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Hubbard JA, Hoffman MA, Ellis SE, Sobolesky PM, Smith BE, Suhandynata RT, Sones EG, Sanford SK, Umlauf A, Huestis MA, Grelotti DJ, Grant I, Marcotte TD, Fitzgerald RL. Biomarkers of Recent Cannabis Use in Blood, Oral Fluid and Breath. J Anal Toxicol 2021; 45:820-828. [PMID: 34185831 DOI: 10.1093/jat/bkab080] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 12/25/2022] Open
Abstract
Proving driving under the influence of cannabis (DUIC) is difficult. Establishing a biomarker of recent use to supplement behavioral observations may be a useful alternative strategy. We determined whether cannabinoid concentrations in blood, oral fluid (OF), or breath could identify use within 3h, likely the period of greatest impairment. In a randomized trial, 191 frequent (≥4/week) and occasional (<4/week) cannabis users smoked one cannabis (placebo [0.02%], 5.9% or 13.4% THC) cigarette ad libitum. Blood, OF and breath samples were collected prior to and up to 6h after smoking. Samples were analyzed for 10 cannabinoids in OF, 8 in blood, and THC in breath. Frequent users had more residual THC in blood and were categorized as "recently used" prior to smoking; this did not occur in OF. Per se limits ranging from undetectable to 5 ng/mL THC in blood offered limited usefulness as biomarkers of recent use. Cannabinol (CBN, cutoff=1 ng/mL) in blood offered 100% specificity but only 31.4% sensitivity, resulting in 100% PPV and 94.0% NPV at 4.3% prevalence; but CBN may vary by cannabis chemovar. A 10 ng/mL THC cutoff in OF exhibited the overall highest performance to detect use within 3h (99.7% specificity, 82.4% sensitivity, 92.5% PPV, 99.2% NPV) but was still detectable in 23.2% of participants ~4.4h post smoking limiting specificity at later time points. OF THC may be a helpful indicator of recent cannabis intake, but this does not equate to impairment. Behavioral assessment of impairment is still required to determine DUIC. This study only involved cannabis inhalation and additional research evaluating alternative routes of ingestion (i.e., oral) is needed.
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Affiliation(s)
- J A Hubbard
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - M A Hoffman
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - S E Ellis
- Department of Cognitive Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92092 USA.,Halıcıoğlu Data Science Institute, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92092 USA
| | - P M Sobolesky
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - B E Smith
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - R T Suhandynata
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - E G Sones
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - S K Sanford
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - A Umlauf
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - M A Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - D J Grelotti
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - I Grant
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - T D Marcotte
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - R L Fitzgerald
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
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