Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor?

• Published in: Frontiers in psychiatry Vol. 11; p. 598150
• Main Authors: Claus, Benedikt Bernd, Specka, Michael, McAnally, Heath, Scherbaum, Norbert, Schifano, Fabrizio, Bonnet, Udo
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 03.12.2020
• Subjects: cannabis withdrawal syndrome subtypes; gender effect; inpatient detoxification treatment; protracted withdrawal syndrome; Psychiatry; urinary 11-nor-9-carboxy-delta9-tetrahydrocannabinol; cannabis withdrawal syndrome subtypes; protracted withdrawal syndrome; urinary 11-nor-9-carboxy-delta9-tetrahydrocannabinol; gender effect; inpatient detoxification treatment
• ISSN: 1664-0640; 1664-0640
• DOI: 10.3389/fpsyt.2020.598150

Background: For cannabis-dependent subjects, the relationship between cannabis withdrawal syndrome (CWS) severity and the urine cannabinoid concentrations are unclear; we investigated this using a commercial point-of-care (POC) enzyme immunoassay detecting 11-nor-9-carboxy-Delta-9-tetrahydrocannabinol (THC-COOH). Methods: Observational study of 78 adult chronic cannabis-dependent subjects assessed over a 24-day inpatient detoxification treatment, with 13 serial measurement days. Repeated Measures Correlation and Multilevel Linear Models were employed. Results: Absolute urinary THC-COOH levels significantly correlated with Marijuana Withdrawal Checklist (MWC) scores across the entire study duration ( r = 0.248; p < 0.001). Correlation between serial creatinine-adjusted THC-COOH ratios and serial MWC scores emerged as significant only in the sample with higher MWC scores (>11 points) at admission ( n = 21; r = 0.247; p = 0.002). The aforementioned significant relationships have persisted when replacing the absolute THC-COOH-levels with the (relative) day-to-day change in urinary THC-COOH levels. MWC scores were significantly correlated with the Clinical Global Impression-Severity (CGI-S; r = 0.812; p < 0.001). Females showed a significantly slower decline in urine THC-COOH levels and prolonged CWS course characterized by substantial illness severity (per CGI-S), occurring in nearly 30% of cases. Conclusion: Urine cannabinoid levels (THC-COOH) determined by POC assay significantly predicted CWS severity (moderate correlation), guiding detoxification treatment duration. In patients with MWC > 11 points upon admission, creatinine-adjusted THC-COOH ratios also significantly predicted CWS severity—again with moderate effect size. Females showed prolonged urinary THC-COOH elimination and cannabis withdrawal.