ArticleJournal of occupational medicine and toxicology (London, England)2025
Pre-employment urine drug screening: examining trends in THC-COOH positivity rates post-legalization of recreational cannabis in California - a retrospective review.
Article in Journal of occupational medicine and toxicology (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study examines trends in delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) positivity rates in pre-employment urine drug screenings at a single university-based hospital occupational medicine clinic from 2017 to 2022, following California's recreational cannabis legalization in 2016, with sales beginning officially on January 1, 2018.
methodsRetrospective analysis of 21,546 de-identified urine drug screenings from 2017 to 2022 was conducted. Initial screening used instant urine drug immunoassays (50 ng/mL cutoff for THC-COOH), followed by confirmatory gas chromatography-mass spectrometry (15 ng/mL cutoff). Positivity rates were calculated annually, and descriptive statistics summarized age and gender distributions among positive cases. The Cochran-Armitage trend test assessed temporal trends.
resultsOf 21,546 screenings, 92 (0.44%) were THC-COOH-positive. The positivity rate increased from 0.12% (4/3,215) in 2017 to 0.94% (45/4,784) in 2022 (Cochran-Armitage, Z = 5.19, p < 0.001), a 683.33% relative increase (absolute change: 0.82%). Among positive cases, 76% were aged 20-39 (mean: 29.00 years, SD = 9.5), and the female proportion rose from 25.00 to 62.22%. Median THC-COOH levels ranged from 60.00 to 176.50 ng/mL (overall: 145.0, IQR: 309.5).
conclusionTHC-COOH positivity rates increased significantly post-legalization, potentially influenced by increased cannabis use. Urine tests detect past use, not impairment, highlighting the need for impairment-focused testing per Assembly Bill 2188 (2024). Missing total sample demographic data limit age/gender subgroup analyses.
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