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Urinary 11-nor-9-carboxy-tetrahydrocannabinol elimination in adolescent and young adult cannabis users during one month of sustained and biochemically-verified abstinence.
J Psychopharmacol. 2020 02; 34(2):197-210.JP

Abstract

BACKGROUND

Despite adolescents and young adults being the most frequent users of cannabis, all information on cannabis drug testing interpretation is based on data from adults.

AIMS

This study aimed to define the time course of urinary 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH) excretion among 70 adolescent and young adult cannabis users during 1 month of biochemically-verified cannabis abstinence.

METHODS

Urine specimens were collected at non-abstinent baseline and after 2, 3, 8, 15, 21 and 28 days of abstinence. Specimens were tested for THCCOOH with a 'rapid' immunoassay drug test and a confirmatory assay using liquid chromatography-tandem mass spectrometry, with a 5 ng/mL limit of quantitation. Elimination rate was tested using a population pharmacokinetics model.

RESULTS/OUTCOMES

Participants had an average of 26 days of abstinence (SD = 6). Initial creatinine-adjusted THCCOOH concentration (CN-THCCOOH) was 148 ng/mg (SD = 157). Half-life was 2 days (SD = 5), with a 10-day window of detection (estimated range: 4-80 days). At the final timepoint and among those with > 25 days of abstinence (n = 62), 40% (n = 25) had THCCOOH concentrations > 5 ng/mL (i.e. detectable on confirmatory assay) and 19% (n = 12) were 'positive' per federal drug testing guidelines (i.e. values greater than 50 ng/mL on the screening immunoassay and 15 ng/mL on the confirmatory assay). More frequent past month cannabis use was associated with higher baseline CN-THCCOOH concentrations, but not with rate of elimination. Nested five-fold cross-validation suggested high model reliability and predictive validity.

CONCLUSIONS/INTERPRETATION

Findings underscore that, as with adults, detectable cannabinoid metabolites do not necessarily indicate recent use in adolescents and young adults. Algorithms that account for THCCOOH levels, assessed longitudinally and time between specimen collections are best equipped to confirm abstinence.

CLINICAL TRIAL REGISTRATION

NCT03276221; https://clinicaltrials.gov/ct2/show/NCT03276221?term=Randi+Schuster&rank=1.

Authors+Show Affiliations

Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA.Johns Hopkins University School of Medicine, Baltimore, MD, USA.Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA.Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Harvard Medical School, Boston, MA, USA. Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31535597

Citation

Schuster, Randi Melissa, et al. "Urinary 11-nor-9-carboxy-tetrahydrocannabinol Elimination in Adolescent and Young Adult Cannabis Users During One Month of Sustained and Biochemically-verified Abstinence." Journal of Psychopharmacology (Oxford, England), vol. 34, no. 2, 2020, pp. 197-210.
Schuster RM, Potter K, Vandrey R, et al. Urinary 11-nor-9-carboxy-tetrahydrocannabinol elimination in adolescent and young adult cannabis users during one month of sustained and biochemically-verified abstinence. J Psychopharmacol. 2020;34(2):197-210.
Schuster, R. M., Potter, K., Vandrey, R., Hareli, M., Gilman, J., Schoenfeld, D., & Evins, A. E. (2020). Urinary 11-nor-9-carboxy-tetrahydrocannabinol elimination in adolescent and young adult cannabis users during one month of sustained and biochemically-verified abstinence. Journal of Psychopharmacology (Oxford, England), 34(2), 197-210. https://doi.org/10.1177/0269881119872206
Schuster RM, et al. Urinary 11-nor-9-carboxy-tetrahydrocannabinol Elimination in Adolescent and Young Adult Cannabis Users During One Month of Sustained and Biochemically-verified Abstinence. J Psychopharmacol. 2020;34(2):197-210. PubMed PMID: 31535597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary 11-nor-9-carboxy-tetrahydrocannabinol elimination in adolescent and young adult cannabis users during one month of sustained and biochemically-verified abstinence. AU - Schuster,Randi Melissa, AU - Potter,Kevin, AU - Vandrey,Ryan, AU - Hareli,Maya, AU - Gilman,Jodi, AU - Schoenfeld,David, AU - Evins,A Eden, Y1 - 2019/09/19/ PY - 2019/9/20/pubmed PY - 2021/1/12/medline PY - 2019/9/20/entrez KW - Cannabis KW - THCCOOH KW - abstinence KW - adolescents KW - marijuana KW - pharmacokinetics KW - young adults SP - 197 EP - 210 JF - Journal of psychopharmacology (Oxford, England) JO - J Psychopharmacol VL - 34 IS - 2 N2 - BACKGROUND: Despite adolescents and young adults being the most frequent users of cannabis, all information on cannabis drug testing interpretation is based on data from adults. AIMS: This study aimed to define the time course of urinary 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH) excretion among 70 adolescent and young adult cannabis users during 1 month of biochemically-verified cannabis abstinence. METHODS: Urine specimens were collected at non-abstinent baseline and after 2, 3, 8, 15, 21 and 28 days of abstinence. Specimens were tested for THCCOOH with a 'rapid' immunoassay drug test and a confirmatory assay using liquid chromatography-tandem mass spectrometry, with a 5 ng/mL limit of quantitation. Elimination rate was tested using a population pharmacokinetics model. RESULTS/OUTCOMES: Participants had an average of 26 days of abstinence (SD = 6). Initial creatinine-adjusted THCCOOH concentration (CN-THCCOOH) was 148 ng/mg (SD = 157). Half-life was 2 days (SD = 5), with a 10-day window of detection (estimated range: 4-80 days). At the final timepoint and among those with > 25 days of abstinence (n = 62), 40% (n = 25) had THCCOOH concentrations > 5 ng/mL (i.e. detectable on confirmatory assay) and 19% (n = 12) were 'positive' per federal drug testing guidelines (i.e. values greater than 50 ng/mL on the screening immunoassay and 15 ng/mL on the confirmatory assay). More frequent past month cannabis use was associated with higher baseline CN-THCCOOH concentrations, but not with rate of elimination. Nested five-fold cross-validation suggested high model reliability and predictive validity. CONCLUSIONS/INTERPRETATION: Findings underscore that, as with adults, detectable cannabinoid metabolites do not necessarily indicate recent use in adolescents and young adults. Algorithms that account for THCCOOH levels, assessed longitudinally and time between specimen collections are best equipped to confirm abstinence. CLINICAL TRIAL REGISTRATION: NCT03276221; https://clinicaltrials.gov/ct2/show/NCT03276221?term=Randi+Schuster&rank=1. SN - 1461-7285 UR - https://www.unboundmedicine.com/medline/citation/31535597/Urinary_11_nor_9_carboxy_tetrahydrocannabinol_elimination_in_adolescent_and_young_adult_cannabis_users_during_one_month_of_sustained_and_biochemically_verified_abstinence_ L2 - https://journals.sagepub.com/doi/10.1177/0269881119872206?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -