Determination of delta 9-tetrahydrocannabinol in human blood and saliva by high-performance liquid chromatography with amperometric detection

Evaluation of the diagnostic performance of an oral fluid screening test device for substance abuse at traffic controls

INTRODUCTION

The aim of this study was to evaluate the analytical performance of the Kite Biotechnology Oral fluid (OF) screening test device, which is used for roadside screening of cannabis, opiates, amphetamines, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cocaine and benzodiazepines by comparing samples with matched plasma samples, analysed via liquid chromatography-tandem mass spectrometry (LC-MS/MS) for confirmation.

METHODS

OF and plasma samples were obtained simultaneously from a total of 100 subjects. OF samples were analysed by OF screening test based on immunochromatography. The OF screening test cut-off values were 50 ng/mL for amphetamines (d-amphetamine) and methamphetamine/MDMA (d-methamphetamine), 30 ng/mL for cocaine (benzoylecgonine), 40 ng/mL for opiates (morphine), 20 ng/mL for benzodiazepines (nordazepam), and 25 ng/mL for cannabis (Δ⁹-tetrahydrocannabinol). LC-MS/MS method validation was performed according to the CLSI C62-A recommendations with the following parameters: matrix effect, lower limit of quantification (LLOQ), linearity, intra-day and inter-day precision and accuracy.

RESULTS

The overall specificity, accuracy and negative predictive values (NPV) were acceptable and met the DRUID standard of >80%. The OF screening test device showed good sensitivity for cocaine, amphetamines and opiates, whereas it indicated poor sensitivity for methamphetamine/MDMA (66.7%) and failed to detect cannabis and benzodiazepines.

CONCLUSION

The present study is the first report to evaluate the Kite Biotechnology OF screening test device. The diagnostic performance of the OF screening test device was acceptable for opiates, cocaine and amphetamines, but it was insufficient for methamphetamine/MDMA, benzodiazepines and cannabis because of sensitivity issues.

Delta-9-tetrahydrocannabinol (Δ9-THC) sensing using an aerosol jet printed organic electrochemical transistor (OECT)

Recreational use of marijuana/cannabis was legalized in Canada in 2018 and has been decriminalized in several other countries; however, the detection of impairment has remained elusive for law enforcement. The psychoactive ingredient in cannabis, delta-9-tetrahydrocannabinol (Δ9-THC), can be detected in saliva and be correlated well with the intake of cannabis. Organic electrochemical transistors (OECTs) have been used for a variety of biosensing applications like glucose, pH, ions, etc. In this work, we demonstrate the use of unfunctionalized OECTs for the detection of Δ9-THC down to 0.1 nM and 1 nM diluted in DI water and synthetic saliva buffer, respectively. These OECTs have been aerosol jet printed entirely with PEDOT:PSS as the channel material. Using a platinum gate coupled with an aerosol jet printed OECT, Δ9-THC concentration can be detected due to its oxidation reaction at the gate. These results were consistent with cyclic voltammetry measurements of Δ9-THC using Pt as the working and counter electrode. Utilizing these OECT based sensors, we have achieved high sensitivity of detection of Δ9-THC in the range from 0.1 nM to 5 μM. These OECT based Δ9-THC sensors demonstrate less than 3% error indicating good repeatability which is averaged over 15 measurements on multiple devices.

Kinetic profile of N,N-dimethyltryptamine and β-carbolines in saliva and serum after oral administration of ayahuasca in a religious context

Ayahuasca is a beverage obtained from Banisteriopsis caapi plus Psychotria viridis. B. caapi contains the β-carbolines harmine, harmaline, and tetrahydroharmine that are monoamine oxidase inhibitors and P. viridis contains N,N-dimethyltryptamine (DMT) that is responsible for the visionary effects of the beverage. Ayahuasca use is becoming a global phenomenon, and the recreational use of DMT and similar alkaloids has also increased in recent years; such uncontrolled use can lead to severe intoxications. In this investigation, liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to study the kinetics of alkaloids over a 24 h period in saliva and serum of 14 volunteers who consumed ayahuasca twice a month in a religious context. We compared the area under the curve (AUC), maximum concentration (C_max ), time to reach C_max (T_max ), mean residence time (MRT), and half-life (t_1/2 ), as well as the serum/saliva ratios of these parameters. DMT and β-carboline concentrations (C_max ) and AUC were higher in saliva than in serum and the MRT was 1.5-3.0 times higher in serum. A generalized estimation equations (GEEs) model suggested that serum concentrations could be predicted by saliva concentrations, despite large individual variability in the saliva and serum alkaloid concentrations. The possibility of using saliva as a biological matrix to detect DMT, β-carbolines, and their derivatives is very interesting because it allows fast noninvasive sample collection and could be useful for detecting similar alkaloids used recreationally that have considerable potential for intoxication.

Saliva: a reliable sample matrix in bioanalytics

Saliva is gaining increasing attention as a bioanalytical sample matrix. Mostly because of the easy and noninvasive collection, it is not only beneficial in endocrinological and behavioral science, but also in pediatrics. Saliva also has the advantage of being the only body fluid which can be collected even during physical exercise, for example, during sportive activities, and there are physiological characteristics that make it superior to serum/plasma or urine for specific scientific questions. This review provides an insight into the physiology of saliva formation, explaining how certain compounds enter this bodily fluid, and gives advice for collection, storage and analytical methods. Finally, it presents a number of reliable and proven applications for saliva analysis from scientific fields including endocrinology, sports medicine, forensics and immunology.

Absorptive stripping voltammetry for cannabis detection

BACKGROUND

Given that Δ(9)-tetrahydrocannabinol, the active constituent of cannabis, has been shown to greatly reduce driving ability, thus being linked to many drug driving accidents, its reliable detection is of great importance.

RESULTS

An optimised carbon paste electrode, fabricated from graphite powder and mineral oil, is utilised for the sensitive detection of Δ(9)-tetrahydrocannabinol (THC) in both aqueous solutions of pH 10.0 and in synthetic saliva solutions. "Absorptive Stripping Voltammetry" is exploited to that effect and the paste is used to pre-concentrate the carbon paste electrode with the target molecule. Practical limits of detection of 0.50 μM and 0.10 μM are determined for THC in stationary and stirred aqueous borate buffer solutions, respectively. Theoretical limits of detection are also calculated; values of 0.48 nM and 0.41 nM are determined for stationary and stirred THC aqueous borate buffer solutions, respectively. THC concentrations as low as 0.50 μM are detected in synthetic saliva solutions. The sensitivity of the sensor was 0.12 μA μM(-1), 0.84 μA μM(-1) and 0.067 μA μM(-1) for the stationary buffer, the stirred buffer and the saliva matrix, respectively.

CONCLUSIONS

"Absorptive Stripping Voltammetry" can be reliably applied to the detection of Δ(9)-tetrahydrocannabinol, after suitable optimisation of the assay. Usefully low practical limits of detection can be achieved.

Development of a simple and sensitive HPLC-UV method for the simultaneous determination of cannabidiol and Δ(9)-tetrahydrocannabinol in rat plasma

There has been increased interest in the medical use of cannabinoids in recent years, particularly in the predominant natural cannabinoids, cannabidiol (CBD) and Δ(9)-tetrahydrocannabinol (THC). The aim of the current study was to develop a sensitive and reliable method for the quantification of CBD and THC in rat plasma. A combination of protein precipitation using cold acetonitrile and liquid-liquid extraction using n-hexane was utilised to extract CBD and THC from rat plasma. Samples were then evaporated and reconstituted in acetonitrile and 30 μL was injected into an HPLC system. Separation was achieved using an ACE C18-PFP 150 mm × 4.6 mm, 3 μm column at 55 °C with isocratic elution using a mobile phase consisting of acetonitrile-water (62:38, v/v) at 1 mL/min for 20 min. Both cannabinoids, as well as the internal standard (4,4-dichlorodiphenyltrichloroethane, DDT) were detected at 220 nm. Our new method showed linearity in the range of 10-10,000 ng/mL and a lower limit of quantification (LLOQ) of 10 ng/mL for both cannabinoids, which is comparable to previously reported LC-MS/MS methods. Inter- and intra-day precision and accuracy were below 15% RSD and RE, respectively. To demonstrate the suitability of the method for in vivo studies in rats, the assay was applied to a preliminary pharmacokinetic study following IV bolus administration of 5 mg/kg CBD or THC. In conclusion, a simple, sensitive, and cost-efficient HPLC-UV method for the simultaneous determination of CBD and THC has been successfully developed, validated and applied to a pharmacokinetic study in rats.

Current knowledge on cannabinoids in oral fluid

Oral fluid (OF) is a new biological matrix for clinical and forensic drug testing, offering non-invasive and directly observable sample collection reducing adulteration potential, ease of multiple sample collections, lower biohazard risk during collection, recent exposure identification, and stronger correlation with blood than urine concentrations. Because cannabinoids are usually the most prevalent analytes in illicit drug testing, application of OF drug testing requires sufficient scientific data to support sensitive and specific OF cannabinoid detection. This review presents current knowledge of OF cannabinoids, evaluating pharmacokinetic properties, detection windows, and correlation with other biological matrices and impairment from field applications and controlled drug administration studies. In addition, onsite screening technologies, confirmatory analytical methods, drug stability, and effects of sample collection procedure, adulterants, and passive environmental exposure are reviewed. Delta-9-tetrahydrocannabinol OF concentrations could be >1000 µg/L shortly after smoking, whereas minor cannabinoids are detected at 10-fold and metabolites at 1000-fold lower concentrations. OF research over the past decade demonstrated that appropriate interpretation of test results requires a comprehensive understanding of distinct elimination profiles and detection windows for different cannabinoids, which are influenced by administration route, dose, and drug use history. Thus, each drug testing program should establish cut-off criteria, collection/analysis procedures, and storage conditions tailored to its purposes. Building a scientific basis for OF testing is ongoing, with continuing OF cannabinoids research on passive environmental exposure, drug use history, donor physiological conditions, and oral cavity metabolism needed to better understand mechanisms of cannabinoid OF disposition and expand OF drug testing applicability. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Saliva as an analytical matrix: state of the art and application for biomonitoring

Analytical tests to measure chemicals in saliva can be employed for numerous analytes, endogenous compounds or xenobiotics. The objective was to determine which chemicals can be analysed with this matrix, which analytical methods are applicable, and what application is possible for biomonitoring. We reviewed the literature using three databases, MEDLINE, PubMed and Scopus, collecting articles on different kinds of analysis in saliva. Studies were principally about molecules of clinical interest, xenobiotics, especially drugs of abuse, and chemicals used at workplaces; some substances show no relevant correlation with exposure data while others seems to be of particular interest for systematic use for biomonitoring. Currently, saliva is used far less than other biological fluids but its use for biomonitoring of exposure to chemicals might open up new areas for research and would certainly simplify the collection of biological samples.

Use of alcohol and drugs by Norwegian employees: a pilot study using questionnaires and analysis of oral fluid

Background

The use of alcohol and drugs may affect workplace safety and productivity. Little is known about the magnitude of this problem in Norway.

Methods

Employee recruitment methods with or without individual follow-up were compared. The employees filled in a questionnaire and provided a sample of oral fluid. Samples were analysed for alcohol, ethyl glucuronide (EtG; a biological marker of recent large alcohol intake), psychoactive medicinal drugs and illegal drugs.

Results

Participation rates with and without individual follow-up were 96% and 68%, respectively. Alcohol was negative (≤0.1 mg/ml) in all samples, but 21.0% reported the intake of alcohol during the last 24 h. EtG was positive (>2.2 ng/ml) in 2.1% of the samples. In-efficiency or hangover at work during the past year was reported by 24.3%, while 6.2% had been absent from work due to the use of alcohol. The combination of self-report and analytical testing indicated that medicinal or illegal drugs had been used during the last 48 h by 5.1% and 1.7% of the participants, respectively; while only 4.2% and 0.4% admitted the use in the questionnaire.

Conclusions

Self-reported data suggest that hangover after drinking alcohol appears to be the largest substance abuse problem at Norwegian workplaces, resulting in absence and inefficiency at work. Analysis of oral fluid revealed that the use of illegal drugs was more common than drinking alcohol before working or at the workplace. The analysis of oral fluid may be a valuable tool in obtaining additional information on alcohol and drug use compared to using questionnaires alone.

Bioanalytical procedures for determination of drugs of abuse in oral fluid

Recent advances in analytical techniques have enabled the detection of drugs and drug metabolites in oral fluid specimens. Although GC-MS is still commonly used in practice, many laboratories have developed and successfully validated methods for LC-MS(-MS) that can detect a large number of compounds in the limited sample volume available. In addition, several enzyme immunoassays have been commercialized for the detection of drugs of abuse in oral fluid samples, enabling the fast screening and selection of presumably positive samples. A number of concerns are discussed, such as the variability in the volume of sample collected and its implications in terms of quantitative measurements, and the drug recoveries of the many different specimen collection systems on the market. Additional considerations that also receive attention are the importance of providing complete validation data with respect to analyte stability, matrix effect, and the choice of collection method.

Interpretation of oral fluid tests for drugs of abuse

Oral fluid testing for drugs of abuse offers significant advantages over urine as a test matrix. Collection can be performed under direct observation with reduced risk of adulteration and substitution. Drugs generally appear in oral fluid by passive diffusion from blood, but also may be deposited in the oral cavity during oral, smoked, and intranasal administration. Drug metabolites also can be detected in oral fluid. Unlike urine testing, there may be a close correspondence between drug and metabolite concentrations in oral fluid and in blood. Interpretation of oral fluid results for drugs of abuse should be an iterative process whereby one considers the test results in the context of program requirements and a broad scientific knowledge of the many factors involved in determining test outcome. This review delineates many of the chemical and metabolic processes involved in the disposition of drugs and metabolites in oral fluid that are important to the appropriate interpretation of oral fluid tests. Chemical, metabolic, kinetic, and analytic parameters are summarized for selected drugs of abuse, and general guidelines are offered for understanding the significance of oral fluid tests.

Development and validation of a method for the quantitation of Δ9 tetrahydrocannabinol in human plasma by high performance liquid chromatography after solid-phase extraction

A high performance liquid chromatography (HPLC) procedure for the determination of Delta9 tetrahydrocannabinol (THC) in human plasma is described. A two-step solid-phase extraction on CN cartridges was coupled with a reversed phase HPLC system. THC was eluted using a mobile phase composed of methanol, acetonitrile and tetrabutylammonium perchlorate solution (0.005 M, pH 3.2), through a C18 Nucleosil column and detected at a wavelength of 215 nm. Calibration curve was linear over the range 5-100 ng/ml with a lower limit of quantification validated at 5 ng/ml. Extraction recovery using the developed extraction procedure was higher than 85%. This method is presently used for the quantification of THC in plasma samples from regular cannabis smokers.

Oral fluid collection: the neglected variable in oral fluid testing

The potential to use oral fluid as a drug-testing specimen has been the subject of considerable scientific interest. The ease with which specimens can be collected and the potential for oral fluid (OF) drug concentrations to reflect blood-drug concentrations make it a potentially valuable specimen in clinical as well as forensic settings. However, the possible effects of the OF collection process on drug detection and quantification has often been over looked. Several studies have documented that drug-contamination of the oral cavity may skew oral fluid/blood drug ratios and confound interpretation when drugs are smoked, insufflated or ingested orally. OF pH is predicted to have an effect on the concentration of drugs in OF. However, in a controlled clinical study, the effect of pH was less than that of collection technique. Mean codeine OF concentrations in specimens collected a non-stimulating control method were 3.6 times higher than those in OF collected after acidic stimulation. Mean codeine concentrations were 50% lower than control using mechanical stimulation and 77% of control using commercial collection devices. Several factors should be considered if a commercial OF collection device is used. In vitro collection experiments demonstrated that the mean collection volume varied between devices from 0.82 to 1.86 mL. The percentage of the collected volume that could be recovered from the device varied from 18% to 83%. In vitro experiments demonstrated considerable variation in the recovery of amphetamines (16-59%), opiates (33-50%), cocaine and benzoylecgonine (61-97%), carboxy-THC (0-53%) and PCP (9-56%). Less variation in collection volume, volume recovered and drug recovery was observed intra-device. The THC stability was evaluated in a common commercial collection protocol. Samples in the collection buffer were relatively stable for 6 weeks when stored frozen. However, stability was marginal under refrigerated conditions and poor at room temperature. Very little has been published on the efficacy of using IgG concentration, or any other endogenous marker, as a measure of OF specimen validity. Preliminary rinsing experiments with moderate (50 mL and 2 x 50 mL) volumes of water did not reduce the OF IgG concentration below proposed specimen validity criteria. In summary, obvious and more subtle variables in the OF collection may have pronounced effects on OF-drug concentrations. This has rarely been acknowledged in the literature, but should to be considered in OF drug testing, interpretation of OF-drug results and future research studies.

Indirect detection of substituted phenols and cannabis based on the electrochemical adaptation of the Gibbs reaction

The voltammetric behaviour of 2,6-dichloro-p-aminophenol (PAP) in aqueous solution at an edge plane pyrolytic graphite electrode was explored and its sensitivity to additions of substituted phenols examined. Proof of concept is shown for the electrochemical adaptation of the Gibbs reaction, where reaction of the oxidised form of PAP with substituted phenols provides an indirect methodology for the analytical detection of these compounds. This indirect protocol provides an attractive alterative to the direct electrochemical oxidation of phenolic compounds, since the latter is plagued by electrode passivation, leading to low sensitivity. It is observed that phenol, 4-phenoxyphenol, methylphenol (para and meta), nitrophenol and most importantly, tetrahydrocannabinol, can be detected voltammetrically. Such a protocol is particularly attractive for roadside testing for cannabis in drug drivers.

SPME-GC analysis of THC in saliva samples collected with "EPITOPE" device

In this study we examined the presence of cannabinoids in saliva samples obtained from 24 drug-abusers. The saliva specimens were collected by "EPITOPE" system and the subsequent elution of samples was achieved by centrifugation. The resulting ultrafiltrates have been directly sampled with solid phase micro-extraction (SPME) and then analyzed by GC/MS. Saliva sampling is less invasive than collection of blood.

Testing for drugs of abuse in saliva and sweat

The detection of marijuana, cocaine, opiates, amphetamines, benzodiazepines, barbiturates, PCP, alcohol and nicotine in saliva and sweat is reviewed, with emphasis on forensic applications. The short window of detection and lower levels of drugs present compared to levels found in urine limits the applications of sweat and saliva screening for drug use determination. However, these matrices may be applicable for use in driving while intoxicated and surveying populations for illicit drug use. Although not an illicit drug, the detection of ethanol is reviewed because of its importance in driving under the influence. Only with alcohol may saliva be used to estimate blood levels and the degree of impairment because of the problems with oral contamination and drug concentrations varying depending upon how the saliva is obtained. The detection of nicotine and cotinine (from smoking tobacco) is also covered because of its use in life insurance screening and surveying for passive exposure.

Determination of cannabinoids in water and human saliva by solid-phase microextraction and quadrupole ion trap gas chromatography/mass spectrometry

Solid-phase microextraction (SPME) is applied to the determination of cannabidiol, delta 8-tetrahydrocannabinol (delta 8-THC), delta 9-tetrahydrocannabinol (delta 9-THC), and cannabinol in pure water and human saliva. The inherent extraction behavior of the cannabinoids in pure water is evaluated along with optimization of the method in human saliva. The commercially available poly(dimethylsiloxane) (PDMS) SPME fibers were found to be the best class for the cannabinoid analysis. Partition coefficients were found to be extremely large for all of the cannabinoids (log K > 4.0). Equilibrium times for the 7- and 30-micron PDMS fibers were 50 and 240 min, respectively. A shorter extraction time of 10 min with the 30-micron PDMS fiber may be used for multiple extractions from the same vial, thus conserving the sample necessary for analysis and speeding up the total analysis time. Recoveries for the cannabinoids in saliva, relative to pure water, were dramatically improved by a method developed in our laboratory involving addition of glacial acetic acid to the sample vial prior to performing SPME. Using this method, recoveries relative to SPME in pure water ranged from 21 to 47% depending on the cannabinoid. The linear range for spiked saliva samples was established at 5-500 ng/mL (r2 > 0.994) with precisions between 11 and 20% RSD. The ultimate level of detection by SPME for the cannabinoids in saliva was 1.0 ng/mL, with signal-to-noise values of > or = 12. A saliva sample collected 30 min after marijuana smoking was subject to SPME and traditional liquid-liquid extraction analysis. Internal standard quantitation results for delta 9-THC by both methods yielded comparable results, indicating that the SPME method of analysis is highly accurate and precise. The level of delta 9-THC by SPME was found to be 9.54 ng/mL for the saliva sample.

Quantification of 9-carboxy-11-nor-delta 9-tetrahydrocannabinol in urine using brominated 9-carboxy-11-nor-delta 9-tetrahydrocannabinol as the internal standard and high-performance liquid chromatography with electrochemical detection

A method was developed for quantitating 9-carboxy-11-nor-delta 9-tetrahydrocannabinol in human urine as part of the process for validating an automated enzyme immunoassay for marijuana metabolites. Sample cleanup was accomplished using a mixed-mode solid-phase extraction. 9-Carboxy-11-nor-delta 9-tetrahydrocannabinol and the internal standard, brominated 9-carboxy-11-nor-delta 9-tetrahydrocannabinol, were quantified using high-performance liquid chromatography with electrochemical detection (+ 0.85 V). The linear range for this method is 0.012-0.20 microgram/mL. No interference was seen for 22 drugs and metabolites. The pooled relative standard deviation is 4.1% (n = 27) for the quality control samples. This method was compared to gas chromatography with mass spectrometry by linear regression analysis. The slope of the line is 1.00 +/- 0.05 (standard error), the intercept is approximately zero, the coefficient of determination is 0.994, and the standard error of the estimate is 0.006 microgram/mL.

Determination of delta 9-tetrahydrocannabinol levels in brain tissue using high-performance liquid chromatography with electrochemical detection

delta 9-Tetrahydrocannabinol (delta 9-THC) is the major psychoactive component of cannabis. To assist in investigating the mechanism(s) of action of delta 9-THC, a convenient method for determining its levels in brain tissue is required. We now describe a method for determining nanogram quantities of delta 9-THC in rat brain tissue. The method employs solvent extraction with methanol-hexane-ethyl acetate, followed by analysis using liquid chromatography with electrochemical detection. Overall recoveries were greater than 80%. The relationship between the peak-height ratio for processed standards extracted in the presence of tissue (delta 9-THC/internal standard) and the amount of delta 9-THC added was shown to be linear within the range of concentrations examined. Quantitative measurements of delta 9-THC in different brain regions following the intravenous administration of delta 9-THC are presented as examples of the applications of this method.

Determination of delta 9-tetrahydrocannabinol from human saliva by tandem immunoaffinity chromatography--high-performance liquid chromatography

Smoking or ingestion of cannabis causes cognitive, perceptual and behavioural changes, which are responsive for impaired performance in driving motor vehicles. In this paper a novel liquid chromatographic assay for the selective quantification of delta 9-tetrahydrocannabinol, the major indicator of a present cannabis intoxication in saliva, is described. The method involves a column-switching procedure and requires an extremely simple pre-treatment of the sample. Deproteinized saliva was directly injected into the chromatographic system. The clean-up and enrichment procedure was performed in an immunoaffinity column, followed by the transfer of the antigens to an octysilica analytical column. The immunoaffinity sorbent was obtained by covalent immobilization of specific antibodies on epoxy-activated silica. The mobile phase consisted of methanol-aqueous 0.15 mol/1 NaCl solution (elution programmed) and the analyte was detected by measuring the UV absorption at 220 nm. Using an injection volume of 4.5 ml (dilution 3:2, v/v) the limit of quantification was 20 ng/ml, at a signal-to-noise ratio of 5. Recoveries were estimated to be in the range of 70%. Both intra- and inter- day coefficients of variation were below 5%.

Drug monitoring in nonconventional biological fluids and matrices

Determination of the concentration of drugs and metabolites in biological fluids or matrices other than blood or urine (most commonly used in laboratory testing) may be of interest in certain areas of drug concentration monitoring. Saliva is the only fluid which can be used successfully as a substitute for blood in therapeutic drug monitoring, while an individual's past history of medication, compliance and drug abuse, can be obtained from drug analysis of the hair or nails. Drug concentrations in the bile and faeces can account for excretion of drugs and metabolites other than by the renal route. Furthermore, it is important that certain matrices (tears, nails, cerebrospinal fluid, bronchial secretions, peritoneal fluid and interstitial fluid) are analysed, as these may reveal the presence of a drug at the site of action; others (fetal blood, amniotic fluid and breast milk) are useful for determining fetal and perinatal exposure to drugs. Finally, drug monitoring in fluids such as cervical mucus and seminal fluid can be associated with morpho-physiological modifications and genotoxic effects. Drug concentration measurement in nonconventional matrices and fluids, although sometimes expensive and difficult to carry out, should therefore be considered for inclusion in studies of the pharmacokinetics and pharmacodynamics of new drugs.

Saliva testing for drugs of abuse

Saliva testing for drugs of abuse can provide both qualitative and quantitative information on the drug status of an individual undergoing testing. Self-administration by the oral, intranasal, and smoking routes often produces "shallow depots" of drug that contaminate the oral cavity. This depot produces elevated drug concentrations that can be detected for several hours. Thereafter, saliva drug concentrations generally reflect the free fraction of drug in blood. Also, many drugs are weak bases and saliva concentrations may be highly dependent upon pH conditions. These factors lead to highly variable S/P ratios for many of the drugs of abuse. Table 3 provides a compilation of experimental and theoretical S/P (total) ratios determined for drugs of abuse. Estimations of the theoretical S/P (total) ratios for acidic and basic drugs were based on the Henderson-Hasselbalch equation. Saliva pH was assumed to be 6.8 unless reported otherwise by the investigators. Generally, there was a high correlation of saliva drug concentrations with plasma, especially when oral contamination was eliminated. Assay methodology varied considerably, indicating that saliva assays could be readily developed from existing methodology. There are many potential applications for saliva testing for drugs of abuse. Table 4 lists several general areas in which information from saliva testing would be useful. Clearly, saliva drug tests can reveal the presence of a pharmacologically active drug in an individual at the time of testing. Significant correlations have been found between saliva concentrations of drugs of abuse and behavioral and physiological effects. Results indicate that saliva testing can provide valuable information in diagnostics, treatment, and forensic investigations of individuals suspected of drug abuse. It is expected that saliva testing for drugs of abuse will develop over the next decade into a mature science with substantial new applications.

Salivary THC following cannabis smoking correlates with subjective intoxication and heart rate

A cannabis smoking trial was conducted using paid volunteers. Subjective intoxication, measured using a visual analogue scale, was compared with heart rate and with salivary delta-9-tetrahydrocannabinol (THC) levels at various times after smoking a cigarette containing 11 mg THC. Subjective intoxication and heart rate elevation were significantly correlated with the log of salivary THC. Salivary THC levels are a sensitive index of recent cannabis smoking, and appear more closely linked with the effects of intoxication than do either blood or urine cannabinoid levels.