Comprehensive Drug Surveillance by Multisegment Injection-Capillary Electrophoresis-Mass Spectrometry: Insights into Medicinal Cannabis Metabolism..

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Medicinal cannabis is of great scientific and public interest to Canadians that promises major socioeconomic benefits. However, there remains a lack of scientific studies that can guide the development of evidence-based cannabis therapeutics for treatment of debilitating health conditions, such as chronic pain. The cannabis plant is a polypharmaceutical substance containing more than 500 chemical constituents, including 100 different cannabinoids whose synergistic biological activities remain poorly understood. To date, guidelines from Health Canada focus on analytical testing for potency of only two cannabinoids (THC, CDB) that do not fundamentally address how patients metabolize cannabinoids. Indeed, dosage regimes and treatment responses vary widely between patients resulting in sub-optimal responses with potential adverse effects from lifestyle (e.g., tobacco) and concurrent medications (e.g., opioids). Our proposal aims to address this major knowledge gap based on a collaborative research project between researchers at McMaster University and PureSinse, a licensed producer with interests in developing innovative medicinal cannabis products tailored to individual patients. Our study will recruit both first-time and returning patients who are being treated for chronic pain, anxiety and/or insomnia. Our proposal will perform comprehensive drug surveillance on paired urine samples collected from patients over a three week period during clinical visits who have been prescribed either dried plants (smoked/vaped) or oil extracts (ingested). Importantly, our data workflow will include non-targeted metabolite profiling in urine for the discovery of novel cannabinoid metabolites and other relevant drug exposures not screened by conventional tests. This approach will not only confirm patient adherence but also reveal differential cannabinoid metabolism between patients from inhaled or ingested cannabis products, including potential adverse effects with other prescribed drugs. Our exciting pilot study will provide healthcare providers an objective yet accurate screening tool that guides optimal medicinal cannabis prescriptions for improved treatment outcomes in patients.