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Detection and confirmation of drug abuse involving delta-9-tetrahydrocannabinol (marijuana)
Delta-9-tetrahydrocannabinol is the active agent of the popularly abused street drug, marijuana.
Following consumption of the drug, either by inhalation or ingestion, it is metabolized to a variety of inactive chemicals, one of them being delta-9-tetrahydrocannabinol carboxylic acid.
The immunochemical procedure used to screen for tetrahydrocannabinol (THC) as part of IDOAU / Drug Abuse Survey, Urine is designed to cross-react with THC carboxylic acid.
In almost all medico-legal cases and in screening of employees, or when the patient adamantly denies THC use and the immunochemical test is positive, confirmation of the result by gas chromatography-mass spectrometry (GC-MS) and EIA are required.
Carboxy-THC- by GC/MS <3.0 ng/mL
The presence of tetrahydrocannabinol carboxylic acid (THC-COOH), a major metabolite of delta-9-tetrahydrocannabinol, in urine at concentrations >15.0 ng/mL is a strong indicator that the patient has used marijuana.
The metabolite of marijuana (THC-COOH) has a long half-life and can be detected in urine for more than 7 days after a single use. The presence of THC-COOH in urine >100.0 ng/mL indicates relatively recent use, probably within the past 7 days. Levels >500.0 ng/mL suggest chronic and recent use. Chronic use causes accumulation of THC and THC-COOH in adipose tissue such that it is excreted into the urine for as long as 30 to 60 days from the time chronic use is halted.
No significant cautionary statements
Moyer TP, Palmen MA, Johnson P, et al: Marijuana testing-how good is it? Mayo Clin Proc 1987;62:413-417