Pitfall in cannabinoid analysis—detection of a previously unrecognized interfering compound in human serum

Disposition of a single oral dose of a cannabidiol medication in healthy cats

The historical use of the marijuana plant for medicinal purposes is long. One of the historical uses has been for the treatment of epilepsy. Recently, the Food and Drug Administration has approved a highly purified cannabidiol medication for the add on therapy in people with certain forms of epilepsy. With the increase interest of the use of cannabidiol in the veterinary community, the aim of this study was to describe the disposition of a single dose of a cannabidiol medication in healthy cats in both the fed and fasted state. Pharmacokinetic analysis reveals that relative bioavailability of cannabidiol shows a near eleven-fold increase when administered in the fed state compared to the fasted state. Additionally, concentrations achieved at a dose of 5 mg/kg, may be sufficient to explore the therapeutic potential in cats with epilepsy.

A rapid Dilute-and-Shoot LC-MS/MS method for quantifying THC-COOH and THC-COO(Gluc) in urine

Cannabis remains one of the most commonly used psychotropes. Cannabis use is frequently evaluated via the testing of suspected patient samples. Thus, there is a high demand for simple, accurate and fast assays to support the increasing needs for testing. This report highlights a reliable, simple and fast liquid chromatography - tandem mass spectrometry assay that quantifies the cannabis metabolites THC-COOH and THC-COO(Gluc) in human urine. The assay employs a direct dilute-and-shoot approach, whereby urine samples are diluted 10X before being directly injected on the liquid chromatography and mass spectrometer. The assay quantification is based on an internal calibration approach that used deuterated analogues for THC-COOH and THC-COO(Gluc) as internal standards. The assay's analysis time was 5 min. The quantification was valid over a wide linear range (25 - 8,000 ng/mL) for both analytes and was free of matrix interferences. The within-day and between-day precision was determined to be ≤ 15 % CV for both analytes. The assay was validated based on the College of American Pathologists (CAP) and Clinical Laboratory Standards Institute (CLSI) guidelines.

Automation System for the Flexible Sample Preparation for Quantification of Δ9-THC-D3, THC-OH and THC-COOH from Serum, Saliva and Urine

In the life sciences, automation solutions are primarily established in the field of drug discovery. However, there is also an increasing need for automated solutions in the field of medical diagnostics, e.g., for the determination of vitamins, medication or drug abuse. While the actual metrological determination is highly automated today, the necessary sample preparation processes are still mainly carried out manually. In the laboratory, flexible solutions are required that can be used to determine different target substances in different matrices. A suitable system based on an automated liquid handler was implemented. It has been tested and validated for the determination of three cannabinoid metabolites in blood, urine and saliva. To extract Δ9-tetrahydrocannabinol-D3 (Δ9-THC-D3), 11-hydroxy-Δ9-tetrahydrocannabinol (THC-OH) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) from serum, urine and saliva both rapidly and cost-effectively, three sample preparation methods automated with a liquid handling robot are presented in this article, the basic framework of which is an identical SPE method so that they can be quickly exchanged against each other when the matrix is changed. If necessary, the three matrices could also be prepared in parallel. For the sensitive detection of analytes, protein precipitation is used when preparing serum before SPE and basic hydrolysis is used for urine to cleave the glucuronide conjugate. Recoveries of developed methods are >77%. Coefficients of variation are <4%. LODs are below 1 ng/mL and a comparison with the manual process shows a significant cost reduction.

Functional brain connectomes reflect acute and chronic cannabis use

Resting state fMRI has been employed to identify alterations in functional connectivity within or between brain regions following acute and chronic exposure to Δ9-tetrahydrocannabinol (THC), the psychoactive component in cannabis. Most studies focused a priori on a limited number of local brain areas or circuits, without considering the impact of cannabis on whole-brain network organization. The present study attempted to identify changes in the whole-brain human functional connectome as assessed with ultra-high field (7T) resting state scans of cannabis users (N = 26) during placebo and following vaporization of cannabis. Two distinct data-driven methodologies, i.e. network-based statistics (NBS) and connICA, were used to identify changes in functional connectomes associated with acute cannabis intoxication and history of cannabis use. Both methodologies revealed a broad state of hyperconnectivity within the entire range of major brain networks in chronic cannabis users compared to occasional cannabis users, which might be reflective of an adaptive network reorganization following prolonged cannabis exposure. The connICA methodology also extracted a distinct spatial connectivity pattern of hypoconnectivity involving the dorsal attention, limbic, subcortical and cerebellum networks and of hyperconnectivity between the default mode and ventral attention network, that was associated with the feeling of subjective high during THC intoxication. Whole-brain network approaches identified spatial patterns in functional brain connectomes that distinguished acute from chronic cannabis use, and offer an important utility for probing the interplay between short and long-term alterations in functional brain dynamics when progressing from occasional to chronic use of cannabis.

Analytical and medico-legal problems linked to the presence of delta-8-tetrahydrocannabinol (delta-8-THC): Results from urine drug testing in Sweden

During routine urine drug testing for cannabis use targeting delta-9-tetrahydrocannabinol carboxylic acid (delta-9-THC-COOH) at the Karolinska University Laboratory in Sweden, an unknown interfering peak was observed in the liquid-chromatographic-tandem mass-spectrometric (LC-MS/MS) confirmative analysis. The peak showed the same exact mass and most abundant fragments as delta-9-THC-COOH but a slightly shorter retention time, thereby not fulfilling all requirements for a positive identification. The analytical results suggested that it was a similar compound, and with access to reference material, it could be identified as the double bond isomer delta-8-THC-COOH. Delta-8-THC has recently become popular as a recreational drug, although its legality varies and is sometimes unclear. In Sweden, all THC isomers are classified substances. The slight difference in retention times was sufficient to distinguish the THC-COOH isomers in the routine LC-MS/MS method, but another LC method allowed better peak separation and individual quantification. At the Karolinska University Laboratory, delta-8-THC-COOH was first observed in April 2020, and the highest incidence was noted in June 2020 when it was present in 5.3% of all THC-COOH-positive samples. The incidence later decreased to today only occasional findings. Large differences in the relative presence of the isomers in the urine samples indicated different origin, for example, synthetically produced pure delta-8-THC, or mixtures of both THC isomers formed during combustion of cannabidiol (CBD). In conclusion, the appearance of delta-8-THC and other isomers on the recreational drug market risks causing analytical and medico-legal problems, due to confusion with delta-9-THC.

Using measured cannabidiol and tetrahydrocannabinol metabolites in urine to differentiate marijuana use from consumption of commercial cannabidiol products

CONTEXT

Detecting marijuana use is a component of most urine drug screens targeting a single Δ⁹-tetrahydrocannabinol metabolite. Recently, the non-intoxicating cannabinoid, cannabidiol (CBD), has gained popular acceptance for a myriad of reasons. Commercially available CBD products sold without purity regulations have become ubiquitous. Many products contain trace tetrahydrocannabinol. Long-term or high dose use of CBD products can result in tetrahydrocannabinol exposures, potentially producing a positive marijuana drug test. These results are not false positives since marijuana biomarkers are present, but inaccurately identify donors as marijuana users. Addressing this conundrum, we developed an assay discriminating marijuana use from the use of CBD contaminated with tetrahydrocannabinol.

METHODS

Following the synthesis of a primary CBD metabolite, a LC-MS/MS assay was developed measuring the urinary metabolites tetrahydrocannabinol, 11-nor-carboxy-Δ⁹-tetrahydrocannabinol, CBD, and 7-carboxy-cannabidiol. The assay was utilized on 425 patients claiming CBD use, and sixteen samples from trusted users of commercial CBD products.

RESULTS AND DISCUSSION

Clear data clusters enabled metabolic cut-points assignments. Forty-three percent of samples contained CBD metabolites in ten-fold excess to tetrahydrocannabinol metabolites which was then used as a set point to classify donors as CBD users. An excess of tetrahydrocannabinol metabolites classify donors as marijuana users. Additionally, urine samples were procured from donors personally known to use commercial CBD ad libitum, yet abstain from tetrahydrocannabinol. Results from trusted users substantiated the use of the resulting metabolic ratios despite 11-carboxy-tetrahydrocannabinol measured in 75% of these samples.

CONCLUSION

A method has been developed and utilized to distinguish marijuana use from tetrahydrocannabinol exposure from contaminated CBD use.

Pitfalls in drug testing by hyphenated low- and high-resolution mass spectrometry

This paper reviews various pitfalls observed during developing, validation, application, and interpretation of drug testing approaches using GC-MS and low- and high-resolution LC-MS. They include sampling and storage of body samples, sample adulteration and contamination, analyte stability, sample preparation without or with cleavage of conjugates, extraction, derivatization, internal standardization, false negative and positive results by GC-MS or LC-MS screening and/or confirmation procedures including artifact formation, ion suppression or enhancement by electrospray ionization, and finally pitfalls in data interpretation. Conclusions and prospects close the Tutorial.

Multi-laboratory validation of a Δ9-tetrahydrocannabinol LC-MS/MS test kit designed for quantifying THC and marijuana metabolites in blood

Marijuana legalization has increased the demand for testing of Δ9-tetrahydrocannabinol (THC) and THC metabolites. The THC ToxBox^® test kit (THC ToxBox^®) is commercially available and supports high-throughput LC-MS/MS analytical methods designed to quantify low levels of THC and THC metabolites in blood. The purpose of this study is to determine if this new test kit meets the rigors of laboratory accreditation and produces equivalent results across six states- and locally-funded laboratories. Each laboratory followed internal method validation procedures established for their clinical (CLIA) or international (ISO17025) accreditation program. Test performance indicators included accuracy, precision, measurement of uncertainty, calibration models, reportable range, sensitivity, specificity, carryover, interference, ion suppression/enhancement and analyte stability. Analytes and interferents were resolved within the 6-min analytical runtime, and the 48-well plate pre-manufactured with calibrators, second source quality control material, and internal standards at precise concentrations allowed for simple and consistent sample preparation in less than one hour. Every laboratory successfully validated test kit procedures for forensic use. Differences in sensitivity were generally associated with the use of older equipment. Statistical analysis of results spanning reportable ranges show that laboratories with different instrument platforms produce equivalent results at levels sufficiently low enough to support per se limit testing of THC and THC metabolites (1-5 ng/mL). THC ToxBox^® represents a viable option for state- and locally-funded laboratories charged with investigating impaired driving cases involving marijuana use.

Development and validation of an automated liquid-liquid extraction GC/MS method for the determination of THC, 11-OH-THC, and free THC-carboxylic acid (THC-COOH) from blood serum

The analysis of Δ⁹-tetrahydrocannabinol (THC) and its metabolites 11-hydroxy-Δ⁹-tetrahydrocannabinol (11-OH-THC), and 11-nor-9-carboxy-Δ⁹-tetrahydrocannabinol (THC-COOH) from blood serum is a routine task in forensic toxicology laboratories. For examination of consumption habits, the concentration of the phase I metabolite THC-COOH is used. Recommendations for interpretation of analysis values in medical-psychological assessments (regranting of driver’s licenses, Germany) include threshold values for the free, unconjugated THC-COOH. Using a fully automated two-step liquid-liquid extraction, THC, 11-OH-THC, and free, unconjugated THC-COOH were extracted from blood serum, silylated with N-methyl-N-(trimethylsilyl) trifluoroacetamide (MSTFA), and analyzed by GC/MS. The automation was carried out by an x-y-z sample robot equipped with modules for shaking, centrifugation, and solvent evaporation. This method was based on a previously developed manual sample preparation method. Validation guidelines of the Society of Toxicological and Forensic Chemistry (GTFCh) were fulfilled for both methods, at which the focus of this article is the automated one. Limits of detection and quantification for THC were 0.3 and 0.6 μg/L, for 11-OH-THC were 0.1 and 0.8 μg/L, and for THC-COOH were 0.3 and 1.1 μg/L, when extracting only 0.5 mL of blood serum. Therefore, the required limit of quantification for THC of 1 μg/L in driving under the influence of cannabis cases in Germany (and other countries) can be reached and the method can be employed in that context. Real and external control samples were analyzed, and a round robin test was passed successfully. To date, the method is employed in the Institute of Legal Medicine in Giessen, Germany, in daily routine. Automation helps in avoiding errors during sample preparation and reduces the workload of the laboratory personnel. Due to its flexibility, the analysis system can be employed for other liquid-liquid extractions as well. To the best of our knowledge, this is the first publication on a comprehensively automated classical liquid-liquid extraction workflow in the field of forensic toxicological analysis.

Graphical abstract