Journal Article

Impact of Lowering Confirmatory Test Cutoff Value in Pre-Enlistment Urine Cannabinoids Screening: About Five Years' Experience in the French Gendarmerie

Yannick Lecompte, Martine Perrin, Sophie Salle and Olivier Roussel

in Journal of Analytical Toxicology

Volume 36, issue 8, pages 569-574
Published in print October 2012 | ISSN: 0146-4760
Published online October 2012 | e-ISSN: 1945-2403 | DOI: http://dx.doi.org/10.1093/jat/bks067
Impact of Lowering Confirmatory Test Cutoff Value in Pre-Enlistment Urine Cannabinoids Screening: About Five Years' Experience in the French Gendarmerie

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The guidelines for screening of urinary cannabinoids require that all specimens testing positive should be confirmed by gas chromatography–mass spectrometry at a confirmatory test cutoff value of 15 ng/mL of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH). To assess the impact of lowering the confirmatory test cutoff value on the diagnostic sensitivity and efficiency of a cannabinoid testing program, the results of 986 confirmation analyses of positive screening tests, conducted in the framework of medical fitness examinations prior to enlistment in the French Gendarmerie between January 1, 2005, and December 31, 2009, were retrospectively studied. If the confirmatory test cutoff value of THCCOOH is set at 5 ng/mL instead of 15 ng/mL as recommended by guidelines, the number of confirmed results increases by 25.2%. The positive predictive value of the initial screening test rises from 63.9 to 80.0%. Only one true-positive applicant has appealed. His THCCOOH urinary concentration, which was incompatible with passive cannabis smoke exposure, was confirmed by another laboratory. The use of a confirmatory test cutoff value lower than that recommended significantly increases the diagnostic sensitivity of the screening program for urinary cannabinoids without altering its specificity.

Journal Article.  4011 words.  Illustrated.

Subjects: Medical Toxicology ; Toxicology (Non-medical)

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