An evaluation of postmortem concentrations of Δ9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH)

Hoffman, Melissa; Trochta, Amber; Gary, Ray D.; Fitzgerald, Robert L.; McIntyre, Iain M.

doi:10.1016/j.forsciint.2020.110414

Cited by 18 publications

(20 citation statements)

References 33 publications

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“…However, individually there was substantial variability between cases preventing any useful estimation for use in future cases. The lack of any appreciable average change in THC concentration post‐mortem has been observed by other researchers (Chu, 2002; Hoffman et al, 2020; Holland et al, 2011). This is surprising given the high lipid solubility of THC with a V D of about 10 L/kg (Huestis, 2007), a log P of 5.6 (PubChem) and the high concentrations of THC in deceased users of cannabis in at least lung, muscle and fat tissues (Chu, 2002; Cliburn et al, 2021).…”

Section: Time‐dependent Redistributionsupporting

confidence: 64%

“…This is surprising given the high lipid solubility of THC with a V D of about 10 L/kg (Huestis, 2007), a log P of 5.6 (PubChem) and the high concentrations of THC in deceased users of cannabis in at least lung, muscle and fat tissues (Chu, 2002; Cliburn et al, 2021). One explanation proposed is that liver concentration differences to blood are an indicator of the extent of post‐mortem changes in blood concentration and THC shows little affinity for liver tissue, hence the apparent low redistribution after death (Hoffman et al, 2020). However, since there are relatively large increases from just before death to admission to the mortuary followed by a decline over the next few days (Chu et al, 2020), suggests a much more dynamic process is occurring; possibly a combination of distribution and redistribution in a setting of developing autolytic changes.…”

Section: Time‐dependent Redistributionmentioning

confidence: 99%

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Post‐mortem redistribution of drugs and other factors affecting interpretation: A review

Drummer

Gerostamoulos

2023

WIREs Forensic Science

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Changes in the post-mortem concentration of drugs, such as through redistributive processes are well known, although not well understood in terms of the mechanisms operating in particular cases and the extent it influences an interpretation of the reported concentrations. This advanced review outlines the mechanisms known to potentially alter blood and tissue concentrations and focuses on publications over the last decade that attempt to quantify the extent of changes occurring for specific drugs or drug classes. Most of the more recent studies show time-dependent changes that do not always alter concentrations in one direction, let alone to the same extent. This increases the uncertainty of interpretation, particularly for drugs with a narrow therapeutic index. Nevertheless, guidelines are provided in this review to improve interpretation of post-mortem drug concentrations in cases where a psychoactive substance(s) are a possible contribution to death.

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Section: Time‐dependent Redistributionsupporting

confidence: 64%

Section: Time‐dependent Redistributionmentioning

confidence: 99%

Post‐mortem redistribution of drugs and other factors affecting interpretation: A review

Drummer

Gerostamoulos

2023

WIREs Forensic Science

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“…A recent Australian study based on the National Coronial Information System counted 104 deaths in which cannabis was the only substance listed, of which 36.5% were suicide and 28.8% were accidental injury 89 . Thirty‐six other cases of deaths have been reported in the literature; among them, thirty one were due to cardiovascular diseases, 4,90–94 two to renal and ionic complications of hyperemesis syndrome, 91 one to seizure complications linked to multiple sclerosis, with identification of cannabis in toxicological assessments, 91 one to self‐mutilation after oral cannabis consumption, 7 and one to extensive necrosis and haemorrhage of the liver and adrenals following maternal use of marijuana in an 11‐day‐old neonate 95 …”

Section: Discussionmentioning

confidence: 99%

Adverse events of recreational cannabis use reported to the French addictovigilance network (2012–2017)

Bouquet

Pain

Eiden

et al. 2021

Brit J Clinical Pharma

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Aims To describe the adverse events (AEs) of recreational cannabis use in France between 2012 and 2017. Methods AEs related to recreational cannabis use, alone or in combination with alcohol and/or tobacco reported to the French Addictovigilance Network were analysed (excluding cannabidiol and synthetic cannabinoids). Results Reporting of AEs tripled between 2012 (n = 179, 6.3%, 95% confidence interval [CI] = 5.4–7.2) and 2017 (n = 562, 10.1%, 95% CI = 9.3–10.9), reaching 2217 cases. They concerned mainly men (76.4%) and users aged between 18 and 34 years (18–25: 30.9%; 26–34: 26.3%, range: 12–84 years). Cannabis was mainly inhaled (71.6%) and exposure was most often chronic (64.2%). Many types of AEs were reported: psychiatric (51.2%), neurological (15.6%), cardiac (7.8%) and gastrointestinal (7.7%), including unexpected AEs (n = 34, 1.1%). The most common effect was dependence, ranging from 10.1% (95% CI = 7.9–12.3) to 20.3% (95% CI = 17.3–23.2) over the study period. Cannabinoid hyperemesis syndrome (n = 87, 2.8%) emerged from 2015. Deaths accounted for 0.2% of all AEs (4 men and 3 women aged on average 35 years). A chronic pattern of cannabis use was reported in 4 of them (intracranial hypertension in the context of lung cancer, suicide, cerebral haematoma, neonatal death with concomitant chronic alcohol use), while in the other cases the toxicological analysis identified cannabis use (ruptured aneurysm and unknown aetiology). Conclusion This study showed a multitude of AEs related to recreational cannabis use, including unexpected AEs and deaths. It highlights the problem of dependence and the emergence of cannabinoid hyperemesis syndrome.

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“…A study by Hoffman et al, including 24 decedents, investigated i.e. central blood to peripheral blood ratios for THC in postmortem cases [25]. The median ratio of central blood to peripheral blood was 1.1 (0.30-4.05) for THC in samples with preservatives.…”

Section: Cardiac Bloodmentioning

confidence: 99%

Distribution of tetrahydrocannabinol and cannabidiol in several different postmortem matrices

Pettersen

Øiestad

Rogde

et al. 2021

Forensic Science International

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An evaluation of postmortem concentrations of Δ9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH)

Cited by 18 publications

References 33 publications

Post‐mortem redistribution of drugs and other factors affecting interpretation: A review

Post‐mortem redistribution of drugs and other factors affecting interpretation: A review

Adverse events of recreational cannabis use reported to the French addictovigilance network (2012–2017)

Distribution of tetrahydrocannabinol and cannabidiol in several different postmortem matrices

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