutoffs of 20, 50, and 100 ng/mL) and gas chromatography-mass spectrometry (GC/MS) results (confirmatory concentration of 15 ng/mL) were assessed. THCCOOH concentrations peaked 4-6 h after cannabis administration. Median maximum concentrations (Cmax) for THCCOOH were qualitatively higher after administration of vaporized cannabis compared to equal doses of smoked cannabis. Urine THCCOOH concentrations were substantially lower in this study relative to prior examinations of experienced cannabis users. The highest agreement between IA and GC/MS was observed at the 50 ng/mL IA cutoff while sensitivity and specificity were highest at the 20 and 100 ng/mL IA cutoffs, respectively. Using federal workplace drug-testing criteria (IA cutoff of 50 ng/mL and GC/MS concentration ≥15 ng/mL) urine specimens tested positive in 47% of vaporized sessions and 21% of smoked sessions with active THC doses (N = 68). Urinary concentrations of THCCOOH are dissimilar after administration of smoked and vaporized cannabis, with qualitatively higher concentrations observed after vaporization. Infrequent users of cannabis may excrete relatively low concentrations of THCCOOH following acute inhalation of smoked or vaporized cannabis.
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Affiliation(s)
- Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, USA
| | - Edward J Cone
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, USA
| | - Nicolas J Schlienz
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, USA
| | - John M Mitchell
- RTI International, Research Triangle Park, 3040 East Cornwallis Rd., NC, USA
| | - George E Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, USA
| | - Ronald Flegel
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD, USA
| | - Eugene Hayes
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, USA
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32
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Franz F, Haschimi B, King LA, Auwärter V. Extraordinary long detection window of a synthetic cannabinoid metabolite in human urine - Potential impact on therapeutic decisions. Drug Test Anal 2020; 12:391-396. [PMID: 31944614 DOI: 10.1002/dta.2770] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/09/2022]
Abstract
Synthetic cannabinoids (SCs) have become established drugs of abuse. They play an increasing role in drug therapy, where abstinence control testing is required. Differentiation between recent drug uptake and uptake in the distant past is important for drug therapy. This study aimed to evaluate the detection window of a metabolite commonly used as a consumption marker for AB-FUBINACA and AMB-FUBINACA (synonym: FUB-AMB) in urine analysis. The acidic hydrolysis metabolite was quantified in urine samples of a drug user by applying a validated analytical method. The concentration profile of the metabolite was correlated with usage data of the subject. Pharmacokinetic properties of AB-FUBINACA were collected by analysis of serum and urine samples from a controlled administration study (single oral ingestion of AB-FUBINACA). Thirteen urine samples were taken without advance notice over 2 years. The metabolite was detected in the first urine sample at 0.77 ng/mg creatinine and subsequently in concentrations ranging from 0.06 to 0.29 ng/mg creatinine. Usage data showed credible abstinence from SCs during this period. The pharmacokinetic properties observed within the controlled self-administration study supported the hypothesis of distribution into deeper compartments and long-lasting elimination (serum concentration-time curve showing biphasic kinetics). An elimination phase of over 1 year after the last drug uptake seems plausible in cases of extensive consumption. To avoid misinterpretation of positive findings, we recommend testing patients with known SC use at the beginning of the abstinence program and to re-test continuously at short time intervals. These data enable the correct interpretation of analytical findings.
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Affiliation(s)
- Florian Franz
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Belal Haschimi
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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33
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Schuster RM, Potter K, Vandrey R, Hareli M, Gilman J, Schoenfeld D, Evins AE. Urinary 11-nor-9-carboxy-tetrahydrocannabinol elimination in adolescent and young adult cannabis users during one month of sustained and biochemically-verified abstinence. J Psychopharmacol 2020; 34:197-210. [PMID: 31535597 PMCID: PMC6989351 DOI: 10.1177/0269881119872206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite adolescents and young adults being the most frequent users of cannabis, all information on cannabis drug testing interpretation is based on data from adults. AIMS This study aimed to define the time course of urinary 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH) excretion among 70 adolescent and young adult cannabis users during 1 month of biochemically-verified cannabis abstinence. METHODS Urine specimens were collected at non-abstinent baseline and after 2, 3, 8, 15, 21 and 28 days of abstinence. Specimens were tested for THCCOOH with a 'rapid' immunoassay drug test and a confirmatory assay using liquid chromatography-tandem mass spectrometry, with a 5 ng/mL limit of quantitation. Elimination rate was tested using a population pharmacokinetics model. RESULTS/OUTCOMES Participants had an average of 26 days of abstinence (SD = 6). Initial creatinine-adjusted THCCOOH concentration (CN-THCCOOH) was 148 ng/mg (SD = 157). Half-life was 2 days (SD = 5), with a 10-day window of detection (estimated range: 4-80 days). At the final timepoint and among those with > 25 days of abstinence (n = 62), 40% (n = 25) had THCCOOH concentrations > 5 ng/mL (i.e. detectable on confirmatory assay) and 19% (n = 12) were 'positive' per federal drug testing guidelines (i.e. values greater than 50 ng/mL on the screening immunoassay and 15 ng/mL on the confirmatory assay). More frequent past month cannabis use was associated with higher baseline CN-THCCOOH concentrations, but not with rate of elimination. Nested five-fold cross-validation suggested high model reliability and predictive validity. CONCLUSIONS/INTERPRETATION Findings underscore that, as with adults, detectable cannabinoid metabolites do not necessarily indicate recent use in adolescents and young adults. Algorithms that account for THCCOOH levels, assessed longitudinally and time between specimen collections are best equipped to confirm abstinence. CLINICAL TRIAL REGISTRATION NCT03276221; https://clinicaltrials.gov/ct2/show/NCT03276221?term=Randi+Schuster&rank=1.
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Affiliation(s)
- Randi Melissa Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Boston, MA
| | - Maya Hareli
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Jodi Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - David Schoenfeld
- Harvard Medical School, Boston, MA,Department of Biostatistics, Massachusetts General Hospital, Boston, MA
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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34
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Connors N, Kosnett MJ, Kulig K, Nelson LS, Stolbach AI. ACMT Position Statement: Interpretation of Urine for Tetrahydrocannabinol Metabolites. J Med Toxicol 2020; 16:240-242. [PMID: 31939053 DOI: 10.1007/s13181-019-00753-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/21/2019] [Accepted: 12/01/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nicholas Connors
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
- Palmetto Poison Center, Columbia, SC, USA
| | | | - Ken Kulig
- Toxicology Associates, Prof LLC, Denver, CO, USA
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35
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Western B, Simes JT. Drug use in the year after prison. Soc Sci Med 2019; 235:112357. [DOI: 10.1016/j.socscimed.2019.112357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 05/29/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
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Duflot T, Vasse M, Guillerme J, Schrapp A, Mory C, Imbert L, Djerada Z, Protais Y, Guillin O, Goetz H, Lamoureux F. Interest of adjusting urine cannabinoids to creatinine level to monitor cannabis cessation therapy in heavy smokers with psychiatric disorders. Drug Test Anal 2019; 11:1453-1459. [DOI: 10.1002/dta.2672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Thomas Duflot
- Laboratory of Pharmacokinetics, Toxicology and PharmacogenomicsRouen University Hospital 76000 Rouen France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD‐VHF 76000 Rouen France
- Department of PharmacologyRouen University Hospital 76000 Rouen France
| | - Marianne Vasse
- Rouvray Psychiatric Hospital F76300 Sotteville‐Lès‐Rouen France
| | - Jennifer Guillerme
- Department of General BiochemistryRouen University Hospital Rouen France
| | - Aurélien Schrapp
- Laboratory of Pharmacokinetics, Toxicology and PharmacogenomicsRouen University Hospital 76000 Rouen France
| | - Celine Mory
- Laboratory of Pharmacokinetics, Toxicology and PharmacogenomicsRouen University Hospital 76000 Rouen France
- Department of PharmacologyRouen University Hospital 76000 Rouen France
| | - Laurent Imbert
- Laboratory of Pharmacokinetics, Toxicology and PharmacogenomicsRouen University Hospital 76000 Rouen France
- Department of PharmacologyRouen University Hospital 76000 Rouen France
| | - Zoubir Djerada
- Department of Pharmacology and ToxicologyReims University Hospital F 51092 Reims France
| | - Yves Protais
- Rouvray Psychiatric Hospital F76300 Sotteville‐Lès‐Rouen France
| | - Olivier Guillin
- Rouvray Psychiatric Hospital F76300 Sotteville‐Lès‐Rouen France
| | - Hélène Goetz
- Rouvray Psychiatric Hospital F76300 Sotteville‐Lès‐Rouen France
| | - Fabien Lamoureux
- Laboratory of Pharmacokinetics, Toxicology and PharmacogenomicsRouen University Hospital 76000 Rouen France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD‐VHF 76000 Rouen France
- Department of PharmacologyRouen University Hospital 76000 Rouen France
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Zimmermann K, Kendrick KM, Scheele D, Dau W, Banger M, Maier W, Weber B, Ma Y, Hurlemann R, Becker B. Altered striatal reward processing in abstinent dependent cannabis users: Social context matters. Eur Neuropsychopharmacol 2019; 29:356-364. [PMID: 30658938 DOI: 10.1016/j.euroneuro.2019.01.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/18/2018] [Accepted: 01/06/2019] [Indexed: 12/14/2022]
Abstract
Public perception of cannabis as relatively harmless, alongside claimed medical benefits, have led to moves towards its legalization. Yet, long-term consequences of cannabis dependence, and whether they differ qualitatively from other drugs, are still poorly understood. A key feature of addictive drugs is that chronic use leads to adaptations in striatal reward processing, blunting responsivity to the substance itself and natural (non-drug) rewards. Against this background, the present study investigated whether cannabis dependence is associated with lasting alterations in behavioral and neural responses to social reward in 23 abstinent cannabis-dependent men and 24 matched non-using controls. In an interpersonal pleasant touch fMRI paradigm, participants were led to believe they were in physical closeness of or touched (CLOSE, TOUCH) by either a male or female experimenter (MALE, FEMALE), allowing contextual modulation of the perceived pleasantness and associated neural responses. Upon female compared to male touch, dependent cannabis users displayed a significantly attenuated increase of pleasantness experience compared to healthy controls. Controls responded to female as compared to male interaction with increased striatal activation whereas cannabis users displayed the opposite activation pattern, with stronger alterations being associated with a higher lifetime exposure to cannabis. Neural processing of pleasant touch in dependent cannabis users was found to be intact. These findings demonstrate that cannabis dependence is linked to blunted striatal processing of non-drug rewards and suggest that these alterations may contribute to social processing deficits.
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Affiliation(s)
- Kaeli Zimmermann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany
| | - Keith M Kendrick
- MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, Clinical Hospital of the Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Xiyuan Ave 2006, 611731 Chengdu, China
| | - Dirk Scheele
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany
| | - Wolfgang Dau
- Department of Addiction and Psychotherapy, LVR-Clinic Bonn, 53111 Bonn, Germany
| | - Markus Banger
- Department of Addiction and Psychotherapy, LVR-Clinic Bonn, 53111 Bonn, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), 53175 Bonn, Germany
| | - Bernd Weber
- Department of Epileptology, Center for Economics and Neuroscience, University of Bonn, Germany; Department of NeuroCognition, Life & Brain Center, 53105 Bonn, Germany
| | - Yina Ma
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute of Brain Research, Beijing Normal University, 100875 Beijing, China
| | - René Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany
| | - Benjamin Becker
- MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, Clinical Hospital of the Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Xiyuan Ave 2006, 611731 Chengdu, China.
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38
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Müller LD, Opdal MS. Developing a rapid semi-automated sample preparation with alkaline hydrolysis in a 96-well plate for quantification of 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid in urine samples by UHPLC-MS/MS. J Pharm Biomed Anal 2018; 161:296-304. [DOI: 10.1016/j.jpba.2018.08.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/09/2018] [Accepted: 08/22/2018] [Indexed: 11/25/2022]
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Rusznák K, Csekő K, Varga Z, Csabai D, Bóna Á, Mayer M, Kozma Z, Helyes Z, Czéh B. Long-Term Stress and Concomitant Marijuana Smoke Exposure Affect Physiology, Behavior and Adult Hippocampal Neurogenesis. Front Pharmacol 2018; 9:786. [PMID: 30083103 PMCID: PMC6064973 DOI: 10.3389/fphar.2018.00786] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
Marijuana is a widely used recreational drug with increasing legalization worldwide for medical purposes. Most experimental studies use either synthetic or plant-derived cannabinoids to investigate the effect of cannabinoids on anxiety and cognitive functions. The aim of this study was to mimic real life situations where young people smoke cannabis regularly to relax from everyday stress. Therefore, we exposed young adult male NMRI mice to daily stress and concomitant marijuana smoke for 2 months and investigated the consequences on physiology, behavior and adult hippocampal neurogenesis. Animals were restrained for 6-h/day for 5-days a week. During the stress, mice were exposed to cannabis smoke for 2 × 30 min/day. We burned 2 “joints” (2 × 0.8 g marijuana) per occasion in a whole body smoking chamber. Cannabinoid content of the smoke and urine samples was measured by HPLC and SFC-MS/MS. Body weight gain was recorded daily and we did unrestrained, whole body plethysmography to investigate pulmonary functions. The cognitive performance of the animals was evaluated by the novel object recognition and Y maze tests. Anxietyrelated spontaneous locomotor activity and self-grooming were assessed in the open field test (OFT). Adult neurogenesis was quantified post mortem in the hippocampal dentate gyrus. The proliferative activity of the precursor cells was detected by the use of the exogenous marker 5-bromo-20-deoxyuridine. Treatment effects on maturing neurons were studied by the examination of doublecortin-positive neurons. Both stress and cannabis exposure significantly reduced body weight gain. Cannabis smoke had no effect on pulmonary functions, but stress delayed the maturation of several lung functions. Neither stress, nor cannabis smoke affected the cognitive functioning of the animals. Results of the OFT revealed that cannabis had a mild anxiolytic effect and markedly increased self-grooming behavior. Stress blocked cell proliferation in the dentate gyrus, but cannabis had no effect on this parameter. Marijuana smoke however had a pronounced impact on doublecortin-positive neurons influencing their number, morphology and migration. In summary, we report here that long-term stress in combination with cannabis smoke exposure can alter several health-related measures, but the present experimental design could not reveal any interaction between these two treatment factors except for body weight gain.
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Affiliation(s)
- Kitti Rusznák
- Neurobiology of Stress Research Group, János Szentágothai Research Centre and Centre for Neuroscience, Pécs, Hungary
| | - Kata Csekő
- Molecular Pharmacology Research Group, János Szentágothai Research Centre and Centre for Neuroscience, Pécs, Hungary.,Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary
| | - Zsófia Varga
- Neurobiology of Stress Research Group, János Szentágothai Research Centre and Centre for Neuroscience, Pécs, Hungary
| | - Dávid Csabai
- Neurobiology of Stress Research Group, János Szentágothai Research Centre and Centre for Neuroscience, Pécs, Hungary
| | - Ágnes Bóna
- Department of Biochemistry and Medical Chemistry, University of Pécs Medical School, Pécs, Hungary
| | - Mátyás Mayer
- Department of Forensic Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Zsolt Kozma
- Department of Forensic Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Zsuzsanna Helyes
- Molecular Pharmacology Research Group, János Szentágothai Research Centre and Centre for Neuroscience, Pécs, Hungary.,Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, János Szentágothai Research Centre and Centre for Neuroscience, Pécs, Hungary.,Department of Laboratory Medicine, University of Pécs Medical School, Pécs, Hungary
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Dziadosz M. Adduct Formation-Supported Two-Way Electrospray Ionization Strategy for the Determination of Urinary Creatinine Concentration with LC–MS-MS in Abstinence Control. J Anal Toxicol 2018; 42:625-629. [DOI: 10.1093/jat/bky042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/31/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Marek Dziadosz
- Institute of Legal Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover, Germany
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41
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Rabin RA, Kozak K, Zakzanis KK, Remington G, George TP. Effects of extended cannabis abstinence on clinical symptoms in cannabis dependent schizophrenia patients versus non-psychiatric controls. Schizophr Res 2018; 194:55-61. [PMID: 28285022 DOI: 10.1016/j.schres.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rates of cannabis use among patients with schizophrenia are high, however little is understood about clinical effects of continued cannabis use and cessation after illness onset. Therefore, we investigated the effects of 28-days of cannabis abstinence on psychotic and depressive symptomatology in cannabis dependent patients with schizophrenia. METHOD Males with cannabis dependence and co-morbid schizophrenia (n=19) and non-psychiatric controls (n=20) underwent 28-days of monitored cannabis abstinence. Clinical symptoms were assessed at baseline and then weekly. Abstinence was encouraged using weekly therapy sessions and contingency reinforcement, confirmed by twice-weekly urine assays. RESULTS Forty-two percent (8/19) of patients and 55% (11/20) of controls achieved 28-days of sustained cannabis abstinence. In patients, PANSS subscores did not change over time irrespective of abstinence status. In contrast, patient abstainers demonstrated a more pronounced reduction in depression scores compared to non-abstainers, however, the Abstinence Status x Time interaction was non-significant. DISCUSSION Short-term (28-days) cannabis abstinence is not associated with improvement in psychotic symptoms, but may be associated with improvement in depressive symptomatology in patients with schizophrenia. Future studies employing larger samples as well as a continuous cannabis-using group may help to better characterize the causal effects of cannabis on symptom outcomes in this disorder.
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Affiliation(s)
- Rachel A Rabin
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
| | - Karolina Kozak
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Gary Remington
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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42
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Rabin RA, Kozak K, Zakzanis KK, Remington G, Stefan C, Budney AJ, George TP. A method to achieve extended cannabis abstinence in cannabis dependent patients with schizophrenia and non-psychiatric controls. Schizophr Res 2018; 194:47-54. [PMID: 28506704 DOI: 10.1016/j.schres.2017.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cannabis use disorders (CUD) are common in schizophrenia (~25%) compared to the general population (~3%). Tetrahydrocannabinol (THC), the principal psychoactive component in cannabis is fat-soluble, resulting in an extended period for cannabinoid elimination. While detection of cannabinoids in urine is indicative of prior cannabis exposure, time of last use is difficult to verify sustained abstinence for extended periods (e.g., 28-days) in chronic cannabis users. Therefore, we evaluated the utility of a sustained cannabis abstinence paradigm in patients with schizophrenia and non-psychiatric controls. METHODS Cannabis dependent patients (n=19) and controls (n=20) underwent 28-days of monitored cannabis abstinence facilitated with contingency management. Urine samples were taken twice weekly. Abstinence was evaluated using 1) Self-report; 2) Qualitative biochemical confirmation using MEDTOX; and 3) in a subset of participants (schizophrenia, n=13; controls, n=13) gas chromatography-mass spectrometry (GC-MS) was performed to obtain quantitative creatinine-normalized carboxy-THC (THC-COOH) metabolite levels <20ng/mL). Subjective assessments were used to assess behavioral correlates of cannabis abstinence and further supported time-dependent abstinence trajectories. RESULTS Abstinence rates of 42.1% (8/19) in patients and 55% (11/19) in controls (p=0.53) were observed. Increased cannabis withdrawal symptoms in both patients and controls supported abstinence. DISCUSSION Our results suggest a feasible method for identification of short-term cannabis abstinence in individuals with schizophrenia at rates comparable to controls. Monitoring sustained abstinence may have implications for potential interventions for CUDs in schizophrenia.
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Affiliation(s)
- Rachel A Rabin
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
| | - Karolina Kozak
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Gary Remington
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alan J Budney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03702, USA
| | - Tony P George
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Hostiuc S, Moldoveanu A, Negoi I, Drima E. The Association of Unfavorable Traffic Events and Cannabis Usage: A Meta-Analysis. Front Pharmacol 2018; 9:99. [PMID: 29487531 PMCID: PMC5816577 DOI: 10.3389/fphar.2018.00099] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/29/2018] [Indexed: 01/07/2023] Open
Abstract
Background: In the last years were published many epidemiological articles aiming to link driving under the influence of cannabis (DUIC) with the risk of various unfavorable traffic events (UTEs), with sometimes contradictory results. Aim: The primary objective of this study was to analyze whether there is a significant association between DUIC and UTEs. Materials and Methods: We used two meta-analytical methods to assess the statistical significance of the effect size: random-effects model and inverse variance heterogeneity model. Results: Twenty-four studies were included in the meta-analysis. We obtained significant increases in the effect size for DUIC tested through blood analysis, with an odds ratio (OR) of 1.97 and a confidence interval (CI) between 1.35 and 2.87; death as an outcome, with an OR of 1.56 and a CI between 1.16 and 2.09; and case–control as the type of study, with an OR of 1.99 and a CI between 1.05 and 3.80. Publication bias was very high. Conclusion: Our analysis suggests that the overall effect size for DUIC on UTEs is not statistically significant, but there are significant differences obtained through subgroup analysis. This result might be caused by either methodological flaws (which are often encountered in articles on this topic), the indiscriminate employment of the term “cannabis use,” or an actual absence of an adverse effect. When a driver is found, in traffic, with a positive reaction suggesting cannabis use, the result should be corroborated by either objective data regarding marijuana usage (like blood analyses, with clear cut-off values), or a clinical assessment of the impairment, before establishing his/her fitness to drive.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Moldoveanu
- Faculty of Automatic Control and Computers, Polytechnic University of Bucharest, Bucharest, Romania
| | - Ionuţ Negoi
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eduard Drima
- Clinical-Medical Department, Faculty of Medicine and Pharmacy, University Dunǎrea de Jos, Galaţi, Romania.,Galai Psychiatry Hospital, Galaţi, Romania
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44
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Huestis MA, Smith ML. Cannabinoid Markers in Biological Fluids and Tissues: Revealing Intake. Trends Mol Med 2018; 24:156-172. [DOI: 10.1016/j.molmed.2017.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/24/2022]
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Effects of Extended Cannabis Abstinence on Cognitive Outcomes in Cannabis Dependent Patients with Schizophrenia vs Non-Psychiatric Controls. Neuropsychopharmacology 2017; 42:2259-2271. [PMID: 28443616 PMCID: PMC5603819 DOI: 10.1038/npp.2017.85] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/10/2017] [Accepted: 04/21/2017] [Indexed: 01/12/2023]
Abstract
Cross-sectional studies of the effects of cannabis on cognition in schizophrenia have produced mixed results. Heavy and persistent cannabis use in schizophrenia is a common clinical problem, and effects of controlled abstinence from cannabis in these patients have not been carefully evaluated. The present study sought to determine the effects of cannabis abstinence on cognition in patients with schizophrenia and co-occurring cannabis dependence. We utilized a 28-day cannabis abstinence paradigm to investigate the state-dependent effects of cannabis on select cognitive outcomes in cannabis-dependent patients with schizophrenia and non-psychiatric controls. Nineteen patients and 20 non-psychiatric male cannabis-dependent participants underwent 28 days of cannabis abstinence. Cognition was assessed on day 0, 14, and 28 using a comprehensive neuropsychological battery. Clinical symptoms were assessed weekly. Abstinence was facilitated by contingency reinforcement confirmed by twice weekly urinalysis. Forty-two percent of patients and 55% of controls achieved end-point abstinence (p=0.53), which was biochemically-verified (day 28 urinary THC-COOH <20 ng/ml). In this preliminary study, schizophrenia-abstainers demonstrated improvements in Hopkins Verbal Learning Test-Revised (HVLT-R) performance over time [F(2,14)=4.73, p<0.03] (d=1.07). Lesser improvements on HVLT-R were observed in non-psychiatric control abstainers (d=0.66), and with abstinence on other cognitive test measures, in both patients and controls. Verbal memory and learning may improve in schizophrenia and control subjects with cannabis abstinence, but larger more definitive studies are needed. Our findings underscore the importance of developing effective interventions for cannabis use disorders in schizophrenia.
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46
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Sempio C, Scheidweiler KB, Barnes AJ, Huestis MA. Optimization of recombinant β-glucuronidase hydrolysis and quantification of eight urinary cannabinoids and metabolites by liquid chromatography tandem mass spectrometry. Drug Test Anal 2017; 10:518-529. [PMID: 28815938 DOI: 10.1002/dta.2230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/21/2017] [Accepted: 06/12/2017] [Indexed: 11/08/2022]
Abstract
Prolonged urinary cannabinoid excretion in chronic frequent cannabis users confounds identification of recent cannabis intake that may be important in treatment, workplace, clinical, and forensic testing programs. In addition, differentiation of synthetic Δ9-tetrahydrocannabinol (THC) intake from cannabis plant products might be an important interpretive issue. THC, 11-hydroxy-THC (11-OH-THC) and 11-nor-9-carboxy-THC (THCCOOH) urine concentrations were evaluated during previous controlled cannabis administration studies following tandem alkaline/E. coli β-glucuronidase hydrolysis. We optimized recombinant β-glucuronidase enzymatic urinary hydrolysis before simultaneous liquid chromatography tandem mass spectrometry (LC-MS/MS) quantification of THC, 11-OH-THC, THCCOOH, cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG), tetrahydrocannabivarin (THCV) and 11-nor-9-carboxy-THCV (THCVCOOH) in urine. Enzyme amount, incubation time and temperature, buffer molarity and pH were optimized using pooled urine samples collected during a National Institute on Drug Abuse, Institutional Review Board-approved clinical study. Optimized cannabinoid hydrolysis with recombinant β-glucuronidase was achieved with 2000 IU enzyme, 2 M pH 6.8 sodium phosphate buffer, and 0.2 mL urine at 37°C for 16 h. The LC-MS/MS quantification method for hydrolyzed urinary cannabinoids was validated per the Scientific Working Group on Toxicology guidelines. Linear ranges were 1-250 μg/L for THC and CBG, 2-250 μg/L for 11-OH-THC, CBD, CBN, THCV and THCVCOOH, and 1-500 μg/L for THCCOOH. Inter-batch analytical bias was 92.4-112.4%, imprecision 4.4-9.3% CV (n = 25), extraction efficiency 44.3-97.1% and matrix effect -29.6 to 1.8% (n = 10). The method was utilized to analyze urine specimens collected during our controlled smoked, vaporized, and edible cannabis administration study to improve interpretation of urine cannabinoid test results.
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Affiliation(s)
- Cristina Sempio
- Chemistry and Drug Metabolism Section, IRP, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Karl B Scheidweiler
- Chemistry and Drug Metabolism Section, IRP, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Allan J Barnes
- Chemistry and Drug Metabolism Section, IRP, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism Section, IRP, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, 21224, USA.,University of Maryland School of Medicine, Baltimore, MD, 21224, USA
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Nader DA, Sanchez ZM. Effects of regular cannabis use on neurocognition, brain structure, and function: a systematic review of findings in adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:4-18. [DOI: 10.1080/00952990.2017.1306746] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Danilo A. Nader
- Departmento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zila M. Sanchez
- Departmento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil
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49
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A contingency management method for 30-days abstinence in non-treatment seeking young adult cannabis users. Drug Alcohol Depend 2016; 167:199-206. [PMID: 27590742 PMCID: PMC5235346 DOI: 10.1016/j.drugalcdep.2016.08.622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/02/2016] [Accepted: 08/18/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rates of young adult cannabis use are rising, perceived harm is at its historical nadir, and most users do not want to quit. Most studies evaluating effects of cannabis use in young adults are cross-sectional, limiting causal inference. A method to reliably induce abstinence periods in cannabis users would allow assessment of the effects of abstinence and resumption of use on a variety of outcomes in a within-subjects, repeated measures design. METHODS We examined the efficacy and feasibility of a voucher-based contingency management procedure for incentivizing one month of continuous cannabis abstinence among young adults who reported at least weekly cannabis use, volunteered to participate in a laboratory study, and did not express a desire to discontinue cannabis use long-term. Continuous cannabis abstinence was reinforced with an escalating incentive schedule, and self-report of abstinence was confirmed by frequent quantitative assays of urine cannabis metabolite (THCCOOH) concentration. New cannabis use during the abstinence period was determined using an established algorithm of change in creatinine-adjusted cannabis metabolite concentrations between study visits. RESULTS Thirty-eight young adults, aged 18-25 years, enrolled and 34 (89.5%) attained biochemically confirmed 30-day abstinence. Among those who attained abstinence, 93.9% resumed regular use within two-weeks of incentive discontinuation. CONCLUSION Findings support the feasibility and efficacy of contingency management to elicit short-term, continuous cannabis abstinence among young adult, non-treatment seeking, regular cannabis users. Further work should test the effectiveness of this contingency management procedure for cannabis abstinence in periods longer than one month, which may be required to evaluate some effects of abstinence.
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Abstract
OBJECTIVES Neuropsychological studies of posttraumatic stress disorder (PTSD) have revealed deficits in attention/working memory, processing speed, executive functioning, and retrospective memory. However, little is known about prospective memory (PM) in PTSD, a clinically relevant aspect of episodic memory that supports the encoding and retrieval of intentions for future actions. METHODS Here we examined PM performance in 40 veterans with PTSD compared to 38 trauma comparison (TC) veterans who were exposed to combat but did not develop PTSD. All participants were administered the Memory for Intentions Test (MIST; Raskin, Buckheit, & Sherrod, 2010), a standardized and validated measure of PM, alongside a comprehensive neurocognitive battery, structured diagnostic interviews for psychiatric conditions, and behavioral questionnaires. RESULTS Veterans with PTSD performed moderately lower than TC on time-based PM, with errors primarily characterized as PM failure errors (i.e., omissions). However, groups did not differ in event-based PM, ongoing task performance, or post-test recognition of PM intentions for each trial. Lower time-based PM performance was specifically related to hyperarousal symptoms of PTSD. Time-based-performance was also associated with neuropsychological measures of retrospective memory and executive functions in the PTSD group. Nevertheless, PTSD was significantly associated with poorer PM above and beyond age and performance in retrospective memory and executive functions. DISCUSSION Results provide initial evidence of PM dysfunction in PTSD, especially in strategic monitoring during time-based PM tasks. Findings have potential implications for everyday functioning and health behaviors in persons with PTSD, and deserve replication and future study. (JINS, 2016, 22, 724-734).
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