The therapeutic use of cannabinoids: Forensic aspects

A B S T R A C T Since 2013 in the Italian market has been introduced the Nabiximols, a drug containing two of the main active cannabinoids: D9 -tetrahydrocannabinol (D9 -THC) and cannabidiol (CBD). This drug has been approved in Italy in the treatment of Multiple Sclerosis (MS). It is an oral spray formulation and each puff of 100 ml contains 2.7 mg of D9 -THC and 2.5 mg of CBD. In the present study we analyzed urine and blood samples collected from a group of 20 patients treated with Nabiximols in order to evaluate: blood D9 -THC concentrations in relation to the dose administered and the duration of treatment and the potentiality of this medication to be used for drug habit. Methods: The study was conducted on a sample group of patients affected by MS, of both sexes, age: 49– 61 years, treated with Nabiximols for short (28 days) or long-term. The results of our study allow affirming that it is unlikely to use this medication for drug habit or to sale it in the black market because of the low blood concentrations available and of its high costs. These statements were confirmed by: (a) the low D9 -THC concentrations in the pharmaceutical formulation; (b) the low blood concentrations produced by Nabiximols administration, more than 10 times smaller than the blood concentrations known to produce psychotropic effects; (c) the presence of CBD (D9 -THC natural antagonist); (d) the route of administration (inhaled, not smoked).