Cannabis Compound Abuse Workup

  • Author: Lawrence Genen, MD, MBA; Chief Editor: David Bienenfeld, MD   more...
 
Updated: May 15, 2012
 

Laboratory Studies

  • Cannabinoids can be detected in the urine for as many as 21 days after use in persons chronically using marijuana because these lipid soluble metabolites are slowly released from fat cells into the blood; however, 1-5 days is the normal urine-positive period.
    • The primary method for urinalysis detection is enzyme immunoassay or radioimmunoassay. This method is inexpensive, quick, and accurate.
    • This is also useful for confirmation of abstinence.
    • Urine samples are difficult to obtain from people who are addicted, and providing a urine sample is easily evaded. Urine toxicology testing should be performed under supervised conditions to ensure reliability of results.
    • Gas chromatography (GC) in combination with mass spectrometry (MS) and/or thin-layer chromatography (TLC) is used to confirm positive results, especially in legal proceedings.
    • With all types of tests mentioned, including TLC, false-negative results tend to be more common than false-positive results.
  • Blood samples may be used to measure quantitative levels of cannabinoids.[27]
    • Serial monitoring of tetrahydrocannabinol (THC)-COOH to creatinine ratios can distinguish between recent use and residual excretion.
    • To assess the extent of cannabis use, determination of free and bound THC-COOH can be useful.
    • Blood analysis is the preferred method of detection for interpretation of acute effects. The cannabis influence factor (CIF) is a tool that is used to interpret concentrations of THC and its metabolites in forensic cases. Absolute driving inability has been proposed in the case of CIF of 10 or higher. The higher the CIF, the more recent the cannabis abuse.
    • Blood samples must be taken within a prescribed 8-day period, and THC-COOH concentration greater than 75 ng/mL is associated with regular consumption of cannabis. THC-COOH concentration less than 5 ng/mL is associated with occasional consumption.
  • Hair analysis is not a sensitive enough tool to detect cannabinoids.[27]
    • THC, and the main metabolite THC-COOH, do not incorporate to a great extent into hair. TCH-COOH is not highly bound to melanin. Hence, concentrations in hair are much lower when compared with other drugs of abuse.
    • Because TCH is present in cannabis smoke, it can also be incorporated into hair simply by second-hand exposure.
  • Saliva testing is a newer technology for detection
    • The presence of delta-9-THC in oral fluid is a better indication of recent use than the presence of 11-nor-delta-9-THC-9-COOH that is detected in urine. Therefore, the probability that a user is experiencing effects is higher.
    • This may prove especially useful in the monitoring of driving while under the influence.
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Imaging Studies

  • Although no confirmatory imaging study exists for marijuana use, pilot investigations involving neuroimaging of marijuana smokers performing various mental tasks have revealed many differences in comparative levels of activity in many regions of the brain with respect to controls.
  • Functional MRI (fMRI) and diffusion tensor imaging (DTI) techniques demonstrate significant differences in the magnitude and pattern of signal intensity change within the anterior cingulate and the dorsolateral prefrontal cortex while performing standardized tasks in chronic marijuana smokers compared with healthy controls.
  • Neuroimaging studies, such as CT scanning, MRI, and positron emission tomography (PET) scans, are extensively used to study the neurobiological effects of cannabis abuse but are not clinically useful in the definitive determination of recent abuse.
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Contributor Information and Disclosures
Author

Lawrence Genen, MD, MBA  Child & Adolescent Psychiatry Fellow, Division of Child & Adolescent Psychiatry, Department of Psychiatry, Keck School of Medicine, University of Southern California

Disclosure: Nothing to disclose.

Coauthor(s)

John Franzen, MD  Resident Physician, Department of Psychiatry, University of Nebraska-Creighton University

Disclosure: Nothing to disclose.

William F Haning III, MD, FASAM, DFAPA  Professor of Psychiatry, Director of Graduate Affairs, Office of the Dean, Program Director, Addiction Psychiatry/Medicine, Department of Psychiatry, University of Hawaii, John A Burns School of Medicine; Principal Investigator and Co-Director, Pacific Addiction Research Center

William F Haning III, MD, FASAM, DFAPA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Addiction Psychiatry, American Medical Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Military Surgeons of the US, and Hawaii Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Barry I Liskow, MD  Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Otsuke Grant/research funds reseach; Merck Honoraria Speaking and teaching

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Robert C Daly, MB, ChB, MPH, BCh; Can M Savasman, MD; Caroline Fisher, MD, PhD; and Lina Cassandra Vawter, MD to the development and writing of this article.

References

  1. Peter J. Cohen. Medical Marijuana: The Conflict Between Scientific Evidence and Political Ideology. Journal Of Pain & Palliative Care Pharmacotherapy. June 2009;23:120-140.

  2. Dan Whitcomb. Marijuana legalization will be on California ballot. Reuters. Available at http://www.reuters.com/article/idUSTRE62O08U20100325. Accessed 7/24/10.

  3. Dan Frosch. V.A. Easing Rules for Users of Medical Marijuana. The New York Times. Available at http://www.nytimes.com/2010/07/24/health/policy/24veterans.html?pagewanted=1&_r=1. Accessed 7/24/10.

  4. MacCoun R, Reuter P. Evaluating alternative cannabis regimes. Br J Psychiatry. Feb 2001;178:123-8. [Medline].

  5. Reinarman C, Cohen PD, Kaal HL. The limited relevance of drug policy: cannabis in Amsterdam and in San Francisco. Am J Public Health. May 2004;94(5):836-42. [Medline]. [Full Text].

  6. van den Brink W. Forum: Decriminalization of cannabis. Curr Opin Psychiatry. Mar 2008;21(2):122-6. [Medline].

  7. D.I. Abrams, C.A. Jay, S.B. Shade, H. Vizoso, H. Reda, S. Press, et al. Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial. Neurology. 2007;68:515-521.

  8. Michael Craig Miller, MD, et. al. Medical marijuana and the mind. Harvard Mental Health Letter. April 2010;26:1-4.

  9. Pletcher MJ, Vittinghoff E, Kalhan R, et al. Association between marijuana exposure and pulmonary function over 20 years. JAMA. Jan 11 2012;307(2):173-81. [Medline].

  10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington D.C.: American Psychiatric Association; 2000.

  11. Ringen PA, Vaskinn A, Sundet K, et al. Opposite relationships between cannabis use and neurocognitive functioning in bipolar disorder and schizophrenia. Psychol Med. Nov 6 2009;1-11. [Medline].

  12. Substance Abuse and Mental Health Services Administration. Results from the 2005 National Survey on Drug Use and Health: National Findings. Rockville, MD: Office of Applied Studies, NSDUH Series H-30;. 2006;DHHS Publication No. SMA 06-4194.

  13. InfoFacts. National Institute on Drug Abuse; January 2010. [Full Text].

  14. Stinson FS, Ruan WJ, Pickering R, Grant BF. Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med. Oct 2006;36(10):1447-60. [Medline].

  15. Annual Report 2006: The State of the Drugs Problem in Europe. Lisbon: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

  16. Wilson N, Cadet JL. Comorbid mood, psychosis, and marijuana abuse disorders: a theoretical review. J Addict Dis. Oct 2009;28(4):309-19. [Medline].

  17. Bosker WM, Kuypers KP, Theunissen EL, Surinx A, Blankespoor RJ, Skopp G, et al. Medicinal THC (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in Standardized Field Sobriety Tests. Addiction. May 4 2012;[Medline].

  18. Maria L. Barrigon, Manuel Gurpegui, Miguel Ruiz-Veguilla, Francisco J. Diaz, Manuel Anguita, Fernando Sarramea, et al. Temporal relationship of first-episode non-affective psychosis with cannabis use: A clinical verification of an epidemiological hypothesis. Journal of Psychiatric Research. 2010;44:413-420. [Medline].

  19. Daniel J. Foti, M.A., Roman Kotov, Ph.D., Lin T. Guey, Ph.D., et al. Cannabis Use and the Course of Schizophrenia: 10-Year Follow-Up After First Hospitalization. Am J Psychiatry. May 2010;167:987-993.

  20. Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. Mar 1 2011;342:d738. [Medline]. [Full Text].

  21. Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis Use and Earlier Onset of Psychosis: A Systematic Meta-analysis. Arch Gen Psychiatry. Jun 2011;68(6):555-61. [Medline].

  22. Peter Hecht. Report: African-Americans disproportionately targeted for pot. The Sacramento Bee. Available at http://blogs.sacbee.com/weed-wars/2010/06/report-african-americans-disproportionately-targeted-for-pot.html. Accessed August 3, 2010.

  23. Lopez-Quintero C, Perez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. May 1 2011;115(1-2):120-30. [Medline]. [Full Text].

  24. U.W. Preuss, A.B. Watzke, J. Zimmermann, J.W.M. Wong, C.O. Schmidt. Cannabis withdrawal severity and short-term course among cannabis-dependent adolescent and young adult inpatients. Drug and Alcohol Dependence. 2010;106:133-141.

  25. A.J. Budney, B.A. Moore, R.G. Vandrey, J.R. Hughes. Review of the validity and significance of cannabis withdrawal syndrome. American Journal of Psychiatry. 2004;161:1967-1977.

  26. Allsop DJ, Norberg MM, Copeland J, Fu S, Budney AJ. The Cannabis Withdrawal Scale development: Patterns and predictors of cannabis withdrawal and distress. Drug Alcohol Depend. Dec 1 2011;119(1-2):123-9. [Medline].

  27. Musshoff F, Madea B. Review of biologic matrices (urine, blood, hair) as indicators of recent or ongoing cannabis use. Ther Drug Monit. Apr 2006;28(2):155-63. [Medline].

  28. Kenneth M. Carpenter, David McDowell, Daniel J. Brooks, Wendy Y. Cheng, Frances R. Levin. A Preliminary Trial: Double Blind Comparison of Nefazodone, Burproprion-SR, and Placebo in the Treatment of Cannabis Dependence. The American Journal on Addictions. 2009;18:53-64. [Medline].

  29. Louisa Degenhardt, Lisa Dierker, Wai Tat Chiu, Maria Elena Medina-Mora, Yehuda Neumark, Nancy Sampson, et al. Evaluating the drug use "gateway" theory using cross-national data: Consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys. Drug and Alcohol Dependence. 2010;108:84-97.

  30. Agrawal A, Lynskey MT. The genetic epidemiology of cannabis use, abuse and dependence. Addiction. Jun 2006;101(6):801-12. [Medline].

  31. Degenhardt L, Hall W. Is cannabis use a contributory cause of psychosis?. Can J Psychiatry. Aug 2006;51(9):556-65. [Medline].

  32. Di Forti M, Morgan C, Dazzan P, et al. High-potency cannabis and the risk of psychosis. Br J Psychiatry. Dec 2009;195(6):488-91. [Medline].

  33. Gruber SA, Yurgelun-Todd DA. Neuroimaging of marijuana smokers during inhibitory processing: a pilot investigation. Brain Res Cogn Brain Res. Apr 2005;23(1):107-18. [Medline].

  34. Haney M, Rabkin J, Gunderson E, Foltin RW. Dronabinol and marijuana in HIV(+) marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology (Berl). Aug 2005;181(1):170-8. [Medline].

  35. Hurd YL, Wang X, Anderson V, Beck O, Minkoff H, Dow-Edwards D. Marijuana impairs growth in mid-gestation fetuses. Neurotoxicol Teratol. Mar-Apr 2005;27(2):221-9. [Medline].

  36. Iversen L. Cannabis and the brain. Brain. Jun 2003;126(Pt 6):1252-70. [Medline].

  37. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national results on adolescent drug use: Overview of key findings, 2005. Bethesday, MD: National Institute on Drug Abuse;. 2006;NIH Publication No. 06-5882.

  38. [Guideline] Kleber HD, Weiss RD, Anton RF, et al. Treatment of patients with substance use disorders, second edition. American Psychiatic Association. Am J Psychiatry. Aug 2006;163(8 Suppl):5-82. [Medline].

  39. Ramaekers JG, Moeller MR, van Ruitenbeek P, et al. Cognition and motor control as a function of Delta9-THC concentration in serum and oral fluid: limits of impairment. Drug Alcohol Depend. Nov 8 2006;85(2):114-22. [Medline].

  40. Strasser F, Luftner D, Possinger K, Ernst G, Ruhstaller T. Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol. Jul 20 2006;24(21):3394-400. [Medline].

  41. Zuardi AW, Crippa JA, Hallak JE, Moreira FA, Guimaraes FS. Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Braz J Med Biol Res. Apr 2006;39(4):421-9. [Medline].

 
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Cannabis sativa.
The major psychoactive component of marijuana is tetrahydrocannabinol (THC).
 
 
 
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