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Benowitz N, Nardone N, St Helen G, et al. Quantitative biochemical screening for marijuana use and concordance with tobacco use in urban adolescents. Drug Alcohol Depend. 2019;205:107583doi: 10.1016/j.drugalcdep.2019.107583.
Benowitz, N., Nardone, N., St Helen, G., Addo, N., Jacob, P., Liakoni, E., Jain, S., Hooshfar, S., & Lynch, K. (2019). Quantitative biochemical screening for marijuana use and concordance with tobacco use in urban adolescents. Drug and alcohol dependence, 205107583. https://doi.org/10.1016/j.drugalcdep.2019.107583
Benowitz, Neal, et al. "Quantitative biochemical screening for marijuana use and concordance with tobacco use in urban adolescents." Drug and alcohol dependence vol. 205 (2019): 107583. doi: https://doi.org/10.1016/j.drugalcdep.2019.107583
Benowitz N, Nardone N, St Helen G, Addo N, Jacob P, Liakoni E, Jain S, Hooshfar S, Lynch K. Quantitative biochemical screening for marijuana use and concordance with tobacco use in urban adolescents. Drug Alcohol Depend. 2019 Dec 01;205:107583. doi: 10.1016/j.drugalcdep.2019.107583. Epub 2019 Sep 25. PMID: 31600618; PMCID: PMC6893148.
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Drug Alcohol Depend. 2019 Dec 01;205:107583. doi: 10.1016/j.drugalcdep.2019.107583. Epub 2019 Sep 25.

Quantitative biochemical screening for marijuana use and concordance with tobacco use in urban adolescents.

Drug and alcohol dependence

Neal Benowitz, Natalie Nardone, Gideon St Helen, Newton Addo, Peyton Jacob, Evangelia Liakoni, Shonul Jain, Shirin Hooshfar, Kara Lynch

Affiliations

  1. Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA United States; Center for Tobacco Control Research and Education, University of California, University of California, San Francisco, CA United States. Electronic address: [email protected].
  2. Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA United States.
  3. Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA United States; Center for Tobacco Control Research and Education, University of California, University of California, San Francisco, CA United States.
  4. Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA United States; Department of Psychiatry, University of California, San Francisco, CA United States.
  5. Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA United States; Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  6. Department of Pediatrics, University of California, San Francisco, CA United States.
  7. Department of Laboratory Medicine, University of California, San Francisco, CA United States.

PMID: 31600618 PMCID: PMC6893148 DOI: 10.1016/j.drugalcdep.2019.107583

Abstract

BACKGROUND: Assessing the prevalence and level of exposure (dose) of tobacco and marijuana use is important in studies of harm from use of these substances. We used biochemical analysis of urine to quantitatively assess exposure to nicotine and delta 9-tetrahydrocannabinol (THC) in adolescents receiving medical care in a public hospital METHODS: Participants were 686 adolescents between 12 and 21 years old seen at Zuckerberg San Francisco General Hospital between 2012 and 2014. Urine samples were assayed using high sensitivity liquid chromatographic assays for cotinine, a major metabolite of nicotine, and 11-nor-9-carboxy-delta 9-THC (THC-COOH), a major metabolite of THC. A commonly used immunoassay screen for THC-COOH was also performed.

RESULTS: The THC-COOH immunoassay substantially underestimated THC exposure, as measured with the high sensitivity assay. THC use was detected in 25% of participants, with higher prevalence with increasing age and in non-Hispanic blacks. Active tobacco smokers had an 80% prevalence of THC use (odds ratio for cigarette smoking predicting THC use 13.2). Urine cotinine and THC-COOH were significantly correlated (r = 0.60).

CONCLUSIONS: The use of a high sensitivity chromatographic urine assay provides a much more complete picture of adolescent tobacco use compared to a commonly used immunoassay. The immunoassay provides high specificity but moderate sensitivity. We confirm high concordance of tobacco and marijuana use and the high predictive value of cigarette smoking in predicting marijuana use, and provide novel data on the quantitative correlation between level of exposure to nicotine and THC. Quantitative screening of nicotine and THC exposure may enhance our understanding of addiction and harm from single and dual product use.

Copyright © 2019 Elsevier B.V. All rights reserved.

Keywords: Adolescents; Analytical chemistry; Cannabis; Marijuana; Nicotine; Urine screening; Young adults

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