Urinary Excretion of 11-Nor-9-Carboxy-Δ9-Tetrahydrocannabinol in a Pregnant Woman Following Heavy, Chronic Cannabis Use

Abstract

Differentiating new intake of drugs-of-abuse from residual drug excretion may be difficult, especially following chronic drug usage and for drugs with long elimination half-lives such as cannabis. In the present case, cannabis was found in the urine of a young pregnant woman following heavy and chronic cannabis use. She was warned that if she continued using cannabis while pregnant she would be forced to be hospitalized. She was subjected to serial urine testing with 2-7-day intervals. Urinary 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) concentrations, measured by liquid chromatography-mass spectrometry, declined from 348 to 3.9 ng/mL over a surprisingly long period of 12 weeks (84 days). Several algorithms for detecting new drug intake were applied during this time course; most indicated that the woman continued to smoke cannabis following the first urine test. The woman denied any use after the first specimen collection. In retrospect, her THCCOOH excretion profile supports her story. Algorithms for detecting new drug intake have been validated for occasional cannabis users only. We advise caution when interpreting urine test results from heavy, chronic cannabis users, especially when serious consequences are involved.

Screening, quantification, and confirmation of synthetic cannabinoid metabolites in urine by UHPLC–QTOF–MS

“…A screening method capable for quantification and confirmation of a variety of SC metabolites at concentrations relevant for clinical and toxicological investigations has been developed. Quantitative screening results are essential when a recent intake needs to be distinguished from residual drug excretion caused by a former intake and repeated samples are available from the same individual . Moreover, the access of quantitative methods is crucial in order to carry out pharmacokinetic studies (ie, to estimate half‐lives, peak concentrations, and detection times in urine).…”

“…Quantification of metabolites can be valuable when a recent intake needs to be distinguished from residual drug excretion from a former intake. This principle is well known after intake of cannabis, and various algorithms have been developed for this purpose . For synthetic cannabinoids some data exist on the urinary pharmacokinetics and excretion rate of the metabolites of JWH‐018 and JWH‐073, whereas for other compounds, very little is known.…”

Can Physical Exercise or Food Deprivation Cause Release of Fat‐Stored Cannabinoids?

“…THC: Δ9-tetrahydrocannabinol, THCCOOH: 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, CC ratio: creatinine-normalized THCCOOH, FD: food deprivation, <LOD: below the 0.2 ng/ml limit of detection, <LOQ: below the 0.6 ng/ml limit of quantification. 1 Serum THC was below LOQ in participant D immediately after FD, but was present the following day, in the concentration shown in the table.…”

“…Our participants had serum THC levels in the 0-3.6 ng/ml range at the time of admission to the ward, which is similar to those described as 'baseline' in the Australian human study [13] and those previously reported in chronic THC: Δ9-tetrahydrocannabinol, THCCOOH: 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, CC ratio: creatinine-normalized THCCOOH, EX: exercise, NA: not applicable, <LOQ: below the 0.6 ng/ml limit of quantification. 1 Due to phlebotic veins, blood sampling failed in participant C after exercise. 2 The baseline urine specimen from participant E was collected the day before the exercise intervention and not immediately prior to exercise.…”

Characteristics and quality of life of opioid-dependent pregnant women in Austria

“…THC was not routinely tested with urine samples; due to the generally long period of positivity in urine toxicology results which can last several weeks or even months with chronic cannabis consumption (e.g. Westin et al 2009), these results would be of limited clinical relevance. For the present analysis, results were only counted if the woman provided at least one valid urine sample per week during the last trimester of pregnancy.…”