The therapeutic use of cannabinoids: Forensic aspects

Indorato, Francesca; Liberto, Aldo; Ledda, Caterina; Romano, Guido; Barbera, Nunziata

doi:10.1016/j.forsciint.2016.03.031

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…Very similar results were published by Stott et al [11], although in their work, the maximum concentrations were reached at about 1 h after nabiximols application (in their control groups). Such a very short time to maximal concentrations for THC was also described by Indorato et al [13], where, in their study, the mean concentration of THC after application of one nabiximols puff was approximately 0.5 ng/mL.…”

Section: Discussionsupporting

confidence: 81%

“…As some metabolites of THC have prolonged elimination half-lives, these metabolites might be useful in monitoring therapeutic application. However, CBD, THC, and the primary hydroxylated metabolites have half-lives of from a few minutes after inhalative application up to a few hours after oromucosal uptake [9][10][11][12][13]; thus, they cannot be used to monitor an appropriate dosing regimen. In many laboratories, THC abuse is monitored by simple 11-nor-9-carboxy-∆ 9 -THC (THC-COOH) analysis of urine samples using commonly available immunological methods, although more elaborate gas-chromatography-coupled mass spectrometry (GC/MS) methods for determining plasma concentrations of THC-COOH have also been described.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of Nabiximols Dose to Steady-State Concentrations of Cannabinoids in Urine Samples from Patients with Multiple Sclerosis

Birke

Meister

Winkelmann

et al. 2022

JCM

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Therapeutic drug monitoring of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is based on a complex procedure and is therefore not possible in most laboratories, especially in emergency cases. This work addresses the question of whether therapeutic drug monitoring of nabiximols can be performed using an immunological urine-based test system for cannabinoid abuse. Seventeen patients with multiple sclerosis were included in this study. Administered doses of nabiximols were correlated with immunologically determined urine concentrations of cannabinoids using the DRITM Cannabinoid (THC) Assay. Significant correlations with the administered nabiximols doses were found for creatinine-normalized urine concentrations of cannabinoids without (r = 0.675; p = 0.0015) and after (r = 0.650; p = 0.0044) hydrolysis, as well as for gas-chromatography-coupled mass spectrometry (GC/MS)-measured concentrations of the THC metabolite 11-nor-9-carboxy-Δ9-THC (THC-COOH) in urine samples (r = 0.571; p = 0.0084) by Pearson’s correlation. In addition, doses were significantly correlated with plasma THC-COOH concentrations (r = 0.667; p = 0.0017) measured by GC/MS. Simple immunological cannabinoid measurements in urine samples could provide an estimate of nabiximols dosage, although the correlations obtained here were weak because of the small number of patients observed. Longitudinal monitoring of individual patients is expected to exhibit good results of therapeutic drug monitoring of nabiximols.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Correlation of Nabiximols Dose to Steady-State Concentrations of Cannabinoids in Urine Samples from Patients with Multiple Sclerosis

Birke

Meister

Winkelmann

et al. 2022

JCM

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“…It is an oral spray formulation, and each puff of 100 µL contains 2.7 mg of THC and 2.5 mg of cannabidiol. A treatment with six puffs over the day revealed >10 times smaller blood THC concentrations than the blood concentrations known to produce psychotropic effects 102. For the nabiximols regimes in the treatment of CWS, cannabis users had been instructed to take eight sprays qid99,100 or a maximum of four sprays every hour (up to 40 sprays/day) 101.…”

Section: Treatment Of Cwsmentioning

confidence: 99%

The cannabis withdrawal syndrome: current insights

Bonnet¹,

Preuss

2017

SAR

176

127

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The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.

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“…Ved terapeutisk bruk av Sativex er det tvilsomt om man kommer opp i nivåer som vil påvirke kjøreevnen, selv ved jevnlig daglig terapeutisk bruk (19). Bruk av Sativex bør derfor etter vår mening kunne vaere forenlig med kravene til førerkort.…”

Section: Medisinsk Behandlingunclassified

Effekter av cannabis varer lenger enn antatt

Mørland¹,

Bramness²

2017

Tidsskriftet

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Etter jevnlig bruk av mye cannabis kan man gjenfinne den psykoaktive substansen THC i blodet i mange dager. Dette kan ha konsekvenser for cannabisbruk og bilkjøring, enten cannabis brukes medisinsk eller i rushensikt. Illustrasjon: SkinkeapeRusmidler kan påvirke psykomotoriske ferdigheter så lenge de finnes i kroppen. Ny innsikt i farmakokinetikken til den viktigste psykoaktive substansen i cannabis, Δ9-

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The therapeutic use of cannabinoids: Forensic aspects

Cited by 6 publications

References 20 publications

Correlation of Nabiximols Dose to Steady-State Concentrations of Cannabinoids in Urine Samples from Patients with Multiple Sclerosis

Correlation of Nabiximols Dose to Steady-State Concentrations of Cannabinoids in Urine Samples from Patients with Multiple Sclerosis

The cannabis withdrawal syndrome: current insights

Effekter av cannabis varer lenger enn antatt

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