California NORML Guide Interpreting Drug Test Results
California NORML Guide Interpreting Drug Test Results
California NORML Guide Interpreting Drug Test Results
Search Detection Time for Marijuana in Blood : Blood tests can detect presence of active THC; high
levels indicate recent use, low levels may persist for hours or days.
GUIDE TO PROP. 64, THE Marijuana Use and Accident Risks : Accident studies show no relation between urine test
ADULT USE OF MARIJUANA results and accident risk; presence of THC in blood a moderate risk factor, comparable to low
ACT OF 2016 (AUMA) levels of blood alcohol beneath threshold of DUI; high levels of THC or combination of THC
with alcohol indicative of DUI.
SUMMARY OF THE MEDICAL
CANNABIS REGULATION and
SAFETY ACT (MCRSA)
Drug Test Detection Times for Marijuana
How long do drug tests detect marijuana? There is no simple answer to this question.
State Bureau of
Detection time depends strongly on the kind and sensitivity of the test employed; the
Marijuana Control
frequency, dosage, and last time of use; the individual subject's genetic makeup, the state of
one's metabolism, digestive and excretory systems; and other random, unknown factors.
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The basic drug test types and their approximate detection times are shown in the table
Frequently Asked
below.
Questions
Preguntas Frecuentes Urine Blood Hair Saliva
Benefits of Legalization
Medical Marijuana
Marijuana - Single Use 1-7+ days 12-24 hrs Doubtful
Collectives/Coops
Dispensaries and
Delivery Services Not validated
Marijuana - Regular Use 7-100 days 2-7 days
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Amphetamines 1-3 days 24 hours (0 -24 hours?)
Starting Collectives
Cocaine 1-3 days 1-3 days Months
List Your
Health Info Hair tests are the most objectionable form of drug testing, since they do not measure
Vaporizers current use, but rather non-psychoactive residues that remain in the hair for months
Drug Testing afterwards. These residues are absorbed internally and do not appear in the hair until 7-10
Laboratories - Ring days after first use. Afterwards, they cannot be washed out by shampoos (though shampoos
Test Results may help remove external smoke particles that get stuck in the hair). Hair tests are more
likely to detect regular than occasional marijuana use. One study found that 85% of daily
Student/Youth Usage
users tested positive for marijuana, versus 52% of occasional smokers (1-5 times per week).
Studies
Ingested cannabis was less likely to be detected than smoked marijuana [01]. It is doubtful
MJ and Driving
whether hair tests are sensitive to one-time use of marijuana.
Pain Patients
Costs of Prohibition Saliva testing is a newer, less proven technology. The sensitivity of saliva tests is not well
established in the case of marijuana. In theory, they are supposed to detect recent use, but
Economic Benefits of
this may range from several hours to over a day. They are supposed to detect secretions
Legalization
from inside the oral tissues that cannot be washed out with mouthwash. Because they are
CA Prisoner/Arrest
less intrusive than blood or urine tests, the industry has been eager to develop saliva tests.
Data Due to reliability problems, they have yet to gain acceptance in the U.S., but they have come
Federal Medical into use in some other countries, such as Australia. An international study of various onsite
Marijuana Cases saliva tests concluded that no device was reliable enough to be recommended for roadside
CAMP data screening of drivers (Rosita Project, 2003-2006).
Crime Reduction
Historical Info Urine Testing Detection Times for Marijuana
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How long marijuana is detected in the urine depends strongly on frequency of use. In regular
California Chapters users (more than once a week), the marijuana metabolite THC-COOH builds up to a high
CaNORML Store level, often on the order of hundreds of nanograms per milliliter (ng/ml), from which it may
Our Staff take weeks to decline back below the threshold of detection. The situation is different for
Join Our Mailing Lists occasional users (no more than once a week), who often clear up in a couple of days.
eMail Us Figure 1 illustrates typical urine testing profiles for "one-time" users - that is, subjects who
were clean before going into the test. This would typically be the case for the occasional user
who indulges a couple of times per month.
Subjects B and G illustrate typical "one-time" responses in a group of study subjects. All
subjects received a dose of one standard NIDA cigarette [02]. They were monitored for urine
levels of marijuana metabolite (THC-COOH) at regular intervals after smoking. Both B and G
were positive at the standard cutoff threshold of 50 ng/ml (the standard in most
government-required testing programs) for up to two days after smoking.
Note that urine levels of metabolite fluctuate throughout the day. For example, Subject G fell
beneath the 50 ng threshold around 24 hours after smoking, but rebounded above it a short
time later. Thus it is possible to flunk a drug test despite having passed one a while earlier.
Subject "E" was an exceptional subject who never exceeded 50 ng/ml despite having smoked
the same dose as other study subjects. This illustrates the high degree of individual variation
in urine testing. While Subjects G and B would likely have flunked a drug test the day after
smoking, Subject E wouldn't have.
Occasional use can sometimes be detected much longer, as shown in Fig. 1 by the oral dose
from a different controlled study [03]. This represents a subject who was given a strong oral
dose of 20 mg of THC, equivalent to a strong brownie or two high-dose Marinol pills. The
subject tested above the 50 ng/ml cutoff for up to six days after dosing. California NORML
has heard unconfirmed reports of occasional users testing positive for as long as two weeks
in exceptional cases. In most cases, however, one-time users are likely to pass after a couple
of days.
In regular users, metabolite levels can build up to background levels above 1,000 ng/ml.
Many days or weeks of abstinence are required to clear out, as illustrated in the following
graph of metabolite levels in test subjects who were regular users [04A].
Subject B took over a week to fall beneath the 50 ng/ml cutoff, while Subject C took a
month. Detection times over three months have been reported in extreme cases.
Note that it is possible to test negative on one day, then positive on the next.
As shown in the following graph, detection times for chronic users typically range from one
to three weeks but can extend much longer. In this study by Ellis [04], chronic users were
tested at 20 ng/ml and 100 ng/ml, but not at the normal standard of 50 ng/ml.
Unlike urine tests, blood tests detect the active presence of THC in the bloodstream. In the
case of smoked marijuana, THC peaks rapidly in the first few minutes after inhaling, often to
levels above 100 ng/ml in blood plasma. It then declines quickly to single-digit levels within
an hour. High THC levels are therefore a good indication that the subject has smoked
marijuana recently. THC can remain at low but detectable levels of 1-2 ng/ml for 8 hours or
more without any measurable signs of impairment in one-time users. In chronic users,
detectable amounts of blood THC can persist for days. In one study of chronic users, residual
THC was detected for 24 to 48 hours or longer at levels of 0.5 - 3.2 ng/ml in whole blood
(1.0 - 6.4 ng/ml in serum) [Skopp and Potsch].
Note: THC blood levels can be measured in two ways. Most labs used by U.S. law
enforcement report levels based on concentration in whole blood, but others report
concentration in blood serum or plasma instead. Concentrations in whole blood are about
half as high as those in serum/plasma. Therefore 0.5 - 3.2 ng/ml in whole blood = 1.0 - 6.4
ng/ml in plasma or serum. Unless otherwise stated, whole blood concentrations are reported
here.
In another study of 25 frequent users, 36% showed no measurable blood THC throughout 7
days of abstinence, while the rest had at least one positive, though not necessarily on the
first day. Six subjects (24%) had detectable blood THC after seven days at levels ranging
from 0.2 to 1.5 ng/ml (that is, 0.4 to 3.0 ng/ml in serum) [Karschner]. There have been
anecdotal reports of even higher day-after blood THC levels in chronic users, but these
haven't been confirmed in controlled studies.
Unlike urine, blood test results can give a useful indicator of whether one is under the
influence of marijuana. Studies have shown that high THC blood levels are correlated with
impaired driving. An expert panel review of scientific studies on driving under the influence
of cannabis concluded that THC levels above 3.5 - 5 ng/ml in blood (or 7 - 10 ng/ml in
serum) indicate likely impairment [Grotenhermen]. The same review found no increased
driving hazard at low levels of THC. Despite the fact that accident studies have repeatedly
failed to find evidence of increased driving risk at low levels (1 or 2 ng in blood) of THC,
numerous states and foreign countries have enacted "zero-tolerance" laws, treating any non-
zero trace of THC as legal evidence for driving under the influence. Others have fixed, per se
limits above which DUI is presumed, often with no scientific basis. However, most states
(including California) don't have per se limits, but define DUI in terms of whether the totality
of evidence (including drug test results) shows that the driver was impaired by marijuana or
drugs.
Although high blood THC is a fairly good indicator of being under the influence, it is not
infallible. Chronic users who develop tolerance to THC may in some cases drive safely with
Oral ingestion
Oral ingestion produces a much different THC blood profile than smoking. Instead of peaking
sharply, THC rises gradually over a couple of hours to a plateau of around 2.5 - 5 ng/ml in
blood (5 - 10 ng/ml in serum), then declines (see blue curve in Figure 5).
Blood metabolites
In addition to THC, blood tests can detect cannabinoid metabolites. Not uncommonly, labs
report levels of THC-COOH, the same non-psychoactive metabolite found in urine. As shown
in Fig. 5, THC-COOH levels for blood are similar to urine. They may be detectable for a
couple of days after a single use or weeks in chronic users, and are therefore not a valid
indicator of being under the influence. There is no scientific basis for treating drivers who
have THC-COOH but not THC in their blood as being legally "under the influence."
References:
(A-B) Smoked dose based on data from M. Huestis , J. Henningfield and E. Cone,M. Huestis ,
J. Henningfield and E. Cone.
(C) Oral dose based on data from B. Law et al.
The situation is somewhat more complicated with respect to blood tests for THC, since high
levels of THC may be correlated with impairment, though low levels less than 3-5 ng/ml are
Fortunately, most states (like California) do not have a zero-tolerance DUI standard for
drugs, but rather require the prosecutor to show that the driver's performance is actually
drug-impaired in order to get a DUIC conviction. In this event, the driver's guilt is
determined by the totality of evidence in the case: driving behavior, performance on roadside
sobriety tests, the driver's conduct, the smell of smoke in the car - and also drug test
results. Defendants can then win acquittal if they can convince the court they were not
impaired, regardless of drug test results.
Accident Studies
Numerous accident studies have confirmed that marijuana is not a major risk factor in
driving fatalities. A recent meta-analysis of 42 different studies on cannabis and driving
concluded that the odds of a fatal accident due to cannabis use are only 1.25 times normal,
significantly less than many other risks such as age, gender, and alcohol use [Elvik]. The
study found higher fatal accident odds for opiates (1.44), benzodiazepine tranquilizers
(2.30), anti-depressants (1.32), cocaine (2.96), amphetamines (4.46) and the sleeping aid
zopiclone (2.60). Alcohol wasn't included, but has elsewhere been calculated at 2 to 6,
depending on blood level.
Table 2 summarizes studies that have assessed the accident risk for drivers with traces of
marijuana in their system. The studies surveyed fatal accidents, looking at levels of
marijuana, alcohol and other drugs in the driver's blood or urine.
For each accident, researchers determine the degree to which the driver was responsible for
the accident. Using this data, they compute a "culpability ratio," comparing the risk of
accidents for drug-positive drivers to drug-free drivers. A culpability ratio of 1 means no
increased risk; above 1 mean increased risk; and below 1 means reduced risk. Culpability
factors above 3 or 4 are considered notably significant.
As shown in the fourth column of Table 2, drivers with high blood alcohol levels (above the
standard legal limits of .08% or .10%) showed consistenly high culpability ratios, on the
order of 5 or 6. In contrast, drivers with THC present in their blood rarely exceeded 2, and in
several cases were less than 1 - indicating they were actually safer than drug free drivers!
This phenomenon has been explained by the fact that marijuana-using drivers tend to slow
down, while alcohol-using drivers tend to speed.
One exception is the 2004 study by Drummer et al, which did not count drivers with less
than 1 nanogram THC in blood. The remaining THC-using drivers had an average culpability
ratio of 2.7, which is similar to the risk ratio for drivers with moderate amounts of alcohol in
their system (as shown in the studies by Laumon and Bédard, which looked at drivers with
blood alcohol content less than 0.05%, a legal amount in the U.S.).
Note that the Drummer study found especially high culpability for drivers with 5 or more
nanograms blood THC, comparable to the risk for drunken drivers. This confirms that high
blood THC, indicating recent usage, is a sign of likely impairment, while lower levels, which
remain for several hours, are not.
Table 2 does not include culpability data for drivers with both alcohol and THC in their system
(that is, all of the marijuana drivers were alcohol-free). In general, studies agree that the
combination of alcohol and THC is particularly dangerous, if anything worse than
"straight" drunken driving.
Not surprisingly, no elevated risk was found in the three studies listed at bottom, which
looked at urine metabolite levels rather than blood THC. This confirms that urine testing has
no bearing on driving impairment. Despite this fact, US Department of Transportation
regulations force millions of commercial drivers to submit to random urine testing. The
government has never produced convincing scientific evidence that this policy is necessary
or effective to protect public safety. But they're the government, so they don't have to
provide any evidence!
0.9
Longo and Hunter
Australia 2,500 6.8 0.36(<1 ng/ml)
(2000 & 1998)
1.8 (>2 ng/ml)*
8.51
U.S. 32,543 Bédard (2007) 1.29
(3.3 BAC ≤.05)
Lowenstein et al
Colorado 414 3.2 1.1 (urine)
(2004)
Soderstrom et al
Maryland 5,573 7.45 1.2 (urine)
(2005)
Footnotes
[01] M Huestis et al., "Cannabinoid concentrations in hair from documented cannabis users,"
Forensic Science International (Aug 2006). Available at www.sciencedirect.com.
[03] B. Law et al, "Forensic aspects of the metabolism and excretion of cannabinoids
following oral ingestion of cannabis resin," J. Pharm. Pharmacol. 36: 289-94 (1984).
[04] G Ellis et al, "Excretion patterns of cannbinoid metabolites after last use in a group of
[05] F Grotenhermen et al., "Developing limits for Driving under cannabis, Addiction Vol.
102#12: 1910-7 (December 2007). Also, "Developing Science-Based Per Se Limits for
Driving Under the Influence of Cannabis: Findings and Recommendations by an Expert
Panel" http://www.canorml.org/healthfacts/DUICreport.2005.pdf.
[06] Strohbeck-Kühner et al, "Fahrtüchtigkeit trotz (wegen) THC" ["Driving ability despite
(or because of) THC"], Archiv für Kriminologie 220:11-19 (2007).
[06a] G Skopp and L Potsch, "Cannabinoid concentrations in spot serum samples 24-48
hours after discontinuation of cannabis smoking," Journal of Analytical Toxicology 32: 160-4
(2008).
[07] EL Karschner et al. "Do Delta(9) THC concentrations indicate recent use in chronic
cannabis users?," Addiction, Oct. 5, 2009 http://www.ncbi.nlm.nih.gov/pubmed/19804462.
[09] Elvik, R. , "Risk of road accident associated with use of drugs: A systematic review and
meta-analysis of evidence from epidemiological studies," Accident Analysis and Prevention
(July 26, 2012).
Terhune, K.W. & Fell, J.C. The Role of Alcohol, Marijuana, and Other Drugs in Accidents of
Injured Drivers. Technical report for the National Highway Traffic Safety Administration, U.S.
Dept of Transportation, NTIS Report No. DOT-HS-806-181. Springfield, VA (1982).
Williams, A.F. et al. Drugs in fatally injured young male drivers. Public Health Reports 100:
19-25 (1985).
Terhune, K.W. et al. The incidence and role of drugs in fatally injured drivers. Washington:
US Dept. of Transportation, National Highway Traffic Safety Administration; Report No. DOT-
HS-808-065 (1992).
Drummer, O.H. Drugs in drivers killed in Australian road traffic accidents. Victorian Institute
of Forensic Pathology, Institute of Forensic Medicine, Monash University, Melbourne,
Australia, Report No. 0594 (1994).
Longo, M.C. et al. The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants
amongst injured drivers and their role in driver culpability: Part ii: the relationship between
drug prevalence and drugculpability. Accid. Anal. Prev. 32, 623–32 (2000).
C. Hunter, R. Lokan, M. Longo, J. White, M. White, The prevalence and role of alcohol,
cannabinoids, benzodiazepines and stimulants in non-fatal crashes, Department for
Administrative and Information Services, Adelaide, South Australia, 1998.
Drummer, O.H. et al.The involvement of drugs in drivers of motor vehicles killed in Australian
road traffic crashes. Accid. Anal. Prev. 36, 239–48 (2004).
Laumon, B. et al. Cannabis intoxication and fatal road crashes in France: population based
case-control study. British Medical Journal, 331:1371 doi:10.1136/bmj.38648.617986.1F
(Dec 10, 2005).
Bédard, M, Dubois, S, and Weaver, B. The impact of cannabis on driving. Canadian Journal of
Public Health, 98#1:6-11. (Jan-Feb 2007).
Movig, KLL et al. Psychoactive substance use and the risk of motor vehicle accidents.
Accident Analysis and Prevention 36: 631-6 (2004).
Lowenstein, S and Koziol-McClain, J. Drugs and traffic crash responsibility: a study of injured
motorists in Colorado. Journal of Trauma, Injury, Infection, and Critical Care 50#2: 313-20
(2001).
Soderstrom, C et al. Crash Culpability Relative to Age and Sex for Injured Drivers Using
Alcohol, Marijuana, or Cocaine. 49th Annual Proceedings, Association for the Advancement of
Automotive Medicine, pp.320-41 (Sep 12-14, 2005).
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