Whether or not to test, and which test to use, depends upon your goals. A psychiatrist screening for a history of substance abuse has different goals than a PEM physician evaluating a toddler for altered mental status who has different goals than a court trying to prove intoxication after a motor vehicle collision.
A qualitative urine immunoassay is a very good test for detecting marijuana exposure. However, it does not prove intoxication; and, if your patient has an acute alteration in mental status, it does not necessarily mean that the current clinical syndrome is from marijuana. However, if a toddler is acting funny and has a positive urine immunoassay - that would seem to be a pretty good conclusion.
If you are testing a baby or toddler, and if you think the result may have child welfare / legal ramifications, you will want to make sure that you handle the specimen properly and confirm the test result with a second method.
Quantitative blood and saliva techniques are also available, and are able to quantitate different relative concentrations of THC metabolites.
You have several options: POC testing, hospital lab testing, send-out testing. The best option for each hospital will probably depend upon a number of local factors.
I'm sure the excellent toxicologists at the California Poison Control System would be happy to work this through with you.
The American College of Medical Toxicology periodically offers short courses on cannabinoid forensics and legal issues if you find that you become extremely interested in this topic.
Kevin Osterhoudt MD, MS, FAAP, FAACT, FACMT
Direct Reply: https://www.docmatter.com/kevinosterhoudt
Attending Physician; Pediatric Emergency Medicine; Medical Director, The Poison Control Center
The Children's Hospital of Philadelphia
This is a reply to the discussion started by Julia Magana MD:
Questions: 1. Are you testing children for suspected THC ingestion?
2. If yes, how? (POC THC specific...
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