Clinical Insight – THC Monitoring

Marijuana is the most commonly abused illicit substance in the United States. Because THC can come from a variety of sources and test results may be influenced by multiple factors, this issue of Clinical Insight reviews key concepts to consider.

Detection Times:

    • Oral Fluid: The window for detection of THC is approximately 24-48 hours. Because of this short time frame, these results can help determine if recent use has occurred but cannot be used to monitor elimination in a person with a history of chronic use.
    • Urine: The detection window depends on the individual’s history of use:
      • Occasional Use: Up to 5 days when smoked and approximately 9 days after an edible product.
      • Chronic Use: Because THC accumulates in the fatty tissues of the body with chronic marijuana use, it can be detected for up to 30 days or more after THC use is stopped.

Drug Levels:

  • Creatinine Adjusted Values (CAV):
    • The CAV is a clinical tool to assist clinicians to compare drug levels in urine samples with different concentrations, which are reflected by the creatinine. This is important because drug levels in urine are directly impacted by the creatinine, which can misleadingly appear to increase or decrease THC levels.
      • The higher the creatinine, the more concentrated the urine. This results in higher detected drug levels and may create the false appearance of continued or new use of a drug.
      • The lower the creatinine, the less concentrated the urine. This results in lower detected drug levels, which may falsely appear like abstinence of drug use.
  • Utilizing the CAV enables comparison of multiple samples from an individual over time while minimizing the impact of fluctuating creatinine levels.

THC Sources:

    • Marijuana: The traditional plant form, which is commonly smoked or made into edibles. Delta-9-THC is the main component that causes the drugs psychoactive effects. Federally, marijuana is a Schedule-1 Controlled Substance but may be deemed legal recreationally depending upon individual state laws.
    • Medical Marijuana: A medical marijuana card is issued by a physician which permits the use of marijuana for the use of certain medical conditions. 
    • CBD: CBD is sourced from either the hemp plant or the marijuana plant. It can contain Delta-9-THC as an impurity. Federal guidelines allow up to 0.3% THC in hemp derived products, but due to lack of regulatory oversight on CBD production, this level may be exceeded.
    • Delta–8-THC: This product is a cannabinoid that has become popular in recent years due to its similarity to Delta-9-THC. Delta-8-THC is also present in low concentrations in the cannabis plant.
    • Dronabinol: A synthetic form of Delta-9-THC available by prescription (Marinol®) to treat anorexia and weight loss due to cancer or HIV.
    • Passive Exposure: Individuals in the immediate environment to smokers may be exposed to THC by passive inhalation.  Studies suggest the environmental conditions needed to contribute to a detection in a urine drug test would be limited to small, unventilated areas with a heavy smoke burden. Detections from this type of exposure are generally low and confined to roughly 24 hours after exposure. Recent studies found that passive inhalation did not produce positive results in oral fluid tests.

Sources:

Huestis M.Human Cannabinoid Pharmacokinetics. Chem Biodivers. 2007 August; 4(8):1770-1804.

Schlienz N, Cone E, Herrmann E et al. Pharmacokinetic Characterization of 11-nor-9-carboxy-delta 9-tetrahydrocannabinol in Urine Following Acute Oral Cannabis Ingestion in Healthy Adults. J Anal Tox 2018. 42: 232-247.

ElsohlyM., Chandra S., Radwan M.,Majunder  C.,Church J.,A Comprehensive Review of Cannabis Potency in the U.S.in the Last Decade. Biol Psych: Cognitive Neuroscience and Neuroimaging.  June 2021 6(6):. 603-606.

Cone E, Huestis M. Interpretation of Oral Fluid Tests for Drugs of Abuse. Ann N Y Acad Sci 2007; 1098: 51-103

Scwike E.et al. Differentiating new cannabis use from residual urinary cannabinoid excretion in chronic, daily cannabis users. Addiction. 2011 March; 106(3): 499-506.

Verstraete, A. Detection Times of Drugs of Abuse in Blood, Urine and Oral Fluid. Ther Drug Monit 2004; 26:200-205.

McCuigan, M. Chapter 83: Cannabinoids. Goldrank’s Toxicologic Emergencies. 9th ed. 2011.

National Institute on Drug Abuse Web site. http://www.drugabuse.gov. . Drug Facts Marijuana. February 2018.

Toennes,S., Ramaekers J, Theunissen E et al. Comparison of Cannabinoid Pharmacokinetic Properties in Occasional and Heavy Users Smoking a Marijuana or Placebo Joint. Journal of Analytical Toxicology. Sept 2008, 12: 470-477.

Marsot A, Audebert C, Attolini L, Lacarelle B, Micallef J, BlinO. Comparison of Cannabinoid Concentrations in Plasma, Oral Fluid and Urine in Occasional Cannabis Smokers After Smoking Cannabis Cigarette. J Pharm Sci. 2016. 19(3) 411-422.

Cone E, Bigelow G, Herrmann E, et al. Non-Smoker Exposure to Secondhand Cannabis Smoke. I. Urine Screening and Confirmation Results. J Anal Tox. Oct 2014; 1-12.

Niedbala S, Kardos K, Salamone S, et al. Passive Cannabis Smoke Exposure and Oral Fluid Testing. J Anal Tox. Oct 2004; 28: 546-552

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Mark Peters, Chief Financial Officer of Dominion Diagnostics

Mark Peters

Chief Financial Officer

Mark Peters joined Dominion Diagnostics in 2021 and serves as the company’s Chief Financial Officer. Mr. Peters is responsible for Dominion’s Financial Planning & Analysis, Accounting, and Revenue Cycle Management functions. He has over 25 years of financial, operations, and strategic management experience in public, private equity, and venture capital backed healthcare companies.

His experience includes executive roles at Seikagaku Corporation (Tokyo Stock Exchange), IST (now part of Integra LifeSciences), Health Language (now part of Wolters Kluwer), and management positions with IBM and PricewaterhouseCoopers.  

Mr. Peters is a licensed CPA and graduated with an MBA in Finance from The University of Notre Dame and a BBA in Accounting from The University of Texas. In his personal time, he enjoys the outdoors, sports, reading, and spending time with his family.

Mark A. McSally, Esq.

Chief Operating Officer / General Counsel

Mark A. McSally, Esq. joined Dominion Diagnostics in 1999 as Outside General Counsel and moved internally in 2006 to assume the role of Corporate Counsel.  He currently serves as Dominion’s Chief Operating Officer and General Counsel.

Mr. McSally is responsible for all aspects of Dominion’s legal and regulatory needs, including government relations and corporate compliance.  As Chief Operating Officer, he is involved in all aspects of the operational management of Dominion Diagnostics, providing oversight to the Payer Relations, Clinical Services, Laboratory, Research and Development and Client Services teams. 

Mr. McSally is a seasoned attorney with deep roots in Rhode Island’s South County. Mr. McSally holds a Bachelor of Arts in History, with honors, from the College of the Holy Cross and a Juris Doctorate, with honors, from Suffolk University Law School.  He has and continues to serve on a number of community boards.

Luke Jessen

Vice President, Sales & Marketing

Luke Jessen joined Dominion Diagnostics in 2010 and currently serves as its Vice President of Sales & Marketing.  Luke has over twenty-three years of experience in healthcare, including fifteen years in diagnostics. 

Prior to joining Dominion Diagnostics, Luke spent eight years working in pharmaceuticals and two and a half years educating health care providers on appropriate opioid prescribing as President & Founder of Opioid Compliance Consulting.  After Opioid Compliance Consulting was acquired by Riverside Partners in 2010, Luke joined Dominion Diagnostics as Western Regional Sales Director. 

Luke has a consistent track record of building highly successful sales teams and driving clinically appropriate results. 

He holds a Bachelor of Arts in Political Science from The Colorado College in Colorado Springs, Colorado.  In his free time, Luke enjoys spending time with his family, surfing, mountain biking, fly fishing, hiking, snow/water skiing, and playing pickleball.  Luke also volunteers in his community at Cherry Hills Community Church, where he serves as a Ruling Elder. 

John Hearn

Vice President, Business Development & Payer Relations

John joined Dominion Diagnostics in 2018. In addition to business development responsibilities at Dominion Diagnostics, he manages the payer relations and inside sales teams. John has over 25 years of business development experience with 14 being in the laboratory space.

Before joining Dominion Diagnostics, John was the Chief Marketing Officer for Pathway Diagnostics. His responsibilities included, business development, managing outside sales, compliance, market and business strategy as well as lab operations. Prior to Pathway Diagnostics, he worked for Cordant Health Solutions, where he sold and managed a 5000 specimen a month book of business that grossed over $48 million in annual revenue as well as managed the Southeast sales team. In 2010, he was hired by Quest Diagnostics to be an account executive. His call points were all specialties including OBGYN and pain management.

Prior to working in the healthcare space, he had a sales role with Fidelity Information Services in their risk management and payment processing division. During his career and with two fortune 500 companies, he has won multiple president club awards.

John has a Bachelor of Business Administration degree from the University of Mississippi. John enjoys being outdoors, playing golf and tennis, watching his three kids play sports and traveling with his family.

Jeff Nally

Senior Vice President, RCM & Corporate Compliance Officer

Jeff joined Dominion Diagnostics in 2014 and currently serves as the SVP of Revenue Cycle Management and is also the company’s Corporate Compliance Officer. Jeff has spent his 25+ year career in finance and the past 20 years focused on healthcare revenue cycle management.

Prior to Dominion Diagnostics Jeff lead the shared services center as the Senior Finance Director for The Mentor Network a national network of local health and human services offering community-based services to adults and children with intellectual and development disabilities. Prior to The Mentor Network Jeff spent 9 years at Perkinelmer leaving as the Director of Insurance and Consumer Billing over seeing revenue cycle management in multiple diagnostic laboratories.

Jeff drives revenue cycle management excellence through streamlined operations and better workflow. Jeff can assess distressed situations, quickly managing necessary change while delivering and improving results and employee success.

In his personal time, he enjoys golf, local sports, and spending time with family and friends.  Jeff is certified in health care compliance (CHC) and has a bachelor’s degree from Curry College.

Denise Driscoll, SPHR, CCP

Vice President, Human Resources

Denise Driscoll is an experienced human resource leader across various industry sectors. Her prior experience includes working for national and global organizations.

Ms. Driscoll’s prior healthcare experience includes the creation of a HR shared services organization for a regional healthcare system.  She’s led programs in support of highly engaged employee populations.  She has significant organizational design, compensation, and benefit management experience as well as in-depth experience with mergers and acquisitions. Her employee relations record includes creating and implementing performance and development systems in support of high-performing companies.

At Dominion Diagnostics, Ms. Driscoll is responsible for organizational health and is the senior executive sponsor of the cross-functional Employee Success Team, which fosters employee engagement through communication, wellness initiatives, and programs that promote connection and a strong sense of community.

Denise has a B.A. in Psychology from Drew University, and an M.B.A. with a concentration in HR from San Francisco State University.  In her free time, she enjoys yoga, hiking, listening to live music, and kayaking. Denise is active with the Rhode Island Community Food Bank, where she is Head of the HR Committee and serves on the Board.

David J. Molusis

Vice President, Information Technology

David J. Molusis joined Dominion Diagnostics in 2015 as Vice President of Information Technology. Mr. Molusis has over 25 years of experience as an accomplished healthcare IT leader and administrator. 

Prior to Dominion Diagnostics, Mr. Molusis held the position of Vice President, Sales & Marketing at Nashville based, Common Cents Systems, a software development firm for reference laboratories. Prior to that as Vice President & CIO at Clinical Laboratory Partners, a member of Hartford Health Care Corporation’s integrated healthcare delivery system. Before his role at Clinical Laboratory Partners, Mr. Molusis held a variety of career evolving positions, including Chief Information Officer, at VNA Health Care, the largest home health care organization in Connecticut.  Earlier in his career, he held various roles in IT, project management, software development and optimization. 

Mr. Molusis is also a contributing author to the industry publications of Laboratory Economics in 2007, The Dark Report in 2011, and most recently, Advance for Administrators of the Laboratory in 2014. 

Mr. Molusis holds a Master’s degree in Information Management from Rensselaer Polytechnic Institute, a Bachelor’s degree in Business Administration from Western Connecticut State University and project management certification from Villanova University. In his personal time, he enjoys the beach, skiing, travel, and spending time with his family and friends between Connecticut, Southern Maine and Florida. 

Charlene Johnson, PhD

Senior Vice President, Laboratory Operations & Quality

Dr. Charlene Johnson first joined Dominion Diagnostics in 2003 as the Director of Molecular Testing.  In 2009, she became the Assistant Laboratory Director for Dominion’s Rhode Island and Vermont laboratories. Dr. Johnson assumed the role of Laboratory Director in 2011, followed by Vice President of Laboratory Operations and Laboratory Director in 2013, and was promoted to serve as the company’s Senior Vice President, Laboratory Operations & Quality in 2021.

Under Dr. Johnson’s exemplary leadership, Dominion’s laboratories have expanded tremendously in both capacity and testing capabilities.  She has driven significant achievements in laboratory operations, research and development, and strategic growth.  The company counts on Dr. Johnson’s expertise and guidance to uphold its reputation for sound science and laboratory integrity. 

Prior to joining Dominion, Dr. Johnson worked as a Senior Research Fellow at the University of Texas Health Science Center in Houston, Texas. 

Dr. Johnson holds a Bachelor of Science from the College of William and Mary and received her PhD from Virginia Commonwealth University/Medical College of Virginia.

Carin Johnson

Senior Vice President, Customer Operations

Carin joined the organization in 2015 and currently holds the position of Senior Vice President of Customer Operations. With a career spanning over 30 years in healthcare management, including 16 years of specialization in laboratory diagnostics, she brings invaluable expertise to the industry.

Before joining Dominion Diagnostics, Carin served as the Field Operations Director at Calloway Labs, where she oversaw and directed nationwide operations. In this role, she played a integral role in driving operational improvements, with a strong focus on enhancing the customer experience. This resulted in increased productivity and streamlined procedures, making a substantial impact during her tenure.

Carin holds a Bachelor of Science in Business Management from the University of Maryland. In her free time, she enjoys spending time with her family, as well as running, hiking, and traveling.

Robert M. Garvey, Jr.

Chief Executive Officer

Bob joined Dominion Diagnostics in 2011 and serves as its Chief Executive Officer. He has over 35 years of experience in healthcare, including over three decades of leadership in laboratory diagnostics and diagnostic imaging. 

Prior to Dominion Diagnostics, Bob ran the Northeast division of Laboratory Corporation of America as the Senior Vice President, which generated over $800M in annual revenue. He drove considerable organizational change to improve quality, service levels and foster growth.

Before his role at LabCorp, he spent 12 years at Quest Diagnostics where he held various Vice President and General Manager roles. Early in his career, he held roles in sales and sales management at GE Healthcare. Bob has a proven track record of growing healthcare businesses and developing high performing teams.

He holds a Bachelor of Science in Finance from the University of Massachusetts – Lowell. In his personal time, he enjoys tennis, golf, hockey, traveling, reading and spending time with his family.