Journal of analytical toxicology
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Besides the psychoactive Delta(9)-tetrahydrocannabinol (THC), hashish and marijuana as well as cannabis-based medicine extracts contain varying amounts of cannabidiol (CBD) and of the degradation product cannabinol (CBN). The additional determination of these compounds is interesting from forensic and medical points of view because it can be used for further proof of cannabis exposure and because CBD is known to modify the effects of THC. Therefore, a method for the simultaneous quantitative determination of THC, its metabolites 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THC-COOH), CBD and CBN from plasma was developed. ⋯ CBN was not detected. Caused by the strong first-pass metabolism, the concentrations of the metabolites were increased during the first hours after drug administration when compared to literature data for smoking. Therefore, the concentration ratio 11-OH-THC/THC was discussed as a criterion for distinguishing oral from inhalative cannabis consumption.
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In Belgium, the driving under the influence of drugs (DUID) procedure consists of three steps: observation of external signs of drug consumption by a police officer; an on-site urine test for amphetamines, cannabinoids, cocaine, and opiates; and blood sampling by a physician for gas chromatography-mass spectrometry analysis. The driver is sanctioned if THC is greater than 2 ng/mL, morphine is greater than 20 ng/mL, or amphetamine, methylenedioxymethamphetamine (MDMA), methylenedioxyethylamphetamine, N-methyl-1-(3.4-methylenedioxyphenyl)-2-butanamine, cocaine, or benzoylecgonine are greater than 50 ng/mL in plasma. We analyzed the results of 450 blood samples taken from May 2000 to February 2005. ⋯ This percentage was 8.4% when urine was obtained and tested on-site and 21.2% when no urine was obtained (chi2 = 8.574, P = 0.0034). In 64.6% of these samples, a target drug (THC in 74.2%) was found under the legal cut-off. These data indicate that roadside urine testing significantly decreases the number of unnecessary blood analyses in DUID.
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Delta(9)-Tetrahydrocannabinol (THC) is frequently found in the blood of drivers suspected of driving under the influence of cannabis or involved in traffic crashes. The present study used a double-blind crossover design to compare the effects of medium (16.5 mg THC) and high doses (45.7 mg THC) of hemp milk decoctions or of a medium dose of dronabinol (20 mg synthetic THC, Marinol on several skills required for safe driving. Forensic interpretation of cannabinoids blood concentrations were attempted using the models proposed by Daldrup (cannabis influencing factor or CIF) and Huestis and coworkers. ⋯ The mathematic model II proposed by Huestis et al. (1992) provided at best a rough estimate of the time of oral administration with 27% of actual values being out of range of the 95% confidence interval. The sum of THC and 11-OH-THC blood concentrations provided a better estimate of impairment than THC alone. This controlled clinical study points out the negative influence on fitness to drive after medium or high dose oral THC or dronabinol.
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Case Reports Comparative Study
Postmortem distribution of tramadol, amitriptyline, and their metabolites in a suicidal overdose.
A case report involving a 34-year-old white male who was found dead at home by his roommate is presented. At the time of his death, he was being treated with tramadol/acetaminophen, metaxalone, oxycodone, and amitriptyline. ⋯ There were no significant findings at autopsy; however, toxicology results supported a cause and manner of death resulting from suicidal mixed tramadol and amitriptyline toxicity. This case reports the tissue and fluid distribution of tramadol, amitriptyline, and their metabolites in an acutely fatal ingestion in an effort to document concentrations of these analytes in 12 matrices with respect to one another to assist toxicologists in difficult interpretations.
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Comparative Study
Urinary excretion rates of ketamine and norketamine following therapeutic ketamine administration: method and detection window considerations.
Ketamine is widely used in veterinary medicine. Its medical application in humans is limited to children because in adults it induces severe psychedelic episodes. In recent years, teenagers have abused ketamine as a recreational and "club drug" because of its hallucinogenic and stimulant effects. ⋯ Using the LC-MS-APCI method, norketamine was detected up to 6 days after drug administration, ranging in concentrations of 2-1559 ng/mL, while ketamine was detected up to 11 days (2-1204 ng/mL). In the urine taken from one child, ketamine was not detected through the entire 16-day period using both methods. The detection window for the analytes is highly dependent on the method used for determination and varies between individuals.