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Zughaibi TA, Alharbi H, Al-Saadi A, Alzahrani AE, Al-Asmari AI. 11-Nor-9-Carboxy Tetrahydrocannabinol Distribution in Fluid from the Chest Cavity in Cannabis-Related Post-Mortem Cases. TOXICS 2023; 11:740. [PMID: 37755750 PMCID: PMC10536215 DOI: 10.3390/toxics11090740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Abstract
In this study, the presence of 11-nor-Δ9-carboxy tetrahydrocannabinol (THC-COOH) in postmortem fluid obtained from the chest cavity (FCC) of postmortem cases collected from drug-related fatalities or criminal-related deaths in Jeddah, Saudi Arabia, was investigated to evaluate its suitability for use as a complementary specimen to blood and biological specimens in cases where no bodily fluids are available or suitable for analysis. The relationships between THC-COOH concentrations in the FCC samples and age, body mass index (BMI), polydrug intoxication, manner, and cause of death were investigated. METHODS Fifteen postmortem cases of FCC were analyzed using fully validated liquid chromatography-positive-electrospray ionization tandem mass spectrometry (LC-MS/MS). RESULTS FCC samples were collected from 15 postmortem cases; only THC-COOH tested positive, with a median concentration of 480 ng/mL (range = 80-3010 ng/mL). THC-COOH in FCC were higher than THC-COOH in all tested specimens with exception to bile, the median ratio FCC/blood with sodium fluoride, FCC/urine, FCC/gastric content, FCC/bile, FCC/liver, FCC/kidney, FCC/brain, FCC/stomach wall, FCC/lung, and FCC/intestine tissue were 48, 2, 0.2, 6, 4, 6, 102, 11, 5 and 10-fold, respectively. CONCLUSION This is the first postmortem report of THC-COOH in the FCC using cannabinoid-related analysis. The FCC samples were liquid, easy to manipulate, and extracted using the same procedure as the blood samples. The source of THC-COOH detected in FCC could be derived from the surrounding organs due to postmortem redistribution or contamination due to postmortem changes after death. THC-COOH, which is stored in adipose tissues, could be a major source of THC-COOH found in the FCC.
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Affiliation(s)
- Torki A Zughaibi
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hassan Alharbi
- Poison Control and Forensic Chemistry Center, Ministry of Health, Jeddah 21176, Saudi Arabia
| | - Adel Al-Saadi
- Poison Control and Forensic Chemistry Center, Ministry of Health, Jeddah 21176, Saudi Arabia
| | - Abdulnasser E Alzahrani
- Poison Control and Forensic Chemistry Center, Ministry of Health, Jeddah 21176, Saudi Arabia
| | - Ahmed I Al-Asmari
- Special Toxicological Analysis Unit, Pathology and Laboratory Medicine DPLM, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia
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Gazarov EA, Zequeira S, Senetra AS, Howard J, Sharma A, McCurdy CR, Lewis J, Bizon JL, Setlow B. Pharmacokinetics of delta-9-tetrahydrocannabinol following acute cannabis smoke exposure in mice; effects of sex, age, and strain. Front Pharmacol 2023; 14:1227220. [PMID: 37701025 PMCID: PMC10493391 DOI: 10.3389/fphar.2023.1227220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
Increased use of cannabis and cannabinoids for recreational and medical purposes has led to a growth in research on their effects in animal models. The majority of this work has employed cannabinoid injections; however, smoking remains the most common route of cannabis consumption. To better model real-world cannabis use, we exposed mice to cannabis smoke to establish the pharmacokinetics of Δ9THC and its metabolites in plasma and brain. To determine the time course of Δ9THC and two major metabolites [11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (11-COOH-THC)], male and female C57BL/6J mice were exposed to smoke from sequentially burning 5 cannabis cigarettes. Following smoke exposure, trunk blood and brains were collected at 6 time points (10-240 min). Plasma and brain homogenates were analyzed for Δ9THC and metabolites using a validated ultraperformance liquid chromatography-tandem mass spectrometry method. To assess effects of age, sex, and mouse strain, we exposed mice of four strains (C57BL/6J, FVB, Swiss Webster, and 129S6/SvEv, aged 4-24 months) to cannabis using the same smoke regimen. Samples were collected 10 and 40 min following exposure. Lastly, to assess effects of dose, C57BL/6J mice were exposed to smoke from burning 3 or 5 cannabis cigarettes, with samples collected 40 min following exposure. The pharmacokinetic study revealed that maximum plasma Δ9THC concentrations (Cmax) were achieved at 10 and 40 min for males and females, respectively, while Cmax for brain Δ9THC was observed at 20 and 40 min for males and females, respectively. There were no age or strain differences in plasma Δ9THC concentrations at 10 or 40 min; however, 129S6/SvEv mice had significantly higher brain Δ9THC concentrations than FVB mice. Additionally, 3 cigarettes produced significantly lower plasma 11-COOH-THC concentrations compared to 5 cigarettes, although dose differences were not evident in plasma or brain concentrations of Δ9THC or 11-OH-THC. Across all experiments, females had higher levels of 11-COOH-THC in plasma compared to males. The results reveal robust sex differences in Δ9THC pharmacokinetics, and lay the groundwork for future studies using mice to model the pharmacodynamics of smoked cannabis.
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Affiliation(s)
- Emely A. Gazarov
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Sabrina Zequeira
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | | | - John Howard
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Abhisheak Sharma
- Department of Pharmaceutics, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
| | - Christopher R. McCurdy
- Department of Pharmaceutics, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
- Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Jada Lewis
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Jennifer L. Bizon
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
| | - Barry Setlow
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, United States
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Forbes CR, Spence KA, Garg NK, Darzi ER. Electrochemical Oxidation of Δ 9-Tetrahydrocannabinol at Nanomolar Concentrations. J Org Chem 2023; 88:11358-11362. [PMID: 37467382 DOI: 10.1021/acs.joc.3c01101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
With increasing marijuana legalization, there is a growing need for technology that can determine if an individual is impaired due to recent marijuana usage. The electrochemical oxidation of Δ9-THC to form its corresponding quinones can be used as a framework to develop an electrochemical sensor for Δ9-THC. This study describes an electrochemical oxidation of Δ9-THC that uses a copper anode, a platinum cathode, and an atmosphere of oxygen. The oxidation is feasible at nanomolar concentrations, which approaches the reactivity that is necessary for developing a real-world marijuana breathalyzer. Moreover, we show that vaporized Δ9-THC can be captured directly in an electrolyte medium and subjected to electrochemical oxidation, thus paving the way for use in future technology development.
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Affiliation(s)
- Christina R Forbes
- ElectraTect Inc., 850 N. 5th Street, Suite 406, Phoenix, Arizona 85004, United States
| | - Katie A Spence
- Department of Chemistry and Biochemistry, University of California, Los Angeles, California 90095, United States
| | - Neil K Garg
- Department of Chemistry and Biochemistry, University of California, Los Angeles, California 90095, United States
| | - Evan R Darzi
- ElectraTect Inc., 850 N. 5th Street, Suite 406, Phoenix, Arizona 85004, United States
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Wightman RS, Metrik J, Lin TR, Li Y, Badea A, Almeida R, Collins AB, Beaudoin FL. Cannabis Use Patterns and Whole-Blood Cannabinoid Profiles of Emergency Department Patients With Suspected Cannabinoid Hyperemesis Syndrome. Ann Emerg Med 2023; 82:121-130. [PMID: 37479395 PMCID: PMC10363750 DOI: 10.1016/j.annemergmed.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/17/2023] [Accepted: 03/03/2023] [Indexed: 07/23/2023]
Abstract
STUDY OBJECTIVES The objectives of this study were to characterize the detailed cannabis use patterns (eg, frequency, mode, and product) and determine the differences in the whole-blood cannabinoid profiles during symptomatic versus asymptomatic periods of participants with suspected cannabinoid hyperemesis syndrome recruited from the emergency department (ED) during a symptomatic episode. METHODS This is a prospective observational cohort study of participants with symptomatic cyclic vomiting onset after chronic cannabis use. Standardized assessments were conducted to evaluate for lifetime and recent cannabis use, cannabis use disorder, and cannabis withdrawal symptoms. Quantitative whole-blood cannabinoid testing was performed at 2 times, first when symptomatic (ie, baseline) and at least 2 weeks after the ED visit when asymptomatic. The differences in cannabinoid concentrations were compared between symptomatic and asymptomatic testing. The study was conducted from September 2021 to August 2022. RESULTS There was a difference observed between delta-9-tetrahydrocannabinol metabolites, but not the parent compound during symptomatic episodes and asymptomatic periods. Most participants (84%) reported using cannabis > once per day (median 3 times per day on weekdays, 4 times per day on weekends). Hazardous cannabis use was universal among participants; the mean cannabis withdrawal discomfort score was 13, indicating clinically significant rates of cannabis withdrawal symptoms with cessation of use. Most participants (79%) previously tried to stop cannabis use, but a few (13%) of them had sought treatment. CONCLUSION Patients presenting to the ED with cannabinoid hyperemesis syndrome have high cannabis use disorder scores. Further studies are needed to better understand the influence of THC metabolism and concentrations on symptomatic cyclic vomiting.
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Affiliation(s)
- Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, School of Public Health at Brown University, Providence, RI.
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, RI; Providence VA Medical Center, Providence, RI
| | | | - Yu Li
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
| | - Adina Badea
- Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Robert Almeida
- Forensic Toxicology Laboratory, Department of Health, Rhode Island, Providence, RI
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health at Brown University, Providence, RI
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Ramirez-Cardenas A, Wingate KC, Pompei R, King B, Scott KA, Hagan-Haynes K, Chosewood LC. Fatalities Involving Substance Use Among US Oil and Gas Extraction Workers Identified Through an Industry Specific Surveillance System (2014-2019). J Occup Environ Med 2023; 65:488-494. [PMID: 36998177 PMCID: PMC11081204 DOI: 10.1097/jom.0000000000002856] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Characteristics of oil and gas extraction (OGE) work, including long hours, shiftwork, fatigue, physically demanding work, and job insecurity are risk factors for substance use among workers. Limited information exists examining worker fatalities involving substance use among OGE workers. METHODS The National Institute for Occupational Safety and Health's Fatalities in Oil and Gas Extraction database was screened for fatalities involving substance use from 2014 through 2019. RESULTS Twenty-six worker deaths were identified as involving substance use. Methamphetamine or amphetamine was the most common substances (61.5%) identified. Other contributing factors were lack of seatbelt use (85.7%), working in high temperatures (19.2%), and workers' first day with the company (11.5%). CONCLUSIONS Employer recommendations to mitigate substance use-related risks in OGE workers include training, medical screening, drug testing, and workplace supported recovery programs.
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Affiliation(s)
- Alejandra Ramirez-Cardenas
- From the Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado (A.R.-C., K.C.W., B.K., K.A.S., K.H.-H.); Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, CU Anschutz, Aurora, Colorado (R.P.); Office of the Director, National Institute for Occupational Safety and Health, Atlanta, Georgia (L.C.C.)
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Penman SL, Berthold EC, Mihalkovic A, Hammond N, McCurdy CR, Blum K, Eiden RD, Sharma A, Thanos PK. Vaporized Delta-9-tetrahydrocannabinol Inhalation in Female Sprague Dawley Rats: A Pharmacokinetic and Behavioral Assessment. Curr Pharm Des 2023; 29:2149-2160. [PMID: 37114788 PMCID: PMC10979821 DOI: 10.2174/1381612829666230419093809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Delta-9-tetrahydrocannabinol (THC) is the main psychoactive component of cannabis. Historically, rodent studies examining the effects of THC have used intraperitoneal injection as the route of administration, heavily focusing on male subjects. However, human cannabis use is often through inhalation rather than injection. OBJECTIVE We sought to characterize the pharmacokinetic and phenotypic profile of acutely inhaled THC in female rats, compared to intraperitoneal injection, to identify any differences in exposure of THC between routes of administration. METHODS Adult female rats were administered THC via inhalation or intraperitoneal injection. Serum samples from multiple time points were analyzed for THC and metabolites 11-hydroxy-delta-9-tetrahydrocannabinol and 11-nor-9-carboxy-delta-9-tetrahydrocannabinol using ultra-performance liquid chromatography-tandem mass spectrometry. Rats were similarly treated for locomotor activity analysis. RESULTS Rats treated with 2 mg/kg THC intraperitoneally reached a maximum serum THC concentration of 107.7 ± 21.9 ng/mL. Multiple THC inhalation doses were also examined (0.25 mL of 40 or 160 mg/mL THC), achieving maximum concentrations of 43.3 ± 7.2 and 71.6 ± 22.5 ng/mL THC in serum, respectively. Significantly reduced vertical locomotor activity was observed in the lower inhaled dose of THC and the intraperitoneal injected THC dose compared to vehicle treatment. CONCLUSION This study established a simple rodent model of inhaled THC, demonstrating the pharmacokinetic and locomotor profile of acute THC inhalation, compared to an i.p. injected THC dose in female subjects. These results will help support future inhalation THC rat research which is especially important when researching behavior and neurochemical effects of inhaled THC as a model of human cannabis use.
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Affiliation(s)
- Samantha L. Penman
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. Buffalo, NY USA
| | - Erin C. Berthold
- Department of Pharmaceutics, College of Pharmacy, University of Florida. Gainesville, FL USA
| | - Abrianna Mihalkovic
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. Buffalo, NY USA
| | - Nikki Hammond
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. Buffalo, NY USA
| | - Christopher R. McCurdy
- Department of Pharmaceutics, College of Pharmacy, University of Florida. Gainesville, FL USA
- Translational Drug Development Core, Clinical and Translational Science Institute, University of Florida. Gainesville, FL USA
- Department of Medicinal Chemistry, University of Florida. Gainesville, FL, USA
| | - Kenneth Blum
- Division of Addiction Research & Education, Center for Mental Health & Sports, Exercise and Global Mental Health, Western University Health Sciences, Pomona, CA 91766, USA
- Department of Psychiatry, School of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Rina D. Eiden
- Department of Psychology, Pennsylvania State University. State College, PA USA
| | - Abhisheak Sharma
- Department of Pharmaceutics, College of Pharmacy, University of Florida. Gainesville, FL USA
- Translational Drug Development Core, Clinical and Translational Science Institute, University of Florida. Gainesville, FL USA
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. Buffalo, NY USA
- Department of Psychology, University at Buffalo. Buffalo, NY, USA
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Berl V, Hurd YL, Lipshutz BH, Roggen M, Mathur EJ, Evans M. A Randomized, Triple-Blind, Comparator-Controlled Parallel Study Investigating the Pharmacokinetics of Cannabidiol and Tetrahydrocannabinol in a Novel Delivery System, Solutech, in Association with Cannabis Use History. Cannabis Cannabinoid Res 2022; 7:777-789. [PMID: 35787693 PMCID: PMC9784610 DOI: 10.1089/can.2021.0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: An oral route of administration for tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) eliminates the harmful effects of smoking and has potential for efficacious cannabis delivery for therapeutic and recreational applications. We investigated the pharmacokinetics of CBD, Δ9-THC, 11-OH-THC, and 11-nor-9-carboxy-Δ9-THC (THC-COOH) in a novel oral delivery system, Solutech™, compared to medium-chain triglyceride-diluted cannabis oil (MCT-oil) in a healthy population. Materials and Methods: Thirty-two participants were randomized and divided into two study arms employing a comparator-controlled, parallel-study design. To evaluate the pharmacokinetics of Δ9-THC, CBD, 11-OH-THC, and THC-COOH, blood was collected at pre-dose (t=0) and 10, 20, 30, and 45, min and 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 12, 24, and 48 h post-dose after a single dose of Solutech (10.0 mg Δ9-THC, 9.76 mg CBD) or MCT (10.0 mg Δ9-THC, 9.92 mg CBD). Heart rate and blood pressure were measured at 0.5, 1, 2, 4, 6, 8, 12, 24, and 48 h. Relationships between cannabis use history, body mass index, sex, and pharmacokinetic parameters were investigated. Safety was assessed before and at 48 h post-acute dose. Results: Acute consumption of Solutech provided a significantly greater maximum concentration (Cmax), larger elimination and absorption rate constants, faster time to Cmax and lag time, and half-life for all analytes compared to MCT-oil (p<0.001). In addition, cannabis use history had a significant influence on the pharmacokinetic parameters of CBD, Δ9-THC, 11-OH-THC, and THC-COOH. On average, participants with later age of first use had higher Δ9-THC, CBD, and THC-COOH Cmax and later time-to-Cmax and half-life for Δ9-THC, CBD, THC-COOH, and 11-OH-THC than those with earlier age of first use (p≤0.032). Those with more years of recreational cannabis use had higher area under the curve for Δ9-THC and CBD, Cmax for CBD, and longer 11-OH-THC half-life than those with less (p≤0.048). Conclusion: This study demonstrated that consumption of Solutech enhanced most pharmacokinetics parameters measured compared to MCT-oil. Participant's cannabis use history, including their age of first use and number of years using cannabis significantly impacted pharmacokinetic parameters investigated. Acute consumption of both products was found to be safe and well tolerated. The results suggest that Solutech may optimize bioavailability from cannabis formulations.
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Affiliation(s)
- Volker Berl
- New Age Ventures, New York, New York, USA.,Address correspondence to: Volker Berl, PhD, New Age Ventures, 521 Fifth Avenue, Floor 17, New York, NY 10175, USA,
| | - Yasmin L. Hurd
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Addiction Institute of Mount Sinai, New York, New York, USA
| | - Bruce H. Lipshutz
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, California, USA
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Stringer RJ. Waiting for the Stop Sign to Turn Green: Contemporary Issues on Drug and Alcohol Impaired Driving Policy. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2022; 47:735-748. [PMID: 36407840 PMCID: PMC9648432 DOI: 10.1007/s12103-022-09705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Impaired driving has been a considerable social problem in the U.S. for decades, but efforts to reduce it have stalled after the initial reductions in the 1980's. As a result, legislators continue to develop more polices aimed at deterring impaired driving. Although alcohol has historically been the focus of these efforts, recently there has been increased concern about marijuana impaired driving policies as well. However, alcohol and marijuana impaired driving differ in many ways. This paper explores the costs and benefits of new zero-tolerance policies such as the reduction of the per-se Blood Alcohol Concentration (BAC) level from .08 to .05 for alcohol and the establishment of similar per-se limits for marijuana. These policies are not based on actual impairment and reflect a net widening effect that will criminalize unimpaired drivers, divert criminal justice resources away from the most problematic impaired drivers, and will have little impact on impaired driving crashes. As such, they have the potential to do more harm than good.
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Rotella JA, Ferretti OG, Raisi E, Seet HR, Sarkar S. Cannabinoid hyperemesis syndrome: A 6-year audit of adult presentations to an urban district hospital. Emerg Med Australas 2022; 34:578-583. [PMID: 35199462 PMCID: PMC9545654 DOI: 10.1111/1742-6723.13944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the local experience of adult patients presenting with cannabinoid hyperemesis syndrome (CHS) to an urban ED in the outer northern suburbs of Melbourne. METHODS Retrospective chart review of adult patients presenting to the ED with a documented history of CHS or equivalent terminology from January 2015 to January 2021. Age, sex, cannabis use, clinical features, pathology results, imaging and symptomatic management were examined as well as outcomes regarding disposition, representation, morbidity and mortality. RESULTS One hundred and forty-two adult presentations were included. Sixty-seven were unique presentations and 29 were patients who represented during the study period. Most represented within 3 months (37.8%) and most represented at least twice. Males were overrepresented (68.7%). Patients were young (median age 31 years, interquartile range 23-35 years) and all had a history of regular cannabis use (usually daily). Cyclical nausea and/or vomiting was the most common clinical feature compared to others in previously reported diagnostic criteria. Patients typically had elevated white cell counts with associated neutrophilia (75.8%) and mild hypokalaemia (57.9%). Lipase was not elevated, and C-reactive protein was typically less than 50 mmol/L (98.2%). Imaging was not commonly performed but largely normal. Treatment was supportive with anti-emetic use, intravenous fluids and analgesia. There were no deaths or admissions to intensive care. CONCLUSIONS Cyclical nausea and vomiting was the most common feature observed in this cohort compared to other clinical features reported in prior studies. Serum lipase was normal and C-reactive protein only mildly elevated. Prospective studies are required to further assess these findings.
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Affiliation(s)
- Joe A Rotella
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Olivia G Ferretti
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Elham Raisi
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Hao Rui Seet
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Soham Sarkar
- Department of Emergency Medicine, Northern Health, Melbourne, Victoria, Australia
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10
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OUP accepted manuscript. J Anal Toxicol 2022; 46:343-349. [DOI: 10.1093/jat/bkac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/07/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
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Tefft BC, Arnold LS. Estimating Cannabis Involvement in Fatal Crashes in Washington State Before and After the Legalization of Recreational Cannabis Consumption Using Multiple Imputation of Missing Values. Am J Epidemiol 2021; 190:2582-2591. [PMID: 34157068 DOI: 10.1093/aje/kwab184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023] Open
Abstract
The government of Washington state legalized recreational cannabis consumption in December 2012. We used data on all drivers involved in fatal crashes in Washington in the years 2008-2019 (n = 8,282) to estimate prevalence in fatal crashes of drivers with ∆9-tetrahydrocannabinol (THC; the main psychoactive compound in cannabis) in their blood before and after legalization. However, nearly half of the drivers were not tested for drugs; we therefore used multiple imputation to estimate THC presence and concentration among them. We used logistic regression followed by marginal standardization to estimate the adjusted prevalence of THC-positive drivers after legalization relative to what would have been predicted without legalization. In the combined observed and imputed data, the proportion of drivers positive for THC was 9.3% before and 19.1% after legalization (adjusted prevalence ratio: 2.3, 95% confidence interval: 1.3, 4.1). The proportion of drivers with high THC concentrations increased substantially (adjusted prevalence ratio: 4.7, 95% confidence interval: 1.5, 15.1). Some of the increased prevalence of THC-positive drivers might have reflected cannabis use unassociated with driving; however, the increased prevalence of drivers with high THC concentrations suggests an increase in the prevalence of driving shortly after using cannabis. Other jurisdictions should compile quantitative data on drug test results of drivers to enable surveillance and evaluation.
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Bosnyak D, McDonald AC, Gasperin Haaz I, Qi W, Crowley DC, Guthrie N, Evans M. Use of a Novel EEG-Based Objective Test, the Cognalyzer ®, in Quantifying the Strength and Determining the Action Time of Cannabis Psychoactive Effects and Factors that May Influence Them Within an Observational Study Framework. Neurol Ther 2021; 11:51-72. [PMID: 34727345 PMCID: PMC8857346 DOI: 10.1007/s40120-021-00293-w] [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: 08/26/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Current methods to detect recent delta-9-tetrahydrocannabinol (THC) use cannot objectively quantify its psychoactive effects (PE). The Cognalyzer®, an electroencephalography (EEG)-based method, detects and quantifies the strength of THC-induced PE on a scale from 0 to 100%. This study assesses the relationship between the magnitude of Cognalyzer® PE predictions and reported subjective drug effects for 4-h post-cannabis inhalation. Methods Seventy-five participants were enrolled in the study. Prior to ad libitum cannabis inhalation, an EEG recording episode was completed. Immediately after inhalation, the Drug Effects Questionnaire (DEQ) was administered and another EEG recording performed. For 25 participants, the study ended. For 50 participants, assessments were repeated at 30-min intervals for 4 h. EEG files were blinded and analyzed using two versions of the Cognalyzer® algorithm. The relationship between the Cognalyzer® PE level results and the DEQ was assessed using generalized linear models and multiple regression. Results There were significant PE increases from pre-cannabis for up to 3.5 h. Mean reports of feeling drug effects were > 0 at all post-inhalation time points (p ≤ 0.024). Furthermore, there were significant relationships between the Cognalyzer® PE and self-reported perception of drug effects (p ≤ 0.001). Subgroup analysis showed that Cognalyzer® PE levels were impacted by cannabis use history, subjective ratings of drug effects, oral fluid THC concentration and the cannabis product inhaled. Conclusion The findings show that the Cognalyzer® can be used to objectively determine the strength of cannabis psychoactive effects that cannabis products create on consumers and how it changes depending on their experience with cannabis. The Cognalyzer® can be used to conduct scientific consumer research to generate trustworthy informational material about the psychoactive experience of cannabis products. For clinical research, the Cognalyzer® can be used to study the pharmacodynamics of cannabinoids or delivery systems, such as nano-emulsifications.
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Affiliation(s)
- Dan Bosnyak
- Zentrela Inc. Suite B21, 175 Longwood Rd S, Hamilton, ON, L8P 0A1, Canada.
| | | | | | - Weikai Qi
- Zentrela Inc. Suite B21, 175 Longwood Rd S, Hamilton, ON, L8P 0A1, Canada
| | - David C Crowley
- KGK Science Inc., 255 Queens Ave, London, ON, N6A 5R8, Canada
| | - Najla Guthrie
- KGK Science Inc., 255 Queens Ave, London, ON, N6A 5R8, Canada
| | - Malkanthi Evans
- KGK Science Inc., 255 Queens Ave, London, ON, N6A 5R8, Canada
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13
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Brunet B, Jagailloux Y, Palazzo P, Lelong J, Mura P, Neau JP. Accidents vasculaires cérébraux du sujet jeune et usage de stupéfiants : 2 – Le cas préoccupant du cannabis. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Kesner AJ, Lovinger DM. Cannabis use, abuse, and withdrawal: Cannabinergic mechanisms, clinical, and preclinical findings. J Neurochem 2021; 157:1674-1696. [PMID: 33891706 PMCID: PMC9291571 DOI: 10.1111/jnc.15369] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022]
Abstract
Cannabis sativa is the most widely used illicit drug in the world. Its main psychoactive component is delta‐9‐tetrahydrocannabinol (THC), one of over 100 phytocannabinoid compounds produced by the cannabis plant. THC is the primary compound that drives cannabis abuse potential and is also used and prescribed medically for therapeutic qualities. Despite its therapeutic potential, a significant subpopulation of frequent cannabis or THC users will develop a drug use syndrome termed cannabis use disorder. Individuals suffering from cannabis use disorder exhibit many of the hallmarks of classical addictions including cravings, tolerance, and withdrawal symptoms. Currently, there are no efficacious treatments for cannabis use disorder or withdrawal symptoms. This makes both clinical and preclinical research on the neurobiological mechanisms of these syndromes ever more pertinent. Indeed, basic research using animal models has provided valuable evidence of the neural molecular and cellular actions of cannabis that mediate its behavioral effects. One of the main components being central action on the cannabinoid type‐one receptor and downstream intracellular signaling related to the endogenous cannabinoid system. Back‐translational studies have provided insight linking preclinical basic and behavioral biology research to better understand symptoms observed at the clinical level. This narrative review aims to summarize major research elucidating the molecular, cellular, and behavioral manifestations of cannabis/THC use that play a role in cannabis use disorder and withdrawal.
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Affiliation(s)
- Andrew J Kesner
- Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Center on Compulsive Behaviors, National Institutes of Health, Bethesda, MD, USA
| | - David M Lovinger
- Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Center on Compulsive Behaviors, National Institutes of Health, Bethesda, MD, USA
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15
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McDonald AC, Gasperin Haaz I, Qi W, Crowley DC, Guthrie N, Evans M, Bosnyak D. Sensitivity, Specificity and Accuracy of a Novel EEG-Based Objective Test, the Cognalyzer ®, in Detecting Cannabis Psychoactive Effects. Adv Ther 2021; 38:2513-2531. [PMID: 33826089 PMCID: PMC8024442 DOI: 10.1007/s12325-021-01718-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/18/2021] [Indexed: 11/13/2022]
Abstract
Introduction Current standards for identifying recent cannabis use are based on body fluid testing. The Cognalyzer® is a novel electroencephalography (EEG) measurement device and algorithm designed to objectively characterize brainwave alterations associated with cannabis. The objective of this study was to assess the accuracy, sensitivity and specificity levels of the Cognalyzer® to characterize brainwave alterations following cannabis inhalation. Methods Seventy-five participants, aged 19–55 years, were enrolled, and oral fluid samples were collected pre-cannabis inhalation. EEG and subjective drug effects questionnaire (DEQ) were administered pre- and post-ad libitum cannabis inhalation. Fifty participants remained in the clinic for 4 h post-inhalation. Blinded analyses of the EEG files were conducted by Zentrela Inc. using two versions (V1 and V2) of the Cognalyzer® algorithm. Pre- vs. post-inhalation comparison status was characterized by the Cognalyzer® and summarized for: sensitivity, specificity, accuracy, percent false positive, percent false negative and positive and negative predictive value. The null hypothesis was tested using McNemar’s test. Cognalyzer® results pre- and post-inhalation were combined with the oral fluid tetrahydrocannabinol (THC) concentration to evaluate potential to improve current drug testing. Results The two versions of the Cognalyzer® algorithm had similar diagnostic results. Diagnostic outcomes were improved when participants with missing EEG recordings or electrode placement errors were removed. The Cognalyzer® accuracy was 85.5% and 83.9%, sensitivity was 87.1% and 88.7%, and specificity was 83.9% and 79.0% for algorithm V1 and V2, respectively. Combining Cognalyzer® results with oral fluid concentrations reduced false-positive oral fluid test results by up to 49%. Conclusion The Cognalyzer® characterized brainwave alterations associated with cannabis inhalation with high levels of accuracy in a population of participants with varied cannabis inhalation histories, relative to the comparison standard of pre- vs. post-inhalation status. The Cognalyzer® allows the results to be generalized to the larger population addressing a limitation in currently accepted standards.
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16
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Peng YW, Desapriya E, Chan H, R Brubacher J. "Residual blood THC levels in frequent cannabis users after over four hours of abstinence: A systematic review.". Drug Alcohol Depend 2020; 216:108177. [PMID: 32841811 DOI: 10.1016/j.drugalcdep.2020.108177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, causes psychomotor impairment and puts drivers at increased risk of motor vehicle collisions. Many jurisdictions have per se limits for THC, often 2 or 5 ng/mL, that make it illegal to drive with THC above the "legal limit". People who use cannabis regularly develop partial tolerance to some of its impairing effects. Regular cannabis users may also have persistent elevation of THC even after a period of abstinence. Some stakeholders worry that current per se limits may criminalize unimpaired drivers simply because they use cannabis. We conducted a systematic review of published literature to investigate residual blood THC concentrations in frequent cannabis users after a period of abstinence. METHODS We identified relevant articles by combining terms for "cannabis" and "blood" and "concentration" and "abstinence" and searching MEDLINE, EMBASE, PsycINFO, and Web of Science. We included studies that reported THC levels in frequent cannabis users after more than 4 h of abstinence. RESULTS Our search identified 1612 articles of which 8 met our inclusion criteria. After accounting for duplicate publications, we had identified 6 independent studies. These studies show that blood THC over 2 ng/mL does do not necessarily indicate recent cannabis use in frequent cannabis users. Five studies reported blood THC >2 ng/mL (or plasma THC >3 ng/mL) in some participants after six days of abstinence and two reported participants with blood THC >5 ng/mL (or plasma THC > 7.5 ng/mL) after a day of abstinence. CONCLUSIONS Blood THC >2 ng/mL, and possibly even THC >5 ng/mL, does not necessarily represent recent use of cannabis in frequent cannabis users.
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Affiliation(s)
- Yuan Wei Peng
- The University of British Columbia, Faculty of Pharmaceutical Sciences, (Student), 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Ediriweera Desapriya
- The University of British Columbia, Faculty of Medicine, Department of Emergency Medicine, VGH Research Pavilion, Room 281 - 828 W 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Herbert Chan
- The University of British Columbia, Faculty of Medicine, Department of Emergency Medicine, VGH Research Pavilion, Room 281 - 828 W 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Jeffrey R Brubacher
- The University of British Columbia, Faculty of Medicine, Department of Emergency Medicine, VGH Research Pavilion, Room 281 - 828 W 10th Ave, Vancouver, BC V5Z 1M9, Canada.
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17
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Loflin MJE, Kiluk BD, Huestis MA, Aklin WM, Budney AJ, Carroll KM, D'Souza DC, Dworkin RH, Gray KM, Hasin DS, Lee DC, Le Foll B, Levin FR, Lile JA, Mason BJ, McRae-Clark AL, Montoya I, Peters EN, Ramey T, Turk DC, Vandrey R, Weiss RD, Strain EC. The state of clinical outcome assessments for cannabis use disorder clinical trials: A review and research agenda. Drug Alcohol Depend 2020; 212:107993. [PMID: 32360455 PMCID: PMC7293929 DOI: 10.1016/j.drugalcdep.2020.107993] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022]
Abstract
There is considerable variability in the use of outcome measures in clinical trials for cannabis use disorder (CUD), and a lack of consensus regarding optimal outcomes may have hindered development and approval of new pharmacotherapies. The goal of this paper is to summarize an evaluation of assessment measures and clinical endpoints for CUD clinical trials, and propose a research agenda and priorities to improve CUD clinical outcome assessments. The primary recommendation is that sustained abstinence from cannabis should not be considered the primary outcome for all CUD clinical trials as it has multiple limitations. However, there are multiple challenges to the development of a reliable and valid indicator of cannabis reduction, including the lack of a standard unit of measure for the various forms of cannabis and products and the limitations of currently available biological and self-report assessments. Development of a core toolkit of assessments is needed to both allow flexibility for study design, while facilitating interpretation of outcomes across trials. Four primary agenda items for future research are identified to expedite development of improved clinical outcome assessments for this toolkit: (1) determine whether minimally invasive biologic assays could identify an acute level of cannabis use associated with psychomotor impairment or other cannabis-related harms; (2) create an indicator of quantity of cannabis use that is consistent across product types; (3) examine the presence of cannabis-specific functional outcomes; and (4) identify an optimal duration to assess changes in CUD diagnostic criteria.
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Affiliation(s)
- Mallory J E Loflin
- University of California San Diego, School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, United States; San Diego Veterans Affairs Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - Brian D Kiluk
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States.
| | - Marilyn A Huestis
- The Lambert Center for the Study of Medicinal Cannabis and Hemp, Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA 19144, United States
| | - Will M Aklin
- NIH/NIDA Division of Therapeutics and Medical Consequences of Drug Abuse, 10 Center Dr, Bethesda, MD 20814, United States
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, United States
| | - Kathleen M Carroll
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| | - Deepak Cyril D'Souza
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| | - Robert H Dworkin
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, United States
| | - Kevin M Gray
- Medical University of South Carolina, 67 President St, MSC861, Charleston, SC 29425, United States
| | - Deborah S Hasin
- Columbia University Medical Center, 722 W. 168(th) St, New York, NY 10027, United States
| | - Dustin C Lee
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Bernard Le Foll
- Centre for Addiction and Mental Health and University of Toronto, 33 Russell St, Toronto, ON, M5S 2S1, Canada
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
| | - Joshua A Lile
- University of Kentucky College of Medicine, 800 Rose Street MN 150, Lexington, KY 40506, United States
| | - Barbara J Mason
- The Scripps Research Institute, 10550 N Torrey Pines Rd, La Jolla, CA 92037, United States
| | - Aimee L McRae-Clark
- Medical University of South Carolina, 67 President St, MSC861, Charleston, SC 29425, United States
| | - Ivan Montoya
- NIH/NIDA Division of Therapeutics and Medical Consequences of Drug Abuse, 10 Center Dr, Bethesda, MD 20814, United States
| | - Erica N Peters
- Battelle Memorial Institute, 6115 Falls Rd #200, Baltimore, MD 21209, United States
| | - Tatiana Ramey
- NIH/NIDA Division of Therapeutics and Medical Consequences of Drug Abuse, 10 Center Dr, Bethesda, MD 20814, United States
| | - Dennis C Turk
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Roger D Weiss
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States; McLean Hospital, 115 Mill St, Belmont, MA 02478, United States
| | - Eric C Strain
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
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18
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Abstract
The use of Cannabis-based preparations for medicinal use has waxed and waned in the multi-millennial history of human co-existence with the plant and its cultivation. Recorded use of preparations from Cannabis is effectively as old as recorded history with examples from China, India and Ancient Egypt. Prohibition and restriction of availability allowed a number of alternatives to take the place of Cannabis preparations. However, there has been a worldwide resurgence in medicinal Cannabis advocacy from the public. Media interest has been piqued by particular evocative cases. Altogether, therefore, there is pressure on healthcare professionals to prescribe and dispense Cannabis-based preparations. This review enunciates some of the barriers which are slowing the wider adoption of medicinal Cannabis.
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Affiliation(s)
- Stephen Ph Alexander
- School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
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19
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Karschner EL, Swortwood-Gates MJ, Huestis MA. Identifying and Quantifying Cannabinoids in Biological Matrices in the Medical and Legal Cannabis Era. Clin Chem 2020; 66:888-914. [DOI: 10.1093/clinchem/hvaa113] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
AbstractBackgroundCannabinoid analyses generally included, until recently, the primary psychoactive cannabis compound, Δ9-tetrahydrocannabinol (THC), and/or its inactive metabolite, 11-nor-9-carboxy-THC, in blood, plasma, and urine. Technological advances revolutionized the analyses of major and minor phytocannabinoids in diverse biological fluids and tissues. An extensive literature search was conducted in PubMed for articles on cannabinoid analyses from 2000 through 2019. References in acquired manuscripts were also searched for additional articles.ContentThis article summarizes analytical methodologies for identification and quantification of multiple phytocannabinoids (including THC, cannabidiol, cannabigerol, and cannabichromene) and their precursors and/or metabolites in blood, plasma, serum, urine, oral fluid, hair, breath, sweat, dried blood spots, postmortem matrices, breast milk, meconium, and umbilical cord since the year 2000. Tables of nearly 200 studies outline parameters including analytes, specimen volume, instrumentation, and limits of quantification. Important diagnostic and interpretative challenges of cannabinoid analyses are also described. Medicalization and legalization of cannabis and the 2018 Agricultural Improvement Act increased demand for cannabinoid analyses for therapeutic drug monitoring, emergency toxicology, workplace and pain-management drug testing programs, and clinical and forensic toxicology applications. This demand is expected to intensify in the near future, with advances in instrumentation performance, increasing LC-MS/MS availability in clinical and forensic toxicology laboratories, and the ever-expanding knowledge of the potential therapeutic use and toxicity of phytocannabinoids.SummaryCannabinoid analyses and data interpretation are complex; however, major and minor phytocannabinoid detection windows and expected concentration ranges in diverse biological matrices improve the interpretation of cannabinoid test results.
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Affiliation(s)
- Erin L Karschner
- Armed Forces Medical Examiner System, Division of Forensic Toxicology, Dover Air Force Base, Dover, DE
| | | | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA
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20
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Schlienz NJ, Spindle TR, Cone EJ, Herrmann ES, Bigelow GE, Mitchell JM, Flegel R, LoDico C, Vandrey R. Pharmacodynamic dose effects of oral cannabis ingestion in healthy adults who infrequently use cannabis. Drug Alcohol Depend 2020; 211:107969. [PMID: 32298998 PMCID: PMC8221366 DOI: 10.1016/j.drugalcdep.2020.107969] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prior controlled cannabis research has mostly focused on smoked cannabis and predominantly included frequent cannabis users. Oral cannabis products ("edibles") make up a large and growing segment of the retail cannabis market. This study sought to characterize the pharmacodynamic effects of oral cannabis among infrequent cannabis users. METHODS Seventeen healthy adults who had not used cannabis for at least 60 days completed four experimental sessions in which they consumed a cannabis-infused brownie that contained 0, 10, 25, or 50 mg THC. Subjective effects, vital signs, cognitive/psychomotor performance, and blood THC concentrations were assessed before and for 8 h after dosing. RESULTS Relative to placebo, the 10 mg THC dose produced discriminable subjective drug effects and elevated heart rate but did not alter cognitive/psychomotor performance. The 25 and 50 mg THC doses elicited pronounced subjective effects and markedly impaired cognitive and psychomotor functioning compared with placebo. For all active doses, pharmacodynamic effects did not manifest until 30-60 min after ingestion, and peak effects occurred 1.5-3 h post-administration. Blood THC levels were significantly correlated with some pharmacodynamic drug effects, but were substantially lower than what is typically observed after cannabis inhalation. CONCLUSION Ingestion of oral cannabis dose-dependently altered subjective drug effects and impaired cognitive performance. Unlike inhaled forms of cannabis for which acute effects occur almost immediately, effects of oral cannabis were considerably delayed. In an era of legalization, education about the time course of drug effects for cannabis edibles is needed to facilitate dose titration and reduce acute overdose incidents.
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Affiliation(s)
- Nicolas J Schlienz
- Department of Psychology, University at Buffalo, 313 Diefendorf Hall, Buffalo, NY, 14214, USA
| | - Tory R Spindle
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Edward J Cone
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Evan S Herrmann
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - George E Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - John M Mitchell
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Ronald Flegel
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Charles LoDico
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
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21
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Funada M, Tomiyama KI. [Dependence and Cytotoxicity of Components of Cannabis]. YAKUGAKU ZASSHI 2020; 140:205-214. [PMID: 32009044 DOI: 10.1248/yakushi.19-00195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cannabis use among the younger population in Japan has been steadily increasing. The aim of the present review is to highlight recent knowledge regarding the molecular mechanisms of action and health risks associated with cannabis and synthetic cannabinoid consumption. We investigated the effects of Δ9-tetrahydrocannabinol (THC) and synthetic cannabinoids on place conditioning in ICR mice. Both Δ9-THC and synthetic cannabinoids produce a significant conditioned place preference. These rewarding effects were completely suppressed by the cannabinoid CB1 receptor type antagonist AM251. The cytotoxicological effects of Δ9-THC and synthetic cannabinoids were also characterized in the limbic forebrain of mice in primary culture in vitro. Δ9-THC and synthetic cannabinoids caused cell death in a dose-dependent manner. The rank order of cytotoxicological potency was synthetic cannabinoids>Δ9-THC and related to the agonistic activities of the CB1 receptor. A recent review on the harmful effects of cannabis use in humans reported that behavioral impairments, especially in terms of attention, memory, and complex information-processing ability, can last for many weeks after cessation of cannabis use among heavy users. In addition, cannabis use could be a risk factor for drug dependence and later psychosis among adolescents. The results of animal and human studies suggest that CB1 receptors play an important role in the expression of harmful effects of cannabis and synthetic cannabinoid use. Moreover, concern regarding increasing concentrations of Δ9-THC in cannabis in many countries has been noted, because more potent cannabis may be associated with worse adverse effects.
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Affiliation(s)
- Masahiko Funada
- Section of Addictive Drug Research, Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry
| | - Ken-Ichi Tomiyama
- Section of Addictive Drug Research, Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry
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22
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de Nijs B, Carnegie C, Szabó I, Grys DB, Chikkaraddy R, Kamp M, Barrow SJ, Readman CA, Kleemann ME, Scherman OA, Rosta E, Baumberg JJ. Inhibiting Analyte Theft in Surface-Enhanced Raman Spectroscopy Substrates: Subnanomolar Quantitative Drug Detection. ACS Sens 2019; 4:2988-2996. [PMID: 31565921 PMCID: PMC6878213 DOI: 10.1021/acssensors.9b01484] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
![]()
Quantitative applications of surface-enhanced
Raman spectroscopy
(SERS) often rely on surface partition layers grafted to SERS substrates
to collect and trap-solvated analytes that would not otherwise adsorb
onto metals. Such binding layers drastically broaden the scope of
analytes that can be probed. However, excess binding sites introduced
by this partition layer also trap analytes outside the plasmonic “hotspots”.
We show that by eliminating these binding sites, limits of detection
(LODs) can effectively be lowered by more than an order of magnitude.
We highlight the effectiveness of this approach by demonstrating quantitative
detection of controlled drugs down to subnanomolar concentrations
in aqueous media. Such LODs are low enough to screen, for example,
urine at clinically relevant levels. These findings provide unique
insights into the binding behavior of analytes, which are essential
when designing high-performance SERS substrates.
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Affiliation(s)
- Bart de Nijs
- NanoPhotonics Centre, Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thompson Avenue, Cambridge CB3 0HE, U.K
| | - Cloudy Carnegie
- NanoPhotonics Centre, Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thompson Avenue, Cambridge CB3 0HE, U.K
| | - István Szabó
- Department of Chemistry, King’s College London, 7 Trinity Street, London SE1 1DB, U.K
| | - David-Benjamin Grys
- NanoPhotonics Centre, Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thompson Avenue, Cambridge CB3 0HE, U.K
| | - Rohit Chikkaraddy
- NanoPhotonics Centre, Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thompson Avenue, Cambridge CB3 0HE, U.K
| | - Marlous Kamp
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, U.K
| | - Steven J. Barrow
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, U.K
| | - Charlie A. Readman
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, U.K
| | - Marie-Elena Kleemann
- NanoPhotonics Centre, Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thompson Avenue, Cambridge CB3 0HE, U.K
| | - Oren A. Scherman
- Melville Laboratory for Polymer Synthesis, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, U.K
| | - Edina Rosta
- Department of Chemistry, King’s College London, 7 Trinity Street, London SE1 1DB, U.K
| | - Jeremy J. Baumberg
- NanoPhotonics Centre, Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thompson Avenue, Cambridge CB3 0HE, U.K
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Ginsburg BC. Strengths and limitations of two cannabis-impaired driving detection methods: a review of the literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:610-622. [DOI: 10.1080/00952990.2019.1655568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Brett C. Ginsburg
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Brubacher JR, Chan H, Erdelyi S, Macdonald S, Asbridge M, Mann RE, Eppler J, Lund A, MacPherson A, Martz W, Schreiber WE, Brant R, Purssell RA. Cannabis use as a risk factor for causing motor vehicle crashes: a prospective study. Addiction 2019; 114:1616-1626. [PMID: 31106494 PMCID: PMC6771478 DOI: 10.1111/add.14663] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/21/2019] [Accepted: 05/10/2019] [Indexed: 11/30/2022]
Abstract
AIM We conducted a responsibility analysis to determine whether drivers injured in motor vehicle collisions who test positive for Δ-9-tetrahydrocannabinol (THC) or other drugs are more likely to have contributed to the crash than those who test negative. DESIGN Prospective case-control study. SETTING Trauma centres in British Columbia, Canada. PARTICIPANTS Injured drivers who required blood tests for clinical purposes following a motor vehicle collision. MEASUREMENTS Excess whole blood remaining after clinical use was obtained and broad-spectrum toxicology testing performed. The analysis quantified alcohol and THC and gave semiquantitative levels of other impairing drugs and medications. Police crash reports were analysed to determine which drivers contributed to the crash (responsible) and which were 'innocently involved' (non-responsible). We used unconditional logistic regression to determine the likelihood (odds ratio: OR) of crash responsibility in drivers with 0 < THC < 2 ng/ml, 2 ng/ml ≤ THC < 5 ng/ml and THC ≥ 5 ng/ml (all versus THC = 0 ng/ml). Risk estimates were adjusted for age, sex and presence of other impairing substances. FINDINGS We obtained toxicology results on 3005 injured drivers and police reports on 2318. Alcohol was detected in 14.4% of drivers, THC in 8.3%, other drugs in 8.9% and sedating medications in 19.8%. There was no increased risk of crash responsibility in drivers with THC < 2 ng/ml or 2 ≤ THC < 5 ng/ml. In drivers with THC ≥ 5 ng/ml, the adjusted OR was 1.74 [95% confidence interval (CI) = 0.59-6.36; P = 0.35]. There was significantly increased risk of crash responsibility in drivers with blood alcohol concentration (BAC) ≥ 0.08% (OR = 6.00;95% CI = 3.87-9.75; P < 0.01), other recreational drugs detected (OR = 1.82;95% CI = 1.21-2.80; P < 0.01) or sedating medications detected (OR = 1.45; 95%CI = 1.11-1.91; P < 0.01). CONCLUSIONS In this sample of non-fatally injured motor vehicle drivers in British Columbia, Canada, there was no evidence of increased crash risk in drivers with Δ-9-tetrahydrocannabinol < 5 ng/ml and a statistically non-significant increased risk of crash responsibility (odds ratio = 1.74) in drivers with Δ-9-tetrahydrocannabinol ≥ 5 ng/ml.
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Affiliation(s)
| | | | | | | | | | - Robert E. Mann
- Centre for Addiction and Mental Health, Toronto and University of TorontoTorontoOntarioCanada
| | - Jeffrey Eppler
- Kelowna General Hospital and University of British ColumbiaKelownaBCCanada
| | - Adam Lund
- Royal Columbian Hospital and University of British ColumbiaNew WestminsterBCCanada
| | - Andrew MacPherson
- Victoria General Hospital and University of British ColumbiaVictoriaBCCanada
| | - Walter Martz
- Institute of Forensic Medicine, Justus Liebig UniversityGiessenGermany
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Brunet B, Sauvageon Y, Palazzo P, Guignet J, Mura P, Neau JP. Accidents vasculaires cérébraux du sujet jeune et usage de stupéfiants : 1 – Analyse des pratiques et données statistiques. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Banks K, Biswas S, Wong M, Byerly S, Clark D, Lam L, Inaba K, Demetriades D. Cannabis Use is Associated with Increased Mechanical Ventilation and Polysubstance Use in Trauma Patients. Am Surg 2019. [DOI: 10.1177/000313481908500234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent policy changes in California regarding cannabis use underscore the need to study outcomes and prevalence of this drug in trauma. Our study aims to study the prevalence of cannabis use and associations with injury types and outcomes in Los Angeles County trauma patients. Data were reviewed from 21,276 adult patients from a Los Angeles countywide database spanning five years (2012–2016), who underwent urine toxicology testing in the ED after sustaining a traumatic injury. The percentage of trauma patients using marijuana increased from 36 to 43 per cent over the five-year period. On univariate analysis, cannabis-positive patients were significantly younger and more likely male, with lower median systolic blood pressure and heart rate on arrival in the ED. A higher proportion of cannabis users had penetrating trauma, and 48 per cent of cannabis users also tested positive for amphetamines, cocaine, opioids, or Phencyclidine. On multivariate analysis, cannabis was associated with an increase in need for mechanical ventilation after adjusting for age, admission Glasgow Coma Score, gender, polysubstance use, blunt or penetrating mechanism, and Injury Severity Score, and was not associated with increases in mortality or ICU length of stay.
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Affiliation(s)
- Kian Banks
- From the LAC+USC Medical Center, Los Angeles, California
| | - Subarna Biswas
- From the LAC+USC Medical Center, Los Angeles, California
| | - Monica Wong
- From the LAC+USC Medical Center, Los Angeles, California
| | - Saskya Byerly
- From the LAC+USC Medical Center, Los Angeles, California
| | - Damon Clark
- From the LAC+USC Medical Center, Los Angeles, California
| | - Lydia Lam
- From the LAC+USC Medical Center, Los Angeles, California
| | - Kenji Inaba
- From the LAC+USC Medical Center, Los Angeles, California
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Nesoff ED, Branas CC, Martins SS. Challenges in studying statewide pedestrian injuries and drug involvement. Inj Epidemiol 2018; 5:43. [PMID: 30506421 PMCID: PMC6275152 DOI: 10.1186/s40621-018-0173-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing U.S. rates of pedestrian injuries could be attributable in part to changing policies and attitudes towards drugs and associated increases in use, yet drug use has not been investigated widely as a risk factor for pedestrian injury. This study details challenges to investigating drug-involved pedestrian crashes using existing surveillance systems. METHODS Using California police reports from 2004 to 2016, we performed simple linear regression with the proportion of data that was missing by year for drug and alcohol use as the outcome of interest. We also explored differences in the relative proportion of missing data across sex, race, and age groups through simple logistic regression. Finally, we compared missing data for alcohol and drug use indicators for pedestrians and drivers. RESULTS From 2004 to 2016, 182,278 pedestrians were involved in crashes across California. Only 1.22% (n = 2219) of records indicated drug use, and 98% had missing data for drug use; the proportion of missing data did not change over time (b = - 0.040, p = 0.145, 95% CI = (- 0.095, 0.016)). The proportion of missing values for alcohol use increased each year (b = 0.49, 95% CI = (0.26, 0.72), p = 0.001). Driver drug and alcohol use indictors showed similar data missingness, and missing data did not show significant variation over time. Hispanics were more likely to have missing data for drug use compared to Whites (OR = 0.61, p < 0.001, 95% CI = (0.56, 0.67)), and Blacks were more likely to have missing data for alcohol use compared to Whites (OR = 0.87, p < 0.0001, 95% CI = (0.84, 0.91)). CONCLUSIONS Drug use may be a key contributing factor to pedestrian injury, but drug use remains consistently and largely unmeasured in existing surveillance systems. Without better collection of drug and alcohol data, monitoring trends in drug-involved pedestrian injury will not be feasible.
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Affiliation(s)
- Elizabeth D. Nesoff
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th floor, New York, NY 10032 USA
| | - Charles C. Branas
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th floor, New York, NY 10032 USA
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th floor, New York, NY 10032 USA
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28
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Schlienz NJ, Cone EJ, Herrmann ES, Lembeck NA, Mitchell JM, Bigelow GE, Flegel R, LoDico CP, Hayes ED, Vandrey R. Pharmacokinetic Characterization of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol in Urine Following Acute Oral Cannabis Ingestion in Healthy Adults. J Anal Toxicol 2018; 42:232-247. [PMID: 29300962 DOI: 10.1093/jat/bkx102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/29/2017] [Indexed: 12/17/2022] Open
Abstract
Understanding the urine excretion profile for Δ9-tetrahydrocannabinol (THC) metabolites is important for accurate detection and interpretation of toxicological testing for cannabis use. Prior literature has primarily evaluated the urinary pharmacokinetics of the non-psychoactive THC metabolite 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH) following smoked cannabis administration. The present study examined the urine THCCOOH excretion profile following oral cannabis administration in 18 healthy adults. Following ingestion of a cannabis-containing brownie with 10, 25 or 50 mg of THC (N = 6 per dose), urine specimens were collected on a closed residential research unit for 6 days, followed by three outpatient visits on Days 7-9. Average maximum concentrations (Cmax) of THCCOOH were 107, 335 and 713 ng/mL, and average times to maximum concentration (Tmax) were 8, 6 and 9 h for the 10, 25 and 50 mg THC doses, respectively. Detection windows to first positive and last positive varied as a function of dose; higher doses had shorter time to first positive and longer time to last positive. Considerable inter-subject variability was observed on study outcomes. Gas chromatography/mass spectrometry (GC/MS; 15 ng/mL cutoff) was used as the criterion to assess sensitivity, specificity and agreement for THCCOOH qualitative immunoassay tests using 20, 50 and 100 ng/mL cutoffs. The 50 ng/mL cutoff displayed good sensitivity (92.5%), specificity (92.4%) and overall agreement (92.4%), whereas the 20 ng/mL cutoff demonstrated poor specificity (58.4%), and the 100 ng/mL cutoff exhibited reduced sensitivity (70.9%). Ingestion of cannabis brownies containing the 10 and 25 mg THC doses yielded THCCOOH concentrations that differed in magnitude and time course from those previously reported for the smoked route of administration of comparable doses.
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Affiliation(s)
- Nicolas J Schlienz
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Edward J Cone
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Evan S Herrmann
- Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD 21209, USA
| | - Natalie A Lembeck
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - John M Mitchell
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - George E Bigelow
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Ronald Flegel
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Charles P LoDico
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Eugene D Hayes
- Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Workplace Programs (DWP), 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Schwerdt MK, Gill JR. The pitfalls of per se thresholds in accurately identifying acute cannabis intoxication at autopsy. Forensic Sci Med Pathol 2018; 14:497-502. [PMID: 30132114 DOI: 10.1007/s12024-018-0019-2] [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] [Accepted: 08/06/2018] [Indexed: 11/25/2022]
Abstract
Some laws in the United States define cannabis-impaired driving criteria using various per se language that uses specific concentrations of various cannabinoid compounds to establish driving-under-the-influence (DUI). We hypothesize that there will be decedents whose postmortem toxicology profiles would be considered indicative of an acute cannabinoid intoxication under varying DUI per se laws, despite having survived longer than the expected duration of cannabinoid impairment effects. This study examined decedents in whom quantified cannabis metabolites were detected in Connecticut medical examiner autopsy samples, in which the medically-confined survival interval was longer (4-12 and > 12 h) than the expected duration of cannabinoid impairment effects. Several of the 15 decedents, despite being intubated and/or comatose during the medically-confined period of abstinence, would have exceeded DUI per se limits based upon their toxicology results. The use of drug concentrations alone to equate to an acute cannabis intoxication may result in inappropriate arrest, prosecution, and civil liability.
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Affiliation(s)
- Mary K Schwerdt
- The Frank H. Netter M.D. School of Medicine at Quinnipiac University, 370 Bassett Rd, North Haven, CT, 06473, USA
| | - James R Gill
- Office of the Chief Medical Examiner, 11 Shuttle Rd, Farmington, CT, 06032, USA.
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Alkylsilyl speciation and direct sample preparation of plant cannabinoids prior to their analysis by GC-MS. Anal Chim Acta 2018; 1021:51-59. [PMID: 29681284 DOI: 10.1016/j.aca.2018.03.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/03/2018] [Accepted: 03/10/2018] [Indexed: 11/20/2022]
Abstract
A literature criticism is given on methods currently using gas chromatography mass spectrometry (GC-MS) to determine plant cannabinoids (p-CBDs). In this study, trialkylsilylation of seven p-CBDs (including their transformation products formed in the drug user's body) was compared applying various alkylsilyl reagents1 and the mass fragmentation properties of the corresponding derivatives were characterized. Derivatization, mass fragmentation and quantitation related model investigations were optimized as a function of the reaction times and conditions. Special emphasis was put (i) on the maximum responses of species, (ii) on the proportions of formed stable products, suitable for selective quantitation of all seven p-CBDs simultaneously. Results, as novel to the field confirmed that HMDS + TFA, for p-CBDs never applied reagent before, serves as their derivatization reagent of choice. These species were characterized by their retention, mass fragmentation and analytical performance characteristics. In model solutions with injected amounts in the range of 20 pg-2000 pg, repeatability (average 4.98% RSD, varying between 2.98 and 6.2% RSD), linearity (R2, 0.9956-0.9995), LOQ (20-80 pg/μL injected species) and recovery (95.2-104%) values were defined. The practical utility of this proposal, along with method development validation, was shown in a particularly unique manner and supported by the novel, extraction free, direct sample preparation working strategy. For this purpose, two Cannabis-type ruderalis (C-trd) plant tissues (C-trd1, C-trd2) were directly derivatized in the presence of the matrix. This process, which approaches green chemistry, performed without the use of organic solvents, was associated with the quantitation of self p-CBD contents of C-trd plant tissues. Applying 0.5-2.0 mg dried tissues, adding standards, the following self p-CBDs contents were confirmed: in C-trd1 6.6 μg/mg CBD, 4.4 μg/mg CBN and 1.3 μg/mg CBC, while in C-trd2 0.46 μg/mg CBD, 0.27 μg/mg CBC and 0.19 μg/mg CBG were found. The latter results were characterized by repeatability (2.52-4.99% RSD), linearity (R2, 0.9640-0.9997) and recovery (87.9-109%) data.
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31
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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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Bough KJ, Pollock JD. Defining Substance Use Disorders: The Need for Peripheral Biomarkers. Trends Mol Med 2018; 24:109-120. [PMID: 29396146 DOI: 10.1016/j.molmed.2017.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 02/07/2023]
Abstract
Addiction is a brain disease, and current diagnostic criteria for substance use disorders (SUDs) are qualitative. Nevertheless, scientific advances are beginning to characterize neurobiological domains. Combining multiple units of measure may provide an opportunity to deconstruct the heterogeneities of a SUD and define endophenotypes by using peripheral biospecimens. There are several recent examples of potential biomarker types that can be examined, together with their categorical applications for SUDs. We propose that, in conjunction with rapidly advancing statistical and mathematical modeling techniques, there is now a unique opportunity for the discovery of composite biomarkers within specific domains of addiction; these may lay the foundation for future biomarker qualification, with important implications for drug development and medical care.
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Affiliation(s)
- Kristopher J Bough
- National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA), Rockville, MD 20852, USA.
| | - Jonathan D Pollock
- National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA), Rockville, MD 20852, USA
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33
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Fodor B, Molnár-Perl I. The role of derivatization techniques in the analysis of plant cannabinoids by gas chromatography mass spectrometry. Trends Analyt Chem 2017. [DOI: 10.1016/j.trac.2017.07.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Relating Observed Psychoactive Effects to the Plasma Concentrations of Delta-9-Tetrahydrocannabinol and Its Active Metabolite: An Effect-Compartment Modeling Approach. J Pharm Sci 2017; 107:745-755. [PMID: 28942005 DOI: 10.1016/j.xphs.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 11/22/2022]
Abstract
The medical use of marijuana is increasing, yet little is known about the exposure-response relationship for its psychoactive effects. It is well known that the plasma concentrations of the principal psychoactive component of marijuana, Δ9-tetrahydrocannabinol (THC), do not directly correlate to the observed psychoactive effects. The purpose of this research was to use an effect-compartment modeling approach to predict and relate the concentrations of the psychoactive components (THC and its active metabolite) in the "hypothetical" effect-site compartment to the observed psychoactive effects. A "hypothetical" effect-compartment model was developed using literature data to characterize the observed delay in peak "highness" ratings compared with plasma concentrations of the psychoactive agents following intravenous administration of THC. A direct relationship was established between the reported psychoactive effects ("highness" or intoxication) and the predicted effect-site concentrations of THC. The differences between estimated equilibration half-lives for THC and THC-OH in the effect-compartment model indicated the differential equilibration of parent drug and the active metabolite between plasma and the effect-site. These models contribute to the understanding of the pharmacokinetic-pharmacodynamic relationships associated with marijuana use and are important steps in the prediction of pharmacodynamic effects related to the psychoactive components in marijuana.
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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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36
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Saenz SR, Lewis RJ, Angier MK, Wagner JR. Postmortem Fluid and Tissue Concentrations of THC, 11-OH-THC and THC-COOH†. J Anal Toxicol 2017; 41:508-516. [DOI: 10.1093/jat/bkx033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 11/15/2022] Open
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Wettlaufer A, Florica RO, Asbridge M, Beirness D, Brubacher J, Callaghan R, Fischer B, Gmel G, Imtiaz S, Mann RE, McKiernan A, Rehm J. Estimating the harms and costs of cannabis-attributable collisions in the Canadian provinces. Drug Alcohol Depend 2017; 173:185-190. [PMID: 28273616 DOI: 10.1016/j.drugalcdep.2016.12.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In 2012, 10% of Canadians used cannabis and just under half of those who use cannabis were estimated to have driven under the influence of cannabis. Substantial evidence has accumulated to indicate that driving after cannabis use increases collision risk significantly; however, little is known about the extent and costs associated with cannabis-related traffic collisions. This study quantifies the costs of cannabis-related traffic collisions in the Canadian provinces. METHODS Province and age specific cannabis-attributable fractions (CAFs) were calculated for traffic collisions of varying severity. The CAFs were applied to traffic collision data in order to estimate the total number of persons involved in cannabis-attributable fatal, injury and property damage only collisions. Social cost values, based on willingness-to-pay and direct costs, were applied to estimate the costs associated with cannabis-related traffic collisions. The 95% confidence intervals were calculated using Monte Carlo methodology. RESULTS Cannabis-attributable traffic collisions were estimated to have caused 75 deaths (95% CI: 0-213), 4407 injuries (95% CI: 20-11,549) and 7794 people (95% CI: 3107-13,086) were involved in property damage only collisions in Canada in 2012, totalling $1,094,972,062 (95% CI: 37,069,392-2,934,108,175) with costs being highest among younger people. DISCUSSION The cannabis-attributable driving harms and costs are substantial. The harm and cost of cannabis-related collisions is an important factor to consider as Canada looks to legalize and regulate the sale of cannabis. This analysis provides evidence to help inform Canadian policy to reduce the human and economic costs of drug-impaired driving.
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Affiliation(s)
- Ashley Wettlaufer
- Canadian Centre on Substance Abuse, Canada; Centre for Addiction and Mental Health, Canada.
| | | | | | | | | | | | - Benedikt Fischer
- Centre for Addiction and Mental Health, Canada; Centre for Criminology and Sociolegal Studies, University of Toronto, Canada
| | - Gerrit Gmel
- Centre for Addiction and Mental Health, Canada; The University of New South Wales, Australia
| | | | | | | | - Jürgen Rehm
- Centre for Addiction and Mental Health, Canada
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Boileau I, Mansouri E, Williams B, Le Foll B, Rusjan P, Mizrahi R, Tyndale RF, Huestis MA, Payer DE, Wilson AA, Houle S, Kish SJ, Tong J. Fatty Acid Amide Hydrolase Binding in Brain of Cannabis Users: Imaging With the Novel Radiotracer [ 11C]CURB. Biol Psychiatry 2016; 80:691-701. [PMID: 27345297 PMCID: PMC5050070 DOI: 10.1016/j.biopsych.2016.04.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 03/24/2016] [Accepted: 04/18/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND One of the major mechanisms for terminating the actions of the endocannabinoid anandamide is hydrolysis by fatty acid amide hydrolase (FAAH), and inhibitors of the enzyme were suggested as potential treatment for human cannabis dependence. However, the status of brain FAAH in cannabis use disorder is unknown. METHODS Brain FAAH binding was measured with positron emission tomography and [11C]CURB in 22 healthy control subjects and ten chronic cannabis users during early abstinence. The FAAH genetic polymorphism (rs324420) and blood, urine, and hair levels of cannabinoids and metabolites were determined. RESULTS In cannabis users, FAAH binding was significantly lower by 14%-20% across the brain regions examined than in matched control subjects (overall Cohen's d = 0.96). Lower binding was negatively correlated with cannabinoid concentrations in blood and urine and was associated with higher trait impulsiveness. CONCLUSIONS Lower FAAH binding levels in the brain may be a consequence of chronic and recent cannabis exposure and could contribute to cannabis withdrawal. This effect should be considered in the development of novel treatment strategies for cannabis use disorder that target FAAH and endocannabinoids. Further studies are needed to examine possible changes in FAAH binding during prolonged cannabis abstinence and whether lower FAAH binding predates drug use.
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Affiliation(s)
- Isabelle Boileau
- Addiction Imaging Research Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Human Brain Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
| | - Esmaeil Mansouri
- Addiction Imaging Research Group, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Human Brain Lab, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada
| | - Belinda Williams
- Addiction Imaging Research Group, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Human Brain Lab, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada
| | - Bernard Le Foll
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Department Pharmacology & Toxicology, University of Toronto, Toronto, Canada,Department Psychiatry, University of Toronto, Toronto, Canada,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Pablo Rusjan
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Department Psychiatry, University of Toronto, Toronto, Canada
| | - Romina Mizrahi
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Department Psychiatry, University of Toronto, Toronto, Canada,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Department Pharmacology & Toxicology, University of Toronto, Toronto, Canada,Department Psychiatry, University of Toronto, Toronto, Canada
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Doris E. Payer
- Addiction Imaging Research Group, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Human Brain Lab, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Department Psychiatry, University of Toronto, Toronto, Canada
| | - Alan A. Wilson
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada
| | - Sylvain Houle
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada
| | - Stephen J. Kish
- Human Brain Lab, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Department Pharmacology & Toxicology, University of Toronto, Toronto, Canada,Department Psychiatry, University of Toronto, Toronto, Canada,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Junchao Tong
- Human Brain Lab, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada,Department Psychiatry, University of Toronto, Toronto, Canada
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Lee D, Bergamaschi MM, Milman G, Barnes AJ, Queiroz RHC, Vandrey R, Huestis MA. Plasma Cannabinoid Pharmacokinetics After Controlled Smoking and Ad libitum Cannabis Smoking in Chronic Frequent Users. J Anal Toxicol 2016; 39:580-7. [PMID: 26378131 DOI: 10.1093/jat/bkv082] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
More Americans are dependent on cannabis than any other illicit drug. The main analytes for cannabis testing include the primary psychoactive constituent, Δ(9)-tetrahydrocannabinol (THC), equipotent 11-hydroxy-THC (11-OH-THC) and inactive 11-nor-9-carboxy-THC (THCCOOH). Eleven adult chronic frequent cannabis smokers resided on a closed research unit with unlimited access to 5.9% THC cannabis cigarettes from 12:00 to 23:00 during two ad libitum smoking phases, followed by a 5-day abstinence period in seven participants. A single cigarette was smoked under controlled topography on the last day of the smoking and abstinence phases. Plasma cannabinoids were quantified by two-dimensional gas chromatography-mass spectrometry. Median plasma maximum concentrations (Cmax) were 28.3 (THC), 3.9 (11-OH-THC) and 47.0 μg/L (THCCOOH) 0.5 h after controlled single cannabis smoking. Median Cmax 0.2-0.5 h after ad libitum smoking was higher for all analytes: 83.5 (THC), 14.2 (11-OH-THC) and 155 μg/L (THCCOOH). All 11 participants' plasma samples were THC and THCCOOH-positive, 58.3% had THC ≥5 μg/L and 79.2% were 11-OH-THC-positive 8.1-14 h after last cannabis smoking. Cannabinoid detection rates in seven participants 106-112 h (4-5 days) after last smoking were 92.9 (THC), 35.7 (11-OH-THC) and 100% (THCCOOH), with limits of quantification of 0.5 μg/L for THC and THCCOOH, and 1.0 μg/L for 11-OH-THC. These data greatly expand prior research findings on cannabinoid excretion profiles in chronic frequent cannabis smokers during ad libitum smoking. Smoking multiple cannabis cigarettes led to higher Cmax and AUC compared with smoking a single cigarette. The chronic frequent cannabis smokers exhibited extended detection windows for plasma cannabinoids, reflecting a large cannabinoid body burden.
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Affiliation(s)
- Dayong Lee
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
| | - Mateus M Bergamaschi
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, SP 14040-903, Brazil
| | - Garry Milman
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
| | - Allan J Barnes
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
| | - Regina H C Queiroz
- School of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, SP 14040-903, Brazil
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, NIH, Biomedical Research Center, 251 Bayview Blvd. Room 05A721, Baltimore, MD 21224, USA
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40
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Gjerde H, Mørland J. Risk for involvement in road traffic crash during acute cannabis intoxication. Addiction 2016; 111:1492-5. [PMID: 27324309 DOI: 10.1111/add.13435] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Hallvard Gjerde
- Norwegian Institute of Public Health, Nydalen, Oslo, Norway.
| | - Jørg Mørland
- Norwegian Institute of Public Health, Nydalen, Oslo, Norway
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41
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Hartman RL, Brown TL, Milavetz G, Spurgin A, Gorelick DA, Gaffney GR, Huestis MA. Effect of Blood Collection Time on Measured Δ9-Tetrahydrocannabinol Concentrations: Implications for Driving Interpretation and Drug Policy. Clin Chem 2016; 62:367-77. [PMID: 26823611 DOI: 10.1373/clinchem.2015.248492] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In driving-under-the-influence cases, blood typically is collected approximately 1.5-4 h after an incident, with unknown last intake time. This complicates blood Δ(9)-tetrahydrocannabinol (THC) interpretation, owing to rapidly decreasing concentrations immediately after inhalation. We evaluated how decreases in blood THC concentration before collection may affect interpretation of toxicological results. METHODS Adult cannabis smokers (≥1×/3 months, ≤3 days/week) drank placebo or low-dose alcohol (approximately 0.065% peak breath alcohol concentration) 10 min before inhaling 500 mg placebo, 2.9%, or 6.7% vaporized THC (within-individuals), then took simulated drives 0.5-1.3 h postdose. Blood THC concentrations were determined before and up to 8.3 h postdose (limit of quantification 1 μg/L). RESULTS In 18 participants, observed Cmax (at 0.17 h) for active (2.9 or 6.7% THC) cannabis were [median (range)] 38.2 μg/L (11.4-137) without alcohol and 47.9 μg/L (13.0-210) with alcohol. THC Cmax concentration decreased 73.5% (3.3%-89.5%) without alcohol and 75.1% (11.5%-85.4%) with alcohol in the first half-hour after active cannabis and 90.3% (76.1%-100%) and 91.3% (53.8%-97.0%), respectively, by 1.4 h postdose. When residual THC (from previous self-administration) was present, concentrations rapidly decreased to preinhalation baselines and fluctuated around them. During-drive THC concentrations previously associated with impairment (≥8.2 μg/L) decreased to median <5 μg/L by 3.3 h postdose and <2 μg/L by 4.8 h postdose; only 1 participant had THC ≥5 μg/L after 3.3 h. CONCLUSIONS Forensic blood THC concentrations may be lower than common per se cutoffs despite greatly exceeding them while driving. Concentrations during driving cannot be back-extrapolated because of unknown time after intake and interindividual variability in rates of decrease.
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Affiliation(s)
- Rebecca L Hartman
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Timothy L Brown
- National Advanced Driving Simulator, University of Iowa, Iowa City, IA
| | - Gary Milavetz
- College of Pharmacy, University of Iowa, Iowa City, IA
| | | | - David A Gorelick
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Gary R Gaffney
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD;
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42
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Abstract
Cannabis sativa is the most commonly used recreational drug, Δ(9)-tetrahydrocannabinol (Δ(9)-THC) being the main addictive compound. Biotransformation of cannabinoids is an important field of xenobiochemistry and toxicology and the study of the metabolism can lead to the discovery of new compounds, unknown metabolites with unique structures and new therapeutic effects. The pharmacokinetics of Δ(9)-THC is dependent on multiple factors such as physical/chemical form, route of administration, genetics, and concurrent consumption of alcohol. This review aims to discuss metabolomics of Δ(9)-THC, namely by presenting all known metabolites of Δ(9)-THC described both in vitro and in vivo, and their roles in the Δ(9)-THC-mediated toxic effects. Since medicinal use is increasing, metabolomics of Δ(9)-THC will also be discussed in order to uncover potential active metabolites that can be made available for this purpose.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- a IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL , Gandra , Portugal .,b UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto , Porto , Portugal , and.,c Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto , Porto , Portugal
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43
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Rapid Changes in CB1 Receptor Availability in Cannabis Dependent Males after Abstinence from Cannabis. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:60-67. [PMID: 26858993 DOI: 10.1016/j.bpsc.2015.09.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/25/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The widespread use of cannabis, the increasing legalization of "medical" cannabis, the increasing potency of cannabis and the growing recreational use of synthetic cannabinoid 1 receptor (CB1R) full agonists underscores the importance of elucidating the effects of cannabinoids on the CB1R system. Exposure to cannabinoids is known to result in CB1R downregulation. However, the precise time course of changes in CB1R availability in cannabis dependent subjects (CDs) following short and intermediate term abstinence has not been determined. METHODS Using High Resolution Research Tomography (HRRT) and [11C]OMAR, CB1R availability as indexed by the volume of distribution (VT) [11C]OMAR was measured in male CDs (n=11) and matched healthy controls (HCs) (n=19). CDs were scanned at baseline (while they were neither intoxicated nor in withdrawal), and after 2 days and 28 days of monitored abstinence. HCs were scanned at baseline and a subset (n=4) was rescanned 28 days later. RESULTS Compared to HCs, [11C]OMAR VT was 15% lower in CDs (effect size Cohen's d=-1.11) at baseline in almost all brain regions. However, these group differences in CB1R availability were no longer evident after just 2 days of monitored abstinence from cannabis. There was a robust negative correlation between CB1R availability and withdrawal symptoms after 2 days of abstinence. Finally, there were no significant group differences in CB1R availability in CDs after 28 days of abstinence. CONCLUSIONS Cannabis dependence is associated with CB1R downregulation, which begins to reverse surprisingly rapidly upon termination of cannabis use and may continue to increase over time.
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44
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Marchetti D, Spagnolo A, De Matteis V, Filograna L, De Giovanni N. Coronary thrombosis and marijuana smoking: a case report and narrative review of the literature. Drug Test Anal 2015; 8:56-62. [PMID: 26607055 DOI: 10.1002/dta.1898] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 11/11/2022]
Abstract
We encountered evidence of myocardial infarction due to coronary thrombosis in an autopsy of an occasional marijuana smoker. These findings prompted us to perform a narrative review of the literature to determine when post-mortem toxicological tests may support a temporal relationship between marijuana smoking and cardiovascular disease. Toxicological examination showed the presence of Δ-9-tetrahydrocannabinol, its main metabolite and cannabinol in blood and urine. Quali-quantitative analysis revealed that Δ-9-tetrahydrocannabinol was taken within 2 h of the onset of cardiovascular symptoms, according to circumstantial data. Post-mortem toxicological results must take into account the degradation and post-mortem redistribution of analytes. However, for any inference about the specific cardiovascular triggering effect of Δ-9-tetrahydrocannabinol intake, we maintain that cannabinoid analysis in blood samples must be considered an essential requirement to estimate the time of last intake and avoid incomplete documentation. The literature, combined with the present case report, highlights an association between marijuana use and negative cardiovascular events, although few authors have supported their conclusions with toxicological results. Thus, additional research is needed.
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Affiliation(s)
- Daniela Marchetti
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Angelico Spagnolo
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Valentino De Matteis
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Laura Filograna
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Nadia De Giovanni
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
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45
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Andrews R, Murphy KG, Nahar L, Paterson S. Cannabinoid Concentrations Detected in Fatal Road Traffic Collision Victims Compared with a Population of Other Postmortem Cases. Clin Chem 2015; 61:1256-64. [DOI: 10.1373/clinchem.2015.240846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/29/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Acute cannabis consumption nearly doubles the risk of motor vehicle collision resulting in injury or death. Limited data have been published regarding the concentrations of cannabinoids associated with fatal road traffic collisions (RTCs), and these have not previously been compared to a population of other postmortem cases.
METHODS
We conducted analysis for cannabinoids [Δ9-tetrahydrocannabinol (THC), 11-hydroxy-THC, 11-nor-THC-9-carboxylic acid, cannabidiol, and cannabinol], drugs, and alcohol on consecutive fatal RTC cases (100) and non-RTC cases (114) from coroners' jurisdictions in London and southeast England and compared the data.
RESULTS
The incidence of cannabinoids detected in non-RTC and RTC cases was similar (25% vs 21%, P = 0.44), but THC was detected more frequently (90% vs 59%, P = 0.01) and at significantly higher concentrations in the cannabinoid-positive RTC cases than the non-RTC cases (P = 0.01). The distribution of non-RTC and RTC cases over 4 categories of THC concentration was significantly different (P = 0.004). There was no significant difference in the concentrations of other cannabinoids detected between the 2 groups. Cannabinoids were detected in more fatal RTC cases (21) than alcohol >80 mg/dL (17). Detection of other drugs was low compared to cannabis and alcohol.
CONCLUSIONS
These first data on the concentrations of cannabinoids in the postmortem blood of fatal RTC victims compared with a population of other routine coroners' cases highlight the importance of specifically measuring THC concentrations in the blood to aid interpretation of postmortem cases where cannabis may be implicated.
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Affiliation(s)
- Rebecca Andrews
- Toxicology Unit, Imperial College London, London, UK, W6 8RP
| | - Kevin G Murphy
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Limon Nahar
- Toxicology Unit, Imperial College London, London, UK, W6 8RP
| | - Sue Paterson
- Toxicology Unit, Imperial College London, London, UK, W6 8RP
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46
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Karschner EL, Swortwood MJ, Hirvonen J, Goodwin RS, Bosker WM, Ramaekers JG, Huestis MA. Extended plasma cannabinoid excretion in chronic frequent cannabis smokers during sustained abstinence and correlation with psychomotor performance. Drug Test Anal 2015; 8:682-9. [PMID: 26097154 DOI: 10.1002/dta.1825] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/08/2015] [Accepted: 05/19/2015] [Indexed: 11/06/2022]
Abstract
Cannabis smoking increases motor vehicle accident risk. Empirically defined cannabinoid detection windows are important to drugged driving legislation. Our aims were to establish plasma cannabinoid detection windows in frequent cannabis smokers and to determine if residual cannabinoid concentrations were correlated with psychomotor performance. Twenty-eight male chronic frequent cannabis smokers resided on a secure research unit for up to 33 days with daily blood collection. Plasma specimens were analyzed for Δ(9) -tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), and 11-nor-9-carboxy-THC (THCCOOH) by gas chromatography-mass spectrometry. Critical tracking and divided attention tasks were administered at baseline (after overnight stay to ensure lack of acute intoxication) and after 1, 2, and 3 weeks of cannabis abstinence. Twenty-seven of the twenty-eight participants were THC-positive at admission (median 4.2 µg/L). THC concentrations significantly decreased 24 h after admission, but were still ≥2 µg/L in 16 of the 28 participants 48 h after admission. THC was detected in 3 of 5 specimens on day 30. The last positive 11-OH-THC specimen was 15 days after admission. THCCOOH was measureable in 4 of 5 participants after 30 days of abstinence. Years of prior cannabis use significantly correlated with THC concentrations on admission, and days 7 and 14. Tracking error, evaluated by the Divided Attention Task, was the only evaluated psychomotor assessment significantly correlated with cannabinoid concentrations at baseline and day 8 (11-OH-THC only). Median THC was 0.3 µg/L in 5 chronic frequent cannabis smokers' plasma samples after 30 days of sustained abstinence. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Erin L Karschner
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA.,Currently at Armed Forces Medical Examiner System, Division of Forensic Toxicology, 115 Purple Heart Drive, Dover AFB, DE, 19902, USA
| | - Madeleine J Swortwood
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA
| | - Jussi Hirvonen
- Molecular Imaging Branch, IRP, National Institute on Mental Health, NIH, 6001 Executive Blvd., Bethesda, MD, 20892, USA.,Currently at Department of Diagnostic Radiology, University of Turku, 20014, Turun yliopisto, Finland
| | - Robert S Goodwin
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA.,Currently at 7 Church Lane, Suite 15A, Pikesville, MD, 21208, USA
| | - Wendy M Bosker
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA.,Currently at Institute for Neuroscience and Medicine-4, Forschungszentrum Jülich, 52425, Jülich, Germany.,Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, 6211 LK, Maastricht, The Netherlands
| | - Johannes G Ramaekers
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, 6211 LK, Maastricht, The Netherlands
| | - Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd. Suite 05A721, Baltimore, MD, 21224, USA
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47
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Odell MS, Frei MY, Gerostamoulos D, Chu M, Lubman DI. Residual cannabis levels in blood, urine and oral fluid following heavy cannabis use. Forensic Sci Int 2015; 249:173-80. [DOI: 10.1016/j.forsciint.2015.01.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 11/26/2022]
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48
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Hunault CC, Böcker KBE, Stellato RK, Kenemans JL, de Vries I, Meulenbelt J. Acute subjective effects after smoking joints containing up to 69 mg Δ9-tetrahydrocannabinol in recreational users: a randomized, crossover clinical trial. Psychopharmacology (Berl) 2014; 231:4723-33. [PMID: 24879495 DOI: 10.1007/s00213-014-3630-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE An increase in the potency of the cannabis cigarettes has been observed over the past three decades. OBJECTIVES In this study, we aimed to establish the impact of Δ9-tetrahydrocannabinol (THC) on the rating of subjective effects (intensity and duration of the effects), up to 23 % THC potency (69 mg THC) among recreational users. METHODS Recreational users (N = 24) smoked cannabis cigarettes with four doses of THC (placebo 29, 49 and 69 mg of THC) on four separate test days in a randomized, double-blind, placebo-controlled, crossover study. The participants filled in three different questionnaires measuring subjective effects during the exposure up to 8 h post-smoking. The 'high' feeling, heart rate, blood pressure and THC serum concentrations were also regularly recorded during these 8 h. RESULTS THC significantly increased the high feeling, dizziness, dry-mouthed feeling, palpitations, impaired memory and concentration, and 'down', 'sedated' and 'anxious' feelings. In addition, THC significantly decreased alertness, contentment and calmness. A cubic relationship was observed between 'feeling the drug' and 'wanting more'. The THC-induced decrease in 'feeling stimulated' and increase in anxiety lasted up to 8 h post-smoking. Sedation at 8 h post-smoking was increased by a factor of 5.7 with the highest THC dose, compared to the placebo. CONCLUSIONS This study shows a strong effect of cannabis containing high percentages of THC on the rating of subjective effects. Regular users and forensic toxicologists should be aware that the THC-induced increase in 'feeling sedated' continues longer with a 69 mg THC dose than with a 29 mg THC dose.
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Affiliation(s)
- Claudine C Hunault
- National Dutch Poisons Information Center, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands,
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Lyvers M, Jamieson R, Thorberg FA. Risky cannabis use is associated with alexithymia, frontal lobe dysfunction, and impulsivity in young adult cannabis users. J Psychoactive Drugs 2014; 45:394-403. [PMID: 24592665 DOI: 10.1080/02791072.2013.844525] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Risky or problematic alcohol use by young adults has been found to be associated with factors such as alexithymia, frontal lobe dysfunction, reward sensitivity, and impulsivity. One interpretation is that these factors reflect inherent traits that predispose to risky substance use in general, a notion examined in the present study. Alexithymia, everyday frontal lobe functioning, sensitivity to reward and punishment, and impulsivity were examined in 138 young adult cannabis users who were divided into Low Risk (n = 99) and Risky (n = 39) users according to their Cannabis Use Disorder Identification Test (CUDIT) scores. Risky cannabis use was significantly positively associated with alexithymia, multiple signs of frontal lobe dysfunction in everyday life, and impulsivity. A broader pattern of dysfunction was indicated for risky cannabis use than for risky alcohol use in this sample. Findings are interpreted as likely reflecting not only inherent traits that predispose to risky substance use in general, but also perhaps residual effects of recent heavy cannabis use in the Risky user group. Longitudinal research is needed to disentangle these competing possibilities.
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Affiliation(s)
- Michael Lyvers
- Department of Psychology, Bond University, Gold Coast, Queensland, Australia.
| | - Reuben Jamieson
- Department of Psychology, Bond University, Gold Coast, Queensland, Australia
| | - Fred Arne Thorberg
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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50
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Westin AA, Mjønes G, Burchardt O, Fuskevåg OM, Slørdal L. Can physical exercise or food deprivation cause release of fat-stored cannabinoids? Basic Clin Pharmacol Toxicol 2014; 115:467-71. [PMID: 24674455 PMCID: PMC4270258 DOI: 10.1111/bcpt.12235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate whether physical exercise or food deprivation may increase cannabinoid levels in serum or urine in abstinent chronic cannabis users. The study took place in a drug detoxification ward parallel to study participants receiving treatment. Six chronic, daily cannabis users (one female, five males, average age 30.0 years; BMI 20.8) were exposed to a 45-min. moderate-intensity workout and a 24-hr period of food deprivation. Serum samples were drawn prior to and after interventions and analysed for Δ9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH) by liquid chromatography–tandem mass spectrometry (LCMSMS), and all voided urine was tested for THCCOOH by LCMSMS and normalized to the creatinine levels, yielding ng/mg ratios. There were no major differences in the measured cannabinoid levels in serum or urine before and after physical exercise or food deprivation. We conclude that exercise and/or food deprivation are unlikely to cause sufficient cannabinoid concentration changes to hamper correct interpretations in drug testing programmes.
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