The Marijuana Detection Window - National Drug Court Institute

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NATIONAL DRUG COURT INSTITUTEpreviously described in the literature (Cary,2002). A drug court participant is deemed tohave reached their abstinence baseline whentwo consecutive urine drug tests yieldingnegative results for cannabinoids have beenachieved, where the two tests are separatedby a several day interval. Any positive drugtest result following the establishment of thisbaseline indicates new drug exposure. Thistechnique can be used with assays that testfor marijuana at either the 20 or 50 ng/mLcutoff concentration. 11CANNABINOID TESTING FOLLOWINGPOSITIVE RESULTSDue to the prolonged excretion profile ofcannabinoids in urine (especially after chronicuse) some drug court programs wrestlewith the issue of whether to continue urinedrug testing during the expected marijuanaelimination period. Simply put, why continuethe expense and sample collection burdenfor clients who have already tested positivefor cannabinoids knowing that the client maycontinue to produce positive cannabinoidresults for many days? There are at leastthree principle reasons drug courts are notadvised to suspend urine drug testing followinga positive result for cannabinoids.First, most court-mandated testing includesdrugs other than marijuana. Client surveillanceoften encompasses testing for many ofthe popularly abused substances such asamphetamines, cocaine, opiates, and alcohol.Programs that forego scheduled testing runthe very real risk of missing covert drug usefor substances other than marijuana. If a drugcourt client knows a positive cannabinoidtest will result in a drug testing “vacation,”they may use that non-testing period to usesubstances with shorter detection windows(i.e. cocaine or alcohol). By continuing to test,the court maintains its abstinence monitoringfor drugs besides marijuana.Second, from a programmatic standpoint thesuspension of scheduled client drug testingsends the wrong therapeutic message. If adrug court's policies and procedures requirea certain schedule of testing, suspendingtesting for even a short period may appearto other program participants that the court is“rewarding” a client who has tested positive.Eliminating scheduled drug tests in responseto a positive cannabinoid result degradesthe program’s efforts at maintaining clientbehavioral expectations.Lastly, depending upon the cutoff concentrationof the drug test being used and whether theclient’s marijuana usage was an isolated event(rather than a full relapse), it is entirely possiblethat a client who has previously tested positivefor cannabinoids may test negative sooner thanthe cannabinoid detection window estimate.As indicated earlier, acute marijuana useresults in cannabinoid positive urine samplesfor only several days following exposure.Curtailing drug testing for longer than threedays extends unnecessarily the period ofuncertainty about a client’s recent behavior andmay delay appropriate therapeutic strategiesor sanction decisions.COURT EXPECTATIONSAND CLIENT BOUNDARIESOne of the most important prerogatives ofdrug court (or any therapeutic court) is toclearly define the behavioral expectations forclients by establishing compliance boundariesrequired for continued program participation.Drug testing used as a surveillance tool definesthose boundaries and monitors client behaviorin order that the court can direct either incentivesor sanctions as needed to maintainparticipant compliance. To fulfill this importantresponsibility, drug courts teams must agreeupon specific drug testing benchmarks inorder to apply court intervention strategiesin an equitable and consistent manner.The primary focus of this article is to promotethe establishment of a drug testing benchmarkthat defines the expected detection windowof cannabinoids in urine following the cessationof smoking. In order for drug courts todetermine their cannabinoid detection window,12
DRUG COURT PRACTITIONER FACT SHEETthe program will need to consider the cutoffconcentration of the urine cannabinoid testbeing utilized and develop criteria for definingchronic marijuana users. Drug courts shouldalso take into account how the cannabinoiddetection window will be incorporated intotheir current policies and procedures and howthe detection window will be used in caseadjudication. Once established, the courtshould apprise program participants of theexpectations associated with the cannabinoiddetection window. Clients should understandthat sanctions will result if continued cannabinoidpositive tests occur beyond the establisheddetection window (the drug eliminationtime limit after which a client should not testpositive if that client has abstained frommarijuana use). Courts are reminded that thecannabinoid detection window may requirerevision if there are modifications to the drugtesting methods or if there are significantchanges in marijuana usage patterns in thecourt’s target population (i.e., significantincreases in chronic use).Practitioners are reminded that the goal inestablishing a cannabinoid detection windowis not to ensure that a monitored client isdrug free. Chronic marijuana users may carryundetectable traces of drug in their bodiesfor a significant time after the cessation ofuse. Rather, the goal is to establish a giventime period (detection window limit) afterwhich a client should not test positive forcannabinoids as a result of continued excretionfrom prior usage.Finally, the cannabinoid detection window isa scientifically supportable, evidence-basedeffort to establish a reasonable and practicalstandard for determining the length of timecannabinoids will remain detectable in urinefollowing the smoking of marijuana. Drug courtsare reminded that science is not black andwhite and that the state of our knowledge iscontinually evolving. While detection windowbenchmarks will and should guide the sanctioningprocess for violations of abstinentbehavior, courts are urged to judge a client’slevel of compliance on a case by case basisusing all of the behavioral data available to thecourt in conjunction with drug testing results.In unconventional situations that confoundthe court, qualified toxicological assistanceshould be sought.Paul L. Cary, M.S. is the Director of the Toxicology& Drug Monitoring Laboratory, University of MissouriHealth Care, Columbia, Missouri; and NDCI FacultyResident Expert on drug testing issues. Mr. Cary canbe reached at carypl@health.missouri.edu.This document was published with support from theOffice of National Drug Control Policy, Executive Officeof the President and the Bureau of Justice Assistance,U.S. Department of Justice.ReferencesBaselt, R.C. (2004). In Disposition of Toxic Drugsand Chemicals in Man, (7th ed.). Foster City,CA: Biomedical Publications.Cary, P.L. (2002). The use creatinine-normalizedcannabinoid results to determine continuedabstinence or to differentiate between newmarijuana use and continuing drug excretionfrom previous exposure. Drug Court Review,4(1), 83-103.Cridland, J.S., Rottanburg, D., & Robins, A.H. (1983).Apparent half-life of excretion of cannabinoidsin man. Human Toxicology 2(4), 641-644.Dackis, C.A., Pottash, A.L.C., Annitto, W., & Gold,M.S. (1982). Persistence of urinary marijuanalevels after supervised abstinence. AmericanJournal of Psychiatry, 139(9), 1196-1198.Ellis, G.M., Mann, M.A., Judson, B.A., Schramm,N.T., & Tashchian, A. (1985). Excretion patternsof cannabinoid metabolites after last use in agroup of chronic users. Clinical Pharmacologyand Therapeutics, 38(5), 572-578.Huestis, M.A. (2002). Cannabis (marijuana): Effectson human behavior and performance. ForensicScience Review, 14(1/2), 15-60.Huestis, M.A., Mitchell, J.M., & Cone, E.J. (1994).Lowering the federally mandated cannabinoidimmunoassay cutoff increases true-positiveresults. Clinical Chemistry, 40(5), 729-733.Huestis, M.A., Mitchell, J.M., & Cone, E.J. (1995).Detection times of marijuana metabolites inurine by immunoassay and gc-ms. Journal ofAnalytical Toxicology, 19(10), 443-449.13
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