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Changes in the Composition of Cannabis from 2000–2017 in Denmark: Analysis of Confiscated Samples of Cannabis Resin

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Changes in the Composition of Cannabis from 2000–2017 in Denmark: Analysis of Confiscated Samples of Cannabis Resin Experimental and Clinical Psychopharmacology © 2019 American Psychological Association 2019, Vol. 27, No. 4, 402–411 1064-1297/19/$12.00 http://dx.doi.org/10.1037/pha0000303 Changes in the Composition of Cannabis From 2000–2017 in Denmark: Analysis of Confiscated Samples of Cannabis Resin Kristine Rømer Thomsen, Christian Lindholst, Lotte Ask Reitzel Birgitte Thylstrup, and Sinikka Kvamme University of Copenhagen Aarhus University Martin Worm-Leonhard Amir Englund University of Southern Denmark King’s College London Tom P. Freeman Morten Hesse University of Bath Aarhus University Globally, recent studies report increases in ⌬-9-tetrahydrocannabinol (THC) concentration in seized samples of cannabis for human consumption. This is important, because use of cannabis with a high concentration of THC has been linked to a number of adverse health outcomes. The objective of this study was to assess recent changes in the composition of seized cannabis resin in Denmark by (a) examining THC concentration in samples from Danish forensic laboratories from 2000 to 2017 (N ϭ 430) and (b) examining cannabidiol (CBD) concentration and the THC:CBD concentration ratio in samples from the forensic laboratory in Western Denmark from 2008 to 2017 (N ϭ 147). Cannabis resin samples were analyzed using a gas chromatographic analysis with flame ionization detection quantifying the total THC and CBD concentration. Results showed that the THC concentration increased 3-fold from 2000 (mean: 8.3%) to 2017 (mean: 25.3%). Significant increases occurred in all areas of Denmark. After 2011, we found a dramatic increase in cannabis resin samples with high THC concentration and the near disappearance of cannabis resin samples with medium- and low THC concentration. Furthermore, the THC:CBD concentration ratio increased significantly from 1.4 in 2008 to 4.4 in 2017. Whereas THC concentration increased, CBD concentration remained stable at ϳ6%. In conclusion, the THC concentration of cannabis resin, and THC:CBD concentration ratio, have increased dramatically in Denmark, potentially leading to higher risk of harm to users. Policymakers, treatment professionals, and educators should be aware of this change. Public Health Significance Based on seized cannabis resin samples from 2000 to 2017, we observe a threefold increase in THC concentration and a rise in THC:CBD concentration ratio, suggesting that cannabis users may be exposed to higher doses of THC, which may carry a greater risk. Observed trends are strikingly similar to trends reported in France, suggesting that the emergence of new, resin products with higher THC concentration has widely penetrated European markets, including Scandinavia. Policymakers, treatment professionals, and educators should be aware of this change. Keywords: cannabis, CBD, gas chromatography with flame ionization detector, THC This document is copyrighted by the American Psychological Association or one of its allied publishers. This article was published Online First June 20, 2019. Kristine Rømer Thomsen and Christian Lindholst contributed equally This article is intended solely for the personal use of the individual userKristine and is not to be disseminated broadly. Rømer Thomsen, Centre for Alcohol and Drug Research, and are shared first-authors. This research was supported by the Danish Department of Psychology and Behavioral Sciences, Aarhus Univer- Ministry of Social Affairs, Research Grant 9172-0001-04 (Kristine sity; Christian Lindholst, Department of Forensic Medicine, Section of Rømer Thomsen, Birgitte Thylstrup, Morten Hesse). Tom P. Freeman Forensic Chemistry, Aarhus University; Birgitte Thylstrup and Sinikka was funded by a Senior Academic Fellowship from the Society for the Kvamme, Centre for Alcohol and Drug Research, Department of Psy- Study of Addiction. Amir Englund has received a travel grant from GW chology and Behavioral Sciences, Aarhus University; Lotte Ask Reit- Pharmaceuticals and a speaker’s fee from Lundbeck Pharma. The zel, Department of Forensic Medicine, Section of Forensic Chemistry, funding sources had no other role than financial support. All authors University of Copenhagen; Martin Worm-Leonhard, Department of contributed in a significant way to the manuscript, and all authors have Forensic Medicine, Section for Forensic Toxicology, University of read and approved the final manuscript. The authors declare no con- Southern Denmark; Amir Englund, Department of Psychosis Studies flicts of interest. and National Addiction Centre, Institute of Psychiatry, Psychology, and Correspondence concerning this article should be addressed to Kristine Neuroscience, King’s College London; Tom P. Freeman, Addiction and Rømer Thomsen, Centre for Alcohol and Drug Research, Department of Mental Health Group (AIM), Department of Psychology, University of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé Bath; Morten Hesse, Centre for Alcohol and Drug Research, Depart- 10, building 1322, 2. Floor, 8000 Aarhus C, Denmark. E-mail: krt.crf@ ment of Psychology and Behavioral Sciences, Aarhus University. psy.au.dk 402 CHANGES IN CANNABIS COMPOSITION DENMARK 2000–2017 403 Cannabis contains at least 144 different cannabinoids, of which increasing almost twofold from 2011 to 2016 (Freeman et al., the main psychoactive component is ⌬-9-tetrahydrocannabinol 2019). This suggests that the emergence of new, higher-THC- (THC; Hanuš, Meyer, Munoz, Taglialatela-Scafati, & Appendino, concentration resin products is not limited to France but instead 2016). The cannabinoids are produced and stored in glandular has penetrated European markets, including central Europe and trichomes, mainly around the flowering tops of the female canna- Scandinavia. Of note, Denmark reported the highest THC concen- bis plant (Potter, 2014). Prevention of pollination increases the tration of resin among all countries submitting data to the number of trichomes the plant produces, which results in a product EMCDDA in 2016 (Freeman et al., 2019). with higher THC concentration (i.e., %THC by weight of sample). The THC concentration of cannabis is important, as it has been Broadly speaking, cannabis products can be divided into four cate- linked to a number of adverse outcomes including increased risk of gories: high-THC-concentration/sinsemilla (unpollinated flower), psychotic disorder (Di Forti et al., 2015; Schoeler et al., 2016), herbal (pollinated flower), hash/resin (compressed cannabis trichomes negative impact on cognitive functions (D’Souza et al., 2004; along with plant matter), and cannabis concentrates (such as hash oil, Morgan et al., 2012; Morrison et al., 2009), and poorer addiction wax dabs, butane hash oil, shatter, etc.) (Potter, Hammond, Tuffnell, outcomes (Curran et al., 2018; Freeman & Winstock, 2015; Meier, Walker, & Di Forti, 2018). 2017). A recent 16-year study found positive time-dependent as- During the past two decades, increases in the THC concentration sociations between changes in cannabis concentration and first- of cannabis have been reported in the United States (ElSohly et al., time admissions to drug treatment, after adjusting for age, sex and 2016; Smart, Caulkins, Kilmer, Davenport, & Midgette, 2017) and noncannabis drug treatment admissions (Freeman et al., 2018). Europe (Dujourdy & Besacier, 2017; Freeman et al., 2019; Pijl- Another main cannabinoid important to monitor is cannabidiol man, Rigter, Hoek, Goldschmidt, & Niesink, 2005; Potter, Clark, (CBD). Accumulating evidence suggests that CBD displays op- & Brown, 2008; Potter et al., 2018; Zamengo, Frison, Bettin, & posing neural, cognitive, and behavioral effects that interact with, Sciarrone, 2014, 2015). A large study of confiscated samples in the and possibly counteract, effects of THC (Englund, Freeman, Mur- United States reported that the THC concentration of illicit can- ray, & McGuire, 2017; Iseger & Bossong, 2015; Osborne, Solowij, nabis products (overall) increased consistently from about 4% in & Weston-Green, 2017; Rømer Thomsen, Callesen, & Feldstein 1995 to about 12% in 2014, and that over the last four years, the Ewing, 2017), including effects on psychotic symptoms (Bhat- number of high-THC-concentration samples seized has increased tacharyya et al., 2018; Leweke et al., 2012; McGuire et al., 2018; while the number of low-THC-concentration samples (herbal) has Morgan et al., 2018; Zuardi et al., 2009; Zuardi et al., 2006) and decreased (ElSohly et al., 2016). In Washington State, a dramatic cognitive functions (Das et al., 2013; Englund et al., 2013; Mor- increase in THC concentration was recently reported within 2 gan, Schafer, Freeman, & Curran, 2010). Hence, information on years of legal sales (average 20.6%), where extremely high-THC- CBD concentration, and the THC:CBD concentration ratio in concentration extracts (average 68.7% THC) now constitute cannabis products, provides important information on the potential around 21.2% of purchases (Smart et al., 2017). health risks and benefits in addition to THC concentration alone, A comprehensive study of confiscated samples from France although more systematic studies are needed to inform us on reported that THC concentrations in cannabis resin increased optimal ratios that carry least risk of harm (Englund et al., 2017). slowly from 1992 to 2009 followed by a dramatic increase from Although recreational cannabis use is illegal in Denmark, it is 10% in 2009% to 23% mid-2016 (Dujourdy & Besacier, 2017). widespread; among 16- to 44-year-olds, nearly half report that they The authors
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