What health screening is recommended for an adult or adolescent with a history of marijuana use?

Health Screening for Marijuana Users

Use validated screening questionnaires annually for all adolescents and adults with marijuana use history, specifically the CRAFFT 2.1+N for adolescents or the AUDIT-C/S2BI for broader substance assessment, followed by urine drug screening when indicated to detect 11-Nor-9-carboxy-THC (detectable 1-3 days after single use, up to 30+ days in heavy users). 1

Validated Screening Tools by Age Group

For Adolescents (Ages 12-21)

Three primary screening instruments are recommended for annual screening:

• CRAFFT 2.1+N (10 items): Assesses past-year cannabis use including specific product types (edibles, vaping, dabbing), motivations for use, hazardous patterns, and negative consequences with clearly defined clinical cutoffs indicating need for further intervention 1

• S2BI (Screening to Brief Intervention): Queries past-year frequency of cannabis use (never, once/twice, monthly, or weekly+) with built-in brief intervention recommendations and sample clinical language for providers 1

• BSTAD (Brief Screener for Tobacco, Alcohol, and other Drugs): Three screening items assessing peer and personal cannabis use in the past year, plus number of use days in the past month, with high sensitivity and specificity 1

For Adults

• AUDIT-C: Three questions identifying quantity and frequency of substance consumption, validated for ages 12-19 and adults 1

Biometric Testing When Indicated

Urine drug screening remains the gold standard for cannabis detection 1:

• Target metabolite: 11-Nor-9-carboxy-THC 1
• Detection window: 1-3 days after single use; 30+ days in heavy users 1
• Collection protocol: Must follow federally approved chain of custody procedures with temperature testing and controls for adulteration/dilution 1
• Critical caveat: Negative screens do NOT rule out cannabis use due to detection window limitations 1

Important Testing Pitfalls to Avoid

• Verify which specific substances are included in your testing panel before administration, as not all panels routinely include cannabis metabolites 1
• Confirm detection windows for the adolescent age group specifically, as metabolism varies 1
• Be aware that false positives can occur with certain medications (e.g., fluoroquinolone antibiotics with opiate screens) 1
• Direct observation of urination raises ethical concerns in adolescents; use proper federal collection protocols instead 1

Clinical Assessment Components

Risk Factor Screening

Assess these demographic and psychosocial factors that increase cannabis use risk 1:

• Age (risk increases throughout adolescence) 1
• Male sex 1
• Mood and affective symptoms (depression, anxiety) 1
• Concurrent use of other substances 1
• Adverse childhood experiences 1
• Parent/guardian cannabis use 1
• Peer cannabis use (query this first as it's less threatening and predicts personal use) 1

Physical Examination Findings During Acute Use

Look for these signs during clinical visits, though most resolve quickly 1:

• Dry or red eyes 1
• Dry mouth/increased fluid intake 1
• Increased appetite 1
• Cognitive or psychomotor impairment 1
• Dental symptoms (inflammation, dry socket) 1
• Sweet or fruit-like smells (for vaped products) 1

Screening for Cannabis-Related Health Consequences

Mental Health Screening

Screen for these psychiatric complications, particularly in adolescent users 1:

• Cannabis use disorder/dependence: Use validated tools like the Severity of Dependence Scale (SDS) or Cannabis Use Disorders Identification Test (CUDIT) 2
• Depression and anxiety disorders 3
• Psychotic symptoms, especially in those with family history or early initiation 4, 3, 5
• Suicidal ideations 4
• ADHD or personality disorder symptoms 1

Neurocognitive Assessment

Consider referral for formal testing if heavy use during adolescence 1:

• Cannabis affects the developing orbitofrontal cortex, critical for decision-making 1
• Neural changes occur more rapidly in adolescents than adults 1
• Assess for deficits in attention, concentration, and working memory 4, 3

Physical Health Screening

• Respiratory function: Assess for chronic bronchitis symptoms in chronic smokers 5, 6
• Cardiovascular assessment: Screen for tachycardia, hypertension, particularly in those with preexisting cardiac disease 4, 5
• Motor coordination: Assess driving safety and accident history 4, 5
• Hyperemesis syndrome: Query recurrent nausea/vomiting patterns 4

Special Populations Requiring Enhanced Screening

Underrepresented and Underserved Youth

Racially/ethnically diverse female adolescents and sexual/gender minority youth show disparities in use and consequences starting at age 12 1:

• These groups may underreport use due to historical mistrust of medical providers 1
• Use culturally attuned assessment approaches like the Cultural Formulation Interview 1
• Motivational interviewing shows efficacy in reducing cannabis use in diverse female adolescents up to 3 months post-intervention 1

Pregnant Individuals

Cannabis should be avoided during pregnancy due to potential fetal harm, though specific risks remain uncertain 6

Screening Frequency and Context

• Annual screening is recommended for all adolescents ages 12-21 1
• Acute care visits should include screening as needed 1
• Primary care settings provide optimal opportunistic screening, as only 6% of adolescents with hazardous substance use receive specialty services 1

Key Clinical Recommendation

The most important message: Advise all patients to delay cannabis initiation until age 25 when brain development is complete 1. The developing brain does not complete maturation until age 25, and cannabis-related structural changes are unique to adolescent users 1. Open, empathic dialogue about navigating peer and family cannabis use environments is essential 1.