title: Cannabinoids in postmortem toxicology.
abstract: Cannabinoids are often excluded from postmortem toxicology screens due to their ubiquitous nature, interpretative difficulties and unanswered questions regarding their postmortem redistribution. In this study, we review 30 postmortem cases where a drug screen gave a positive cannabinoids result and a confirmation identified Δ⁹-tetrahydrocannabinol (THC), 11-hydroxy-Δ⁹-tetrahydrocannabinol (11-OH-THC), and/or 11-nor-9-carboxy-Δ⁹-tetrahydrocannabinol (THC-COOH) in peripheral (BL-P) or cardiac/central blood (BL-C) and/or urine (UR). Had cannabinoids not been included in these toxicologic evaluations, incomplete or erroneous inferences would have been drawn in a substantial number of cases regarding cause/manner of death. THC was detected in 28 BL-C and in all 30 BL-P. THC and THC-COOH were confirmed present in 2 and 23 UR, respectively. 11-OH-THC was detected in 4 BL-C, 6 BL-P, and 0 UR. The mean THC concentrations in BL-C and BL-P were 8.0 and 15.8 ng/mL, respectively. The mean THC-COOH concentrations in BL-C and BL-P were 55.2 and 60.6 ng/mL, respectively. The mean 11-OH-THC concentrations in BL-C and BL-P were 17.0 and 12.5 ng/mL, respectively. Postmortem interval (PMI) for each case was determined and evaluated in relation to BL-C/BL-P concentration ratios with THC-COOH exhibiting a possible trend. This study is the first of its kind and demonstrates the usefulness of cannabinoid analyses as part of death investigations. Furthermore, it provides distribution data that will improve the ability of toxicologists and pathologists to evaluate cannabinoid concentrations in human postmortem specimens.
authors.affiliation: Forensic Laboratory Division, Office of the Chief Medical Examiner, Hall of Justice-North Terrace, 850 Bryant Street, San Francisco, California 94103, USA.
authors.forename: Nikolas P
authors.initials: NP
authors.lastname: Lemos
authors.forename: Eric A
authors.initials: EA
authors.lastname: Ingle
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D002186:Cannabinoids / Q000097:blood* / Q000652:urine; D002423:Cause of Death; D005260:Female; D053593:Forensic Toxicology / Q000379:methods*; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D057230:Limit of Detection; D008297:Male; D008875:Middle Aged; D011180:Postmortem Changes; D013048:Specimen Handling; D055815:Young Adult
chemical_list: D002186:Cannabinoids