Identifying and Quantifying Cannabinoids in Biological Matrices in the Medical and Legal Cannabis Era

Abstract Background Cannabinoid analyses generally included, until recently, the primary psychoactive cannabis compound, Δ9-tetrahydrocannabinol (THC), and/or its inactive metabolite, 11-nor-9-carboxy-THC, in blood, plasma, and urine. Technological advances revolutionized the analyses of major and m...

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Bibliographic Details
Published in:Clinical chemistry (Baltimore, Md.) Md.), 2020-07, Vol.66 (7), p.888-914
Main Authors: Karschner, Erin L, Swortwood-Gates, Madeleine J, Huestis, Marilyn A
Format: Article
Language:English
Subjects:
Blood
Breast milk
Breath Tests
Cannabinoids
Cannabinoids - analysis
Cannabis
Cannabis - chemistry
Chromatography, Liquid
Data interpretation
Forensic science
Forensic Toxicology
Hair - chemistry
Hair Analysis
Hemopoiesis
Humans
Innovations
Instrumentation
Instruments
Marijuana
Meconium
Medical marijuana
Metabolites
Phenols
Substance Abuse Detection - methods
Tandem Mass Spectrometry
Tetrahydrocannabinol
THC
Therapeutic drug monitoring
Toxicity
Toxicology
Umbilical cord
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Summary:Abstract Background Cannabinoid analyses generally included, until recently, the primary psychoactive cannabis compound, Δ9-tetrahydrocannabinol (THC), and/or its inactive metabolite, 11-nor-9-carboxy-THC, in blood, plasma, and urine. Technological advances revolutionized the analyses of major and minor phytocannabinoids in diverse biological fluids and tissues. An extensive literature search was conducted in PubMed for articles on cannabinoid analyses from 2000 through 2019. References in acquired manuscripts were also searched for additional articles. Content This article summarizes analytical methodologies for identification and quantification of multiple phytocannabinoids (including THC, cannabidiol, cannabigerol, and cannabichromene) and their precursors and/or metabolites in blood, plasma, serum, urine, oral fluid, hair, breath, sweat, dried blood spots, postmortem matrices, breast milk, meconium, and umbilical cord since the year 2000. Tables of nearly 200 studies outline parameters including analytes, specimen volume, instrumentation, and limits of quantification. Important diagnostic and interpretative challenges of cannabinoid analyses are also described. Medicalization and legalization of cannabis and the 2018 Agricultural Improvement Act increased demand for cannabinoid analyses for therapeutic drug monitoring, emergency toxicology, workplace and pain-management drug testing programs, and clinical and forensic toxicology applications. This demand is expected to intensify in the near future, with advances in instrumentation performance, increasing LC-MS/MS availability in clinical and forensic toxicology laboratories, and the ever-expanding knowledge of the potential therapeutic use and toxicity of phytocannabinoids. Summary Cannabinoid analyses and data interpretation are complex; however, major and minor phytocannabinoid detection windows and expected concentration ranges in diverse biological matrices improve the interpretation of cannabinoid test results.
ISSN:0009-9147
1530-8561
DOI:10.1093/clinchem/hvaa113