Clarifications on CBD and Drug Testing
Medical marijuana has been an issue in the US since the inception on the war on drugs in the 1970’s. In 1978, Robert Randall sued the federal government for arresting him for using cannabis to treat his glaucoma. The judge ruled Randall needed cannabis for medical purposes. This medical marijuana standard persisted until 1992 when George H.W. Bush discontinued the program. Since that time there has been an explosion of states that have authorized medical marijuana for “compassionate care.” Currently there are 31 states and the District of Columbia that have medical marijuana statutes.
Why did I start a CBD blog with a blurb on medical marijuana? Well cannabidiol (CBD) is a naturally occurring cannabinoid that is found in the hemp family of plants, which includes Cannabis Sativa and Cannabis Indica. The majority of the positive health effects touted by medical marijuana users actually come from the CBD component. The CBD component is the anti-epileptic. Studies also show that CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. CBD has shown to be useful in treating anxiety particularly anxiety causing sleep dysfunction since CBD helps with both falling asleep and staying asleep.
In June of this year the US Food and Drug Administration approved Epidiolex (CBD oral solution) for treatment of rare childhood seizure disorders. The Drug Enforcement Agency followed suit and removed CBD from the Schedule 1 list. Schedule 1 drugs include Heroin (diacetylmorphine, LSD (lysergic acid diethylamide), Marijuana (cannabis, THC), Mescaline (peyote) and MDMA (3, 4-methylenedioxymethamphetamine or ectasy) which are illegal to prescribe, possess, or use. Currently Epidiolex is a DEA Schedule 5 drug since CBD does not cause intoxication or euphoria. It is the THC that is the primary psychoactive component of marijuana. When thinking of Schedule 5 drugs, think about low dose narcotic cough syrups.
CBD and Drug Testing
Epidiolex is an ultrapure extract of the Cannabis Sativa plant. The Epidiolex extraction process essentially eliminates all of the THC component from the solution. If a drug screening donor is using Epidiolex, that donor will not test positive for marijuana. The reason for this is that all drug testing looks for THC or a unique metabolite of THC. CBD is not THC.
Many of the CBD products available are not manufactured according to FDA standards as Epidiolex is. Extracts of CBD from the marijuana plants in many cases are massively contaminated with THC since these manufacturers are not FDA approved. Further plant extracts with THC in them beyond FDA approved levels remain Schedule 1 drugs under the Controlled Substances Act. In drug testing use of these contaminated CBD oils is no different than admitted to smoking/ingesting marijuana. From a medical review perspective CDB oil is not a medical explanation for a positive THC drug test.
Best Practice Recommendations
Let the buyer beware – CBD as a medication has the majority of the therapeutic actions associated with medical marijuana (particularly for seizure control and chronic pain). However, many of the state dispensaries as well as online retailers of this product are not FDA approved and do not follow the process to remove THC to a degree that will not affect a drug test. If you work for an organization that has a drug-free workplace program, I strongly encourage you to obtain your recommended CBD product from a FDA approved manufacturer. Remember, the allegation of CBD use is not a reasonable medical explanation for a positive THC drug test result and it will be up to the employer to assess that positive result.
Unless specifically permitted by law, employers should not consider CBD product use as a valid, reasonable medical explanation for a positive marijuana drug test result as delineated in the above paragraphs.
Employers in states with medical marijuana statutes need to address those positive drug tests for THC (marijuana) in a way that is supported by their drug free workplace program as well as the underlying state statute despite the donor’s CBD use allegation. CBD products sold in these states may not adhere to FDA manufacturing standards. CBD is these instances is just another form of medical marijuana that from an employment law perspective fall under those state rules.
Find free resources to help your company develop its marijuana policy at our Resource Library
Dr. Todd Simo
Dr. Simo is the Chief Medical Officer and the Managing Director of Transportation at HireRight. He served as HireRight’s Medical Director starting in 2009 and was promoted to Chief Medical Officer in 2015. Dr. Simo was also appointed to the role of Managing Director of Transportation in 2018. Dr. Simo came to HireRight with a decade of experience in the medical consulting arena. Before that he was Medical Director at an occupational health clinic in Virginia and owned a consulting firm providing medical director services to employers across the United States.
What Can Cause False Positives for Drug Test?
Many companies ask prospective employees to complete a drug test as part of the hiring process. Some employers may also screen their staff for drug use at random times to check their systems for the presence of illicit drugs or other illegal substances like marijuana (THC), opiates, cocaine, amphetamines, methadone, steroids, barbiturates, benzodiazepines, phencyclidine (PCP), ecstasy, and more.
However, drug tests are known for sometimes producing false positive results, which means that people who have not taken drugs may get a positive result after the screening. This could lead to someone losing their career for no real reason. Therefore, everyone who is expecting to complete a drug screening should take proper precautions to avoid this problem.
What Does It Mean to Get A False Positive?
When someone gets a “false positive” on a screening, the test detects the presence of a substance that isn’t really in someone’s body. As testing methods have improved over the years, there have been less cases of false positive results. While these outcomes are not common, they are still very possible today.
What Causes False Positives?
If someone eats certain foods, takes specific medications, or uses other substances before taking a drug test, they have a chance of seeing a false positive result. The substances below may or may not cause a false positive result on a drug test depending on how much of the substance a person consumed, how the test is processed, and what the test is screening for.
Some bagels and other foods with poppy seeds could cause a false positive for opioid screenings. This is because poppy seeds naturally have small amounts of codeine and morphine.
Certain screenings can detect even the smallest amount of alcohol. Many products such as mouth wash, vanilla extract, and liquid medications contain ethanol, which is a simple grain alcohol. The presence of ethanol may be detected in a urine test for alcohol use.
Secondhand Marijuana Smoke
If someone is exposed to a large amount of marijuana before completing a urine drug test, THC may be detected. However, modern tests are very unlikely to yield positive results from secondhand smoke.
While Cannabidiol (CBD) does not make people high, large amounts of consumption could lead to a positive result on a urine test for THC.
Cough Suppressants, Decongestants, and Sleep Aides
Over-the-counter cough suppressants like Robitussin include an active ingredient called Dextromethorphan, which could cause false positives in tests for opiates and PCP. Pseudoephedrine, or Sudafed, could cause false positives for amphetamine or methamphetamine. Over-the-counter sleep aid drugs like Unisom may also lead to false positive results for PCP and methadone.
Weight Loss Pills
Some weight loss medications like phentermine have caused false positives in amphetamine urine tests.
ADHD Medications, such as Ritalin (methylphenidate) are known to cause false positives tests for LSD, amphetamine, and methamphetamine.
Several different antidepressant medications have the potential to cause false positives. Other antidepressants not included in this list could also lead to false positive screenings.
- Quetiapine, known as Seroquel, could yield false positives for methadone or opiates.
- Sertraline, known as Zoloft, could lead to false positives for benzodiazepine or LSD screenings.
- Trazodone may also cause a false positive test for amphetamine, LSD, or methamphetamine.
- Tricyclic antidepressants (TCA), such as Amitril, Norpramin, Zonalon, Prudoxin, or Tofranil, may lead to false positive urine tests for LSD.
- Venlafaxine, known as Effexor XR, could lead to a false positive on a PCP urine test.
Be sure to speak to a medical professional about these medications when taking a drug test.
Levofloxacin and Ofloxacin are known as Quinolone antibiotics. They may cause false positives for opiate, amphetamine, or methamphetamine tests. The antibiotic used to treat tuberculosis (Rifampin) could also cause false positives for opioid urine screenings.
Pain or Anti-Inflammatory Medication
Tramadol or Ultram could register a false positive in opiate or PCP screenings. Ibuprofen (Motrin or Advil) could lead to false positives for barbiturates, PCP, or THC. Aleve, or Naproxen, may also lead to a false positive for barbiturates of THC.
Benadryl, Tylenol PM, Advil PM, and other medications contain diphenhydramine. This could lead to positive results in screenings for methadone, PCP, or opiates.
False positives for marijuana screenings could occur as a result of taking Sustiva (Efavirenz), an antiretroviral medication used to treat HIV infections.
Chlorpromazine may cause false positives for amphetamine. Quetiapine could lead to a false positive for methadone on a urine test.
Other Prescription Medications
Medications used to treat hypertension, such as Cardizem (Diltiazem), could lead to a false positive on a urine LSD test. Metformin, a common prescription for diabetes treatment, has led to some positive results in tests for amphetamine or methamphetamine.
This may not be a complete list, as there are so many variables to consider when discussing drug tests and the potential for false positives. If you have any questions about false positive substance results from a test, speak with a medical professional. Let the medical professional administering the screening know if you are taking any of these medications. If you experience what you believe to be a false positive, request a second drug screening test.
For more information about drug screenings and false positive results, contact our team of substance abuse treatment representatives by calling 866-345-2147.