1. By: Paul L. Cary Toxicology Laboratory University of Missouri
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
formualting 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 of therapeutic intervention
hindered timely use of judicial sanctioning
fostered denial of marijuana usage by clients

4. CDW Discussion: general drug detection window issues
necessity for establishing detection window
cannabinoid elimination research
what perpetuates the 30+ day elimination assumption
guidance for establishing a cannbinoid 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
The importance of witnessed collection (for urine monitoring) can not be over-emphasized. As indicated on the slide, urine collections which are not witnessed are of little or no assessment value because of the propensity of drug court participants not to provide a legitimate sample (denial; efforts to hide relapse). The definition of “witnessed collections” is direct line-of-sight observation – basically staring at a participants genitals. Difficult? - yes! Uncomfortable? - no doubt! Necessary? - absolutely critical. Put another way; if drug courts don’t directly observe urine collections, they should not waste their time and money on testing efforts! It’s THAT important!
The success of monitoring depends on a legitimate specimen for testing. The most likely guarantor that a legitimate specimen will be produced is with direct-observation collections. Remember, a drug court can employ the absolute best testing methods available, but that testing is worthless if the sample has been tampered with (by the participant) prior to the testing process.

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 - by Drug
amphetamines: 1-4 days
cocaine: up to 72 hours
opiates: 1-4 days
PCP: up to 6 days
barbiturates: up to a week
benzodiazepines: up to a week
. . then there’s alcohol & cannabinoids
Detection time in urine is based on an average of the most commonly tested drugs of abuse. It is important to stress that these estimates can vary significantly depending on client-specific parameters (such as those listed as variables in the notes for the preceding slide). In addition to those variables, the cutoff concentration of each drug test will have an impact on detection times. For example, a cannabin test with a 20 ng/mL cutoff level is 2.5 times more sensitive than a cannabinoid test with a 50 ng/mL threshold – accordingly, the 20 ng/mL test will have a detection window that is considerably longer (maybe several days) than the 50 ng/mL cannabinoid test.
Again, the general estimates provided on this slide are just that – estimates.
Alcohol elimination is rapid – being removed from the body in only a few hours. Cannabinoids (marijuana), being fat-soluble, can be detected in urine for up to a couple of weeks with testing performed at the 20 ng/mL cutoff level – however 30-day elimination rates often quoted would be considered extremely rare (if not physiologically highly unlikely).

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 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 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 of detection of 1–2 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

16. Despite these problems . . . .
Smith-Kielland, et. al. – average time to the first negative sample (cannabinoid cutoff of 20 ng/mL)
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 with all thirteen subjects having an average last day with detectable levels (using a 20 ng/mL cutoff) of 9.8 days
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 3-6 days following high dose cigarette
1996 (Huestis, et. al.) six health males - locked medical ward - 15 ng/mL GC/MS cutoff
CDW 122 hours following high dose cigarette
2001 (Niedbala, et. al.) 18 health males - locked medical ward - 50 ng/mL cutoff
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 daily testing to control covert THC use
maximum cannabinoid elimination time – hours or 18.1 days
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) ng/mL cutoff
5/17 tested negative at one week
by the second week - 9/17 were negative
by week /17 tested negative
study ended at day 28 with six still testing positive

21. Recent Research - Chronic Studies
even under extraordinary exposure criteria, the average CDW is approximately 14 days, 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 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. Establishing a Cannbinoid Detection Window

25. 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

26. GC/MS Cutoff Irrelevent
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

27. Cannabinoid Detection Window
detection time: at 50 ng/mL cutoff
1 - 3 days for single event/occasional use
up to 10 days for heavy chronic use
detection time: at 20 ng/mL cutoff
5-7 days for single event/occasional use
up to 21 days for heavy chronic use

28. 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 entry into court program
detox or “clean out” phase
following initial detox - past chronic usage will not effect CDW

29. 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

30. 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

31. 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 recent behavior and may delay appropriate therapeutic strategies or sanction decisions

32. 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 ?
an issue only in first phase of program
only drug that poses concern is cannabinoids
“two negative test” rule – two back-to-back negative drug tests post clean out

33. Drug Court’s Competing Imperatives
the need for rapid therapeutic intervention (sanctioning designed to produce behavioral change)
the need to ensure that the evidentiary standards, crafted to protect client rights, are maintained

34. 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 information
in unconventional situations that confound the court, qualified toxicological assistance should be sought

35. 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.

36. 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-case basis using all of the behavioral data available to the court in conjunction with drug testing results.

37. 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

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