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Scherer JN, Vasconcelos M, Dalanhol CS, Govoni B, Dos Santos BP, Borges GR, de Gouveia GC, Viola PP, Carlson RLR, Martins AF, Costa JL, Huestis MA, Pechansky F. Reliability of roadside oral fluid testing devices for ∆ 9 -tetrahydrocannabinol (∆ 9 -THC) detection. Drug Test Anal 2024. [PMID: 38440942 DOI: 10.1002/dta.3669] [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: 09/05/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
Driving under the influence of cannabis (DUIC) is increasing worldwide, and cannabis is the most prevalent drug after alcohol in impaired driving cases, emphasizing the need for a reliable traffic enforcement strategy. ∆9 -tetrahydrocannabinol (THC) detection in oral fluid has great potential for identifying recent cannabis use; however, additional data are needed on the sensitivities, specificities, and efficiencies of different oral fluid devices for detecting cannabinoids at the roadside by police during routine traffic safety enforcement efforts. At the roadside, 8945 oral fluid THC screening tests were performed with four devices: AquilaScan®, Dräger DrugTest®, WipeAlyser Reader®, and Druglizer®. A total of 530 samples screened positive for THC (5.9%) and were analyzed by liquid chromatography-tandem mass spectrometry at multiple cutoff concentrations (2 ng/mL, 10 ng/mL, and manufacturers' recommended device cutoffs) to investigate device performance. Results varied substantially, with sensitivities of 0%-96.8%, specificities of 89.8%-98.5%, and efficiencies of 84.3%-97.8%. The Dräger DrugTest® outperformed the other devices with a 96.8% sensitivity, 97.1% specificity, and 97.0% efficiency at a 5-ng/mL LC-MS/MS confirmation cutoff. The WipeAlyser Reader® had good performance with a 91.4% sensitivity, 97.2% specificity, and 96.4% efficiency. AquilaScan® and Druglizer® had unacceptable performance for cannabinoid detection, highlighted by sensitivity <13%. The choice of roadside oral fluid testing device must offer good analytical performance for cannabinoids because of its high prevalence of use and impact on road safety.
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Affiliation(s)
- Juliana Nichterwitz Scherer
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Mailton Vasconcelos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Bruna Govoni
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Bruno Pereira Dos Santos
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gabriela Ramos Borges
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Patrícia Pacheco Viola
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Aline Franco Martins
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Jose Luiz Costa
- Campinas Poison Control Center, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Severna Park, Maryland, USA
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Suraev A, McCartney D, Kevin R, Gordon R, Grunstein RR, Hoyos CM, McGregor IS. Detection of Δ 9 -tetrahydrocannabinol (THC) in oral fluid using two point-of-collection testing devices following oral administration of a THC and cannabidiol containing oil. Drug Test Anal 2024. [PMID: 38414100 DOI: 10.1002/dta.3658] [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: 06/22/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
Point-of-collection testing (POCT) devices are widely used in roadside and workplace drug testing to identify recent cannabis use by measuring the presence of Δ9 -tetrahydrocannabinol (THC) in oral fluid (OF). However, the performance of POCT devices with oral medicinal cannabis products remains poorly described. In a randomised, double-blinded, crossover trial, adults with insomnia disorder (n = 20) received a single (2 mL) oral dose of oil containing 10 mg THC + 200 mg cannabidiol, or placebo, prior to sleep. Participants were tested with the Securetec DrugWipe® 5S (10 ng/mL THC cut-off) and Dräger DrugTest® 5000 (25 ng/mL THC cut-off) POCT devices at baseline (pre-treatment) and then at 0.5, 10, and 18 h post-treatment. An OF sample, taken at each time point, was also analysed using liquid chromatography-tandem mass spectrometry. Large individual variability in OF THC concentrations was observed 0.5 h post-treatment (range: 0-425 ng/mL; mean (SD) 48.7 (107.5) ng/mL). Both the Securetec DrugWipe® 5S and DrugTest® 5000 demonstrated poor sensitivity to THC at 0.5 h post-treatment (25% and 50%, respectively). At 10 and 18 h post-treatment, all participant OF THC concentrations were below screening cut-offs, and all test results were negative. These findings highlight the relatively poor sensitivity of both devices in detecting recent use of an oral medicinal cannabis product. They also suggest a low probability of obtaining a positive THC result the morning after ('one-off') use. Further research is required to establish the probability of obtaining a positive THC result with regular medicinal cannabis use.
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Affiliation(s)
- Anastasia Suraev
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Danielle McCartney
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Kevin
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
- St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Gordon
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Human Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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Clément P, Schlage WK, Hoeng J. Recent advances in the development of portable technologies and commercial products to detect Δ 9-tetrahydrocannabinol in biofluids: a systematic review. J Cannabis Res 2024; 6:9. [PMID: 38414071 PMCID: PMC10898188 DOI: 10.1186/s42238-024-00216-0] [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: 10/27/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The primary components driving the current commercial fascination with cannabis products are phytocannabinoids, a diverse group of over 100 lipophilic secondary metabolites derived from the cannabis plant. Although numerous phytocannabinoids exhibit pharmacological effects, the foremost attention has been directed towards Δ9-tetrahydrocannabinol (THC) and cannabidiol, the two most abundant phytocannabinoids, for their potential human applications. Despite their structural similarity, THC and cannabidiol diverge in terms of their psychotropic effects, with THC inducing notable psychological alterations. There is a clear need for accurate and rapid THC measurement methods that offer dependable, readily accessible, and cost-effective analytical information. This review presents a comprehensive view of the present state of alternative technologies that could potentially facilitate the creation of portable devices suitable for on-site usage or as personal monitors, enabling non-intrusive THC measurements. METHOD A literature survey from 2017 to 2023 on the development of portable technologies and commercial products to detect THC in biofluids was performed using electronic databases such as PubMed, Scopus, and Google Scholar. A systematic review of available literature was conducted using Preferred Reporting Items for Systematic. Reviews and Meta-analysis (PRISMA) guidelines. RESULTS Eighty-nine studies met the selection criteria. Fifty-seven peer-reviewed studies were related to the detection of THC by conventional separation techniques used in analytical laboratories that are still considered the gold standard. Studies using optical (n = 12) and electrochemical (n = 13) portable sensors and biosensors were also identified as well as commercially available devices (n = 7). DISCUSSION The landscape of THC detection technology is predominantly shaped by immunoassay tests, owing to their established reliability. However, these methods have distinct drawbacks, particularly for quantitative analysis. Electrochemical sensing technology holds great potential to overcome the challenges of quantification and present a multitude of advantages, encompassing the possibility of miniaturization and diverse modifications to amplify sensitivity and selectivity. Nevertheless, these sensors have considerable limitations, including non-specific interactions and the potential interference of compounds and substances existing in biofluids. CONCLUSION The foremost challenge in THC detection involves creating electrochemical sensors that are both stable and long-lasting while exhibiting exceptional selectivity, minimal non-specific interactions, and decreased susceptibility to matrix interferences. These aspects need to be resolved before these sensors can be successfully introduced to the market.
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Affiliation(s)
- Pierrick Clément
- Centre Suisse d'Electronique Et de Microtechnique SA (CSEM), Rue Jaquet-Droz 1, 2002, Neuchâtel, Switzerland.
| | - Walter K Schlage
- Biology Consultant, Max-Baermann-Strasse 21, 51429, Bergisch Gladbach, Germany
| | - Julia Hoeng
- Biology Consultant, Max-Baermann-Strasse 21, 51429, Bergisch Gladbach, Germany
- Vectura Fertin Pharma, C/O Jagotec AG, Messeplatz 10, 4058, Basel, Switzerland
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Sharma P, Rao V, Chand PK, Murthy P. Quantification of Δ9-tetrahydrocannabinol in urine as a marker of cannabis abuse. Indian J Med Res 2023; 158:535-541. [PMID: 37929356 PMCID: PMC10878489 DOI: 10.4103/ijmr.ijmr_3899_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND OBJECTIVES Cannabis use has long been associated with celebration and hospitality, although abuse must be confirmed through testing. It has always been difficult to develop an accurate and reliable confirmatory method for the quantification of tetrahydrocannabinol carboxylic acid (THC-COOH) that meets local requirements. The goal was to develop a rapid, cost-effective analytical technique that can handle large batches. METHODS Because of the wide metabolite detection window and ease of collection, urine was preferable sample. The extraction of a pre-screened urine sample (adulteration and multidrug screening) was done on Bond Elut cartridges using a positive pressure vacuum manifold, followed by quantification using a gas chromatograph and mass spectrometer. RESULTS The assay was linear between 15 and 300 ng/ml ( r2 of 0.99). The intra-day precision was 8.69 per cent and the inter-day precision was 10.78 per cent, respectively with a 97.5 per cent recovery rate for the lowest concentration. A total of 939 urine samples were examined, with 213 detecting cannabis. Sixty per cent of the total individuals tested positive for simply cannabinoids, 33 per cent for cannabinoids and sedatives, five per cent for cannabinoids and morphine and one for cannabis, morphine and cocaine. INTERPRETATION CONCLUSIONS Assay characteristics included modest sample preparation, rapid chromatography, high specificity and small sample volume with a processing time of 12 h. The assay described here can be applied for diagnostic laboratories and in forensic settings as well.
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Affiliation(s)
- Priyamvada Sharma
- Department of Clinical Psychopharmacology & Neurotoxicology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vijayashree Rao
- Department of Centre for Addicition Medicine, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Prabhat Kumar Chand
- Department of Centre for Addicition Medicine, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Clinical Psychopharmacology & Neurotoxicology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
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Alvarez JC, Pelissier AL, Mura P, Goullé JP. [Cannabidiol (CBD): Analytical and toxicological aspects]. Therapie 2023; 78:639-645. [PMID: 36868996 DOI: 10.1016/j.therap.2023.02.006] [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] [Received: 07/05/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
Cannabidiol (CBD) is a phytocannabinoid present in cannabis, obtained either by extraction from the plant or by synthesis. The latter has the advantage of being pure and contains few impurities, unlike CBD of plant origin. It is used by inhalation, ingestion or skin application. In France, the law stipulates that specialties containing CBD may contain up to 0.3% of tetrahydrocannabinol (THC), the psychoactive principle of cannabis. From an analytical point of view, it is therefore important to be able to quantify the two compounds as well as their metabolites in the various matrices that can be used clinically or forensically, in particular saliva and blood. The transformation of CBD into THC, which has long been suggested, appears to be an analytical artifact under certain conditions. CBD is not without toxicity, whether acute or chronic, as seems to attest to the serious adverse effects recorded by pharmacovigilance during the experiment currently being conducted in France by the Agence Nationale de Sécurité du Médicament et des Produits de Santé. Although CBD does not seem to modify driving abilities, driving a vehicle after consuming CBD containing up to 0.3% THC, and sometimes much more in products bought on the internet, can lead to a positive result in screening and confirmation tests by law enforcement agencies, whether salivary or blood tests, and therefore lead to a legal sanction.
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Affiliation(s)
- Jean-Claude Alvarez
- Laboratoire de pharmacologie/toxicologie, CHU Garches, université Paris-Saclay (Versailles-St Quentin-en-Yvelines), plateforme de spectrométrie de masse MasSpecLab, UFR médecine Simone Veil, Inserm U-1018, CESP, Équipe MOODS, 92380 Garches, France.
| | - Anne-Laure Pelissier
- Laboratoire de toxicologie, service de médecine légale, AP-HM, CHU Timone, Aix-Marseille université, 13005 Marseille, France
| | - Patrick Mura
- Académie nationale de Pharmacie, 75270 Paris, France
| | - Jean-Pierre Goullé
- Laboratoire de toxicologie, UNIROUEN, UR ABTE EA 4651, UFR de santé, université de Rouen, 76183 Rouen, France
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Siva Prasad MS, Priyatha CV, K Joseph J, Aneesh EM. Use of psychoactive substances by goods carriage drivers associated with Kerala, India. TRAFFIC INJURY PREVENTION 2023; 24:663-669. [PMID: 37603111 DOI: 10.1080/15389588.2023.2246163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/05/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE This study aimed to measure the prevalence of drugs of abuse (DOA) among the goods carriage drivers associated with the southern State of India, Kerala. METHODS Point-of-collection testing (POCT) of oral fluid collected from the participants (n = 249) was done using the Evidence MultiSTAT DOA Oral Fluid II Assay kits and the Evidence MultiSTAT analyzer. RESULTS Out of the total samples, 53 (21.29%) were positive for one or more DOA. A high prevalence of tetrahydrocannabinol (THC) (10.04%) and synthetic cannabinoids were detected in the samples. The use of ketamine, alpha-PVP, LSD, methamphetamine, opiate, 6-MAM, benzodiazepines I, methadone, PCP, tramadol, and amphetamine was also detected and their frequency of use ranged between 4.02 and 0.80%. An association between drug abuse and distance of travel was found in drivers in this study, χ2 (5, N = 249) = 123.5, p < 0.001. Confirmatory analysis using ultra-high performance liquid chromatography-tandem mass spectrometry showed excellent agreement with the results of the screening test. CONCLUSIONS This was the first study conducted among drivers in India for the detection of DOA. Tetrahydrocannabinol (THC) was used more by the goods carriage drivers associated with Kerala State, India. The use of psychoactive substances significantly increased with the distance of travel. Point-of-collection testing (POCT) by the biochip array technology is an efficient method for the detection of these substances.
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Affiliation(s)
- M S Siva Prasad
- Department of Life Sciences, University of Calicut, Kerala Police Academy, Thrissur, India
| | - C V Priyatha
- Endocrinology and Toxicology Laboratory, Department of Zoology, University of Calicut, Malappuram, India
| | | | - E M Aneesh
- Department of Zoology, University of Calicut, Malappuram, India
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Fordjour E, Manful CF, Sey AA, Javed R, Pham TH, Thomas R, Cheema M. Cannabis: a multifaceted plant with endless potentials. Front Pharmacol 2023; 14:1200269. [PMID: 37397476 PMCID: PMC10308385 DOI: 10.3389/fphar.2023.1200269] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Cannabis sativa, also known as "hemp" or "weed," is a versatile plant with various uses in medicine, agriculture, food, and cosmetics. This review attempts to evaluate the available literature on the ecology, chemical composition, phytochemistry, pharmacology, traditional uses, industrial uses, and toxicology of Cannabis sativa. So far, 566 chemical compounds have been isolated from Cannabis, including 125 cannabinoids and 198 non-cannabinoids. The psychoactive and physiologically active part of the plant is a cannabinoid, mostly found in the flowers, but also present in smaller amounts in the leaves, stems, and seeds. Of all phytochemicals, terpenes form the largest composition in the plant. Pharmacological evidence reveals that the plants contain cannabinoids which exhibit potential as antioxidants, antibacterial agents, anticancer agents, and anti-inflammatory agents. Furthermore, the compounds in the plants have reported applications in the food and cosmetic industries. Significantly, Cannabis cultivation has a minimal negative impact on the environment in terms of cultivation. Most of the studies focused on the chemical make-up, phytochemistry, and pharmacological effects, but not much is known about the toxic effects. Overall, the Cannabis plant has enormous potential for biological and industrial uses, as well as traditional and other medicinal uses. However, further research is necessary to fully understand and explore the uses and beneficial properties of Cannabis sativa.
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Affiliation(s)
- Eric Fordjour
- School of Science and the Environment, Memorial University of Newfoundland, Corner Brook, NL, Canada
- Biotron Experimental Climate Change Research Centre/Department of Biology, University of Western Ontario, London, ON, Canada
| | - Charles F. Manful
- School of Science and the Environment, Memorial University of Newfoundland, Corner Brook, NL, Canada
| | - Albert A. Sey
- School of Science and the Environment, Memorial University of Newfoundland, Corner Brook, NL, Canada
| | - Rabia Javed
- School of Science and the Environment, Memorial University of Newfoundland, Corner Brook, NL, Canada
| | - Thu Huong Pham
- School of Science and the Environment, Memorial University of Newfoundland, Corner Brook, NL, Canada
| | - Raymond Thomas
- Biotron Experimental Climate Change Research Centre/Department of Biology, University of Western Ontario, London, ON, Canada
| | - Mumtaz Cheema
- School of Science and the Environment, Memorial University of Newfoundland, Corner Brook, NL, Canada
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Wennberg E, Windle SB, Filion KB, Thombs BD, Gore G, Benedetti A, Grad R, Ells C, Eisenberg MJ. Roadside screening tests for cannabis use: A systematic review. Heliyon 2023; 9:e14630. [PMID: 37064483 PMCID: PMC10102219 DOI: 10.1016/j.heliyon.2023.e14630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/20/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
As more countries legalize recreational cannabis, roadside screening programs are imperative to detect and deter driving under the influence of cannabis. This systematic review evaluated roadside screening tests for cannabis use. We searched six databases (inception-March 2020) and grey literature sources for primary studies evaluating test characteristics of roadside screening tests for cannabis use compared to laboratory tests for cannabinoids in blood or oral fluid. The synthesis was focused on sensitivity and specificity of delta-9-tetrahydrocannabinol (THC) detection. 101 studies were included. Oral fluid tests were higher in specificity and lower in sensitivity compared to urine tests when evaluated against blood laboratory tests. Oral fluid tests were higher in sensitivity and similar in specificity compared to observational tests when evaluated against blood and oral fluid laboratory tests. Sensitivity was variable among oral fluid tests; two instrumented immunoassays (Draeger DrugTest 5000 [5 ng/mL THC cut-off] and Alere DDS 2 Mobile Test System) appeared to perform best, but definitive conclusions could not be drawn due to imprecise estimates. Specificities were similar. Overall, oral fluid tests showed the most promise for use in roadside screening for blood THC levels over legal limits; their continued development and testing are warranted. Urine tests are generally inadvisable, and observational tests require sensitivity improvements.
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Erridge S, Olsson F, Sodergren MH. Patient priorities for research: A focus group study of UK medical cannabis patients. Complement Ther Clin Pract 2023; 50:101693. [PMID: 36399996 DOI: 10.1016/j.ctcp.2022.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/06/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There has yet to be an evaluation of medical cannabis patient preferences with respect to future research. As such, prioritisation of research agendas has been largely driven by academia and industry. The primary aim of this study was to elicit priorities for research from medical cannabis patients in the United Kingdom (UK). METHODS Patients undergoing active treatment for health conditions with medical cannabis in the UK were invited to take part in focus groups from December 2021 to February 2022. An inductive thematic analysis of responses was performed. Participants also completed a ranking exercise whereby they assigned ten counters (each equivalent to £1 million GBP) to competing research priorities. RESULTS 30 medical cannabis patients participated across 3 focus groups. The following themes were identified as research priorities: adverse events, comparison between cannabis-based medicinal products, health conditions, pharmacology of cannabis, types of study, healthcare professionals' attitudes, social environment, agriculture and manufacturing, and the cannabis plant. Participants assigned the highest proportion of research funding to 'assessment of effect on specific symptoms' (26 counters; 8.7%). CONCLUSIONS This study highlighted specific themes within which to focus future research on medical cannabis. Clinically, there was a directive towards ensuring that research is condition- or symptom-specific. Participants also emphasised themes on the social impact of medical cannabis, such as knowledge of medical cannabis among healthcare professionals, stigma, and effects on driving and in the workplace. These findings can guide both research funders and researchers into effectively conducting research which fits within a more patient-centric model.
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Affiliation(s)
- Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK; Sapphire Medical Clinics, London, UK
| | - Fabian Olsson
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK; Sapphire Medical Clinics, London, UK.
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Cheng JYK, Hui JWS, Chan WS, So MH, Hong YH, Leung WT, Ku KW, Yeung HS, Lo KM, Fung KM, Ip CY, Dao KL, Cheung BKK. Interpol review of toxicology 2019-2022. Forensic Sci Int Synerg 2022; 6:100303. [PMID: 36597440 PMCID: PMC9799715 DOI: 10.1016/j.fsisyn.2022.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Bobbie Kwok-keung Cheung
- Corresponding author. Government Laboratory, 7/F, Homantin Government Offices, 88 Chung Hau Street, Ho Man Tin, Kowloon, SAR, Hong Kong, China. http://www.govtlab.gov.hk/
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Baker AN, Hawker-Bond GW, Georgiou PG, Dedola S, Field RA, Gibson MI. Glycosylated gold nanoparticles in point of care diagnostics: from aggregation to lateral flow. Chem Soc Rev 2022; 51:7238-7259. [PMID: 35894819 PMCID: PMC9377422 DOI: 10.1039/d2cs00267a] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Current point-of-care lateral flow immunoassays, such as the home pregnancy test, rely on proteins as detection units (e.g. antibodies) to sense for analytes. Glycans play a fundamental role in biological signalling and recognition events such as pathogen adhesion and hence they are promising future alternatives to antibody-based biosensing and diagnostics. Here we introduce the potential of glycans coupled to gold nanoparticles as recognition agents for lateral flow diagnostics. We first introduce the concept of lateral flow, including a case study of lateral flow use in the field compared to other diagnostic tools. We then introduce glycosylated materials, the affinity gains achieved by the cluster glycoside effect and the current use of these in aggregation based assays. Finally, the potential role of glycans in lateral flow are explained, and examples of their successful use given. Antibody-based lateral flow (immune) assays are well established, but here the emerging concept and potential of using glycans as the detection agents is reviewed.![]()
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Affiliation(s)
- Alexander N Baker
- Department of Chemistry, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK.
| | - George W Hawker-Bond
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital Oxford, Oxford, OX3 9DU, UK
| | - Panagiotis G Georgiou
- Department of Chemistry, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK.
| | | | - Robert A Field
- Iceni Glycoscience Ltd, Norwich, NR4 7GJ, UK.,Department of Chemistry and Manchester Institute of Biotechnology, University of Manchester, Manchester M1 7DN, UK
| | - Matthew I Gibson
- Department of Chemistry, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK. .,Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK
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12
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Savage T, Sanders T, Pieters R, Miles A, Barkholtz H. Suitability of SoToxa® Oral Fluid Screening Over Time: Re-examination of Drugged Driving in Wisconsin. J Anal Toxicol 2022; 46:825-834. [PMID: 35767245 DOI: 10.1093/jat/bkac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Drug impaired driver detection is a critical element of traffic safety. However, shifting drug use patterns over time and geography may limit long-term reliability of assay-based screening tools. In this work, we compare qualitative results from the Abbott SoToxa® oral fluid (OF) screening device to Quantisal™ OF and whole blood. Our objective was to examine these three qualitative toxicological approaches, scope applicability of OF collection at the roadside, and compare to a previous analysis of SoToxa® in Wisconsin. OF specimens were screened with the SoToxa® for six drugs or drug classes including amphetamine, benzodiazepines, cocaine, methamphetamine, opioids, and tetrahydrocannabinol (THC). OF and blood specimens were collected from 106 participants. Quantisal™ OF and blood specimens were screened for drugs on ultra-performance liquid chromatography coupled to quadrupole time-of-flight high-resolution mass spectrometry (UPLC-QToF-HRMS) using a data independent acquisition mode. UPLC-QToF-HRMS data was compared to comprehensive spectral libraries and drugs were qualitatively identified. Drug Recognition Expert evaluations were performed, and face sheets submitted for 21 participants in this work. In general, the SoToxa® results were consistent with the combined qualitative results observed in Quantisal™ OF specimens and whole blood specimens. Limitations were uncovered for benzodiazepines, opioids, and THC. The SoToxa® benzodiazepine assay has high cutoff concentrations for diazepam and clonazepam, limiting its sensitivity and positive predictive value when considering these drugs. SoToxa® opioid screening did not detect fentanyl, which is increasingly prevalent among drug users. Finally, ∆9-THC and its major metabolite 11-nor-9-carboxy-∆9-THC are lipophilic, limiting partitioning into oral fluid. Despite these limitations, the SoToxa® instrument may be useful in assisting law enforcement with identifying individuals driving under the influence of drugs and establishing probable cause at roadside for making impaired driving arrests. Furthermore, Quantisal™ OF may be useful as screening specimens due to their ease of collection and results consistent with whole blood.
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Affiliation(s)
- Theodore Savage
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Therese Sanders
- Wisconsin Department of Transportation, Bureau of Transportation Safety and Technical Services, Chemical Testing Section, 3502 Kinsman Boulevard, Madison, WI 53704, USA
| | - Ryan Pieters
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Amy Miles
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Heather Barkholtz
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA.,Pharmaceutical Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA
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13
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Towards the Validation of an Observational Tool to Detect Impaired Drivers-An Online Video Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127548. [PMID: 35742798 PMCID: PMC9223496 DOI: 10.3390/ijerph19127548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/31/2022]
Abstract
Abuse of alcohol and other drugs is a major risk factor at work. To reduce this risk, workplace drug testing is performed in transportation and other industries. VERIFY, an observational method, is one of the key elements in a procedure adopted by the police of the canton of Zurich, Switzerland, for detecting impaired drivers. The observational method has been successfully applied by adequately trained police officers since 2014. The aim of this study is to examine the interrater reliability of the observational method, the effect of training in use of the method, and the role of having experience in the police force and traffic police force on the outcome when rating a driver’s impairment. For this purpose, driver impairment in staged road traffic controls presented in videos was rated by laypeople (n = 81), and police officers without (n = 146) and with training (n = 172) in the VERIFY procedure. In general, the results recorded for police officers with training revealed a moderate to very good interrater reliability of the observational method. Among the three groups, impaired drivers were best identified by officers with training (ranging between 82.6% and 89.5% correct identification). Trained officers reported a higher impairment severity of the impaired drivers than the other two groups, indicating that training increases sensitivity to signs of impairment. Our findings also suggest that online video technology could be helpful in identifying impaired drivers. Trained police officers could be connected to a road traffic control to make observations via live video. By this method efficiency and reliability in detecting abuse of alcohol and other drugs could be improved. Our findings also apply to workplace drug testing in general.
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14
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McCartney D, Arkell TR, Irwin C, Kevin RC, McGregor IS. Are blood and oral fluid Δ 9-tetrahydrocannabinol (THC) and metabolite concentrations related to impairment? A meta-regression analysis. Neurosci Biobehav Rev 2021; 134:104433. [PMID: 34767878 DOI: 10.1016/j.neubiorev.2021.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022]
Abstract
Blood and oral fluid Δ9-tetrahydrocannabinol (THC) concentrations are often used to identify cannabis-impaired drivers. We used meta-analytic techniques to characterise the relationships between biomarkers of cannabis use, subjective intoxication, and impairment of driving and driving-related cognitive skills. Twenty-eight publications and 822 driving-related outcomes were reviewed. Each outcome was measured in concert with one or more biomarkers of cannabis/THC use and/or subjective intoxication. Higher blood THC and 11-OH-THC concentrations, oral fluid THC concentrations and subjective ratings of intoxication were associated with greater impairment in 'other' (mostly occasional) cannabis users (p's<0.05). Blood 11-COOH-THC concentrations were associated with impairment after inhaling, but not orally ingesting, cannabis/THC. However t these 'biomarker-performance' relationships (R) were only very weak (blood THCpost-ingestion: -0.08; blood THCpost-inhalation: -0.10; blood 11-OH-THCpost-ingestion: -0.13), weak (blood 11-OH-THCpost-inhalation: -0.24; oral fluid THCpost-inhalation: -0.36; subjective intoxication: -0.29) or moderate (blood 11-COOH-THCpost-inhalation: -0.43) in strength. No significant biomarker-performance relationships were observed in 'regular' (weekly or more often) cannabis users (p's>0.10), although the analyses were less robust. Blood and oral fluid THC concentrations are relatively poor indicators of cannabis/THC-induced impairment.
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Affiliation(s)
- Danielle McCartney
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.
| | - Thomas R Arkell
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Christopher Irwin
- Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Richard C Kevin
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
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15
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Abstract
As more states in the U.S legalize recreational and medicinal cannabis, rates of driving under the influence of this drug are increasing significantly. Aspects of this emerging public health issue potentially pit science against public policy. The authors believe that the legal cart is currently significantly ahead of the scientific horse. Issues such as detection procedures for cannabis-impaired drivers, and use of blood THC levels to gauge impairment, should rely heavily on current scientific knowledge. However, there are many, often unacknowledged research gaps in these and related areas, that need to be addressed in order provide a more coherent basis for public policies. This review focuses especially on those areas. In this article we review in a focused manner, current information linking cannabis to motor vehicle accidents and examine patterns of cannabis-impairment of driving related behaviors, their time courses, relationship to cannabis dose and THC blood levels, and compare cannabis and alcohol-impaired driving patterns directly. This review also delves into questions of alcohol-cannabis combinations and addresses the basis for of per-se limits in cannabis driving convictions. Finally, we distinguish between areas where research has provided clear answers to the above questions, areas that remain unclear, and make recommendations to fill gaps in current knowledge.
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Affiliation(s)
- Godfrey D. Pearlson
- Department of Psychiatry, Olin Neuropsychiatry Research Center, Institute of Living, Hartford Healthcare Corporation, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States
| | - Michael C. Stevens
- Department of Psychiatry, Olin Neuropsychiatry Research Center, Institute of Living, Hartford Healthcare Corporation, Hartford, CT, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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16
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McCartney D, Kevin RC, Suraev AS, Irwin C, Grunstein RR, Hoyos CM, McGregor IS. Orally administered cannabidiol does not produce false-positive tests for Δ 9 -tetrahydrocannabinol on the Securetec DrugWipe® 5S or Dräger DrugTest® 5000. Drug Test Anal 2021; 14:137-143. [PMID: 34412166 PMCID: PMC9292716 DOI: 10.1002/dta.3153] [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: 06/15/2021] [Revised: 07/21/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
Many jurisdictions use point‐of‐collection (POC) oral fluid testing devices to identify driving under the influence of cannabis, indexed by the presence of Δ9‐tetrahydrocannabinol (THC), an intoxicating cannabinoid, in oral fluid. Although the use of the non‐intoxicating cannabinoid, cannabidiol (CBD), is not prohibited among drivers, it is unclear whether these devices can reliably distinguish between CBD and THC, which have similar chemical structures. This study determined whether orally administered CBD produces false‐positive tests for THC on standard, POC oral fluid testing devices. In a randomised, double‐blind, crossover design, healthy participants (n = 17) completed four treatment sessions involving the administration of either placebo or 15‐, 300‐ or 1500‐mg pure CBD in a high‐fat dietary supplement. Oral fluid was sampled, and the DrugWipe®‐5S (DW‐5S; 10 ng·ml−1 THC cut‐off) and Drug Test® 5000 (DT5000; 10 ng·mL−1 THC cut‐off) devices administered, at baseline (pretreatment) and ~20‐, ~145‐ and ~185‐min posttreatment. Oral fluid cannabinoid concentrations were measured using ultra‐high performance liquid chromatography–tandem mass spectrometry. Median (interquartile range [IQR]) oral fluid CBD concentrations were highest at ~20 min, quantified as 0.4 (6.0), 15.8 (41.6) and 167 (233) ng·ml−1 on the 15‐, 300‐ and 1500‐mg CBD treatments, respectively. THC, cannabinol and cannabigerol were not detected in any samples. A total of 259 DW‐5S and 256 DT5000 tests were successfully completed, and no THC‐positive tests were observed. Orally administered CBD does not appear to produce false‐positive (or true‐positive) tests for THC on the DW‐5S and DT5000. The likelihood of an individual who is using a CBD (only) oral formulation being falsely accused of DUIC therefore appears low.
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Affiliation(s)
- Danielle McCartney
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Richard C Kevin
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Anastasia S Suraev
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Irwin
- Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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17
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Knott J, Yap C, Mitra B, Gerdtz M, Daniel C, Braitberg G. Screening major trauma patients for prevalence of illicit drugs. Drug Alcohol Rev 2021; 41:285-292. [PMID: 34263497 DOI: 10.1111/dar.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Australasian emergency departments (ED) routinely test patient alcohol levels following major trauma, but assessment for illicit drugs is uncommon. METHODS A prospective cross-sectional study of major motor-vehicle-related trauma patients attending both adult major trauma centres in Victoria, Australia. All eligible patients had point-of-care saliva testing to determine the prevalence of common illicit drugs. RESULTS Over 12 months, 1411 patients were screened, 36 refused (2.6%) and 63 were excluded. Of the final 1312 cases included, 173 (13.2%; 95% confidence interval 11.5, 15.1) tested positive to at least one illicit substance, with 133 (76.9%; 69.7, 82.8) positive for meth/amphetamines. One in five had more than one illicit substance detected. Patients testing positive were most frequently in motor vehicles (91.9% vs. 85.6%) and least frequently cyclists (2.3% vs. 4.2%) or pedestrians (5.2% vs. 10.3%), compared to those testing negative. They were younger (mean age 35.4 vs. 43.1 years), more likely to arrive overnight (27.2% vs. 12.1%) or after single vehicle crashes (54.3% vs. 42.3%). Although the initial disposition from ED did not differ, those testing positive were more likely to re-present within 28 days (13.9% vs. 5.4%). DISCUSSION AND CONCLUSIONS A high prevalence of potentially illicit substances among patients presenting with suspected major trauma supports the need for urgent preventive strategies. The low rate of patient refusal and large numbers screened by ED staff suggests that point-of care testing for illicit substances in major trauma is acceptable and feasible. This study and ongoing surveillance may be used to inform driver education strategies.
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Affiliation(s)
- Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, Melbourne, Australia
| | - Celene Yap
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Biswadev Mitra
- Emergency Department, Alfred Hospital, Melbourne, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Catherine Daniel
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - George Braitberg
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
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18
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Arkell TR, Lintzeris N, Mills L, Suraev A, Arnold JC, McGregor IS. Driving-Related Behaviours, Attitudes and Perceptions among Australian Medical Cannabis Users: Results from the CAMS 18-19 Survey. ACCIDENT; ANALYSIS AND PREVENTION 2020; 148:105784. [PMID: 33017729 DOI: 10.1016/j.aap.2020.105784] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
As the use of cannabis for medical purposes becomes increasingly prevalent, driving under the influence of cannabis (DUIC) is emerging as a major public health issue. Understanding current behaviours, attitudes and perceptions around DUIC in medical cannabis users is an important first step in addressing this issue. Here we present the results from the driving-related subsection of the Cannabis as Medicine 2018-2019 Survey (CAMS18) of current Australian medical cannabis users (n = 1388). Of the 806 respondents who reported driving a motor vehicle in the last month, 34.6% said they typically drive within 3 hours of cannabis use, thereby risking DUIC, while more than 50% waited at least 7 hours before driving. A majority of respondents thought that their medical cannabis use did not affect their driving ability, and most denied any specific effects of cannabis on speeding, risk taking, reaction time, attentiveness or lane departures. A substantial majority (70.9%) felt confident in accurately assessing their own driving ability after using medical cannabis. Binary logistic regression showed that frequency of use and confidence to assess driving ability were strongly related to DUIC behaviour (i.e. driving soon after cannabis use). These results suggest a relatively high prevalence of DUIC and low perception of risk among this sample of medical cannabis users. Further research is needed to better understand the acute and chronic effects of medical cannabis use on driving and the relation between perceived and actual driving ability.
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Affiliation(s)
- Thomas R Arkell
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, University of Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, NSW, Australia; Faculty Medicine and Health, Division Addiction Medicine, University of Sydney, NSW, Australia
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, NSW, Australia
| | - Anastasia Suraev
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, NSW, Australia
| | - Jonathon C Arnold
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, NSW, Australia; Faculty of Medicine and Health, Discipline of Pharmacology, University of Sydney, NSW, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, NSW, Australia.
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19
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McGregor IS, Cairns EA, Abelev S, Cohen R, Henderson M, Couch D, Arnold JC, Gauld N. Access to cannabidiol without a prescription: A cross-country comparison and analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102935. [DOI: 10.1016/j.drugpo.2020.102935] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 01/03/2023]
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20
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Scherer J, Schuch J, Rabelo-da-Ponte F, Silvestrin R, Ornell R, Sousa T, Limberger R, Pechansky F. Analytical reliability of four oral fluid point-of-collection testing devices for drug detection in drivers. Forensic Sci Int 2020; 315:110434. [DOI: 10.1016/j.forsciint.2020.110434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
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21
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Abstract
The Australian Federal Government legalised access to medicinal cannabis in 2016 More than 100 different cannabis products are now available to prescribe. Most are oral preparations (oils) or capsules containing delta-9-tetrahydrocannabinol or cannabidiol. Dried-flower products are also available As most products are unregistered drugs, prescribing requires approval under the Therapeutic Goods Administration Special Access Scheme-B or Authorised Prescriber Scheme Special Access Scheme Category B applications can be made online, with approval usually being given within 24–48 hours. However, supply chain problems may delay dispensing by the pharmacy By the end of 2019, over 28,000 prescribing approvals had been issued to patients, involving more than 1400 doctors, mostly GPs. More than 70,000 approvals are projected by the end of 2020 Most prescriptions are for chronic non-cancer pain, anxiety, cancer-related symptoms, epilepsy and other neurological disorders. However, the evidence supporting some indications is limited Many doctors are cautious about prescribing cannabis. While serious adverse events are rare, there are legitimate concerns around driving, cognitive impairment and drug dependence with products containing delta-9-tetrahydrocannabinol. Cannabidiol-only products pose fewer risks
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Affiliation(s)
- Jonathon C Arnold
- University of Sydney.,National Institute of Integrative Medicine, Melbourne
| | - Tamara Nation
- University of Sydney.,National Institute of Integrative Medicine, Melbourne
| | - Iain S McGregor
- University of Sydney.,National Institute of Integrative Medicine, Melbourne
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22
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Brighenti V, Protti M, Anceschi L, Zanardi C, Mercolini L, Pellati F. Emerging challenges in the extraction, analysis and bioanalysis of cannabidiol and related compounds. J Pharm Biomed Anal 2020; 192:113633. [PMID: 33039911 DOI: 10.1016/j.jpba.2020.113633] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
Cannabidiol (CBD) is a bioactive terpenophenolic compound isolated from Cannabis sativa L. It is known to possess several properties of pharmaceutical interest, such as antioxidant, anti-inflammatory, anti-microbial, neuroprotective and anti-convulsant, being it active as a multi-target compound. From a therapeutic point of view, CBD is most commonly used for seizure disorder in children. CBD is present in both medical and fiber-type C. sativa plants, but, unlike Δ9-tetrahydrocannabinol (THC), it is a non-psychoactive compound. Non-psychoactive or fiber-type C. sativa (also known as hemp) differs from the medical one, since it contains only low levels of THC and high levels of CBD and related non-psychoactive cannabinoids. In addition to medical Cannabis, which is used for many different therapeutic purposes, a great expansion of the market of hemp plant material and related products has been observed in recent years, due to its usage in many fields, including food, cosmetics and electronic cigarettes liquids (commonly known as e-liquids). In this view, this work is focused on recent advances on sample preparation strategies and analytical methods for the chemical analysis of CBD and related compounds in both C. sativa plant material, its derived products and biological samples. Since sample preparation is considered to be a crucial step in the development of reliable analytical methods for the determination of natural compounds in complex matrices, different extraction methods are discussed. As regards the analysis of CBD and related compounds, the application of both separation and non-separation methods is discussed in detail. The advantages, disadvantages and applicability of the different methodologies currently available are evaluated. The scientific interest in the development of portable devices for the reliable analysis of CBD in vegetable and biological samples is also highlighted.
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Affiliation(s)
- Virginia Brighenti
- Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 103, 41125 Modena, Italy
| | - Michele Protti
- Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy
| | - Lisa Anceschi
- Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 103, 41125 Modena, Italy; Doctorate School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Via G. Campi 103/287, 41125 Modena, Italy
| | - Chiara Zanardi
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Via G. Campi 103, 41125 Modena, Italy
| | - Laura Mercolini
- Department of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy.
| | - Federica Pellati
- Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 103, 41125 Modena, Italy.
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23
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McCartney D, Benson MJ, Suraev AS, Irwin C, Arkell TR, Grunstein RR, Hoyos CM, McGregor IS. The effect of cannabidiol on simulated car driving performance: A randomised, double-blind, placebo-controlled, crossover, dose-ranging clinical trial protocol. Hum Psychopharmacol 2020; 35:e2749. [PMID: 32729120 DOI: 10.1002/hup.2749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Interest in the use of cannabidiol (CBD) is increasing worldwide as its therapeutic effects are established and legal restrictions moderated. Unlike Δ9 -tetrahydrocannabinol (Δ9 -THC), CBD does not appear to cause cognitive or psychomotor impairment. However, further assessment of its effects on cognitively demanding day-to-day activities, such as driving, is warranted. Here, we describe a study investigating the effects of CBD on simulated driving and cognitive performance. METHODS Thirty healthy individuals will be recruited to participate in this randomised, double-blind, placebo-controlled crossover trial. Participants will complete four research sessions each involving two 30-min simulated driving performance tests completed 45 and 210 min following oral ingestion of placebo or 15, 300, or 1,500 mg CBD. Cognitive function and subjective drug effects will be measured, and blood and oral fluid sampled, at regular intervals. Oral fluid drug testing will be performed using the Securetec DrugWipe® 5S and Dräger DrugTest® 5000 devices to determine whether CBD increases the risk of "false-positive" roadside tests to Δ9 -THC. Noninferiority analyses will test the hypothesis that CBD is no more impairing than placebo. CONCLUSION This study will clarify the risks involved in driving following CBD use and assist in ensuring the safe use of CBD by drivers.
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Affiliation(s)
- Danielle McCartney
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Melissa J Benson
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Anastasia S Suraev
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Irwin
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Thomas R Arkell
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, New South Wales, Australia
| | - Camilla M Hoyos
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Suraev A, Grunstein RR, Marshall NS, D'Rozario AL, Gordon CJ, Bartlett DJ, Wong K, Yee BJ, Vandrey R, Irwin C, Arnold JC, McGregor IS, Hoyos CM. Cannabidiol (CBD) and Δ 9-tetrahydrocannabinol (THC) for chronic insomnia disorder ('CANSLEEP' trial): protocol for a randomised, placebo-controlled, double-blinded, proof-of-concept trial. BMJ Open 2020; 10:e034421. [PMID: 32430450 PMCID: PMC7239553 DOI: 10.1136/bmjopen-2019-034421] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/06/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Insomnia is a highly prevalent and costly condition that is associated with increased health risks and healthcare utilisation. Anecdotally, cannabis use is frequently reported by consumers to promote sleep. However, there is limited research on the effects of cannabis on sleep and daytime function in people with insomnia disorder using objective measures. This proof-of-concept study will evaluate the effects of a single dose of an oral cannabis-based medicine on sleep and daytime function in participants with chronic insomnia disorder. METHODS AND ANALYSIS A randomised, crossover, placebo-controlled, single-dose study design will be used to test the safety and efficacy of an oral oil solution ('ETC120') containing 10 mg Δ9-tetrahydrocannabinol (THC) and 200 mg cannabidiol (CBD) in 20 participants diagnosed with chronic insomnia disorder. Participants aged 35-60 years will be recruited over an 18-month period commencing August 2019. Each participant will receive both the active drug and matched placebo, in a counterbalanced order, during two overnight study assessment visits, with at least a 1-week washout period between each visit. The primary outcomes are total sleep time and wake after sleep onset assessed via polysomnography. In addition, 256-channel high-density electroencephalography and source modelling using structural brain MRI will be used to comprehensively examine brain activation during sleep and wake periods on ETC120 versus placebo. Next-day cognitive function, alertness and simulated driving performance will also be investigated. ETHICS AND DISSEMINATION Ethics approval was received from Bellberry Human Research Ethics Committee (2018-04-284). The findings will be disseminated in a peer-reviewed open-access journal and at academic conferences. TRIAL REGISTRATION NUMBER ANZCTRN12619000714189.
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Affiliation(s)
- Anastasia Suraev
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Angela L D'Rozario
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Delwyn J Bartlett
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
| | - Keith Wong
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Brendon J Yee
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chris Irwin
- Menzies Health Institute Queensland, School Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Jonathon C Arnold
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Discipline of Pharmacology, Sydney, New South Wales, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
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25
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Thapa D, Samadi N, Patel N, Tabatabaei N. Thermographic detection and quantification of THC in oral fluid at unprecedented low concentrations. BIOMEDICAL OPTICS EXPRESS 2020; 11:2178-2190. [PMID: 32341875 PMCID: PMC7173880 DOI: 10.1364/boe.388990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 06/11/2023]
Abstract
With recent changes in the legalization of cannabis around the world, there is an urgent need for rapid, yet sensitive, screening devices for testing drivers and employees under the influence of cannabis at the roadside and at the workplace, respectively. Oral fluid lateral flow immunoassays (LFAs) have recently been explored for such applications. While LFAs offer on-site, low-cost and rapid detection of tetrahydrocannabinol (THC), their nominal detection threshold is about 25 ng/ml, which is well above the 1-5 ng/ml per se limits set by regulations. In this paper, we report on the development of a thermo-photonic imaging system that utilizes the commercially available low-cost LFAs but offers detection of THC at unprecedented low concentrations. Our reader technology examines photothermal responses of gold nanoparticles (GNPs) in LFA through lock-in thermography (LIT). Our results (n = 300) suggest that the demodulation of localized surface plasmon resonance responses of GNPs captured by infrared cameras allows for detection of THC concentrations as low as 2 ng/ml with 96% accuracy. Quantification of THC concentration is also achievable with our technology through calibration.
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Affiliation(s)
- Damber Thapa
- Department of Mechanical Engineering, Lassonde School of Engineering, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
- Equal contribution
| | - Nakisa Samadi
- Department of Mechanical Engineering, Lassonde School of Engineering, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
- Equal contribution
| | - Nisarg Patel
- Department of Mechanical Engineering, Lassonde School of Engineering, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Nima Tabatabaei
- Department of Mechanical Engineering, Lassonde School of Engineering, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
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Arkell TR, Kevin RC, Stuart J, Lintzeris N, Haber PS, Ramaekers JG, McGregor IS. Detection of Δ 9 THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point-of-collection testing devices. Drug Test Anal 2019; 11:1486-1497. [PMID: 31442003 PMCID: PMC6856818 DOI: 10.1002/dta.2687] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 01/19/2023]
Abstract
Point‐of‐collection testing (POCT) for Δ9‐tetrahydrocannabinol (THC) in oral fluid is increasingly used to detect driving under the influence of cannabis (DUIC). However, previous studies have questioned the reliability and accuracy of two commonly used POCT devices, the Securetec DrugWipe® 5 s (DW5s) and Dräger DrugTest® 5000 (DT5000). In the current placebo controlled, double‐blind, crossover study we used liquid chromatography‐tandem mass spectrometry (LC–MS/MS) to accurately quantify cannabinoid concentrations in the oral fluid of 14 participants at various timepoints (10, 60, 120, and 180 minutes) following vaporization of 125 mg of THC‐dominant (11% THC; <1% CBD), THC/CBD equivalent (11% THC; 11% CBD) and placebo (<1% THC; <1% CBD) cannabis. At each timepoint, oral fluid was also screened using the DW5s (10 ng/mL THC cut‐off) and DT5000 (10 ng/mL THC cut‐off). LC–MS/MS analysis showed peak oral fluid THC concentrations at the 10 minute timepoint with a rapid decline thereafter. This trajectory did not differ with THC dominant and THC/CBD equivalent cannabis. With a 10 ng/mL confirmatory cut‐off, 5% of DW5s test results were false positives and 16% false negatives. For the DT5000, 10% of test results were false positives and 9% false negatives. Neither the DW5s nor the DT5000 demonstrated the recommended >80% sensitivity, specificity and accuracy. Accuracy was lowest at 60 minutes, when THC concentrations were often close to the screening cut‐off (10 ng/mL). POCT devices can be useful tools in detecting recent cannabis use; however, limitations should be noted, and confirmatory LC–MS/MS quantification of results is strongly advisable.
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Affiliation(s)
- Thomas R Arkell
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard C Kevin
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Jordyn Stuart
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Faculty of Medicine, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,The Langton Centre, Drug and Alcohol Services, South East Sydney Local Health District, NSW Health, New South Wales, Australia
| | - Paul S Haber
- Faculty of Medicine, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, School of Psychology, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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