Review ArticlesReview of Biologic Matrices (Urine, Blood, Hair) as Indicators of Recent or Ongoing Cannabis UseMusshoff, Frank; Madea, BurkhardAuthor Information Institute of Legal Medicine, University Bonn, Bonn, Germany Reprints: Frank Musshoff, Institute of Legal Medicine, University Bonn, Stiftsplatz 12, 53111 Bonn, Germany (e-mail: [email protected]) Presented in part at the Congress of the German Society of Traffic Medicine, Bonn, Germany, March 10 to 12, 2005. Received for publication July 21, 2005; accepted November 4, 2005 Therapeutic Drug Monitoring: April 2006 - Volume 28 - Issue 2 - p 155-163 doi: 10.1097/01.ftd.0000197091.07807.22 Buy Metrics Abstract Especially for cannabinoids, analytical procedures for the verification of recent use and generally for the assessment of the extent of drug abuse are of interest in clinical and forensic toxicology. For confirmation of abstinence, urine analysis seems to be a useful tool. Serial monitoring of THC-COOH to creatinine ratios can differentiate between recent drug use and residual THC-COOH excretion (THC-COOH/creatinine ratio ≥0.5 compared with previous specimen ratio). For an assessment of the extent of cannabis use, the determination of free and bound THC-COOH and especially of THC and 11-OH-THC glucuronides are suggested as useful but need further confirmation. Blood analysis is preferred for the interpretation of acute effects after cannabis abuse. The cannabis influence factor (CIF) was demonstrated as a better tool to interpret the concentrations of THC and its metabolites in blood in forensic cases and therefore it was proposed to assume absolute driving inability because of cannabis intoxication from a CIF ≥10. Additionally, a higher CIF is indicative of a recent cannabis abuse. Also discrimination between occasional use of cannabis and regular drug consumption is possible by analysis of THC-COOH in blood samples because of the long plasma half-life of THC-COOH and its accumulation in the blood of frequent cannabis consumers. In routine tests, blood samples have to be taken within a prescribed 8-day-period, and a THC-COOH concentration >75 ng/mL is assumed to be associated with regular consumption of cannabis products, whereas plasma THC-COOH concentrations <5 ng/mL are associated with occasional consumption. In contrast to other illicit drugs, hair analysis lacks the sensitivity to act as a detector for cannabinoids. THC and especially the main metabolite THC-COOH have a very low incorporation rate into hair and THC is not highly bound to melanin, resulting in much lower concentrations in hair compared with other drugs. Additionally, THC is present in cannabis smoke and also can be incorporated into the hair only by contamination. For the determination of the main metabolite THC-COOH in the picogram or femtogram per milligram range, which indicates an active consumption, special analytical procedures, such as GC/MS/MS techniques, are required. © 2006 Lippincott Williams & Wilkins, Inc.