How Oral THC (Dronabinol) Affects Blood Cannabinoid Levels in Daily Cannabis Smokers
High-dose oral THC increased blood cannabinoid levels in a dose-dependent manner, but smoked cannabis could only be distinguished from oral THC for about one hour after smoking.
Quick Facts
What This Study Found
During placebo dosing periods, blood THC and its metabolites consistently decreased, supporting the withdrawal symptoms observed. During active dronabinol dosing, all cannabinoid blood levels increased in a dose-dependent fashion. At the 120 mg/day dose, the metabolite THCCOOH increased significantly, and at 60 mg/day, the metabolite 11-OH-THC increased significantly.
After a smoked cannabis challenge (5.9% THC cigarette), peak blood concentrations occurred within 15 minutes. However, the spike from smoking was only distinguishable from oral THC blood levels for about one hour, making it impractical to detect cannabis relapse during dronabinol treatment.
The ratio of THCCOOH to THC was higher after overnight dronabinol abstinence but could not reliably distinguish oral dosing from smoked cannabis.
Key Numbers
11 participants. Dronabinol doses: 0, 30, 60, 120 mg/day. Challenge cigarette: 5.9% THC. THC peak within 15 minutes of smoking. Smoked cannabis distinguishable from oral THC for approximately 1 hour only.
How They Did This
Eleven daily cannabis smokers participated in a within-subject design with four 5-day medication sessions receiving 0, 30, 60, or 120 mg/day oral THC (dronabinol). Sessions were separated by 9 days of ad libitum cannabis smoking. On day 5 of each session, participants smoked one 5.9% THC cigarette. Blood samples were collected and analyzed for THC, 11-OH-THC, and THCCOOH using two-dimensional gas chromatography mass spectrometry.
Why This Research Matters
Understanding the pharmacokinetics of oral THC during substitution therapy is essential for developing cannabis dependence treatments. The finding that relapse to smoked cannabis is nearly undetectable during dronabinol therapy has implications for clinical monitoring in treatment settings.
The Bigger Picture
Dronabinol (oral THC) has been studied as a substitution therapy for cannabis dependence, similar to methadone for opioid dependence. This pharmacokinetic data helps explain both its therapeutic effects (withdrawal suppression) and its limitations (inability to monitor for relapse through blood testing).
What This Study Doesn't Tell Us
Only 11 participants were included. All were chronic, daily cannabis smokers, so results may not generalize to lighter users. The cannabis challenge used a relatively low-potency cigarette (5.9% THC). The study examined pharmacokinetics only, not clinical outcomes like sustained abstinence.
Questions This Raises
- ?Can alternative biomarkers better detect cannabis relapse during dronabinol therapy?
- ?What is the optimal dronabinol dose for balancing withdrawal suppression with side effects?
- ?Would newer oral cannabinoid formulations offer better pharmacokinetic profiles for dependence treatment?
Trust & Context
- Key Stat:
- Smoked cannabis was distinguishable from oral THC for only ~1 hour in blood tests
- Evidence Grade:
- This is a controlled pharmacokinetic study with a within-subject design, but the sample size was very small (n=11).
- Study Age:
- Published in 2014. Research on cannabinoid substitution therapy for cannabis dependence continues.
- Original Title:
- Plasma cannabinoid concentrations during dronabinol pharmacotherapy for cannabis dependence.
- Published In:
- Therapeutic drug monitoring, 36(2), 218-24 (2014)
- Authors:
- Milman, Garry(3), Bergamaschi, Mateus M(2), Lee, Dayong(6), Mendu, Damodara R, Barnes, Allan J, Vandrey, Ryan, Huestis, Marilyn A
- Database ID:
- RTHC-00833
Evidence Hierarchy
Participants are randomly assigned to treatment or placebo groups to test cause and effect.
What do these levels mean? →Frequently Asked Questions
What is dronabinol?
Dronabinol is synthetic THC in capsule form, FDA-approved for nausea and appetite stimulation. It has also been studied as a substitution therapy for cannabis dependence, similar to how methadone is used for opioid dependence.
Why can't blood tests detect relapse during dronabinol treatment?
Because both oral dronabinol and smoked cannabis produce the same compound (THC) and metabolites in the blood. The spike from smoking is brief and blends into the background levels from oral dosing within about an hour.
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Cite This Study
https://rethinkthc.com/research/RTHC-00833APA
Milman, Garry; Bergamaschi, Mateus M; Lee, Dayong; Mendu, Damodara R; Barnes, Allan J; Vandrey, Ryan; Huestis, Marilyn A. (2014). Plasma cannabinoid concentrations during dronabinol pharmacotherapy for cannabis dependence.. Therapeutic drug monitoring, 36(2), 218-24. https://doi.org/10.1097/FTD.0b013e3182a5c446
MLA
Milman, Garry, et al. "Plasma cannabinoid concentrations during dronabinol pharmacotherapy for cannabis dependence.." Therapeutic drug monitoring, 2014. https://doi.org/10.1097/FTD.0b013e3182a5c446
RethinkTHC
RethinkTHC Research Database. "Plasma cannabinoid concentrations during dronabinol pharmaco..." RTHC-00833. Retrieved from https://rethinkthc.com/research/milman-2014-plasma-cannabinoid-concentrations-during
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.