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August 9, 1985, Vol 254, No. 6 >
ARTICLE | August 9, 1985

Laboratory Detection of Marijuana Use FREE

Richard H. Schwartz, MD; Richard L. Hawks, PhD
[+] Author Affiliations

Reprint requests to 410 Maple Ave W, Vienna, VA 22180 (Dr Schwartz).


JAMA. 1985;254(6):788-792. doi:10.1001/jama.1985.03360060090032
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References

Frequent smoking of cannabis (marijuana) has been shown to be associated with a decline in social, mental, and perceptual skills and, during adolescence, with maladaptive emotional development. Urinalysis for the detection of such use can be a useful tool for the physician responsible for treatment and counseling of adolescents who develop habitual use of marijuana. Primary methods for urinalysis detection of cannabis use include the homogenous enzyme immunoassay (EMIT) and the radioimmunoassay. These and other methods are discussed along with the issues of "false" results (both positive and negative) and the "limits of interpretation" that can be placed on a positive urine result. The pharmacokinetics and metabolism of the active constituents of cannabis are described as well as the interpretation of urinalysis results as they relate to use patterns. Guidelines are presented for the primary care physician for selecting candidates for such testing and for the use of such tests in the treatment or counseling of adolescents for whom marijuana abuse has become a psychological and social problem.

(JAMA 1985;254:788-792)

REFERENCES

1 +
Schwartz RH:  Frequent marijuana use in adolescence . Am Fam Physician 1985;;31:201-205.
2 +
Committee to Study the Health Related Effects of Cannabis and Its Derivatives: Marijuana and Health: Report of a Study by a Committee of the Institute of Medicine . Washington, DC, National Academy Press, 1982;, pp 115-120, 124-125.
3 +
Klonoff H:  Marijuana and driving in real-life situations . Science 1971;;186:317-324.
4 +
Smiley AM, Moskowitz H, Ziedman K:  Driving simulator studies of marijuana alone and in combination with alcohol , in Proceedings of the 25th Conference of the American Association for Automotive Medicine . San Francisco, American Association for Automotive Medicine, 1981;, pp 107-116.
5 +
Owens SM, McBay AJ, Cook CE:  The use of marijuana, ethanol, and other drugs among drivers killed in single-vehicle crashes . J Forensic Sci 1983;;28:372-379.
6 +
Moskowitz H, Sharma S, Ziedman K:  Duration of skills performance impairment , in Proceedings of the 25th Conference of the American Association for Automotive Medicine . San Francisco, American Association for Automotive Medicine, 1981;, pp 87-96.
7 +
Hingson R, Heeren T, Mangione T, et al:  Teenage driving after using marijuana or drinking and traffic accident involvement . J Safety Res 1982;;13:33-38.
8 +
Hunt CA, Jones RT:  Tolerance and disposition of THC in man . J Pharmacol Exp Ther 1980;;215:135-144.
9 +
Hollister LE, Gillespie HK, Ohlsson A, et al:  Do plasma concentrations of Δ9-tetrahydrocannabinol reflect the degree of intoxication? J Clin Pharmacol 1981;;21( (8) -9 suppl):171S-177S.
10 +
Wall ME, Perez-Reyes M:  The metabolism of delta-9-tetrahydrocannabinol and related compounds in man . J Clin Pharmacol 1980;; 21:1785-1795.
11 +
Wall ME, Brine DR, Perez-Reyes M:  Metabolism of cannabinoids in man , in Braude MC, Szara S (eds): The Pharmacology of Marijuana . New York, Raven Press, 1976;, vol 1, pp 93-116.
12 +
Perez-Reyes M, Lipton MA, Timmons MC, et al:  Pharmacology of orally administered delta-9-tetrahydrocannabinol . Clin Pharmacol Ther 1973;;14:48-55.
13 +
Ohlsson A, Lindren JE, Wahlen A, et al:  Plasma delta-9-tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking . Clin Pharmacol Ther 1980;;28:409-416.
14 +
Halldin MM, Carlsson S, Kanter SL, et al:  Urinary metabolites of Δ1-tetrahydrocannabinol in man . Arzneimittelforsch 1982;;32:764-768.
15 +
Halldin MM, Andersson LKR, Widman M, et al:  Further urinary metabolites of Δ1-tetrahydrocannabinol in man . Arzneimittelforsch 1982;; 32:1135-1138.
16 +
McBay AJ, Dubowksi KM, Finkle BS:  Urine testing for marijuana use . JAMA 1983;; 249:881.
17 +
Hawks RL:  Developments in cannabinoid analysis of body fluids: Implications for forensic applications , in Agurell S, Dewey W, Willette R (eds): The Cannabinoids: Chemical, Pharmacologic and Therapeutic Aspects . New York, Academic Press Inc, 1984;.
18 +
Clinical Summary Addendum: EMIT d.a.u. and EMIT-st Urine Cannabinoid Assays . Palo Alto, Calif, SYVA Co, 1982;.
19 +
Dakis CA, Potlash ALC, Annito W, et al:  Persistence of urinary marijuana levels after supervised abstinence . Am J Psychiatry 1982;; 139:1196-1198.
20 +
 Urine testing for detection of marijuana: An advisory . MMWR 1983;;32:469-471.
21 +
Shepard RM, Milne GM:  The use of high-pressure liquid chromatography with electrochemical detection for the assay of nantradol and its application to Δ9-tetrahydrocannabinol . Natl Inst Drug Abuse Res Monogr Ser 1982;; 42:7-18.
22 +
DeLaurentis MJ, McNeil K, Mann AJ, et al:  An EMIT assay for cannabinoid metabolites in urine . Natl Inst Drug Abuse Res Monogr Ser 1982;;42:69-84.
23 +
Law B, Pocok K, Moffat AC:  An evaluation of homogenous enzyme immunoassay (EMIT) for cannabinoid detection in biological fluids . J Forensic Sci Soc 1982;;22:275-281.
24 +
O'Connor JE, Rejent TA:  EMIT cannabinoid assay: Confirmation by RIA and GC/MS . J Anal Toxicol 1981;;5:168-173.
25 +
O'Connor JE, Rejent TA:  EMIT cannabinoid assay for urinary metabolites and confirmation by alternate techniques . Clin Chem 1981;; 27:1104.
26 +
Rogers R, Crowl CP, Eimstad WM, et al:  Homogenous enzyme immunoassay for cannabinoids in urine . Clin Chem 1978;;24:95-100.
27 +
Cook CE, Hawes ML, Amerson EW, et al:  Radioimmunoassay of delta-9-tetrahydrocannabinol . Natl Inst Drug Abuse Res Monogr Ser 1976;;7:15-27.
28 +
Chase AR, Kelley PR, Tauton-Rigby A, et al:  Quantitation of cannabinoids in biological fluids by radioimmunoassay . Natl Inst Drug Abuse Res Monogr Ser 1976;;7:1-9.
29 +
Soares JR, Grant JD, Gross SJ:  Significant developments in radioimmune methods applied to delta-9-THC and its 9-substituted metabolites . Natl Inst Drug Abuse Res Monogr Ser 1982;;42:44-55.
30 +
Foltz RL, Fentiman AF Jr, Foltz RB:  GC/MS assays for abused drugs in body fluids . Natl Inst Drug Abuse Res Monogr Ser 1980;; 32:62-89.
31 +
Rosenthal D, Harvey TM, Bursey JT, et al:  Comparison of gas chromatography mass spectrometry methods for the determination of delta-9-tetrahydrocannabinol in plasma . Biomed Mass Spectrom 1978;;5:312-316.
32 +
Foltz RL, McGinnis KM, Chinn DM:  Quantitative measurement of Δ9-tetrahydrocannabinol and two major metabolites in physiological specimens using capillary column gas chromatography in negative chemical ionization mass spectrometry . Biomed Mass Spectrom 1983;; 10:316-323.
33 +
Whiting D, Manders WW:  Confirmation of a tetrahydrocannabinol metabolite in urine by gas chromatography . J Anal Toxicol 1982;;6:49-52.
34 +
Garrett ER, Hunt CA:  Picogram analysis of THC and application to biological fluids . J Pharm Sci 1973;;62:1211-1214.
35 +
ElSohly MA, Arafatt ES, Jones AB:  Analysis of the major metabolite of Δ9-tetrahydrocannabinol in urine: III. A GC/ECD procedure . J Anal Toxicol 1984;;8:7-9.
36 +
Law B, Mason PA, Moffat AC, et al:  Confirmation of cannabis use by the analysis of Δ9-tetrahydrocannabinol metabolites in blood and urine by combined HPLC and RIA . J Anal Toxicol 1984;;8:19-21.
37 +
ElSohly MA, ElSohly HN, Jones AB, et al:  Analysis of the major metabolite of Δ9-tetrahydrocannabinol in urine: II. A HPLC procedure . J Anal Toxicol 1983;;7:262-264.
38 +
Kaistha KK, Tadrus R:  Semi-quantitative thin-layer mass-screening detection of 11-nor-Δ9-THC-9-carboxylic acid in human urine . J Chromatogr 1982;;237:528-533.
39 +
Kanter SL, Hollister LE, Zamora JU:  Marijuana metabolites in urine of man: XI. Detection of unconjugated and conjugated Δ9-THC-11-oic acid by thin-layer chromatography . J Chromatogr 1982;;235:507-512.
40 +
Kogan MJ, Newman E, Willson NJ:  Detection of the marijuana metabolite 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid in human urine by bonded-phase absorption and thin-layer chromatography . J Chromatogr 1984;; 303:441-443.
41 +
Norton LE, Garriott JC:  Detection of marijuana use by GC/MS analysis of mouth swabs . Am J Forensic Med Pathol 1983;;4:185-188.
42 +
Morgan JP:  Problems of mass urine screening for misused drugs . J Psychoactive Drugs 1984;;16:305-316.
43 +
Waterhouse GAW, Pence PJC, Forney RB:  Positive urine cannabinoid levels produced in individuals passively exposed to marijuana smoke , abstract K27 (Toxicology section). Abstracts of the 35th Annual Meeting of the American Academy of Forensic Sciences, Cincinnati, Feb 15-19, 1983 .
44 +
Mason AP, Perez-Reyes M, McBay AJ, et al:  Cannabinoids in plasma after passive inhalation of marijuana smoke . JAMA 1983;;249:475-476.
45 +
Perez-Reyes M, Guiseppi SD, Mason AP, et al:  Passive inhalation of marijuana smoke and urinary excretion of cannabinoids . Clin Pharmacol Ther 1983;;34:36-41.
46 +
Falck R:  Passive inhalation of marijuana smoke . JAMA 1983;;250:898.
47 +
Law B, Mason PA, Moffat CA, et al:  Passive inhalation of cannabis smoke . J Pharm Pharmacol 1984;;36:578-581.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Schwartz RH:  Frequent marijuana use in adolescence . Am Fam Physician 1985;;31:201-205.
2 +
Committee to Study the Health Related Effects of Cannabis and Its Derivatives: Marijuana and Health: Report of a Study by a Committee of the Institute of Medicine . Washington, DC, National Academy Press, 1982;, pp 115-120, 124-125.
3 +
Klonoff H:  Marijuana and driving in real-life situations . Science 1971;;186:317-324.
4 +
Smiley AM, Moskowitz H, Ziedman K:  Driving simulator studies of marijuana alone and in combination with alcohol , in Proceedings of the 25th Conference of the American Association for Automotive Medicine . San Francisco, American Association for Automotive Medicine, 1981;, pp 107-116.
5 +
Owens SM, McBay AJ, Cook CE:  The use of marijuana, ethanol, and other drugs among drivers killed in single-vehicle crashes . J Forensic Sci 1983;;28:372-379.
6 +
Moskowitz H, Sharma S, Ziedman K:  Duration of skills performance impairment , in Proceedings of the 25th Conference of the American Association for Automotive Medicine . San Francisco, American Association for Automotive Medicine, 1981;, pp 87-96.
7 +
Hingson R, Heeren T, Mangione T, et al:  Teenage driving after using marijuana or drinking and traffic accident involvement . J Safety Res 1982;;13:33-38.
8 +
Hunt CA, Jones RT:  Tolerance and disposition of THC in man . J Pharmacol Exp Ther 1980;;215:135-144.
9 +
Hollister LE, Gillespie HK, Ohlsson A, et al:  Do plasma concentrations of Δ9-tetrahydrocannabinol reflect the degree of intoxication? J Clin Pharmacol 1981;;21( (8) -9 suppl):171S-177S.
10 +
Wall ME, Perez-Reyes M:  The metabolism of delta-9-tetrahydrocannabinol and related compounds in man . J Clin Pharmacol 1980;; 21:1785-1795.
11 +
Wall ME, Brine DR, Perez-Reyes M:  Metabolism of cannabinoids in man , in Braude MC, Szara S (eds): The Pharmacology of Marijuana . New York, Raven Press, 1976;, vol 1, pp 93-116.
12 +
Perez-Reyes M, Lipton MA, Timmons MC, et al:  Pharmacology of orally administered delta-9-tetrahydrocannabinol . Clin Pharmacol Ther 1973;;14:48-55.
13 +
Ohlsson A, Lindren JE, Wahlen A, et al:  Plasma delta-9-tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking . Clin Pharmacol Ther 1980;;28:409-416.
14 +
Halldin MM, Carlsson S, Kanter SL, et al:  Urinary metabolites of Δ1-tetrahydrocannabinol in man . Arzneimittelforsch 1982;;32:764-768.
15 +
Halldin MM, Andersson LKR, Widman M, et al:  Further urinary metabolites of Δ1-tetrahydrocannabinol in man . Arzneimittelforsch 1982;; 32:1135-1138.
16 +
McBay AJ, Dubowksi KM, Finkle BS:  Urine testing for marijuana use . JAMA 1983;; 249:881.
17 +
Hawks RL:  Developments in cannabinoid analysis of body fluids: Implications for forensic applications , in Agurell S, Dewey W, Willette R (eds): The Cannabinoids: Chemical, Pharmacologic and Therapeutic Aspects . New York, Academic Press Inc, 1984;.
18 +
Clinical Summary Addendum: EMIT d.a.u. and EMIT-st Urine Cannabinoid Assays . Palo Alto, Calif, SYVA Co, 1982;.
19 +
Dakis CA, Potlash ALC, Annito W, et al:  Persistence of urinary marijuana levels after supervised abstinence . Am J Psychiatry 1982;; 139:1196-1198.
20 +
 Urine testing for detection of marijuana: An advisory . MMWR 1983;;32:469-471.
21 +
Shepard RM, Milne GM:  The use of high-pressure liquid chromatography with electrochemical detection for the assay of nantradol and its application to Δ9-tetrahydrocannabinol . Natl Inst Drug Abuse Res Monogr Ser 1982;; 42:7-18.
22 +
DeLaurentis MJ, McNeil K, Mann AJ, et al:  An EMIT assay for cannabinoid metabolites in urine . Natl Inst Drug Abuse Res Monogr Ser 1982;;42:69-84.
23 +
Law B, Pocok K, Moffat AC:  An evaluation of homogenous enzyme immunoassay (EMIT) for cannabinoid detection in biological fluids . J Forensic Sci Soc 1982;;22:275-281.
24 +
O'Connor JE, Rejent TA:  EMIT cannabinoid assay: Confirmation by RIA and GC/MS . J Anal Toxicol 1981;;5:168-173.
25 +
O'Connor JE, Rejent TA:  EMIT cannabinoid assay for urinary metabolites and confirmation by alternate techniques . Clin Chem 1981;; 27:1104.
26 +
Rogers R, Crowl CP, Eimstad WM, et al:  Homogenous enzyme immunoassay for cannabinoids in urine . Clin Chem 1978;;24:95-100.
27 +
Cook CE, Hawes ML, Amerson EW, et al:  Radioimmunoassay of delta-9-tetrahydrocannabinol . Natl Inst Drug Abuse Res Monogr Ser 1976;;7:15-27.
28 +
Chase AR, Kelley PR, Tauton-Rigby A, et al:  Quantitation of cannabinoids in biological fluids by radioimmunoassay . Natl Inst Drug Abuse Res Monogr Ser 1976;;7:1-9.
29 +
Soares JR, Grant JD, Gross SJ:  Significant developments in radioimmune methods applied to delta-9-THC and its 9-substituted metabolites . Natl Inst Drug Abuse Res Monogr Ser 1982;;42:44-55.
30 +
Foltz RL, Fentiman AF Jr, Foltz RB:  GC/MS assays for abused drugs in body fluids . Natl Inst Drug Abuse Res Monogr Ser 1980;; 32:62-89.
31 +
Rosenthal D, Harvey TM, Bursey JT, et al:  Comparison of gas chromatography mass spectrometry methods for the determination of delta-9-tetrahydrocannabinol in plasma . Biomed Mass Spectrom 1978;;5:312-316.
32 +
Foltz RL, McGinnis KM, Chinn DM:  Quantitative measurement of Δ9-tetrahydrocannabinol and two major metabolites in physiological specimens using capillary column gas chromatography in negative chemical ionization mass spectrometry . Biomed Mass Spectrom 1983;; 10:316-323.
33 +
Whiting D, Manders WW:  Confirmation of a tetrahydrocannabinol metabolite in urine by gas chromatography . J Anal Toxicol 1982;;6:49-52.
34 +
Garrett ER, Hunt CA:  Picogram analysis of THC and application to biological fluids . J Pharm Sci 1973;;62:1211-1214.
35 +
ElSohly MA, Arafatt ES, Jones AB:  Analysis of the major metabolite of Δ9-tetrahydrocannabinol in urine: III. A GC/ECD procedure . J Anal Toxicol 1984;;8:7-9.
36 +
Law B, Mason PA, Moffat AC, et al:  Confirmation of cannabis use by the analysis of Δ9-tetrahydrocannabinol metabolites in blood and urine by combined HPLC and RIA . J Anal Toxicol 1984;;8:19-21.
37 +
ElSohly MA, ElSohly HN, Jones AB, et al:  Analysis of the major metabolite of Δ9-tetrahydrocannabinol in urine: II. A HPLC procedure . J Anal Toxicol 1983;;7:262-264.
38 +
Kaistha KK, Tadrus R:  Semi-quantitative thin-layer mass-screening detection of 11-nor-Δ9-THC-9-carboxylic acid in human urine . J Chromatogr 1982;;237:528-533.
39 +
Kanter SL, Hollister LE, Zamora JU:  Marijuana metabolites in urine of man: XI. Detection of unconjugated and conjugated Δ9-THC-11-oic acid by thin-layer chromatography . J Chromatogr 1982;;235:507-512.
40 +
Kogan MJ, Newman E, Willson NJ:  Detection of the marijuana metabolite 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid in human urine by bonded-phase absorption and thin-layer chromatography . J Chromatogr 1984;; 303:441-443.
41 +
Norton LE, Garriott JC:  Detection of marijuana use by GC/MS analysis of mouth swabs . Am J Forensic Med Pathol 1983;;4:185-188.
42 +
Morgan JP:  Problems of mass urine screening for misused drugs . J Psychoactive Drugs 1984;;16:305-316.
43 +
Waterhouse GAW, Pence PJC, Forney RB:  Positive urine cannabinoid levels produced in individuals passively exposed to marijuana smoke , abstract K27 (Toxicology section). Abstracts of the 35th Annual Meeting of the American Academy of Forensic Sciences, Cincinnati, Feb 15-19, 1983 .
44 +
Mason AP, Perez-Reyes M, McBay AJ, et al:  Cannabinoids in plasma after passive inhalation of marijuana smoke . JAMA 1983;;249:475-476.
45 +
Perez-Reyes M, Guiseppi SD, Mason AP, et al:  Passive inhalation of marijuana smoke and urinary excretion of cannabinoids . Clin Pharmacol Ther 1983;;34:36-41.
46 +
Falck R:  Passive inhalation of marijuana smoke . JAMA 1983;;250:898.
47 +
Law B, Mason PA, Moffat CA, et al:  Passive inhalation of cannabis smoke . J Pharm Pharmacol 1984;;36:578-581.

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