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Drug test

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"Drug testing" redirects here. For The Office episode, see Drug Testing (The Office).

A drug test is a technical analysis of a biological specimen - for example urine, hair, blood, sweat, or oral fluid / saliva - to determine the presence or absence of specified parent drugs or their metabolites.

Detection periods

The following chart from LabCorp gives approximate detection periods for each substance by test type.[1]

The detection windows depend upon multiple factors - drug class,amount and frequency of use, metabolic rate, body mass, age, overall health, and urine pH. For ease of use, the detection times of metabolites have been incorporated into each parent drug. For example, heroin and cocaine can only be detected for a few hours after use, but their metabolites can be detected for several days in urine. In this type of situation, we will report the (longer) detection times of the metabolites.

  • NOTE 1: Oral fluid or saliva testing results for the most part mimic that of blood. The only exceptions are THC and benzodiazepines. Oral fluid will likely detect THC from ingestion up to a maximum period of 18–24 hours. Low saliva:plasma ratio continues to cause difficulty in oral fluid detection of benzodiazepines [2]
  • NOTE 2: Urine cannot detect current drug use. It takes approximately 6–8 hours or more post-consumption for drug to be metabolized and excreted in urine. Similarly, hair requires two weeks, and sweat, seven days.
Approximate values for detection periods
Substance Urine Hair Blood / Oral Fluid
Alcohol 6–24 hours [3] up to 90 days 12–24 hours
Amphetamines (except meth) 1 to 3 days[4] up to 90 days 12 hours
Methamphetamine 3 to 5 days[5] up to 90 days 1–3 days[5]
MDMA (Ecstasy) 24 hours up to 90 days 25 hours
Barbiturates (except phenobarbital) 1 day up to 90 days 1 to 2 days
Phenobarbital 2 to 3 weeks[6] up to 90 days 4 to 7 days
Benzodiazepines Therapeutic use: up to 7 days. Chronic use (over one year): 4 to 6 weeks up to 90 days 6 to 48 hours
Cannabis 3 to 7 days, up to >30 days after heavy use and/or in users with high body fat [7] up to 90 days [7] 2–3 days in blood, up to 2 weeks in blood of heavy users[7]
Cocaine 2 to 5 days with exceptions for certain kidney disorders up to 90 days 2 to 5 days
Codeine 2 to 3 days
Cotinine (a break-down product of nicotine) 2 to 4 days up to 90 days 2 to 4 days
Morphine 2 to 4 days up to 90 days 1 – 3 days
Heroin 3 to 4 days[8] up to 90 days 1– 2 days
LSD 24 to 72 hours (however tests for LSD are very uncommon) up to 3 days[citation needed] 0 to 3 hours
Methadone 3 days up to 97 days 24 hours
PCP 3 to 7 days for single use; up to 30 days in chronic users[9] up to 90 days 1 to 3 days[9]

Common types of drug tests

Urine drug screen

When an employer requests a drug test from an employee the employee is typically instructed to go to a collection site. The employee’s urine is collected at a remote location in a specially designed secure cup, sealed with a tamper resistant tape, and sent via express delivery service to a testing laboratory to be screened for drugs (typically SAMHSA 5 panel).

The first step at the testing site is to split the urine into two aliquots. One aliquot is first screened for drugs using an analyzer that performs immunoassay as the initial screen. If the urine screen is positive then another aliquot of the sample is used to confirm the findings by gas chromatography - mass spectrometry (GC-MS) methodology. All test results are relayed to an MRO (Medical Review Office) where a medical physician reviews the results. If the result of the screen is negative, the MRO informs the employer that the employee has no detectable drug in the urine. However, if the test result of the immunoassay and GC-MS are non-negative and show a concentration level of parent drug or metabolite above the established limit, the MRO contacts the employee and to determine if there is any legitimate reason - such as a medical treatment or prescription.

On-site instant drug testing is becoming more widely used in states allowing it as a more cost-efficient method of effectively detecting drug abuse amongst employees, as well as in rehabilitation programs to monitor patient progress. These instant tests can be used for both urine and saliva testing. Although the accuracy of such tests varies with the manufacturer, some kits boast extremely high rates of accuracy, correlating closely with laboratory test results.

About 5% of the all pre-employment urine samples tested in the U.S. turn out positive for drugs. The percentages are much higher for post-accident and/or reasonable suspicion testing.

The efficacy of urine testing is debatable due to systematic oxidant not generally available in the classic adulterants category because of its corrosive nature. Stealth is an enzyme system that generates hydrogen peroxide.

There are many reasons that an individual may produce a dilute urine specimen, the majority of which are the result of normal physiological processes (e.g. pregnancy, diabetes, a diet high in water etc.) specific circumstances, or an individual's personal characteristics (e.g., body type, sex, race, athleticism). Because dilute specimens are relatively common for these reasons, neither the HHS Guidelines nor the U.S. Department of Transportation Procedures for Transportation Workplace Drug and Alcohol Testing Programs permit further processing of negative and dilute specimens. Specific gravity testing can be done to identify whether or not the sample is of dilute nature.

Adulteration tests can detect the use of some of these "detox" products. Adulteration tests analyze the properties of the urine to identify if the sample is abnormal. Such properties include the pH and specific gravity of the urine. They also test the level of creatinine, nitrite, glutaraldehyde, specific gravity, bleach and pyridinium chlorochromate.

New regulations from the U.S. Department of Transportation are requiring that specimens which indicate a low temperature or show signs of adulteration be admitted with a second specimen from the donor, which is collected under direct observation. That is, the donor voids in full view of the collector or observer. The new regulations also require that the donor raise and lower clothing and turn around in front of the collector or observer to show that the donor is not in possession of any device or substance with intent to falsify the test. In several states, it is illegal to sell or possess such a device or substance.

Hair alcohol testing

Hair absorbs special markers called fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG) into its structure, which remain in the hair indefinitely. These markers are only produced when there is alcohol in the bloodstream, such that the more markers there are, the more alcohol you have consumed.

Tests detecting both FAEE and EtG levels have been used by UK courts. Trimega is the 1st company to commercialise this testing in both the UK and US judicial system is Trimega Laboratories of London. The company also is the only company in the world that can provide testing of both ETG and FAEE at the same time therefore increasing accuracy of the results.

Analysis of hair samples has many advantages as a preliminary screening method for the presence of toxic substances deleterious to health after exposures in air, dust, sediment, soil and water, food and toxics in the environment. The advantages of hair analysis include the non-invasiveness, low cost and the ability to measure a large number of, potentially interacting, toxic and biologically essential elements. Hence, head hair analysis is now increasingly being used as a preliminary test to see whether individuals have absorbed poisons linked to behavioral health problems.

In contrast to other drugs consumed, alcohol is not deposited directly in the hair. For this reason the investigation procedure looks for direct products of ethanol metabolism. The main part of alcohol is oxidized in the human body. This means it is released as water and carbon dioxide. One part of the alcohol reacts with fatty acids to produce esters. The sum of the concentrations of four of these fatty acid ethyl esters (FAEEs: ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate) are used as indicators of the alcohol consumption. The amounts found in hair are measured in nanograms (one nanogram equals only one billionth of a gram), however with the benefit of modern technology, it is possible to detect such small amounts. In the detection of Ethyl Glucuronide, or EtG, testing can detect amounts in picograms (one picogram equals 0.001 nanograms).

However there is one major difference between most drugs and alcohol metabolites in the way in which they enter into the hair: on the one hand like other drugs FAEEs enter into the hair via the keratinocytes, the cells responsible for hair growth. These cells form the hair in the root and then grow through the skin surface taking any substances with them. On the other hand the sebaceous glands produce FAEEs in the scalp and these migrate together with the sebum along the hair shaft (Auwärter et al., 2001, Pragst et al., 2004). So these glands lubricate not only the part of the hair that is just growing at 0.3 millimeters per day on the skin surface, but also the more mature hair growth, providing it with a protective layer of fat.

FAEEs (nanogram = one billionth of a gram) appear in hair in almost one order of magnitude lower than (the relevant order of magnitude of) EtG (picogram = one trillionth of a gram). It has been technically possible to measure FAEEs since 1993, and the first study reporting the detection of EtG in hair was done by Sachs in 1993.[10]

In practice, most hair which is sent for analysis has been cosmetically treated in some way (bleached, permed etc.). It has been proven that FAEEs are (surprisingly) not significantly affected by such treatments (Hartwig et al., 2003a). FAEE concentrations in hair from other body sites can be interpreted in a similar fashion as scalp hair (Hartwig et al., 2003b).

Saliva drug screen / Oral fluid-based drug screen

Saliva / oral fluid-based drug tests can generally detect use during the previous few days. Saliva or oral fluid based drug tests are becoming more prevalent because of their convenience and the fact that they are very difficult to adulterate. Furthermore, on-site oral based tests in particular enable the implementation of random testing programs, proven to be the most effective type of drug screening. Testing is usually performed by employers, for either pre-employment, random, post-accident, reasonable suspicion, or return-to-duty testing. Oral fluid based testing most closely mimics results found with blood and is preferable for detecting on-the-job drug use or in post-accident applications in this case because the degree of intoxication can be approximated based on the amount of substance.

Detection in saliva tests begins almost immediately upon use of the following substances, and lasts for approximately the following times:

NOTE: Saliva tests are highly sensitive and detection times can vary considerably based on the cutoffs used.

Sweat drug screen

Sweat tests are patches attached to the skin to collect sweat over a long period of time (1-4 Hours). These are almost exclusively used by child protective services, parole departments, and other government institutions concerned with drug use over long periods, when urine testing is not practical.[13]

Drug testing methodologies

The different types of drug tests are tested in very similar ways. Before testing the sample, the tamper-evident seal is checked for integrity. If it appears to have been tampered with or was damaged in transit, the laboratory rejects the sample and does not test it.

One of the first steps for all drug tests is to make the sample testable. Urine and oral fluid can be used "as is" for some tests, but other tests require the drugs to be extracted from urine beforehand. Strands of hair, patches, and blood must be prepared before testing. Hair is washed in order to eliminate second-hand sources of drugs on the surface of the hair, then the keratin is broken down using enzymes. Blood plasma may need to be separated by centrifuge from blood cells prior to testing. Sweat patches are opened up and the sweat collection component is soaked in a solvent to dissolve any drugs present.

Laboratory-based drug testing is done in a two-tiered fashion using two different types of detection methods. The first is known as the screening test, and this is applied to all samples that go through the laboratory. The second, known as the confirmation test, is only applied to samples that test positive during the screening test. Screening tests are usually done by immunoassay (EMIT, ELISA, and RIA are the most common). A "dipstick" drug testing method which could at some future time provide screening test capabilities to field investigators has been developed at the University of Illinois.[14]

After a suspected positive sample is detected during screening, the sample is flagged and tested using the confirmation test. Samples that are negative on the screening test are discarded and reported as negative. The confirmation test in most laboratories (and all SAMHSA certified labs) is performed using mass spectrometry, and is extremely precise but also fairly expensive to run. False positive samples from the screening test will be negative on the confirmation test. Samples testing positive during both screening and confirmation tests are reported as positive to the entity that ordered the test. Most laboratories save positive samples for some period of months or years in the event of a disputed result or lawsuit. For workplace drug testing, a positive result is generally not confirmed without a review by a Medical Review Officer that will normally interview the subject of the drug test.

Types of testing

Pre-employment drug testing

This is by far the most common type of drug test used by businesses[citation needed], however, it is also the least effective[citation needed]. It is considered to be an "intelligence test" by drug testing professionals.[citation needed] It has the advantage of being inexpensive, since only one test per employee needs to be paid for by the company. However, since most pre-employment drug testing is urine-based and subject to sample adulteration or substitution, the effectiveness of this approach has been questioned by federal legislators.[who?] Some organizations have a witness in the room at the time of the testing, but the privacy implications of this, as well as the potential for shy bladder syndrome has limited the use of witnesses outside jails and drug treatment programs. Companies and testing centers that do not use witnesses normally disconnect sources of water from the testing room to discourage dilution, and if there is water in the toilet, it is dyed blue. Other countermeasures, such as making the donor change into a gown, may also be used.

Random drug testing

In the USA, random drug testing is used by a growing number of corporations, drug rehab centers, prisons, the military, police and fire departments, government agencies, and more recently, schools. It may also be used on teens by their parents, or mandated to be performed at school. The objective of a random drug test is deterrence, as the threat of detection is much higher versus other testing methods. Various random selection methods are used, ranging from drawing names out of a hat to using random number generators.

Critics of random testing claim that random drug testing introduces a presumption of guilt, and is a violation of privacy if the drug user is not actually intoxicated during working hours. In addition, urine-based random testing is more likely to catch cannabis users, since THC metabolites are fat soluble and have a longer duration in the body than those of many other drugs.

Post-incident drug testing

Post-incident drug testing is not a very commonly administered test compared to the other two, but the financial ramifications of not testing employees after an accident (or other incident) on the job makes this test worthwhile for most businesses. The point of this test is not necessarily to cause the employee to lose his or her job, but rather to protect the company from liability in the event that the individual is under the influence at the time of the accident. If drugs or alcohol are detected in any significant quantity, the argument can be made in court that the individual was intoxicated on the job, and for that reason, the company should not be held liable for injuries sustained by the employee. This argument, however, can only reasonably be made if blood or oral fluid / saliva testing is used. Urine, hair, or sweat based testing can only detect past drug use. Depending upon the facts of each case, this may help a company avoid litigation completely or may do nothing to help their case. DUI testing would also fall into this category. Another time this type of test may be used is if an employee shows up for work intoxicated, has alcohol on his or her breath, or appears to be impaired in some other way.

The sample should follow chain of custody requirements and should always be sent to a lab after collection. Positive on-site tests that may affect an employee's position or situation should always be followed up with a laboratory test before any action is taken against the employee.

Diagnostic screening

In the case of life-threatening symptoms, unconsciousness, or bizarre behavior in an emergency situation, screening for common drugs and toxins may help find the cause, called a toxicology test or tox screen to denote the broader area of possible substances than self-administered drugs. The test is usually done within 96 hours (4 days) after the estimated time of intoxication. Both a urine sample and a blood sample may be tested.[15] A blood sample is routinely used to detect ethanol/methanol and ASA/paracetamol intoxication. Various panels are used for screening urine samples for common substances, e.g. triage 8 that detects amphetamine, benzodiazepines, cocaine, methadone, opiates, cannabis, barbiturates and tricyclic antidepressants.[16] Results are given in 10–15 minutes.

Similar screenings may be used in to evaluate the possible use of date rape drugs. This is usually done on a urine sample.[15]

Drug testing methods

Urine drug testing

Urine drug test kits are available as on-site tests, or laboratory analysis. Urinalysis is the most common test type and used by federally mandated drug testing programs, yet likely the least effective.

The main disadvantages of urine-based drug test kits are (1.) the ease at which they can be "cheated" via simple adulteration or substitution, unless specimen collection is directly observed, (2.) inability to detect current / on-the-job drug abuse, (3.) the need for bathroom facilities, and (4.) with respect to SAMHSA-5, or NIDA-5, the inability to test for drugs commonly abused/mis-used in current society.

Saliva drug testing

Saliva (oral) drug test kits are very donor friendly, non-invasive and easy to collect the specimen. There is no need for a bathroom to administer the tests. Saliva drug testing tends to detect recent drug use. Also these drug tests are harder to adulterate than the urine drug tests since the sample can be obtained under direct supervision. Depending on the test, up to 8 different drugs could be detected. This method is the best method for determining recent use and is a potential indicator of impairment.

A disadvantage of saliva based drug testing is that it is not approved by SAMHSA for use with DOT / Federal Mandated Drug Testing. Oral fluid is not considered a bio-hazard unless there is visible blood, however, it should be treated with care.

Spray (sweat) drug testing

Spray (sweat) drug test kits are non-invasive. It is very easy to collect the specimen and no bathroom is needed for taking the specimen. The detection window is long and usually can detect drug use up to a couple of hours. These drug tests are relatively tamper proof since they are hard to manipulate. A laboratory is not required for analysis.

The main disadvantage of spray or sweat based drug testing is the fact that they are open to contamination. Also large variations of sweat production rates of possible donors make some results inconclusive. There is not much variety in these drug tests since they are not as popular as urine or saliva drug testing kits. Their prices tend to be higher per test conducted. One main disadvantage of this testing method is the limited number of drugs that can be detected, and the ability to produce instant results.

Hair drug testing

Hair drug testing can provide a much longer window of detection, which is useful for highly safety-critical positions where there is zero tolerance of drug usage.[17] Even if the person being tested has a shaved head (perhaps in preparation for the test), hair can also be taken from almost any other area of the body. This includes facial hair, the underarms, arms, and legs.

Though it is often claimed that hair test cannot be tampered with, it has been shown that this is simply untrue. For example, THC does not readily deposit inside epithelial cells so it is possible for cosmetic and other forms of adulteration to reduce the amount of testable canaboids within a hair sample [10].

Legality and ethics of mandatory drugs testing

United Kingdom

A study in 2004 by the Independent Inquiry into Drug Testing at Work found that attempts by employers to force employees to take drug tests could potentially be challenged as a violation of privacy under the Human Rights Act 1998 and Article 8 of the European Convention of Human Rights.[18] However, this does not apply to industries where drug testing is a matter of personal and public safety or security rather than productivity. European Union legislation is expected in the future to clarify the legal situation regarding workplace drug testing.

United States

Mandatory drug testing entered American life through two separate historical routes. The first was through the common law system, employing precedents philosophically derived from the idiosyncratic rules governing the "king's forest" and the "king's highway". From these arcane precepts are derived the laws which allow legal authorities to detain and test persons under suspicion of driving under the influence of a psychoactive drug.[19]

The second route was more recently constructed and originated from an incident that occurred in the US Navy. After a plane crashed onto the carrier deck of the USS Nimitz in 1981, killing and injuring dozens of personnel, drug testing was instituted immediately. The results revealed a large substance-abusing cohort within the ranks of enlisted persons and officers. As a result of this single incident, the Secretary of the Navy instituted an intensive drug testing and regulation program. These interventions were then adopted by other branches of the service over a three-year period. From these actions was derived the concept of a "drug-free workplace". In consultation with his drug-czar, Dr. Carlton Turner, President Ronald Reagan issued Executive Order 12564. In doing so, he instituted mandatory drug-testing for all safety-sensitive executive-level and civil-service Federal employees. This was challenged in the courts by the National Treasury Employees Union. In 1988, this challenge was considered by the US Supreme Court[20] A similar challenge resulted in the Court extending the drug-free workplace concept to the private sector.[21] These decisions were then incorporated into the White House Drug Control Strategy directive issued by President George H.W. Bush in 1989.[22]

See also

References

  1. ^ "Drugs of Abuse Reference Guide," LabCorp Inc, Retrieved online April 11, 2007.
  2. ^ U.S. Department of Transportation: National Highway Traffic Safety Administration (DOT HS 810 704). Pilot Test of New Roadside Survey Methodology for Impaired Driving. January, 2007.
  3. ^ http://www.erowid.org/chemicals/alcohol/alcohol_testing.shtml
  4. ^ http://www.erowid.org/chemicals/amphetamines/amphetamines_testing.shtml
  5. ^ a b http://www.erowid.org/chemicals/meth/meth_testing.shtml
  6. ^ http://www.erowid.org/chemicals/barbiturates/barbiturates_testing.shtml
  7. ^ a b c http://www.erowid.org/plants/cannabis/cannabis_testing.shtml
  8. ^ http://www.erowid.org/chemicals/opiates/opiates_testing.shtml
  9. ^ a b http://www.erowid.org/chemicals/pcp/pcp_testing.shtml
  10. ^ a b "Analytical And Practical Aspects of Drug Testing in Hair, By Pascal Kintz, 2006"
  11. ^ a b c d http://www.erowid.org/psychoactives/testing/testing_info1.shtml Drug Testing Basics by Erowid, Last Updated Apr 23, 2009
  12. ^ http://www.erowid.org/psychoactives/testing/testing_info1.shtml Drug Testing Basics by Erowid, Last Updated Apr 23, 2009
  13. ^ "Federal Court Drug-Testing Device Under Fire, PharmChem Sweat Patch May Be "Too Good"". 2001-01-05.
  14. ^ Jim Barlow (November 2006). "A Little Dab Will Do It". LASNews. University of Illinois. Retrieved 2006-11-29.
  15. ^ a b WebMD --> Toxicology Tests Author: Jeannette Curtis. Primary Medical Reviewer: Kathleen Romito, MD - Family Medicine. Specialist Medical Reviewer: R. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care, Medical Toxicology. Last Updated: May 9, 2008
  16. ^ Sixteen devices for the detection of drugs of abuse in urine MHRA Report No. MHRA 03078. Report Date: October 2003
  17. ^ Hatala, John W. (2003), The Feasibility of Testing Hair for Illicit Drug Use in the United States Marine Corps (PDF), Monterey, California: Naval Postgraduate School, p. 2, retrieved 2009-05-07 {{citation}}: Unknown parameter |month= ignored (help)
  18. ^ "Drug testing in the workplace: Summary conclusions of the Independent Inquiry into Drug Testing at Work". Retrieved 2008-01-17. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  19. ^ AJ Giannini, JN Giannini. Social ,legal and ethical issues in drug testing. Journal of Nursing: Administration, Health care, Law & Ethics.2:105-111, 2001.PMID 11799872.
  20. ^ . National Treasury Employees Union v. von Raab. 86-1879, US Supreme Court, 1989.
  21. ^ Skinner v. Railway Labor Executives Assoc. 87-15555. US Supreme Court, 1989
  22. ^ NS Miller, AJ Giannini, MS Gold, JA Philomena.Drug testing: Medical, legal and ethical issues. Journal of Substance Abuse Treatment.7(4):239-244,1990. PMID 2290186.
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