Matthew Frei

Residual cannabis levels in blood, urine and oral fluid following heavy cannabis use

An understanding of tetrahydrocannabinol (THC) kinetics and residual levels after cannabis use is essential in interpreting toxicology tests in body fluids from live subjects, particularly when used in forensic settings for drug abuse, traffic and interpersonal violence cases. However the current literature is largely based on laboratory studies using controlled cannabis dosages in experienced users, with limited research investigating the kinetics of residual THC concentrations in regular high dose cannabis users. Twenty-one dependent cannabis users were recruited at admission to two residential detoxification units in Melbourne, Australia. After being provided with information about, and consenting to, the study, subjects volunteered to provide once-daily blood, urine and oral fluid (saliva) samples for seven consecutive days following admission, involving cessation and abstinence from all cannabis use. Blood and oral fluid specimens were analysed for THC and urine specimens for the metabolite THC-COOH. In some subjects THC was detectable in blood for at least 7 days and oral fluid specimens were positive for THC up to 78 h after admission to the unit. Urinary THC-COOH concentrations exceeded 1000 ng/mL for some subjects 129 h after last use. The presented blood THC levels are higher and persist longer in some individuals than previously described, our understanding and interpretation of THC levels in long term heavy cannabis users may need to be reconsidered.

Beyond ice: rethinking Australia's approach to illicit drugs

Ice is now readily available in illicit drug markets. Drug use surveillance found that, between 2009 and 2014, the proportion of drug users finding it “easy” or “very easy” to obtain the drug increased from 65% to 91%, and those reporting recent ice use increased from 37% to 61%. Between 2012 and 2014, ice as a drug most commonly injected in the previous month went from 10% to 22%. Recent ice users had a mean age of 40 years, were more likely to be unemployed, and tended toward multiple or polydrug use. Less than half were in treatment. Many reported recent borrowing, lending and re-using of needles and syringes, injection injury (such as bruising or scarring), a mental health problem, and commission of a crime or arrest. At the same time, the number of methylamphetamine interdictions increased more than 12-fold from 88 in 2009e10, to 1084 in 2012e13. The weight of the drug seized similarly increased from 160 kg in 2011e12 to almost 1.5 tonnes in 2012e13. These data suggest that the problem is demand for drugs; while this demand remains strong, there will always be a supply.

An audit examining the impact of a training session on interest in prescribing opioid maintenance treatment among psychiatrists and trainees

94 The government priority of protection of patient and others from harm is thus apparent. Here, risk minimisation outweighs self-determination. The judge presiding over the Tarasoff case famously wrote, “The protective privilege ends where the public peril begins”.3 Perhaps protective privilege ends even when the personal peril begins. Unfortunately, detriment to the patient from the trauma of repeated involuntary containment is often not considered.