Embed Size (px)
Citation preview
THE MARIJUANA DETECTION WINDOW:DETERMINING THE LENGTH OF TIME
CANNABINOIDS WILL REMAINDETECTABLE IN URINE FOLLOWING SMOKING
By: Paul L. CaryBy: Paul L. Cary
Toxicology LaboratoryToxicology Laboratory
University of MissouriUniversity of Missouri
Introductory Comments: urinary cannabinoid detection window (CDW) urinary cannabinoid detection window (CDW) is not settled scienceis not settled science
The law is not black & white – neither is The law is not black & white – neither is sciencescience
elimination of cannabinoids is complexelimination of cannabinoids is complex formualting a CDW invites controversy formualting a CDW invites controversy should not preclude the court from should not preclude the court from development of a reasonable & pragmatic CDW development of a reasonable & pragmatic CDW for the vast majority case adjudicationsfor the vast majority case adjudications
Cannabinoid Detection in Urine Conventional wisdom has led to the common Conventional wisdom has led to the common assumption that cannabinoids will remain assumption that cannabinoids will remain detectable in urine for 30 days or longer detectable in urine for 30 days or longer following the use of marijuana. following the use of marijuana.
RESULT:RESULT: delay of therapeutic interventiondelay of therapeutic intervention hindered timely use of judicial hindered timely use of judicial sanctioningsanctioning
fostered denial of marijuana usage by fostered denial of marijuana usage by clientsclients
CDW Discussion:
general drug detection window issuesgeneral drug detection window issues necessity for establishing detection necessity for establishing detection windowwindow
cannabinoid elimination researchcannabinoid elimination research what perpetuates the 30+ day what perpetuates the 30+ day elimination assumptionelimination assumption
guidance for establishing a cannbinoid guidance for establishing a cannbinoid detection windowdetection window
effective use of the CDW benchmarkeffective use of the CDW benchmark
The Drug Detection Window
Defining the detection window: the length of time in days following the length of time in days following the last substance usage that urine the last substance usage that urine samples will continue to produce samples will continue to produce positive drug test results positive drug test results
the number of days until last the number of days until last positive positive
NOT - how long drugs will remain in a NOT - how long drugs will remain in a client’s “system”client’s “system”
reasonable estimate based upon many reasonable estimate based upon many factors – drug use, biological and factors – drug use, biological and testing issuestesting issues
Factors Influencing Detection Factors Influencing Detection Window:Window:
drug dosedrug dose route of entry into bodyroute of entry into body duration & frequency of duration & frequency of useuse
rate of metabolismrate of metabolism testing sensitivitytesting sensitivity specificity of testing specificity of testing methodmethod
Relative
Detection Times –by Specimen
Drug Detection Times - by Drug
amphetamines: 1-4 days amphetamines: 1-4 days cocaine: up to 72 hourscocaine: up to 72 hours opiates: 1-4 daysopiates: 1-4 days PCP: up to 6 daysPCP: up to 6 days barbiturates: up to a weekbarbiturates: up to a week benzodiazepines: up to a weekbenzodiazepines: up to a week . . then there’s alcohol & . . then there’s alcohol & cannabinoids cannabinoids
Why is establishing a CDW important?
How many days is it likely to take for How many days is it likely to take for a chronic marijuana user to reach a a chronic marijuana user to reach a negative urine drug test result?negative urine drug test result?
How long can cannabinoids be excreted How long can cannabinoids be excreted and detected in urine after a single and detected in urine after a single exposure to marijuana?exposure to marijuana?
How many days of positive urine drug How many days of positive urine drug tests for cannabinoids constitutes tests for cannabinoids constitutes continued marijuana usage?continued marijuana usage?
Why is establishing a CDW important?
How often should a client’s urine be tested to How often should a client’s urine be tested to monitor for continued abstinence from monitor for continued abstinence from marijuana?marijuana?
How many days should the court wait before How many days should the court wait before retesting a client after a positive urine drug retesting a client after a positive urine drug test for cannabinoids has been obtained?test for cannabinoids has been obtained?
How should the court interpret a positive urine How should the court interpret a positive urine drug test for cannabinoids after a client has drug test for cannabinoids after a client has completed an initial 30-day detoxification completed an initial 30-day detoxification period designed to “clean out” their system? period designed to “clean out” their system?
Cannabinoid Elimination Research
Conflicting Research?
In a recent forensic publication, Dr. Marilyn Huestis: “Monitoring In a recent forensic publication, Dr. Marilyn Huestis: “Monitoring acute cannabis usage with a commercial cannabinoid acute cannabis usage with a commercial cannabinoid immunoassay with a 50-ng/mL cutoff concentration provides only immunoassay with a 50-ng/mL cutoff concentration provides only a narrow window of detection of 1–2 days,” (2002). a narrow window of detection of 1–2 days,” (2002).
In a 1985 article by Ellis et. al.; “that under very strictly supervised In a 1985 article by Ellis et. al.; “that under very strictly supervised abstinence, chronic users can have positive results for abstinence, chronic users can have positive results for cannabinoids in urine at 20 ng/mL or above for as many as 46 cannabinoids in urine at 20 ng/mL or above for as many as 46 consecutive days from admission”consecutive days from admission”
Many of the early cannabinoid studies often cited as proof of 30+ day detection periods suffered from . . .
unable to ensure abstinence unable to ensure abstinence duringduring the study the study
detection cutoffs used very lowdetection cutoffs used very low used testing methods no longer used testing methods no longer available - poor specificityavailable - poor specificity
Despite these problems . . . . Smith-Kielland, et. al. – average time to the first Smith-Kielland, et. al. – average time to the first negative sample (cannabinoid cutoff of 20 ng/mL) negative sample (cannabinoid cutoff of 20 ng/mL) 3.8 days for infrequent users3.8 days for infrequent users 11.3 days for frequent users 11.3 days for frequent users
Swatek study– 8 of 10 chronic subjects tested below the Swatek study– 8 of 10 chronic subjects tested below the 50 ng/mL cutoff after an average of 13 days 50 ng/mL cutoff after an average of 13 days
Johansson et. al. identified only one subject that Johansson et. al. identified only one subject that tested positive for longer than 14 days with all tested positive for longer than 14 days with all thirteen subjects having an average last day with thirteen subjects having an average last day with detectable levels (using a 20 ng/mL cutoff) of 9.8 days detectable levels (using a 20 ng/mL cutoff) of 9.8 days
despite potential factors restricting interpretation, despite potential factors restricting interpretation, study subjects with exceptionally long CDW (30-plus study subjects with exceptionally long CDW (30-plus days) were just that—exceptionaldays) were just that—exceptional
Recent Research - Acute Use
1995 (Huestis, et. al.) six health males - 1995 (Huestis, et. al.) six health males - locked medical ward - 20 ng/mL cutofflocked medical ward - 20 ng/mL cutoff CDW 3-6 days following high dose cigaretteCDW 3-6 days following high dose cigarette
1996 (Huestis, et. al.) six health males - 1996 (Huestis, et. al.) six health males - locked medical ward - 15 ng/mL GC/MS cutofflocked medical ward - 15 ng/mL GC/MS cutoff CDW 122 hours following high dose cigaretteCDW 122 hours following high dose cigarette
2001 (Niedbala, et. al.) 18 health males - 2001 (Niedbala, et. al.) 18 health males - locked medical ward - 50 ng/mL cutofflocked medical ward - 50 ng/mL cutoff CDW averaged 42 hours after high dose CDW averaged 42 hours after high dose cigarette cigarette
Recent Research - Acute Recent Research - Acute UseUse acute marijuana elimination studies acute marijuana elimination studies
conclude that after single usage events conclude that after single usage events cannabinoids are detected in urine for no cannabinoids are detected in urine for no more than a few daysmore than a few days
Recent Research - Chronic Studies
2001 (Reiter, et. al.) 52 volunteer 2001 (Reiter, et. al.) 52 volunteer chronic users on detox ward - using chronic users on detox ward - using 20 ng/mL cutoff20 ng/mL cutoff used daily testing to control used daily testing to control covert THC usecovert THC use
maximum cannabinoid elimination maximum cannabinoid elimination time – 433.5 hours or 18.1 days time – 433.5 hours or 18.1 days
mean elimination 117.5 or 4.9 daysmean elimination 117.5 or 4.9 days
Recent Research - Chronic Studies
1999 (Kouri, et. al.) 17 chronic users - 1999 (Kouri, et. al.) 17 chronic users - documented 5000 separate “episodes” documented 5000 separate “episodes” marijuana use (one joint per day for marijuana use (one joint per day for 13.7 years) - 20 ng/mL cutoff13.7 years) - 20 ng/mL cutoff 5/17 tested negative at one week5/17 tested negative at one week by the second week - 9/17 were negativeby the second week - 9/17 were negative by week 3 - 11/17 tested negativeby week 3 - 11/17 tested negative study ended at day 28 with six still study ended at day 28 with six still testing positive testing positive
Recent Research - Chronic Studies even under even under extraordinaryextraordinary exposure criteria, the exposure criteria, the average CDW is approximately average CDW is approximately 14 days, with significant 14 days, with significant majority of chronic marijuana majority of chronic marijuana users testing negative prior users testing negative prior to 30 days to 30 days
Perpetuating the Myth
Perpetuating 30-Plus Day Perpetuating 30-Plus Day AssumptionAssumption Substance abuse treatment literatureSubstance abuse treatment literature that proclaims, “some that proclaims, “some
parts of the body still retain THC even after a couple of parts of the body still retain THC even after a couple of months”. months”.
Drug abuse information targeted toward teensDrug abuse information targeted toward teens “Traces of THC “Traces of THC can be detected by standard urine and blood tests for about 2 can be detected by standard urine and blood tests for about 2 days up to 11 weeks”.days up to 11 weeks”.
Health information websitesHealth information websites that provide the following that provide the following guidance; “At the confirmation level of 15 ng/ml, the frequent guidance; “At the confirmation level of 15 ng/ml, the frequent user will be positive for perhaps as long as 15 weeks.”user will be positive for perhaps as long as 15 weeks.”
And, last but not least Dr. Drew Pinsky (a.k.a. Dr. Drew) who And, last but not least Dr. Drew Pinsky (a.k.a. Dr. Drew) who has been the co-host on the popular call-in radio show has been the co-host on the popular call-in radio show "Loveline" for 17 years who states; “Pot stays in your body, "Loveline" for 17 years who states; “Pot stays in your body, stored in fat tissues, potentially your whole life.”stored in fat tissues, potentially your whole life.”
Establishing a Cannbinoid Detection
Window
CDW – Preface Comments
30+ day detection window often exaggerates 30+ day detection window often exaggerates duration of detection windowduration of detection window
established need reasonable & pragmatic court established need reasonable & pragmatic court guidanceguidance
detection window based upon screening test detection window based upon screening test cutoff as benchmark (50 & 20 ng/mL)cutoff as benchmark (50 & 20 ng/mL)
based upon current screening methodsbased upon current screening methods no studies of cannabinoid elimination using no studies of cannabinoid elimination using on-site testing devices (i.e. “instant” on-site testing devices (i.e. “instant” tests)tests)
confirmation (GC/MS) cutoff irrelevantconfirmation (GC/MS) cutoff irrelevant
GC/MS Cutoff Irrelevent
initial screen (–); sample not sent initial screen (–); sample not sent for confirmationfor confirmation
initial screen (+) & confirmation initial screen (+) & confirmation (+); confirmation merely validating (+); confirmation merely validating screenscreen
initial screen (+); sample fails to initial screen (+); sample fails to confirm (–); CDW shorter than confirm (–); CDW shorter than guidance - not prejudicial to clientguidance - not prejudicial to client
Cannabinoid Detection Window
detection time: at 50 ng/mL cutoffdetection time: at 50 ng/mL cutoff 1 - 3 days for single event/occasional 1 - 3 days for single event/occasional useuse
up to 10 days for heavy chronic useup to 10 days for heavy chronic use
detection time: at 20 ng/mL cutoffdetection time: at 20 ng/mL cutoff 5-7 days for single event/occasional 5-7 days for single event/occasional useuse
up to 21 days for heavy chronic useup to 21 days for heavy chronic use
Marijuana Usage Issues
Chronic Use - Chronic Use - do drug court practitioners need do drug court practitioners need to be concerned about the potential of extended to be concerned about the potential of extended cannabinoid detection times impacting court decisions cannabinoid detection times impacting court decisions (i.e., sanctions)?(i.e., sanctions)? client entry into court programclient entry into court program detox or “clean out” phasedetox or “clean out” phase following initial detox - past chronic usage will following initial detox - past chronic usage will
not effect CDWnot effect CDW
Detox Stage or “Clean-Out” Phase
30-day period commonplace regardless of origin - represents a reasonable time period
it is unlikely (utilizing reasonable physiological or technology criteria) that a drug court client would continue to remain cannabinoid positive at the end of this designated abstinence period
Establishing an Abstinence Baseline
““actual” baseline – client has actual” baseline – client has demonstrateddemonstrated abstinence via repeated abstinence via repeated negative drug testsnegative drug tests
““science-based” baseline – court-science-based” baseline – court-established time limit after which a established time limit after which a client client should notshould not test positive if that test positive if that client has abstained from drug useclient has abstained from drug use
primarily applies to marijuanaprimarily applies to marijuana individuals who continue to produce individuals who continue to produce positive drug test results beyond the positive drug test results beyond the established baseline maximums are subject established baseline maximums are subject to sanctionto sanction
AB – not a secret! Inform clientsAB – not a secret! Inform clients
Testing Following Positive ResultsDue to cannabinoids prolonged Due to cannabinoids prolonged elimination - Why continue drug elimination - Why continue drug testing?testing?
testing includes drug other than testing includes drug other than cannabinoidscannabinoids
suspension of scheduled client drug testing sends the suspension of scheduled client drug testing sends the wrongwrong therapeutic message therapeutic message
curtailingcurtailing testing extends unnecessarily the period of testing extends unnecessarily the period of uncertainty about a client’s recent behavior and may uncertainty about a client’s recent behavior and may delay appropriate therapeutic strategies or sanction delay appropriate therapeutic strategies or sanction decisionsdecisions
Recent Cannabinoid Use versus Non-recent use (double sanction issue):
How do drug courts discriminate between How do drug courts discriminate between new drug exposure and continued new drug exposure and continued elimination from previous (chronic) use ?elimination from previous (chronic) use ? an issue only in first phase of programan issue only in first phase of program only drug that poses concern is only drug that poses concern is cannabinoidscannabinoids
““two negative test” rule – two back-to-two negative test” rule – two back-to-back negative drug tests post clean outback negative drug tests post clean out
Drug Court’s Competing Imperatives
the need for rapid therapeutic the need for rapid therapeutic intervention (sanctioning intervention (sanctioning designed to produce behavioral designed to produce behavioral change) change)
the need to ensure that the the need to ensure that the evidentiary standards, crafted to evidentiary standards, crafted to protect client rights, are protect client rights, are maintainedmaintained
Addressing Imperatives for Cannabinoids acknowledge research reporting prolonged acknowledge research reporting prolonged THC elimination THC elimination
establish a reasonable and pragmatic establish a reasonable and pragmatic detection window guidance for the vast detection window guidance for the vast majority of case adjudicationsmajority of case adjudications
sound judicial practice requires that sound judicial practice requires that court decisions be based upon case-court decisions be based upon case-specific informationspecific information
in unconventional situations that confound in unconventional situations that confound the court, qualified toxicological the court, qualified toxicological assistance should be soughtassistance should be sought
SUMMARY
One of the most important prerogatives of drug court is One of the most important prerogatives of drug court is to clearly define the behavioral expectations for clients to clearly define the behavioral expectations for clients by establishing compliance boundaries required for by establishing compliance boundaries required for continued program participation.continued program participation.
Establishing a detection window allows the application Establishing a detection window allows the application court intervention strategies in an equitable and court intervention strategies in an equitable and consistent manner.consistent manner.
Establish the cannabinoid detection window based upon Establish the cannabinoid detection window based upon drug testing cutoff.drug testing cutoff.
Clients need to understand abstinence benchmarks.Clients need to understand abstinence benchmarks.
SUMMARY (continued)
The goal is to establish a given time period (detection The goal is to establish a given time period (detection window limit) after which a client should not window limit) after which a client should not testtest positive positive for cannabinoids as a result of continued excretion from for cannabinoids as a result of continued excretion from prior usage.prior usage.
““Drug-Free” is not an attainable measurement.Drug-Free” is not an attainable measurement. While detection window benchmarks should guide the While detection window benchmarks should guide the
sanctioning process for violations of abstinent behavior, sanctioning process for violations of abstinent behavior, courts are urged to judge a client’s level of compliance on a courts are urged to judge a client’s level of compliance on a case-by-case basis using all of the behavioral data available case-by-case basis using all of the behavioral data available to the court in conjunction with drug testing results. to the court in conjunction with drug testing results.
Full Text of:Full Text of:
The Marijuana Detection Window: The Marijuana Detection Window: Determining the Length of Time Determining the Length of Time Cannabinoids Will Remain Detectable in Cannabinoids Will Remain Detectable in Urine following Smoking: A Critical Urine following Smoking: A Critical Review of Relevant Research and Review of Relevant Research and Cannabinoid Detection Guidance for Drug Cannabinoid Detection Guidance for Drug Courts, Courts, Drug Court ReviewDrug Court Review (publication (publication of the National Drug Court Institute, of the National Drug Court Institute, Arlington VirginiaArlington Virginia Volume V, Issue 1, Spring Volume V, Issue 1, Spring 2006, pages 23-582006, pages 23-58..
