Notes: Peak urinary level achieved approximately 3 hours postdose. Urine continued to test positive at 24 hours postdose CBD quantitative result corrected for creatinine concentration.
In the interests of supporting physicians and their patients in the use of medically effective forms of marijuana, 6 as distinguished from recreational interests, we have adapted a gas chromatography mass spectrometry (GC/MS) procedure for the detection of CBD in urine. The intended use is as a tool for physicians to determine the major components of marijuana being used by a patient and whether that composition is primarily THC, CBD, or a combination of THC and CBD.
Unfortunately, properly conducted clinical trials are limited. The preponderance of reports are anecdotal or small studies. Patients have used, and will continue to use marijuana for relief of their medical problems. They will seek marijuana from legal dispensaries that predominantly provide psychotropic forms of marijuana. Perhaps 90% or more of these offerings are primarily for recreational use. Patients and physicians need facts to inform their choices among marijuana products. Formal study is needed in the clinical management of patients including evaluation of anti-inflammatory effectiveness, as well as pain alleviation. Use of opiates for chronic pain has led to increasing dosage over time; this may cause respiratory depression that can be fatal. In recognition of dangers associated with opiate treatment of chronic pain, the Medical Board of California offers physicians a course 9 in the use of opiates for severe persistent pain for what the Medical Board termed a serious public health crisis of addiction, overdose, and death. Is it feasible that the use of CBD or an optimal concentration of CBD and THC might have significant value in alleviating persistent, severe pain and therefore a diminished need for opiate use, either totally or in lower dosages? It is a responsibility that the medical community holds to provide such a benefit should studies determine marijuana can effectively relieve such pain with opioid sparing. The need for additional study is further indicated by reports of CBD competition for opiate receptor sites. 10
The detection method is a GC/MS procedure performed on an Agilent 6890 GC (gas chromatography) coupled with an Agilent 5973 Mass Selective Detector (Agilent Technologies, Santa Clara, CA, USA). The GC is equipped with a Zebron ZB-5 capillary column (5% phenyl–95% dimethylpolysiloxane liquid phase), 15 m, 0.25 mm internal diometer, 0.25 µm film thickness (Agilent Technologies). The GC uses a temperature ramp of 160°C–250°C at 25°C/min held for 1 minute. Quantitation occurs using the internal standard method.
All (40) urine samples in the Group I tested negative for urine CBD. It is likely that this group represented individuals who had used marijuana for recreational purposes. All (40) tested positive for the THC metabolite, carboxy-THC.
Legislature that distinguishes medical marijuana from recreational marijuana would inure to the benefit of patients and society as a whole. 11
Limitations of this study include its small size and the lack of knowing the concentrations of the cannabinoids, THC, and CBD in the marijuana used.
“2 of 6 participants tested positive for cannabis after they inhaled CBD-dominant cannabis vapor.”
“There is a need to understand whether the use of CBD products (. ) can impact drug testing for cannabis given their growing availability and increased interest in CBD for therapeutic purposes.”
Finally, Spindle pointed out the findings of the Johns Hopkins study are highlight the issue of some poorly regulated CBD products being advertised as “THC free,” even though they were found to contain levels of THC similar to (or higher) than the THC levels present in the cannabis used in a study conducted by Ryan Vandrey, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
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“Conventional urine drug testing for cannabis targets a common metabolite of THC called THCCOOH (THC is the primary psychoactive component of cannabis). Importantly, many CBD-dominant products contain low levels of THC, including hemp-derived CBD products which can legally contain up to 0.3% THC,” he said. “There is a need to understand whether the use of CBD products, with and without low levels of THC, can impact drug testing for cannabis given their growing availability and increased interest in CBD for therapeutic purposes.”
A team at Johns Hopkins Medicine conducted a study in which six individuals administered pure CBD, both orally and using a vaporizer, as well as inhaled vaporized CBD-dominant cannabis (containing 0.39% THC) on separate occasions.
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Vandrey and his collaborators at the University of Pennsylvania had published a JAMA study showing that that 21% of CBD/hemp products sold on the Internet contained THC, even though their labels didn’t properly disclose it.
“THC can potentially build up in a person’s system with repeated use [of CBD products], which could further increase the chances of a positive result for cannabis.”