NATIONAL DRUG COURT INSTITUTE KAREN FREEMAN-WILSON, EXECUTIVE DIRECTOR APRIL 2006 VOL. IV, NO. 2 is clear—more research is needed in the area cannabinoidelimination. is clear—moreresearch isneededinthearea pr of thisresearch.However, of asourknowledgeevolves, therelevancy todiscreditthefindingsor authors not beinterpretedasaneffort elimination assumptionisbased.Carefulscrutiny ofthesestudiesshould This reviewchallengessomeoftheresearchupon whichthe30-plusday usage bydrugcourtparticipants. timely useofjudicialsanctioning,andfoster likely resultedinthedelayoftherapeuticintervention, thwartedthe of marijuana.Thesepr will r Conventional wisdomhasledtothecommonassumption thatcannabinoids elimination ofmarijuanafr information clarifiessomeofthecomplexissuesassociatedwith to enhanceit.Itishopedthatdrugcourtpractitionerswillfindthis makes nopretensetolimitthisimportantdiscussion,butrather, seeks toxicologists andamatterofon-goingscientificr traditional dr smoking, necessaryforcannabinoidstobecomenon-detectableusing science. Thenumberofdays,followingthecessationmarijuana The durationoftheurinar P FACT SHEET P D By PaulL.Cary, M.S. D A C D T T HE HE ETECTION eviously publishedscientific datashouldbeevaluatedanew REF TCAL IN ETECTABLE emain detectableinurinefor30daysorlonger following theuse RITICAL A M L RACTITIONER CE ENGTH RUG ARIJUANA ug testingmethodsisthesubjectofdebateamongfor G R UID VE OF EVIEW OF ANCE olonged cannabinoideliminationpr U T D IME RINE y cannabinoiddetectionwindowisnotsettled FOR om thehumanbody ETECTION R ELEVANT D C RUG F ANNABINOIDS OLLOWING C C R OURTS W SAC AND ESEARCH INDOW ed thedenialofmarijuana OURT . esear S : D MOKING W ch. Thisar ILL ETERMINING ojections have C ANNABINOID . Onefact R EMAIN ticle ensic NATIONAL DRUG COURT INSTITUTE

Merely attempting to formulate cannabinoid the cutoff calibrator for ten consecutive days.” detection guidance invites controversy. Some Based upon these seemingly divergent findings, will argue that the proposed detection window it is not difficult to comprehend why judges, defined in this article is too short. Others will attorneys and other drug court professionals suggest the opposite. Still others will insist are in a quandary regarding the length of time that the scientific evidence is insufficient to marijuana can remain detectable in urine allow the establishment of such guidance. following use. The dilemma—if the scientific To some degree, each position has merit. No research seems not to be able to achieve detection window guidance, regardless of the consensus on the urinary cannabinoid detection extent of scientific support, will encompass window, how are those responsible for court every set of circumstances or all client situations. mandated drug supervision programs suppose If nothing else, the research demonstrates that to understand and resolve this issue? there is significant variability between individuals Like many other scientific and technical topics in the time required to eliminate drugs. that have been thrust into the judicial environ- These facts, however, should not preclude ment, the detection window of marijuana the development of reasonable and pragmatic is both complex and controversial, yet the guidance, supported by scientific research, for understanding of the pharmacology of this use in the majority of drug court adjudications. popular substance is crucial to the adjudication It is widely accepted that in order to instill of cases in which marijuana usage is involved. successful behavioral changes in a substance While the difficulties associated with estab- abusing population, that consequences need lishing the length of time a drug will continue to be applied soon after the identification of to test positive in urine after use are not unique renewed or continued drug use. In a drug court to marijuana, the problem is exacerbated by context, the application of judicial sanctions the extended elimination characteristics of and the initiation of therapeutic interventions cannabinoids relative to other drugs of abuse, have been needlessly delayed due to a lack most notably after chronic use. of coherent guidance regarding the length of The questions posed by drug court professionals time cannabinoids will likely remain detectable related to cannabinoid detection in urine include: in urine following the cessation of marijuana smoking. The purpose of this article is to • How many days is it likely to take for a chronic marijuana user to reach a negative urine drug provide that much needed guidance. test result? • How long can cannabinoids be excreted and INTRODUCTION detected in urine after a single exposure to marijuana? In a recent forensic publication, Dr. Marilyn How many days of positive urine drug Huestis wrote: “Monitoring acute cannabis • tests for cannabinoids constitutes continued usage with a commercial cannabinoid marijuana usage? immunoassay with a 50-ng/mL cutoff concen- • How often should a client’s urine be tested tration provides only a narrow window of to monitor for continued abstinence from detection of 1–2 days,” (2002). In a 1985 marijuana? article by Ellis et. al., researchers concluded; • How many days should the court wait before “that under very strictly supervised absti- retesting a client after a positive urine drug nence, chronic users can have positive results test for cannabinoids has been obtained? for cannabinoids in urine at 20 ng/mL or • How should the court interpret a positive above on the EMIT-d.a.u. assay 1 for as many urine drug test for cannabinoids after a client as 46 consecutive days from admission, and has completed an initial 30-day detoxification period designed to “clean out” their system? can take as many as 77 days to drop below

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To one degree or another, answering these questions depends upon the ability of the court to estimate the length of time cannabinoids Study subjects with exceptionally long will likely remain detectable in urine following cannabinoid detection times (30-plus the use of marijuana by a drug court client. Thus, the cannabinoid detection window days) were just that-exceptional. becomes a determinative factor in the appro- priate interpretation of urine drug testing results for marijuana. The lack of adequate guidance has hindered the development of For those compounds with uncomplicated these standards for use in drug court. metabolic pathways or for those drugs that are not significantly retained in body storage It is important to note that while courts compartments, detection times have been may be seeking absolute answers (an exact established and generally accepted. These cannabinoid detection window), the science include urinary detection windows for drugs of drug detection in urine can only provide such as cocaine (1-3 days), amphetamines reasonable best estimates. The law is not and opiates (1-4 days), and PCP (1-6 days) always black and white; neither is science. (Baselt, 2004). For marijuana, the urine elimi- Therefore, precise “yes/no” answers or nation profile used to establish the detection exact detection windows are generally not window is more complex. It is well docu- attainable. Sensible guidance for the interpre- mented and understood that cannabinoids are tation of urine cannabinoid results by drug lipid-soluble compounds that preferentially courts, however, is achievable. bind to fat-containing structures within the human body (Baselt, 2004). This and other FRAMING THE QUESTION chemical characteristics can prolong the elimi- nation half-life of cannabinoids and extend the Simply put, the detection window is the length detection window beyond that of other abused of time in days following the last substance substances. Chronic marijuana use, which usage that sequentially collected urine samples expands body stores of drug metabolites will continue to produce positive drug test faster than they can be eliminated, further results—in other words, the number of days increases cannabinoid detection time in urine. until last positive sample. This time period is not the same as the length of time a drug will remain in someone’s system—that concept VARIABLES is, in reality, indeterminable (given that there Estimating the detection time of a drug in urine is no analytical method capable of detecting is a complex task because of the many factors the presence of a single molecule of drug in a that influence a compound’s elimination from donor’s body). The question being addressed the body. Additionally, technical aspects of the herein is not how long minute traces of mari- testing methods themselves also affect how juana will remain in a client’s tissues or fluids long a drug will continue to be detected in urine. after smoking, but rather how long those The pharmacological variables affecting the residual cannabinoid metabolites will continue duration of detection include drug dose, route to be excreted in urine in sufficient quantities of administration, duration of use (acute or to produce a positive drug test (by standard chronic), and rate of metabolism. Detection screening and confirmation testing). time is also dependent upon analytical factors including the sensitivity of the test (cutoff concentration) and the method’s specificity (the actual drug and/or metabolite that is being detected).

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Generally speaking, the following factors The differentiation between acute (a single affect the marijuana detection window use event or occasional use) versus chronic accordingly: (persistent, long-term, continued usage) is • Drug Dose important to establishing reliable detection The higher the dose; the longer the detection benchmarks. As a result, drug court practitioners window. The percentage of psychologically should attempt to gather as much information active delta-9 THC in marijuana plant material as they can about client drug use behavior varies considerably, making dosage difficult to estimate. and patterns. • Route of Entry Finally, the detection window by its very Inhalation (smoking) is the only route of nature is subject to the timing of events administration to be evaluated in this review. outside the purview of the court. The last use • Duration/Frequency of Use of marijuana by a client prior to a positive test The longer the duration and the greater the is often unknown to drug court staff. Thus, frequency of cannabinoid usage (chronic); the greater the body storage of fat-soluble the real interval between drug usage and metabolites; the longer the cannabinoid first detection can rarely be ascertained. detection window. Drug surveillance pro- For example, if a client smoked marijuana on grams may be able to define use patterns Monday and a urine sample collected on based on client self-reporting, arrest reports, Friday produced a positive result, the window documentation of previous treatment, or other court records. of detection is 4 days shorter than if that same client had smoked on Thursday and produced a • Metabolism Rate The higher the metabolic functions of the client; positive cannabinoid test on Friday. Therefore, the faster cannabinoids are broken down; the actual detection window for marijuana will the shorter the detection window. Monitoring almost always be longer than the analytically programs cannot determine this parameter. derived detection window as determined via • Test Sensitivity positive tests. The lower the cutoff concentration; the more sensitivity the testing method toward cannabi- noids; the longer the detection window. Court RESEARCH REVIEW staff can select between various cannabinoid Research associated with the detection window testing cutoffs. of cannabinoids in urine spans several decades. • Test Specificity While these studies have produced a signifi- The less specific the testing method; the greater number of cannabinoid metabolites cant amount of valuable information about detected; the longer the detection window. marijuana elimination, older studies (primarily This is difficult for monitoring programs to those performed in the 1980’s) have also assess without technical assistance. yielded some unintended consequences as pertains to the detection window. The tech- Of these variables, drug courts are effectively nologies of drug testing and the methodologies limited to controlling only the sensitivity of used in drug detection have advanced rapidly the drug test itself (i.e., cutoff concentration). in recent years. Consequently, cannabinoid Initial screening test cutoffs for cannabinoids detection studies performed twenty years in urine generally include thresholds at 20, 50, ago (employing older immunoassays methods) and 100 ng/mL. The choice of testing cutoff utilized drug testing methods that are either has a profound effect on the cannabinoid no longer in widespread use or assays that detection window. The only other factor that have been extensively reformulated. can assist the court in the interpretation of cannabinoid testing results and the estimation As cannabinoid screening tests evolved, these of a client’s detection window is attempting improved assays became more selective in to define the duration and extent of a client’s the manner in which they detected marijuana marijuana use over time (acute or chronic). metabolites (breakdown products). As detection

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Table 1. Review of Cannabinoid Studies Reporting Long Detection Times

Maximum Factors Potentially Affecting the Relevance Year Author Detection Times of Study Findings to Cannabinoid Detection Determined for Window Interpretation Cannabinoids

36 days Retrospective case study of a single patient; report 1982 Dackis on 6 similar cases included; no testing data provided et al. in publication; no cannabinoid cutoff given

37 days 27 subjects studied, no testing data provided in publication; 1983 Cridland cannabinoid cutoff not provided; “calculated” cannabinoid et al. cutoff less than 10 ng/mL; 37 day detection derived from 95% confidence interval for calculated elimination half-life; actual length of positivity averaged 9.7 days (5-20 days); authors acknowledge subjects may have been able to obtain marijuana during study; possibility supported by staff monitoring subjects

40 days 10 subjects studied; self-reported as chronic users; subjects 1984 Swatek housed on unrestricted drug treatment ward; marijuana use during study suspected by authors and confirmed by several subjects

67 days 86 subjects studied; self-reported as chronic users; subjects 1985 Ellis et al. treated on “closely supervised” ward; single case of an individual’s time to last positive urine (at or above 20 ng/ mL) of 67 days (77 days to drop below the cutoff calibra- tor for ten consecutive days); spikes in urine cannabinoid levels during the study are not explained by the authors

25 days 11 subjects studied for cannabinoid elimination patterns 1985 Schwartz (70 participants in entire study); only one subject et al. remained positive for 25 days; mean elimination for self-reported “heavy” users was 13 days; immunoassay used in study not commercially available since 1995.

25 days 13 subjects studied; self-reported as chronic users; subject 1989 Johansson abstinence not supervised during study; subjects allowed & Halldin to smoke marijuana before and on the day of test drug administration; only one subject tested positive beyond 14 days

25 days Subject detection times determined using methods with 1994 Iten a 5 ng/mL cannabinoid cutoff concentration

32 days 19 subjects studied - half withdrew from study prior to 1999 Smith- completion; subjects were prisoners housed in general Kielland population with no additional surveillance; participants et al. not asked to report new drug use during study; marijuana use during study suspected by authors

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specificity increased, the length of time effect of this flaw on determining the true cannabinoids were being detected in urine cannabinoid elimination time after marijuana decreased. The greater the cannabinoid testing cessation is significant. Drug use during an specificity, the shorter the detection window. elimination study would extend the duration Studies have demonstrated that detection cannabinoids would be detected in the urine times of cannabinoid metabolites in urine of subjects and would produce inaccurately monitored by immunoassay have decreased long detection windows. In several cases, the over the past two decades (Huestis, 2002; authors themselves in their own review of Huestis, Mitchell, & Cone, 1994). Therefore, results raise this concern. Other study design the results of cannabinoid elimination issues that may limit their usefulness include investigations performed in the 1980’s may the use of detection methods with cannabinoid no longer be applicable to estimating the cutoff concentrations far below those tradi- detection window for marijuana in urine using tionally utilized in criminal justice programs, the today’s testing methodologies. Not to men- use of testing methods no longer commercially tion that twenty years ago, the routine use of available and the use of immunoassay drug on-site drug testing devices was nonexistent. tests with reduced cannabinoid specificity (as compared with current immunoassay testing Studies of chronic marijuana users reporting methods). It is not the intention of this article prolonged cannabinoid excretion profiles have to discredit these studies, but rather to illus- provided the basis for the common assump- trate the degree to which their prolonged tion that marijuana can be detected in urine cannabinoid detection findings have influenced for weeks or even months following use. In the understanding of the length of time general, cannabinoid elimination studies that cannabinoids can be detected in urine. have manifested exceptionally long detection times suffer from a variety of research design This critical evaluation (Table 1) is not present- shortcomings that raise concerns about their ed to imply that these peer-reviewed articles usefulness in establishing a reliable cannabi- are unscientific or contain no information of noid detection window for use in the modern probative value. It is insufficient, however, to drug court movement. Table I examines merely read the abstract of a scientific paper some of the potentially limiting factors from or the findings of a research study and draw studies that produced prolonged cannabinoid the conclusion that a drug court client can detection times. remain positive for 30 days or longer, based upon the longest cannabinoid detection time reported therein. The data from these studies The detection window for cannabinoids are often misused to make such claims. Despite the potential limitations affecting the in urine must be seen in the proper interpretation of the data produced by the context-as a reasonable estimate. studies in Table 1, the research does present some general cannabinoid elimination trends worth further examination. A closer evaluation of the study by Smith-Kielland, Skuterud, & The research studies presented in Table 1 Morland indicates that even with the factors contain numerous design details that confound identified as limiting its relevance, the aver- the use of the data presented in establishing age time to the first negative urine sample at a reasonable and pragmatic cannabinoid a cannabinoid cutoff of 20 ng/mL was just 3.8 detection window for drug court proceedings. days for infrequent users and only 11.3 days The most serious of these obfuscating factors for frequent users (1999). In the Swatek study, is the inability to assure marijuana abstinence eight out of ten chronic subjects tested below of the subjects during the studies. The adverse the 50 ng/mL cutoff after an average of only

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13 days (range 5-19 days) (1984). Johansson Niedbala et. al. demonstrated similar results and Halldin identified only one study subject with 18 healthy male subjects following the that tested positive for longer than 14 days smoking of cigarettes containing an average with all thirteen subjects having an average THC content of 20-25 mg. Analyzing urine last day with detectable levels (using a 20 samples at a 50 ng/mL immunoassay cutoff ng/mL cutoff) of 9.8 days (1989). In other yielded an average cannabinoid detection words, despite the potential factors restricting time of 42 hours. These acute marijuana interpretation, those study subjects with elimination studies conclude that after single exceptionally long cannabinoid detection times usage events cannabinoids are detected in (30-plus days) were just that—exceptional. urine for no more than a few days. In several of the studies presented in Table 1, While studies of the cannabinoid detection only a single subject was the source of the window in chronic substance users have maximum cannabinoid detection time. been more difficult to accomplish, research Unfortunately, these rare occurrences have protocols have been developed to overcome had a disproportional influence on the overall concerns about marijuana usage during the cannabinoid detection window discussion in study. Using a well-crafted study design, a manner that has led to the general assump- Kouri, Pope, & Lukas in 1999 determined the tion that 30-plus day detection times are cannabinoid elimination profiles of 17 chronic routine in drug court clients—regardless of users. Subjects were selected after reporting use patterns (chronic vs. acute). Moreover, a history of at least 5000 separate “episodes” this prolonged elimination assumption and of marijuana use in their lifetime (the equiva- its widespread use as exculpatory evidence lent of smoking once per day for 13.7 years) has most likely fostered client denial and plus continuing daily usage. Abstinence during hindered legitimate sanctioning efforts. the 28-day study was ensured by withdrawing By contrast, the research associated with acute those subjects whose normalized urine marijuana usage and resulting cannabinoid cannabinoid levels (cannabinoid/creatinine detection window is considerably more ratio) indicated evidence of new marijuana use. straightforward and less contentious. In a 1995 Kouri, et al, found that five of the 17 subjects study using six healthy males (under continu- reached non-detectable levels (less than 20 ous medical supervision), Huestis, Mitchell, ng/mL) within the first week of abstinence, & Cone determined that the mean detection four during the second week, two during the times following a low dose marijuana cigarette third week and the remaining six subjects ranged from 1 to 5 days and after a high dose still had detectable cannabinoid urinary levels cigarette from 3 to 6 days at a 20 ng/mL at the end of the 28-day abstinence period. immunoassay cutoff concentration (average Unfortunately, analytical results related to the 2.1 days and 3.8 days, respectively) (1995). cannabinoid testing in the article were scant They also concluded that immunoassays at as the primary objective of the study was to the 50 ng/mL cannabinoid cutoff provide only assess changes in aggressive behavior during a narrow window of detection of 1-2 days withdrawal from long-term marijuana use. following single-event use. In 1996, Huestis Even though this represents one of the best et. al. published research focusing on carboxy- studies of chronic marijuana users, interpreta- THC, the cannabinoid metabolite most often tion of this data for cannabinoid elimination identified by gas chromatography/mass purposes is limited because the actual drug spectrometry (GC/MS) confirmation methods. testing data is not available. Nonetheless, Using the 15 ng/mL GC/MS cutoff, the detec- Kouri, et al, shows that after at least 5000 tion time for the last positive urine sample marijuana smoking episodes, 30-day elimination (for six subjects following high dose smoking) times are possible. was 122 hours—just over five days. In 2001,

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A 2001 research project by Reiter et al. also • Criminal justice publications that list the seemed to avoid many of the design issues cannabinoid detection limits of a “Chronic 4 cited as concerns in Table 1. Reiter’s case Heavy Smoker” as “21-27 days.” study involved 52 volunteer chronic substance • Drug testing manufacturers’ pamphlets abusers drug tested on a detoxification ward. that state the time to last cannabinoid positive urine sample as “Mean = 27.1 days; Daily urine and blood tests excluded illicit Range = 3-77 days.” 5 drug consumption during the study. Using a • General information websites that offer 20 ng/mL immunoassay cutoff, the maximum “expert” advice concluding, “The average elimination time (last time urine tested above time pot stays in your system is 30 days.” 6 the cutoff) for cannabinoids in urine was • Urine tampering promotions in magazines 433.5 hours (or just over 18 days); with a such as High Times and on websites that mean elimination time of 117.5 hours (4.9 offer urine drug cleansing supplements and days). When controlling for covert marijuana adulterants intended to chemically mask the use by subjects during the study, chronic presence of drugs in urine often exaggerate the detection window in an effort to promote users in this study did not exhibit detectable the continued use of their products. Some of urine cannabinoid levels for even three weeks. their claims include: drug detection times in urine [for] “Cannabinoids (THC, Marijuana) In aggregate, using the data from the five 20-90 days,” 7 and detection times for smokers studies cited in this review that researchers who use “5-6x per week—33-48 days.” 8 described as chronic marijuana users (even • Health information websites that provide the including data from Table 1), the average following guidance; “At the confirmation level detection window for cannabinoids in urine at of 15 ng/ml, the frequent user will be positive the lowest cutoff concentration of 20 ng/mL for perhaps as long as 15 weeks.” 9 was just 14 days (Ellis, et al, 2002; Iten, 1994; • Dr. Drew Pinsky (a.k.a. Dr. Drew), who has Niedbala, 2001; Schwartz, Hayden, & Riddile, co-hosted the popular call-in radio show 1985; Swatek, 1984). Loveline for 17 years, states that “Pot stays in your body, stored in fat tissues, potentially your whole life.” 10 ERPETUATING HE LUS P T 30-P Based upon these information sources that DAY ASSUMPTION claim cannabinoids elimination profiles of 25 The assumption that cannabinoids can be rou- days, 11 weeks, 90 days, up to 15 weeks after tinely detected in urine following the smoking use, and for “your whole life,” is it any wonder of marijuana for 30 days or longer appears that drug court professionals cannot reach widespread and longstanding. Exacerbating consensus on this issue? Is there any doubt this problem is the nearly constant proliferation why drug court clients make outlandish of published material that continually reinforces cannabinoid elimination claims in court? These the 30-plus day cannabinoid detection window represent but a sampling of the many dubious into the criminal justice psyche. Examples of sources that perpetuate the prolonged cannabi- the enormous body of information/literature noid detection window. As a consequence, that propagates the 30-plus day cannabinoid the 30-plus day cannabinoid elimination period detection times abound: remains a commonly assumed “fact.” • Substance abuse treatment literature pro- claiming that “some parts of the body still retain THC even after a couple of months.” 2 ESTABLISHING THE CANNABINOID • Drug abuse information targeted toward teens DETECTION WINDOW IN URINE that often presents unrealistic cannabinoid The detection window for cannabinoids in detection times such as; “Traces of THC can urine must be seen in the proper context— be detected by standard urine and blood tests as a reasonable estimate. Detection times for about 2 days up to 11 weeks.” 3 for cannabinoids in urine following smoking vary considerably between subjects even in

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controlled smoking studies using standardized This cannabinoid detection guidance should dosing techniques. Research studies have also be applicable in the majority of drug court demonstrated significant inter-subject differ- cases. These parameters (acute vs. chronic), ences in cannabinoid elimination rates. The however, represent opposite ends of the timing of marijuana elimination is further com- marijuana usage spectrum. Clients will often plicated by the uncertainty of the termination of exhibit marijuana-smoking patterns between use and continued abstinence. That said, gen- these two extremes resulting in an actual eral estimates for establishing a cannabinoid detection window that lies within these limits. detection window in urine can be advanced As noted in the Kouri, et al, study, research and accepted for use in drug courts. Based suggests that under extraordinary circum- upon the current state of cannabinoid elimina- stances of sustained, extended and on-going tion knowledge and the drug testing methods chronic marijuana abuse (thousands of available in today’s market, the following practical smoking episodes over multiple years) cannabinoid detection guidance is offered. that 30-day urinary cannabinoid detection is possible in some individuals at the 20 ng/mL Based upon recent scientific evidence, at cutoff (1999). However, the burden of proof the 50 ng/mL cutoff concentration for the for documenting such aberrant and chronic detection of cannabinoids in urine (using marijuana use patterns should fall on the drug the currently available laboratory-based court client or the client’s representatives. screening methods) it would be unlikely for For a client to simply disclose “chronic” use is a chronic user to produce a positive urine insufficient corroboration. drug test result for longer than 10 days after the last smoking episode. Although there are Much has been made about marijuana research no scientific cannabinoid elimination studies that has produced dramatically prolonged on chronic users using non-instrumented cannabinoid elimination times, particularly in testing devices, one would assume that if those subjects identified as chronic. This data the on-site devices are properly calibrated has often been used to explain continuing at the 50 ng/mL cutoff level the detection positive cannabinoid test results in clients long guidance would be the same. after their drug elimination threshold (resulting in negative urine drug tests) should have been At the 20 ng/mL cutoff concentration for the reached. The pertinent question: to what detection of cannabinoids in urine (using extent does the scientific data (demonstrating the currently available laboratory-based 30-plus day cannabinoid detection times in screening methods) it would be uncommon chronic users) influence the disposition of for a chronic marijuana smoker to produce drug court cases? Put another way, do drug a positive urine drug test result longer than court practitioners need to be concerned 21 days after the last smoking episode. about the potential of extended cannabinoid For occasional marijuana use (or single detection times impacting court decisions event usage), at the 50 ng/mL cutoff level, (i.e., sanctions)? In reality, the only timeframe it would be unusual for the detection of in which an individual’s chronic marijuana use cannabinoids in urine to extend beyond (possibly leading to extended cannabinoid 3-4 days following the smoking episode elimination) is relevant is during a client’s (using the currently available laboratory- admission into the drug court program. It is based screening methods or the currently during this initial phase that the court may available on-site THC detection devices). find itself attempting to estimate the number At the 20 ng/mL cutoff for cannabinoids, of days necessary for a client’s body to rid positive urine drug test results for the itself of acquired cannabinoid stores and the single event marijuana use would not be time required to produce negative drug test expected to be longer than 7 days. results. In many programs, a detoxification

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period is established for this purpose. Once in test. The only scenario in which the confirma- the drug court program (following the initial tion cutoff could potentially impact the length detoxification phase), the extent of a client’s of the cannabinoid detection window is if a past chronic marijuana usage does not influence sample screened positive and the confirmation the cannabinoid detection window as long as procedure failed to confirm the presence of appropriate supervision and drug monitoring cannabinoids (and the results of the drug test for abstinence continues on a regular basis. were reported as negative). In this circum- It would seem reasonable to assume that stance, the cannabinoid detection window chronic client marijuana usage of the extreme might be shorter than the estimate provided as levels discussed here while within a properly guidance. This would be true on the condition administered drug court would be highly that the confirmation cutoff concentration was unlikely. Therefore, the consequences of lower than that of the screening procedure— chronic marijuana usage on the cannabinoid which is nearly always the case. A shorter detection window are effectively limited to cannabinoid detection window would not the initial entry phase of the program. be seen as prejudicial to the client and might actually be beneficial to the drug court.

Using this cannabinoid detection window Science is not black and white guidance, the drug court decision-making hierarchy should be able to establish reason- and the state of our knowledge able and pragmatic cannabinoid detection is continually evolving. benchmarks that both provide objective criteria for court decisions and protect clients from inappropriate or unsupportable conse- quences. Some courts may choose to use the The cannabinoid detection window guidance cannabinoid elimination information detailed provided herein relies upon the widely used in this paper exactly as presented to establish cutoff concentrations for the initial screening a marijuana detection window that will allow tests—20 ng/mL and 50 ng/mL. For programs the differentiation between abstinence and utilizing GC/MS confirmation for the validation continued/renewed use. Other courts may of positive screening results, the confirmation decide to build into the guidance an additional cutoff has little influence on the length of safety margin, granting clients further benefit the cannabinoid detection window in urine. of the doubt. Regardless of the approach, A review of the potential result possibilities however, courts are urged to establish detec- demonstrates this point. If a drug court sample tion benchmarks and utilize these scientifically tests negative for cannabinoids on the initial supportable criteria for case disposition. screen, the confirmation cutoff is obviously Every day drug courts grapple with two seem- irrelevant because the sample is not submitted ingly disparate imperatives—the need for rapid for confirmation testing. If a sample both therapeutic intervention (sanctioning designed screens and confirms as positive for cannabi- to produce behavioral change) and the need to noids (and is reported as positive), then the ensure that the evidentiary standards, crafted cutoff concentration of the confirmation to protect client rights, are maintained. While analysis is also not relevant because the sam- administrative decision-making in a drug ple would not have been sent for confirmation court environment (or a probation revocation unless it produced a result greater than or hearing) does not necessitate the same due equal to the cutoff level of the initial screening process requirements and protections that test. In other words, the confirmation proce- exist in criminal cases, as professionals we dure is merely validating the results (and are obliged to ensure that court decisions therefore the cutoff) of the original screening have a strong evidentiary foundation.

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Courts establishing detection windows for cannabinoids need to be aware of the exis- tence of research studies indicating prolonged Courts are urged to establish elimination times in urine. It is not recom- detection benchmarks and utilize mended, however, that drug courts manipulate their detection windows to include these these scientifically supportable exceptional findings. Sound judicial practice requires that court decisions be based upon criteria for case disposition. case-specific information. In weighing the evidence, courts also acknowledge the reality that a particular client’s individualities or the cannabinoid detection guidelines presented in uniqueness of circumstances may not always this review, it is unlikely (utilizing reasonable allow the strict application of cannabinoid physiological or technology criteria) that a drug detection window parameters in a sentencing court client would continue to remain cannabi- decision. These uncommon events, however, noid positive at the end of this designated should not preclude the development of abstinence period. After 30 days, using either cannabinoid detection windows for the use a 20 or 50 ng/mL testing cutoff, continued in the majority of court determinations. cannabinoid positive urine drug tests almost certainly indicate marijuana usage at some CLIENT DETOXIFICATION: point during the detoxification period and THE “CLEAN OUT” PHASE should provoke a court response to reinforce program expectations. As a result of the extended elimination of cannabinoids (as compared to other abused drugs), some drug courts have instituted a ABSTINENCE BASELINE detoxification stage or “clean out” period in The abstinence baseline can either be a point the first phase of program participation. This at which a client has demonstrated their grace period allows new clients a defined abstinence from drug use via sequentially time frame for their bodies to eliminate stores negative testing results (actual baseline) or of drugs that may have built up over years a court-established time limit after which a of substance abuse without the fear of court client should not test positive if that client sanctions associated with a positive drug has abstained from marijuana use (scientific test. In many cases this detoxification period baseline). Each baseline has importance in extends for 30 days, which corresponds a court-mandated drug monitoring program. to the commonly held assumption that The later has been the focus of this review. this represents the time period required for It is exemplified by establishing the detection marijuana metabolites to be eliminated from window for marijuana and utilizing positive a client’s system. urine drug testing results to guide court Regardless of the origin of the 30-day marijuana intervention. Individuals who continue to detection window and its influence on the produce cannabinoid positive results beyond duration of the detoxification period, 30 days the established detection window maximums is certainly an equitable time period for client (the scientific baseline) are subject to sanction drug elimination purposes. Simply because for failing to remain abstinence during pro- the science may not support the necessity of gram participation. a detoxification period of this duration does The alternative approach uses negative test not mean that a court cannot use the 30-day results in establishing the actual abstinence parameter in order to establish program baseline. This has been referred to as the expectations. However, based upon the “two negative test approach” and has been

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previously described in the literature (Cary, drug court's policies and procedures require 2002). A drug court participant is deemed to a certain schedule of testing, suspending have reached their abstinence baseline when testing for even a short period may appear two consecutive urine drug tests yielding to other program participants that the court is negative results for cannabinoids have been “rewarding” a client who has tested positive. achieved, where the two tests are separated Eliminating scheduled drug tests in response by a several day interval. Any positive drug to a positive cannabinoid result degrades test result following the establishment of this the program’s efforts at maintaining client baseline indicates new drug exposure. This behavioral expectations. technique can be used with assays that test Lastly, depending upon the cutoff concentration for marijuana at either the 20 or 50 ng/mL of the drug test being used and whether the cutoff concentration.11 client’s marijuana usage was an isolated event (rather than a full relapse), it is entirely possible CANNABINOID TESTING FOLLOWING that a client who has previously tested positive POSITIVE RESULTS for cannabinoids may test negative sooner than Due to the prolonged excretion profile of the cannabinoid detection window estimate. cannabinoids in urine (especially after chronic As indicated earlier, acute marijuana use use) some drug court programs wrestle results in cannabinoid positive urine samples with the issue of whether to continue urine for only several days following exposure. drug testing during the expected marijuana Curtailing drug testing for longer than three elimination period. Simply put, why continue days extends unnecessarily the period of the expense and sample collection burden uncertainty about a client’s recent behavior and for clients who have already tested positive may delay appropriate therapeutic strategies for cannabinoids knowing that the client may or sanction decisions. continue to produce positive cannabinoid results for many days? There are at least COURT EXPECTATIONS three principle reasons drug courts are not AND CLIENT BOUNDARIES advised to suspend urine drug testing following One of the most important prerogatives of a positive result for cannabinoids. drug court (or any therapeutic court) is to First, most court-mandated testing includes clearly define the behavioral expectations for drugs other than marijuana. Client surveillance clients by establishing compliance boundaries often encompasses testing for many of required for continued program participation. the popularly abused substances such as Drug testing used as a surveillance tool defines amphetamines, cocaine, opiates, and alcohol. those boundaries and monitors client behavior Programs that forego scheduled testing run in order that the court can direct either incen- the very real risk of missing covert drug use tives or sanctions as needed to maintain for substances other than marijuana. If a drug participant compliance. To fulfill this important court client knows a positive cannabinoid responsibility, drug courts teams must agree test will result in a drug testing “vacation,” upon specific drug testing benchmarks in they may use that non-testing period to use order to apply court intervention strategies substances with shorter detection windows in an equitable and consistent manner. (i.e. cocaine or alcohol). By continuing to test, The primary focus of this article is to promote the court maintains its abstinence monitoring the establishment of a drug testing benchmark for drugs besides marijuana. that defines the expected detection window Second, from a programmatic standpoint the of cannabinoids in urine following the cessa- suspension of scheduled client drug testing tion of smoking. In order for drug courts to sends the wrong therapeutic message. If a determine their cannabinoid detection window,

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the program will need to consider the cutoff behavior, courts are urged to judge a client’s concentration of the urine cannabinoid test level of compliance on a case by case basis being utilized and develop criteria for defining using all of the behavioral data available to the chronic marijuana users. Drug courts should court in conjunction with drug testing results. also take into account how the cannabinoid In unconventional situations that confound detection window will be incorporated into the court, qualified toxicological assistance their current policies and procedures and how should be sought. the detection window will be used in case adjudication. Once established, the court Paul L. Cary, M.S. is the Director of the Toxicology should apprise program participants of the & Drug Monitoring Laboratory, University of Missouri expectations associated with the cannabinoid Health Care, Columbia, Missouri; and NDCI Faculty detection window. Clients should understand Resident Expert on drug testing issues. Mr. Cary can be reached at [email protected]. that sanctions will result if continued cannabi- This document was published with support from the noid positive tests occur beyond the estab- Office of National Drug Control Policy, Executive Office lished detection window (the drug elimination of the President and the Bureau of Justice Assistance, time limit after which a client should not test U.S. Department of Justice. positive if that client has abstained from marijuana use). Courts are reminded that the References cannabinoid detection window may require Baselt, R.C. (2004). In Disposition of Toxic Drugs revision if there are modifications to the drug and Chemicals in Man, (7th ed.). Foster City, CA: Biomedical Publications. testing methods or if there are significant changes in marijuana usage patterns in the Cary, P.L. (2002). The use creatinine-normalized cannabinoid results to determine continued court’s target population (i.e., significant abstinence or to differentiate between new increases in chronic use). marijuana use and continuing drug excretion from previous exposure. Drug Court Review, Practitioners are reminded that the goal in 4(1), 83-103. establishing a cannabinoid detection window Cridland, J.S., Rottanburg, D., & Robins, A.H. (1983). is not to ensure that a monitored client is Apparent half-life of excretion of cannabinoids drug free. Chronic marijuana users may carry in man. Human Toxicology 2(4), 641-644. undetectable traces of drug in their bodies Dackis, C.A., Pottash, A.L.C., Annitto, W., & Gold, for a significant time after the cessation of M.S. (1982). Persistence of urinary marijuana use. Rather, the goal is to establish a given levels after supervised abstinence. American time period (detection window limit) after Journal of Psychiatry, 139(9), 1196-1198. which a client should not test positive for Ellis, G.M., Mann, M.A., Judson, B.A., Schramm, cannabinoids as a result of continued excretion N.T., & Tashchian, A. (1985). Excretion patterns from prior usage. of cannabinoid metabolites after last use in a group of chronic users. Clinical Pharmacology Finally, the cannabinoid detection window is and Therapeutics, 38(5), 572-578. a scientifically supportable, evidence-based Huestis, M.A. (2002). Cannabis (marijuana): Effects effort to establish a reasonable and practical on human behavior and performance. Forensic Science Review, 14(1/2), 15-60. standard for determining the length of time cannabinoids will remain detectable in urine Huestis, M.A., Mitchell, J.M., & Cone, E.J. (1994). Lowering the federally mandated cannabinoid following the smoking of marijuana. Drug courts immunoassay cutoff increases true-positive are reminded that science is not black and results. Clinical Chemistry, 40(5), 729-733. white and that the state of our knowledge is Huestis, M.A., Mitchell, J.M., & Cone, E.J. (1995). continually evolving. While detection window Detection times of marijuana metabolites in benchmarks will and should guide the sanc- urine by immunoassay and gc-ms. Journal of tioning process for violations of abstinent Analytical Toxicology, 19(10), 443-449.

13 NATIONAL DRUG COURT INSTITUTE

Huestis, M.A., Mitchell, J.M., & Cone, E.J. (1996). in the fat cells and therefore takes longer to Urinary excretion profiles of 11-nor-9-carboxy- fully clear the body than with any other common ∆9-tetrahydrocannabinol in humans after single drug. This means that some parts of the body smoked does of marijuana. Journal of Analytical still retain THC even after a couple of months, Toxicology, 20(10), 441-452. rather than just the couple of days or weeks for Iten, P.X. (1994). In Fahren untrer Drogen-o-der water soluble drugs.” Medikamenteneinfluss. Forensische 3. Website: TeenHealthFX. URL: Interpretation und Begutachtung. Zürich: Institut http://www.teenhealthfx.com/answers/12.html. für Rechtsmedizin der Universtät Zürich. TeenHealthFX.com is a project funded by Johansson, E. & Halldin, M.M. (1989). Urinary Atlantic Health System, a New Jersey hospital excretion half-life of ∆1-tetrahydrocannabinol-7- consortium. The website states that “the oic acid in heavy marijuana users after smoking. professional staff who answer questions from Journal of Analytical Toxicology, 13(7/8), 218-223. our vast audience and provide oversight include clinical social workers, health educators, Kouri, E. M., Pope, H. G. Jr., & Lukas, S. E. (1999). adolescent medicine physicians, pediatricians Changes in aggressive behavior during with- and pediatric subspecialists, psychiatrists, drawal form long-term marijuana use. psychologists, nurses, nutritionists, and many Psychopharmacology, 143(3), 302-308. other health professionals.” Niedbala, R.S., Kardos, K.W., Fritch, D.F., Kardos, QUESTION: “Dear TeenHealthFX, T.F., & Waga, J. (2001). Detection of marijuana Smoking marijuana can be detected how long? use by oral fluid and urine analysis following I’ve heard a couple of weeks in urine, a couple single-dose administration of smoked and of days in blood, and a couple of years in hair… oral marijuana. Journal of Analytical Toxicology, please clarify! Also, during a routine physical at 25(7/8), 289-303. the doctor, will they check for marijuana in the Reiter, A., Hake, J., Meissner, C., Rohwer, J., blood or urine sample? Friedrich, H.J., & Ochmichen, M. (2001). Time Signed: Longevity Of Marijuana - How Long of drug elimination in chronic drug abusers: Case Does It Stay In Your System” study of 52 patients in a “low-step” detoxifica- ANSWER: “Dear Longevity Of Marijuana - How tion ward. Forensic Science International, 119, Long Does It Stay In Your System, The chemical 248-253. in marijuana, THC, is absorbed by fatty tissues in Schwartz, R.H., Hayden, G. F., & Riddile, M. (1985). various organs. Traces of THC can be detected Laboratory detection of marijuana use. by standard urine and blood tests for about American Journal of Diseases of Children, 2 days up to 11 weeks depending on the per- 139(11), 1093-1096. son’s metabolism, how much they smoked and Smith-Kielland, A., Skuterud, B., & Morland J. how long they smoked. THC can be detected (1999). Urinary excretion of 11-nor-9-carboxy- for the life of the hair. Again, the sensitivity of ∆9-tetrahydrocannabinol and cannabinoids in the test ranges from person to person depending frequent and infrequent drug users. Journal of on many factors including the amount of body Analytical Toxicology, 23(9), 323-332. fat, differences in metabolism, and how long and how much they smoked.” Swatek, R. (1984). Marijuana use: Persistence and urinary elimination. Journal of Substance Abuse Presumably, the 11 week estimate comes from Treatment 1(4), 265-270. the research finding of Ellis, et. al. (1985) which has been described earlier. Endnotes 4. Bureau of Justice Assistance Monograph entitled: Integrating Drug Testing into a Pretrial Services 1. EMIT is a registered trademark of the Dade System: 1999 Update, July 1999, NCJ # 176340. Behring/SYVA Company and stands for (Enzyme On page 48, Exhibit 5-3 titled; Approximate Multiplied Immunoassay Technique). EMIT Duration of Detectability of Selected Drugs in is a commercial drug testing product for the Urine lists Cannabinoids (marijuana) Chronic analysis of drugs of abuse in urine (d.a.u.). heavy use as 21 to 27 days. Source: Adapted 2. Detoxing from Marijuana (pamphlet). (1992). from the Journal of the American Medical Marijuana Anonymous: 12-Step Program for Association’s Council on Scientific Affairs (1987, Marijuana Addicts, 4. The entire text reads as p. 3112). follows: “Why do some effects last so long?” The source material citation is the Journal of “Unlike most other drugs, including alcohol, the American Medical Association. (1987, June) THC (the active chemical in marijuana) is stored

14 DRUG COURT PRACTITIONER FACT SHEET

12;257(22):3110-4. The article is titled; 7. Website: Health Choice of New York. URL: “Scientific Issues in Drug Testing—Council on http://www.clearchoiceofny.com/drugtestinfo.htm Scientific Affairs.” On page 3112, Table 2. titled . This website states: “It's One Stop Shopping “Approximate Duration of Detectability of For All Of Your Detoxifying Needs. We Have All Selected Drugs in Urine” lists chronic heavy The Products You Need To Pass A Urine Drug smoker as 21-27 days. The references cited for Test.” In a section entitled “Drug Approximate this data are Dackis, et. al (1982), and Ellis, et. Detection Time in Urine,” the site provides the al. (1985), the potential shortcomings of both following information: “Cannabinoids (THC, have been discussed in this article. It is note- Marijuana) 20-90 days.” worthy and illustrative that this 1999 “updated” 8. Website: IPassedMyDrugTest.Com. URL: publication still relies on research performed in http://www.ipassedmydrugtest.com/drug_test_ 1982 and 1985. faq.asp#detect_time 5. Cannabinoid Issues: Passive Inhalation, The following table is provided: Excretion Patterns and Retention Times (pamphlet). (1991). Dade Behring, SYVA Cannabinoids (THC, Marijuana) Detection Time: Company, S-10036. On page 25 in a table 1 time only 5-8 days titled: “Emit d.a.u. Cannabinoid Assay (20 2-4x per month 11-18 days ng/mL)” is listed the following: 2-4x per week 23-35 days All Subjects (n = 86): 5-6x per week 33-48 days First Negative: Daily 49-63 days Mean = 16.0 days Range = 3-46 days 9. Website: HealthWorld Online. URL: Last Positive: http://www.healthy.net/clinic/lab/labtest/004.asp. Mean = 27.1 days Range = 3-77 days Site’s mission statement; “HealthWorld Online is your 24-hour health resource center—a virtual Examination of the references associated with health village where you can access informa- this data indicates the following sources; Ellis, tion, products, and services to help create your et. al. (1985), Schwartz, Hayden, & Riddile (1985), wellness-based lifestyle.” In the section called and Johansson& Halldin (1989). All of these “Detection of Cannabinoids in Urine,” the fol- references and their potential study design issues lowing information is provided: “Cutoff and have been reviewed in this article. This pam- Detection Post Dose: The initial screening cut- phlet also contains cannabinoid elimination data off level is 50 ng/ml. The GC/MS cutoff level is using the Emit-st Cannabinoid Assay testing 15 ng/ml. The elimination half-life of marijuana method. Given that this assay is no longer ranges from 14-38 hours. At the initial cutoff of being manufactured, the data was not included. 50 ng/ml, the daily user will remain positive for 6. Website: What You Need to Know. About.com perhaps 7 to 30 days after cessation. At the URL: http://experts.about.com/q/1319/718935.htm. confirmation level of 15 ng/ml, the frequent This is a popular website for general information user will be positive for perhaps as long as 15 inquiries about almost any subject matter. In a weeks.” section entitled “About Our Service” the web- 10.Website: Dr. Drew. URL: site states, “Allexperts, created in early 1998, http://drdrew.com/Office/faq.asp?id=1083&sec- was the very first large-scale question and tion=5002 answer service on the net! We have thousands of volunteers, including top lawyers, doctors, QUESTION: How long does pot (or other drugs) engineers, and scientists, waiting to answer stay in your body? Is there any way to detect it? your questions. All answers are free and most ANSWER: Most readily available drug screens come within a day!” are tests of the urine. Blood tests and breath The question submitted to the site was, “How analyzers are another way substances can be long does marijuana stay in your system?” The detected. Pot stays in your body, stored in fat expert response was: “The average time pot tissues, potentially your whole life. However, stays in your system is 30 days. The time may it is very unusual to be released in sufficient differ depending on your metabolism. If you quantities to have an intoxicating effect or be have a fast metabolism it may be shorter than measurable in urine screens. Heavy pot smokers, 30 days, if you have a slow metabolism it may people who have smoked for years on a daily be more. The average though is about 30 days.” basis, very commonly have detectable amounts Note that in this answer, 30 days is given as an in their urine for at least two weeks. average cannabinoid elimination time.

15 11.Research data indicates that in the terminal phase of cannabinoid elimination, subjects can produce urine samples with levels below the FACT SHEET QUIZ: cutoff concentration (negative results), followed subsequently by samples with levels slightly WHAT DID YOU LEARN? above the cutoff (positive results) (Huestis, 2002). This fluctuation between positive and negative did not occur in all subjects and in those that Test your new knowledge. Answer did exhibit this pattern, the fluctuation was these true and false questions based generally transitory. Based on this elimination on the Fact Sheet text. pattern, it is recommended that programs using a cannabinoid cutoff of 50 ng/mL allow T F 1. The “detection window” means an interval of at least three days between the the length of time a drug will two negative result samples to establish the remain in someone’s system. abstinence baseline. It is further recommended that programs using the 20 ng/mL cannabinoid cutoff allow an interval of at least five days T F 2. The choice of testing cutoff between the two negative result samples to has a profound effect on the establish the abstinence baseline. If a program’s cannabinoid detection window. testing frequency is greater than every five days (using the 20 ng/mL cutoff), a total of three or T F 3. Despite changes in testing more negative tests may be required before methodologies, detection times the five-day interval is achieved. of cannabinoid metabolites in urine monitored by immunoas- Publisher say have remained the same over the past two decades. C. West Huddleston, III Director, National Drug Court Institute T F 4. Chronic users of marijuana National Drug Court Institute commonly produce a positive 4900 Seminary Road, Suite 320 urine drug test result 30 days Alexandria, VA 22311 after the last smoking episode. 703.575.9400 ext. 13 703.575.9402 fax [email protected] T F 5. Any positive drug test result following two successive negative urine drug tests several days apart indicates new or recent drug exposure.

T F 6. Since marijuana has such a prolonged elimination period, temporarily suspending drug testing of a client who tests positive for marijuana is a

good money-saving strategy.

1. False; 2. True; 3. False; 4. False; 5. True; 6. False 6. True; 5. False; 4. False; 3. True; 2. False; 1. Answers:

NATIONAL DRUG COURT INSTITUTE

4900 Seminary Road, Suite 320 Alexandria, VA 22311 (703) 575-9400 1-877-507-3229 (703) 575-9402 Fax www.ndci.org