THE MARIJUANA DETECTION WINDOW: DETERMINING THE LENGTH OF TIME CANNABINOIDS WILL REMAIN DETECTABLE IN URINE FOLLOWING SMOKING

Transcription

1 THE MARIJUANA DETECTION WINDOW: DETERMINING THE LENGTH OF TIME CANNABINOIDS WILL REMAIN DETECTABLE IN URINE FOLLOWING SMOKING By: Paul L. Cary Toxicology Laboratory University of Missouri

2 Introductory Comments: urinary cannabinoid detection window (CDW) is not settled science The law is not black & white neither is science elimination of cannabinoids is complex formulating a CDW invites controversy should not preclude the court from development of a reasonable & pragmatic CDW for the vast majority case adjudications

3 Cannabinoid Detection in Urine Conventional wisdom has led to the common assumption that cannabinoids will remain detectable in urine for 30 days or longer following the use of marijuana. RESULT: delay delay of therapeutic intervention hindered hindered timely use of judicial sanctioning fostered fostered denial of marijuana usage by clients

4 CDW Discussion: general drug detection window issues value in establishing detection window cannabinoid elimination research what perpetuates the 30+ day elimination assumption guidance for establishing a cannabinoid detection window effective use of the CDW benchmark

5 The Drug Detection Window

6 Defining the detection window: the length of time in days following the last substance usage that urine samples will continue to produce positive drug test results the number of days until last positive NOT - how long drugs will remain in a client s system reasonable estimate based upon many factors drug use, biological and testing issues

7 Factors Influencing Detection Window: drug dose route of entry into body duration & frequency of use rate of metabolism testing sensitivity specificity of testing method

8 Relative Detection Times by Specimen

9 Drug Detection Times in Urine - by Drug amphetamines: days cocaine: up to 72 hours opiates: days PCP: up to 6 days barbiturates: up to a week benzodiazepines: up to a week.. then there s alcohol & cannabinoids

10 Why is establishing a CDW important? How many days is it likely to take for a chronic marijuana user to reach a negative urine drug test result? How long can cannabinoids be excreted and detected in urine after a single exposure to marijuana? How many days of positive urine drug tests for cannabinoids constitutes continued marijuana usage?

11 Why is establishing a CDW important? How often should a client s s urine be tested to monitor for continued abstinence from marijuana? How many days should the court wait before retesting a client after a positive urine drug test for cannabinoids has been obtained? How should the court interpret a positive urine drug test for cannabinoids after a client has completed an initial 30-day detoxification period designed to clean out their system?

12 Cannabinoid Elimination Research

13 Conflicting Research? In n a recent forensic publication, Dr. Marilyn Huestis: Monitoring acute cannabis usage with a commercial cannabinoid immunoassay with a 50-ng/mL cutoff concentration provides only a narrow window w of detection of days, (2002). In a 1985 article by Ellis et. al.; that under very strictly supervised abstinence, chronic users can have positive results for cannabinoids in urine at 20 ng/ml or above for as many as 46 consecutive days from admission

14 Many of the early cannabinoid studies often cited as proof of 30+ day detection periods suffered from... unable to ensure abstinence during the study detection cutoffs used very low used testing methods no longer available - poor specificity

15 Maximum Detection Times Determined Factors Potentially Affecting the Relevance of Study Findings to Cannabinoid Detection Window Interpretation 40 days 10 subjects studied; self-reported as chronic users; subjects housed on unrestricted drug treatment ward; marijuana use during study suspected by authors and confirmed by several subjects. (Swatek) 25 days 11 subjects studied for cannabinoid elimination patterns (70 participants in entire study); only one subject remained positive for 25 days; mean elimination for self-reported ŅheavyÓusers was 13 days; immunoassay used in study not commercially available since (Schwartz, Hayden, & Riddile) 25 days 13 subjects studied; self-reported as chronic users; subject abstinence not supervised during study; subjects allowed to smoke marijuana before and on the day of test drug administration; only one subject tested positive beyond 14 days. (Johansson & Halldin) 32 days 19 subjects studied - half withdrew from study prior to completion; subjects were prisoners housed in general population with no additional surveillance; participants not asked to report new drug use during study; marijuana use during study suspected by authors. (Smith-Kielland, Skuterud, & Morland) Year

16 Despite these problems.... Smith-Kielland, et. al. average time to the first negative (20 ng/ml cutoff) 3.8 days for infrequent users 11.3 days for frequent users Swatek study 8 of 10 chronic subjects tested below the 50 ng/ml cutoff after an average of 13 days Johansson et. al. identified only one subject that tested positive for longer than 14 days (20 ng/ml cutoff) despite potential factors restricting interpretation, study subjects with exceptionally long CDW (30-plus days) were just that exceptional

17 Recent Research - Acute Use 1995 (Huestis, et. al.) six health males - locked medical ward - 20 ng/ml cutoff CDW CDW days following high dose cigarette 1996 (Huestis, et. al.) six health males - locked medical ward - 15 ng/ml GC/MS cutoff CDW CDW 122 hours following high dose cigarette 2001 (Niedbala, et. al.) 18 health males - locked medical ward - 50 ng/ml cutoff CDW CDW averaged 42 hours after high dose cigarette

18 Recent Research - Acute Use acute marijuana elimination studies conclude that after single usage events cannabinoids are detected in urine for no more than a few days

19 Recent Research - Chronic Studies 2001 (Reiter, et. al.) 52 volunteer chronic users on detox ward - using 20 ng/ml cutoff used used daily testing to control covert THC use maximum cannabinoid elimination time hours or 18.1 days mean mean elimination or 4.9 days

20 Recent Research - Chronic Studies 1999 (Kouri, et. al.) 17 chronic users - documented 5000 separate episodes marijuana use (one joint per day for 13.7 years) - 20 ng/ml cutoff 5/17 5/17 tested negative at one week by by the second week - 9/17 were negative by by week 3-11/17 tested negative study study ended at day 28 with six still testing positive

21 Recent Research - Chronic Studies even under extraordinary exposure criteria, the average CDW was approximately 14 days (low cutoff), with significant majority of chronic marijuana users testing negative prior to 30 days

22 Perpetuating the Myth

23 Perpetuating 30-Plus Day Assumption Substance abuse treatment literature that proclaims, some parts of the body still retain THC even after a couple of months. Drug abuse information targeted toward teens Traces of THC can be detected by standard urine and blood tests for about 2 days up to 11 weeks. Health information websites that provide the following guidance; At the confirmation level of 15 ng/ml, the frequent 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 has s been the co-host on the popular call-in radio show "Loveline" for 17 years who states; Pot stays in your body, stored in fat tissues, potentially your whole life.

24 Use my urine tampering product Remember companies marketing products designed to adulterate or otherwise tamper with client urine samples have a vested interest in prolonging the use of their products thus inappropriately lengthen the CDW!

25 Establishing a Cannabinoid Detection Window

26 CDW Preface Comments 30+ day detection window often exaggerates duration of detection window established need reasonable & pragmatic court guidance detection window based upon screening test cutoff as benchmark (50 & 20 ng/ml) based upon current screening methods no studies of cannabinoid elimination using on-site testing devices (i.e. instant tests) confirmation (GC/MS) cutoff irrelevant

27 GC/MS Cutoff Irrelevant initial screen ( );( sample not sent for confirmation initial screen (+) & confirmation (+); confirmation merely validating screen initial screen (+); sample fails to confirm ( );( CDW shorter than guidance - not prejudicial to client

28 Cannabinoid Detection Window detection time: at 50 ng/ml cutoff up to 3 days for single event/occasional use up to 10 days for heavy chronic use detection time: at 20 ng/ml cutoff up to 7 days for single event/occasional use up to 21 days for heavy chronic use

29 Detection Window Guidance guidance something that provides direction or advice as to a decision or course of action black & white - guilty or not guilty legal weasel words: beyond beyond reasonable doubt probable probable cause substantial probability

30 Marijuana Usage Issues Chronic Use - do drug court practitioners need to be concerned about the potential of extended cannabinoid detection times impacting court decisions (i.e., sanctions)? client client entry into court program detox detox or clean out phase following following initial detox - past chronic usage will not effect CDW

31 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

32 Client Accountability: the court should not assume the role of client excuse evaluator clients need to be held responsible for their own behavior and maintaining a drug-free physiology if testing performed appropriately (with confirmation) HOW the drug got into their sample is mostly irrelevant

33 Client Accountability: (continued) a positive drug test result puts the client in violation as a practical and resource matter the court cannot afford to argue over or dispute with every client who has a positive test result or comes up with a new excuse burden of proof for documenting aberrant drug elimination should rest with the client

34 Establishing an Abstinence Baseline actual baseline client has demonstrated abstinence via repeated negative drug tests science-based baseline court-established time limit after which a client should not test positive if that client has abstained from drug use primarily applies to marijuana individuals who continue to produce positive drug test results beyond the established baseline maximums are subject to sanction AB not a secret! Inform clients

35 Testing Following Positive Results Due to cannabinoids prolonged elimination - Why continue drug testing? testing includes drug other than cannabinoids suspension of scheduled client drug testing sends the wrong therapeutic message curtailing testing extends unnecessarily the period of uncertainty about a client s s recent behavior and may delay appropriate therapeutic strategies or sanction decisions

36 Recent Cannabinoid Use versus Non-recent use (double sanction issue): How do drug courts discriminate between new drug exposure and continued elimination from previous (chronic) use? chronic issue only in first phase of program only only drug that poses concern is cannabinoids two two negative test approach two sequential negative urine cannabinoid drug tests

37 Addressing Imperatives for Cannabinoids acknowledge research reporting prolonged THC elimination establish a reasonable and pragmatic detection window guidance for the vast majority of case adjudications sound judicial practice requires that court decisions be based upon case-specific specific information in unconventional situations that confound the court, qualified toxicological assistance should be sought

38 SUMMARY One of the most important prerogatives of drug court is to clearly define the behavioral expectations for clients by establishing compliance boundaries required for continued program participation. Establishing a detection window allows the application court intervention strategies in an equitable and consistent manner. Establish the cannabinoid detection window based upon drug testing cutoff. Clients need to understand abstinence benchmarks.

39 SUMMARY (continued) The goal is to establish a given time period (detection window limit) after which a client should not test positive for cannabinoids as a result of continued excretion from prior usage. Drug-Free is not an attainable measurement. While detection window benchmarks should guide the sanctioning process for violations of abstinent behavior, courts are urged to judge a client s level of compliance on a case-by by-case basis using all of the behavioral data available to the court in conjunction with drug testing results.

40 Full Text of: The Marijuana Detection Window: Determining the Length of Time Cannabinoids Will Remain Detectable in Urine following Smoking: A Critical Review of Relevant Research and Cannabinoid Detection Guidance for Drug Courts, Drug Court Review (publication of the National Drug Court Institute, Arlington Virginia Volume V, Issue 1, Spring 2006, pages

41 address: