Biological correlates of self-reported new and continued abstinence in cannabis cessation treatment clinical trials. (1st June 2018)

• Record Type: Journal Article
• Authors: Baker, Nathaniel L.; Gray, Kevin M.; Sherman, Brian J.; Morella, Kristen; Sahlem, Gregory L.; Wagner, Amanda M.; McRae-Clark, Aimee L.
• Is Part Of: Drug and alcohol dependence. Volume 187(2018)
• Page Start: 270
• Page End: 277
• Publication Date: 2018-06-01
• Subjects: Cannabis -- Self-Report -- Contingency management -- Urine cannabinoid -- Concentrations -- Clinical trials; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2018.03.017
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Traditional 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH) abstinence cut-offs are not sensitive to recent abstinence initiation. Agreement between cannabis use and urine THCCOOH measures are not well defined. Combining current THCCOOH with recent changes in CN-THCCOOH may be more sensitive. Inclusion of a contingency management may decrease the agreement. Abstract: Background: The agreement between self-reported cannabis abstinence with urine cannabinoid concentrations in a clinical trials setting is not well characterized. We assessed the agreement between various cannabinoid cutoffs and self-reported abstinence across three clinical trials, one including contingency management for abstinence. Methods: Three cannabis cessation clinical trials where participants reported use and provided weekly urine samples for cannabis and creatinine concentration measurements were included. Bootstrapped data were assessed for agreement between self-reported 7+ day abstinence and urine cannabinoid tests using generalized linear mixed effects models for clustered binary outcomes. One study implemented contingency management for cannabis abstinence. Four hundred and seventy-three participants with 3787 valid urine specimens were included. Urine was analyzed for 11-nor-9-carboxy-Δ9-tetrahydrocannabinol and creatinine using immunoassay methods Biological cutoffs of 50, 100, and 200 ng/ml, as well as changes in CN normalized THCCOOH (25%/50% decrease), were assessed for agreement with self-reported abstinence during the three clinical trials. Results: Agreement between measured THCCOOH and self-reported abstinence increases with increasing cutoff concentrations, while the agreement with self-reported non-abstinence decreases with increasing cutoff concentrations. Combining THCCOOH cutoffs with recent changes in CN-THCCOOH provides a better agreement in those self-reporting abstinence. Participants in the studies that received CM for abstinence had a lower agreement between self-reported abstinence and returned to use than those in studies that did not have a contingency management component. Conclusion: Using combinations of biological measurements and self-reported abstinence, confirmation of study related abstinence may be verifiable earlier and with greater accuracy than relying on a single measurement.