Δ9-THC and CBD in Plasma, Oral Fluid, Exhaled Breath, and Urine from 23 Patients Administered Sativex.

Background: Detecting the presence of Δ⁹-THC and CBD is mainly done through venous blood sampling, but other methods are becoming available. Oromucosal administration of Δ⁹-THC and CBD is less studied than inhalation, but this mode of administration is growing. In this study, we analyze samples obtained through invasive and noninvasive methods in a cohort of patients given oromucosally administered Δ⁹-THC and CBD to gain understanding in the strengths and weaknesses of the various detection methods. Materials and Methods: Blood, oral fluid (OF), exhaled breath, and urine were collected at several time points from 23 cannabis-naive patients after receiving a single dose of Sativex^®; dose ranges: Δ⁹-THC, 2.7-18.9 mg; CBD 2.5-17.5 mg. Detection of Δ⁹-THC and CBD was done using liquid chromatography-mass spectrometry methods. Results: Δ⁹-THC and CBD were present in plasma, OF, and exhaled breath in all 23 patients. The detection time of Δ⁹-THC and CBD in OF and exhaled breath was longer than in blood. Urine analysis detected the Δ⁹-THC carboxy metabolite (THC-COOH) up to 7 days after administration, also in a patient who received 8.1/7.5 mg Δ⁹-THC/CBD. Conclusion: Time to detection of cannabinoids in blood samples was shorter than in exhaled breath and OF. Relative ease of sample collection combined with high sensitivity makes OF and exhaled breath specimens a valuable addition when samples are handled correctly. Δ⁹-THC metabolites were detected for an unexpected long period of time in urine. EudraCT Number: 2014-005553-39. Date of registration, December 29, 2015.