Δ9-Tetrahydrocannabinol and 11-hydroxy-Δ9-tetrahydrocannabinol as markers of cannabis use in urinary drug testing

With some exceptions, California Assembly Bill 2188 will preclude the use of triangle(9)-tetrahydrocannabinol-9-carboxylic acid (Delta(9)-THC-COOH) as a marker of cannabis use in urinary workplace drug testing. The bill allows for the use of psychoactive cannabis markers, which include Delta(9)-tetrahydrocannabinol (Delta(9)-THC) and the metabolite 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-Delta(9)-THC). Both analytes are present in urine mainly as conjugated metabolites and will require hydrolysis prior to analysis, but very little is known about expected concentrations in urine. The aim of this study was to report the concentrations from two large datasets comprising 1411 workplace drug-testing urine specimens that tested positive by immunoassay (50 ng/mL cutoff) and discuss strategies for using 11-OH-Delta(9)-THC and/or Delta(9)-THC to detect cannabis use. Median 11-OH-Delta(9)-THC and Delta(9)-THC concentrations were 28%-35% and 1.1%-1.6% of those of Delta(9)-THC-COOH, respectively, and correlations between the analytes were observed. To avoid the risk of positives from passive exposure, laboratories could use a cutoff with equivalent sensitivity to cannabis exposure. A 5 ng/mL cutoff for 11-OH-Delta(9)-THC showed 92% agreement with a 15 ng/mL cutoff for Delta(9)-THC-COOH, with only 0.9% of specimens being positive only for 11-OH-Delta(9)-THC. It was not possible to propose an estimated cutoff for Delta(9)-THC, due to the constraints of the limit of detection used in this study.