It’s been said, “The devil is in the details”. It’s true that it’s devilish work to get everything perfectly right, and I do try, but I don’t claim to be perfect. But still, it’s a worthy goal to be as correct as possible, when people are depending on what you write. So I often agonize a bit over it.

With the help of just under a gram of Phenibut, I’m trying to calmly assess what turned a normal discussion into a bit of a kerfuffle on the web today. It started about a week ago when I somehow got linked to this discussion on Dr. Christian Thurstone’s site. Dr. Thurstone wrote an interesting article about how his patients — he’s a Colorado doctor who specializes in pediatric addictions, and claims that many of these teenagers are addicted to marijuana — have been showing extremely high levels of THC in their bloodstreams for the past few years, as indicated by urinalysis; that this is somehow connected to medical marijuana and the recent legalization of marijuana in Colorado for adults; and that he expects to see people injecting it soon.

I’m not the confrontational type, so I didn’t want to get into an argument, and especially not on his own site, so I calmly submitted a simple question:

I’d be interested to know whether those urinalysis results were for actual THC or for THC metabolites like 11-hydroxy-THC.

It took a good few days and a polite email for that to get cleared from the moderation queue and posted, but when it finally did appear, Dr. Thurstone claimed that they were indeed measuring THC. I kind of scratched my head at that one, because as far as I know, you can’t actually measure active THC via urinalysis, only via an actual blood test. So I submitted another observation (which, at press time, has not appeared on that site):

Thank you, Dr. Thurstone. Those results are really fascinating. So the average adolescent in your practice is apparently 100 times higher than the 5 ng/ml limit for DUI recently passed by the Colorado House. I’d be concerned too, and in fact I’m a major proponent of microdosing for medical users.

Not that I condone teenagers using cannabis recreationally, but thank goodness they weren’t drinking alcohol! I believe that’s fatal at a mere 2 or 3 times the DUI limit.

Well, “Radical Russ” Belville, who is not the least bit afraid of confrontations, and who had gotten involved in this conversation himself, picked up on this, and wrote a rather scathing article about the whole thing. He went to the trouble of contacting “a number of experts in the field of marijuana testing” who confirmed that you can’t actually detect these levels of actual THC in urine.

In fact, what virtually all urine tests do detect are metabolites of THC, which is what I was alluding to in my original question to Dr. Thurstone and which I’ve discussed in my article on drug testing. But for the record, let me hopefully clear up a few misconceptions, because I’ve even been confused myself by some of this more than once:

• 11-hydroxy-THC (AKA 11-OH-THC, sometimes nicknamed “hydroxy”) is created in the body after smoking or inhaling cannabis, and generally is formed in the liver in much larger quantities (relatively) when cannabis is consumed orally via capsules or edibles. It is more psychoactive than THC itself, which helps explain  why edibles tend to hit you so much harder. Because it’s psychoactive, it’s known as an “active metabolite”. It is sometimes used in urine tests.
• 11-nor-9-Carboxy-THC (AKA THC-COOH, sometimes nicknamed “carboxy”) is a secondary metabolite of THC, caused by the liver further processing the above 11-hydroxy-THC. It is non-psychoactive. This is the main substance looked for in urine tests for “THC”. The controversy over using this metabolite for legal testing purposes is that its detection and amount have virtually no actual connection with how much THC (or even 11-hydroxy-THC) is in your body, therefore it does not accurately measure how high or impaired you are. So that makes it kind of useless for its usual intended purpose of detecting impaired drivers. What its presence means is that the person has had some unknown quantity of cannabis in their system at some time during the past month or two. Not very useful for much of anything in legal medical states, therefore.
• Tetrahydrocannabinolic acid (AKA THC-A or 2-COOH-THC) is the form that THC is stored in the cannabis plant itself. This is the substance that we must decarboxylate by heating to make it “active” as THC, in order to experience the benefits of cannabis.