New drug reporting limit may overlook cannabis in children

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<root generator="drupal.xsl" gversion="1.7"> <header> <fileName>166107</fileName> <TBEID>0C04D774.SIG</TBEID> <TBUniqueIdentifier>MD_0C04D774</TBUniqueIdentifier> <newsOrJournal>News</newsOrJournal> <publisherName>Frontline Medical Communications</publisherName> <storyname/> <articleType>2</articleType> <TBLocation>QC Done-All Pubs</TBLocation> <QCDate>20231128T131149</QCDate> <firstPublished>20231128T131800</firstPublished> <LastPublished>20231128T131800</LastPublished> <pubStatus qcode="stat:"/> <embargoDate/> <killDate/> <CMSDate>20231128T131800</CMSDate> <articleSource/> <facebookInfo/> <meetingNumber/> <byline>Jake Remaly</byline> <bylineText>JAKE REMALY</bylineText> <bylineFull>JAKE REMALY</bylineFull> <bylineTitleText/> <USOrGlobal/> <wireDocType/> <newsDocType/> <journalDocType/> <linkLabel/> <pageRange/> <citation/> <quizID/> <indexIssueDate/> <itemClass qcode="ninat:text"/> <provider qcode="provider:imng"> <name>IMNG Medical Media</name> <rightsInfo> <copyrightHolder> <name>Frontline Medical News</name> </copyrightHolder> <copyrightNotice>Copyright (c) 2015 Frontline Medical News, a Frontline Medical Communications Inc. company. All rights reserved. This material may not be published, broadcast, copied, or otherwise reproduced or distributed without the prior written permission of Frontline Medical Communications Inc.</copyrightNotice> </rightsInfo> </provider> <abstract/> <metaDescription>Among children with urine drug screens that are positive for cannabinoids, confirmatory testing based on liquid chromatography–mass spectrometry (LC-MS) may be </metaDescription> <articlePDF/> <teaserImage/> <teaser>“Confirming THC-COOH in children’s and adolescents’ urine may be relevant at concentrations less than 15 ng/mL, particularly if child protection is pertinent.”</teaser> <title>New drug reporting limit may overlook cannabis in children</title> <deck/> <disclaimer/> <AuthorList/> <articleURL/> <doi/> <pubMedID/> <publishXMLStatus/> <publishXMLVersion>1</publishXMLVersion> <useEISSN>0</useEISSN> <urgency/> <pubPubdateYear/> <pubPubdateMonth/> <pubPubdateDay/> <pubVolume/> <pubNumber/> <wireChannels/> <primaryCMSID/> <CMSIDs/> <keywords/> <seeAlsos/> <publications_g> <publicationData> <publicationCode>fp</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>pn</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>mdemed</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> <journalTitle/> <journalFullTitle/> <copyrightStatement/> </publicationData> </publications_g> <publications> <term canonical="true">15</term> <term>25</term> <term>58877</term> </publications> <sections> <term>39313</term> <term canonical="true">27970</term> </sections> <topics> <term canonical="true">271</term> <term>27442</term> <term>305</term> </topics> <links/> </header> <itemSet> <newsItem> <itemMeta> <itemRole>Main</itemRole> <itemClass>text</itemClass> <title>New drug reporting limit may overlook cannabis in children</title> <deck/> </itemMeta> <itemContent> <h2>TOPLINE:</h2> <p><span class="tag metaDescription">Among children with urine drug screens that are positive for cannabinoids, confirmatory testing based on liquid chromatography–mass spectrometry (LC-MS) may be negative despite detectable concentrations of a cannabis metabolite</span>, according to a research letter <span class="Hyperlink"><a href="https://jamanetwork.com/journals/jama/fullarticle/10.1001/jamapediatrics.2023.4957">published online</a></span> in JAMA Pediatrics.</p> <h2>METHODOLOGY:</h2> <ul class="body"> <li>After a laboratory changed its reporting threshold for the metabolite 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) from 5 ng/mL to 15 ng/mL in 2019 to match federal standards, researchers examined the rate of false positives for the initial urine drug screen and the false-negative rate with LC-MS.</li> <li>Their study focused on 976 cannabinoid-positive drug screens conducted at a pediatric hospital between Nov. 18, 2019, and May 31, 2021, that had confirmatory LC-MS to rule out false-positive results.</li> <li>Patients had a median age of 16 years.</li> </ul> <h2>TAKEAWAY:</h2> <ul class="body"> <li>The false-positive rate was 10.1% based on the 15 ng/mL threshold compared with 2% based on the 5 ng/mL limit of quantification.</li> <li>About 81% of samples with negative LC-MS reports had detectable concentrations of THC-COOH.</li> </ul> <h2>IN PRACTICE:</h2> <p>“Confirming THC-COOH in children’s and adolescents’ urine may be relevant at concentrations less than 15 ng/mL, particularly if child protection is pertinent,” according to the study authors.</p> <p>“Confirmatory testing should be reserved for select cases and must be interpreted with caution,” they added. “Laboratories should report down to the limit of quantification on request.”</p> <h2>SOURCE:</h2> <p>Christopher J. Watson, MD, emergency medicine physician, Maine Medical Center, Portland, is the study’s corresponding author.</p> <h2>LIMITATIONS:</h2> <p>The researchers lacked information about the clinical context in which patients underwent drug screening.</p> <h2>DISCLOSURES:</h2> <p>A coauthor disclosed royalties from UpToDate outside of the study.<br/><br/></p> <p> <em>A version of this article appeared on <span class="Hyperlink"><a href="https://www.medscape.com/viewarticle/998780">Medscape.com</a></span>.</em> </p> </itemContent> </newsItem> <newsItem> <itemMeta> <itemRole>teaser</itemRole> <itemClass>text</itemClass> <title/> <deck/> </itemMeta> <itemContent> </itemContent> </newsItem> </itemSet></root>