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Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration?
Drug Alcohol Depend 2013; 130(1-3):68-76DA

Abstract

OBJECTIVES

We characterize cannabinoid disposition in oral fluid (OF) after dronabinol, synthetic oral Δ(9)-tetrahydrocannabinol (THC), and Sativex, a cannabis-extract oromucosal spray, and evaluate whether smoked cannabis relapse or Sativex compliance can be identified with OF cannabinoid monitoring.

METHODS

5 and 15 mg synthetic oral THC, low (5.4 mg THC, 5.0 mg cannabidiol (CBD)) and high (16.2 mg THC, 15.0 mg CBD) dose Sativex, and placebo were administered in random order (n=14). Oral fluid specimens were collected for 10.5 h after dosing and analyzed for THC, CBD, cannabinol (CBN), and 11-nor-9-carboxy-THC (THCCOOH).

RESULTS

After oral THC, OF THC concentrations decreased over time from baseline, reflecting residual THC excretion from previously self-administered smoked cannabis. CBD and CBN also were rarely detected. After Sativex, THC, CBD and CBN increased greatly, peaking at 0.25-1 h. Median CBD/THC and CBN/THC ratios were 0.82-1.34 and 0.04-0.06, respectively, reflecting cannabinoids' composition in Sativex. THCCOOH/THC ratios within 4.5 h post Sativex were ≤ 1.6 pg/ng, always lower than after oral THC and placebo. THCCOOH/THC ratios increased throughout each dosing session.

CONCLUSIONS

Lack of measurable THC, CBD and CBN in OF following oral THC, and high OF CBD/THC ratios after Sativex distinguish oral and sublingual drug delivery routes from cannabis smoking. Low THCCOOH/THC ratios suggest recent Sativex and smoked cannabis exposure. These data indicate that OF cannabinoid monitoring can document compliance with Sativex pharmacotherapy, and identify relapse to smoked cannabis during oral THC medication but not Sativex treatment, unless samples were collected shortly after smoking.

Authors+Show Affiliations

Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD 21224, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

23146820

Citation

Lee, Dayong, et al. "Can Oral Fluid Cannabinoid Testing Monitor Medication Compliance And/or Cannabis Smoking During Oral THC and Oromucosal Sativex Administration?" Drug and Alcohol Dependence, vol. 130, no. 1-3, 2013, pp. 68-76.
Lee D, Karschner EL, Milman G, et al. Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration? Drug Alcohol Depend. 2013;130(1-3):68-76.
Lee, D., Karschner, E. L., Milman, G., Barnes, A. J., Goodwin, R. S., & Huestis, M. A. (2013). Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration? Drug and Alcohol Dependence, 130(1-3), pp. 68-76. doi:10.1016/j.drugalcdep.2012.10.011.
Lee D, et al. Can Oral Fluid Cannabinoid Testing Monitor Medication Compliance And/or Cannabis Smoking During Oral THC and Oromucosal Sativex Administration. Drug Alcohol Depend. 2013 Jun 1;130(1-3):68-76. PubMed PMID: 23146820.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration? AU - Lee,Dayong, AU - Karschner,Erin L, AU - Milman,Garry, AU - Barnes,Allan J, AU - Goodwin,Robert S, AU - Huestis,Marilyn A, Y1 - 2012/11/10/ PY - 2012/07/10/received PY - 2012/10/01/revised PY - 2012/10/16/accepted PY - 2012/11/14/entrez PY - 2012/11/14/pubmed PY - 2014/1/28/medline SP - 68 EP - 76 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 130 IS - 1-3 N2 - OBJECTIVES: We characterize cannabinoid disposition in oral fluid (OF) after dronabinol, synthetic oral Δ(9)-tetrahydrocannabinol (THC), and Sativex, a cannabis-extract oromucosal spray, and evaluate whether smoked cannabis relapse or Sativex compliance can be identified with OF cannabinoid monitoring. METHODS: 5 and 15 mg synthetic oral THC, low (5.4 mg THC, 5.0 mg cannabidiol (CBD)) and high (16.2 mg THC, 15.0 mg CBD) dose Sativex, and placebo were administered in random order (n=14). Oral fluid specimens were collected for 10.5 h after dosing and analyzed for THC, CBD, cannabinol (CBN), and 11-nor-9-carboxy-THC (THCCOOH). RESULTS: After oral THC, OF THC concentrations decreased over time from baseline, reflecting residual THC excretion from previously self-administered smoked cannabis. CBD and CBN also were rarely detected. After Sativex, THC, CBD and CBN increased greatly, peaking at 0.25-1 h. Median CBD/THC and CBN/THC ratios were 0.82-1.34 and 0.04-0.06, respectively, reflecting cannabinoids' composition in Sativex. THCCOOH/THC ratios within 4.5 h post Sativex were ≤ 1.6 pg/ng, always lower than after oral THC and placebo. THCCOOH/THC ratios increased throughout each dosing session. CONCLUSIONS: Lack of measurable THC, CBD and CBN in OF following oral THC, and high OF CBD/THC ratios after Sativex distinguish oral and sublingual drug delivery routes from cannabis smoking. Low THCCOOH/THC ratios suggest recent Sativex and smoked cannabis exposure. These data indicate that OF cannabinoid monitoring can document compliance with Sativex pharmacotherapy, and identify relapse to smoked cannabis during oral THC medication but not Sativex treatment, unless samples were collected shortly after smoking. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/23146820/Can_oral_fluid_cannabinoid_testing_monitor_medication_compliance_and/or_cannabis_smoking_during_oral_THC_and_oromucosal_Sativex_administration L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(12)00411-5 DB - PRIME DP - Unbound Medicine ER -