Molnar Anna, Fu Shanlin, Lewis John, Allsop David J, Copeland Jan
Centre for Forensic Science, University of Technology Sydney (UTS) , Broadway, Sydney 2007, NSW, Australia.
Centre for Forensic Science, University of Technology Sydney (UTS) , Broadway, Sydney 2007, NSW, Australia.
Forensic Sci Int. 2014 May;238:113-9. doi: 10.1016/j.forsciint.2014.03.004. Epub 2014 Mar 12.
Sativex(®) is an oromucosal spray used to treat spasticity in multiple sclerosis sufferers in some European countries, the United Kingdom, Canada and New Zealand. The drug has also recently been registered by the Therapeutic Goods Administration (TGA) in Australia for treatment of multiple sclerosis. Sativex(®) contains high concentrations of Δ(9)-tetrahydrocannabinol (THC) and cannabidiol (CBD), with the former being the subject of random roadside drug tests across Australia to detect cannabis use. This pilot study aims to determine whether or not patients taking Sativex(®) will test positive to THC using these roadside screening tests. Detectable levels of THC, CBD and cannabinol (CBN) in their oral fluid were also confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The study was a double-blind, placebo controlled design. Oral fluid was tested prior to and immediately after dosing with either Sativex(®) or placebo at intervals up to 2h after the dose. Two Sativex(®) doses were studied. The low dose contained 5.4mg THC, the high dose 21.6mg THC. Results indicate that the primary screening test used in Australian roadside drug testing, the DrugWipe(®) II Twin, often gave a false negative response for THC, even with high concentrations present. However, secondary screening test, Cozart(®) DDS (used by police after a DrugWipe test gives a positive result), gave true positive results in all cases where patients were being treated with Sativex(®). Confirmatory testing showed high concentrations of THC and CBD (>5356ng/mL THC and >3826ng/mL CBD) in the oral fluid shortly after dosing and also elevated concentrations of CBN. Levels dropped quickly but remained at detectable concentrations (>67.6ng/mL) two hours after drug administration. The average concentration ratio of THC/CBD across all positive samples was 1.10 (%RSD 19.9) reflecting the composition of the Sativex(®) spray. In conclusion, Sativex(®) users may test positive for THC by roadside drug testing within 2-3h of use. Confirmatory analysis can identify Sativex(®) treatment through use of THC/CBD ratios, however, these ratios would unlikely be sufficient to differentiate non-medicinal cannabis use from Sativex(®) use if both are taken concurrently.
在一些欧洲国家、英国、加拿大和新西兰，Sativex(®)是一种口腔黏膜喷雾剂，用于治疗多发性硬化症患者的痉挛。该药物最近也已在澳大利亚治疗用品管理局（TGA）注册，用于治疗多发性硬化症。Sativex(®)含有高浓度的Δ(9)-四氢大麻酚（THC）和大麻二酚（CBD），前者是澳大利亚各地路边毒品检测中用于检测大麻使用情况的随机检测对象。这项初步研究旨在确定服用Sativex(®)的患者使用这些路边筛查检测对THC是否呈阳性反应。还通过液相色谱-串联质谱法（LC-MS/MS）确认了他们口腔液中可检测到的THC、CBD和大麻酚（CBN）水平。该研究采用双盲、安慰剂对照设计。在服用Sativex(®)或安慰剂之前以及给药后立即对口腔液进行检测，给药后间隔长达2小时。研究了两种Sativex(®)剂量。低剂量含有5.4毫克THC，高剂量含有21.6毫克THC。结果表明，澳大利亚路边毒品检测中使用的主要筛查检测方法DrugWipe(®) II Twin，即使存在高浓度的THC，也经常给出假阴性结果。然而，二级筛查检测Cozart(®) DDS（在DrugWipe检测呈阳性结果后由警方使用），在所有接受Sativex(®)治疗的患者中均给出了真阳性结果。确证检测显示，给药后不久口腔液中THC和CBD浓度很高（THC>5356纳克/毫升，CBD>3826纳克/毫升），CBN浓度也有所升高。浓度迅速下降，但在给药两小时后仍保持在可检测浓度（>67.6纳克/毫升）。所有阳性样本中THC/CBD的平均浓度比为1.10（相对标准偏差19.9%），反映了Sativex(®)喷雾剂的成分。总之，服用Sativex(®)的患者在使用后2至3小时内进行路边毒品检测可能对THC呈阳性反应。确证分析可以通过使用THC/CBD比值来识别Sativex(®)治疗情况，然而，如果同时使用非药用大麻和Sativex(®)，这些比值不太可能足以区分两者。
