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Methodologies of Drug Testing

Drug Testing Methodologies

Drug Testing

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 lab. 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 (Enzyme Multiplied Immunoassay Technique|EMIT, ELISA, and RIA are the most common). A "Wiktionary:dipstick|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 at Urbana-Champaign|University of Illinois. Screening tests are typically less sensitive and more prone to Type I and type II errors|false positives and Type I and type II errors|false negatives than the confirmation test.

Once 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 labs (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 labs save positive samples for some period of months or years in the event of a disputed result or lawsuit.

methods of drug testing

D.O.T. mandated tests require a Medical Review Officer, an M.D. or a D.O., to contact the donor to determine if an alternative medical explanation justifies the presence of the drug identified by the lab. Doctors need not be licensed in the state where the donor resides nor where the test was administered. She must be a licensed physician in one state within the U.S. to participate as an MRO. This substantially limits the degree of influence from out of state medical review boards. In addition, many courts do not allow a private cause of action against MROs, labs, collectors, etc. If an MRO and a D.O.T. participating employer conspire to falsify drug test results, the innocent donor has little if any recourse. The perception that American citizens are "innocent until proven guilty" is just that. Specific mandated drug testing regulations which entitle access to drug testing chain of custody and procedural evidence from the commercial sector may be discounted or ignored by the ODAPC and government agencies. In other words, the government may chose not to enforce their own regulations. To address negligence and abuse, agencies may utilize a PIE (Public Interest Exclusion) to restrict doctors, labs, hospitals and others from participating in D.O.T. testing. Since the implementation of this kind of testing over a decade ago with tens of millions of tests performed, a PIE not has been issued. [needs citation as to accuracy of tests]

How Do They Do Drug Testing?

Drugs eventually show up in your body fluids and hair in one form or another. So, you'll be asked to "donate" a sample (specimen) of one of the two, which is submitted to a drug testing lab for chemical analysis.

   * Because your hair grows, certain drugs can be detected for longer periods historically but might not reveal recent use.
   * Blood analysis is the most accurate, but pricey and invasive, and not allowed in the Federal drug testing at this writing.
   * Saliva and sweat analysis are accurate, but not yet popular methods at this writing.
   * Urine analysis is less invasive than blood analysis, typically least expensive, can detect infrequent or recent single use.

Millions of users; Drug Testing is Big Bucks

Then your specimen is off to a drug testing lab, where they'll typically test it for the drug itself or the substances (metabolites) produced by your body when it processes (metabolizes) the drug. If they follow the Federal drug testing guidelines, they'll perform an initial screening and then confirm the results with more sophisticated tests.

Under the Federal guidelines, drug testing has two cutoff levels for positive detection. That is, labs that follow the guidelines consider drug testing to be negative if detection is below either cutoff level. In the case of urine analysis, drug testing cutoff levels are measured in nanograms per milliliter (ng/ml). For example, an initial screening for marijuana must show at least 50 ng/ml, and then confirmatory tests must prove at least 15 ng/ml. If the initial screening doesn't show at least at least 50 ng/ml, then it's considered to be negative and the confirmatory tests aren't performed.

But, to put it into perspective, a gram is only thirty-five thousandths (0.035) of an ounce, and a nanogram is a mere one-billionth (0.000000001 or 10-9) of a gram. So, we're talking about microscopic particles measurable in only a few drops of urine. Molecules. Consequently, even infrequent, recreational drug use might cause employees to fail drug testing.

Drug Testing Standards and Accuracy

The accuracy of drug testing is an area where I’ve decided to neglect all statistics. Those who oppose drug testing provide numbers indicating a high level of false positives. Those who favor drug testing provide numbers indicating high levels of accuracy. The fact is that accuracy varies widely from lab to lab. Generally speaking, NIDA labs are accurate. Clinton writes:

NIDA (The National Institute of Drug Abuse)

NIDA is the government organization responsible for regulating the drug-testing industry. The vast majority of urine drug screens done these days conform to NIDA specs, and ALL testing associated with the government (department of transportation, etc.) complies with the NIDA standard. It is NIDA that decides what the “safe” cutoffs are to avoid false positives…. Despite what you might hear on the net, urinalysis, if done correctly, is a very accurate scientific procedure. I know of no labs that simply report the results of the initial EMIT screening without confirming the sample on GC/MS. The fact is, labs WANT you to test negative, because then they only have to run an EMIT test on your urine (a few cents). If you test positive, they must then confirm the positive result on GC/MS, which is considerably more expensive. . . . Incidentally, the machine which tests the hair is a relative of the GC/MS, but is FAR more precise. It can accurately detect levels of THC in a solution that are below 1 ng/mL!

CAP (College of American Pathologists)

Certifies laboratories the way NIDA does. NIDA keeps it’s labs in check by sending positive and negative double-blind samples. Lab personnel does not know what samples came from NIDA. If the lab results are wrong, NIDA may take away the labs certification. Only labs that perform the GC/MS on site can be NIDA certified. Labs that send samples to another laboratory for GC/MS confirmation are ineligible for NIDA certification. “Drug testing when done properly with all required controls and confirmation procedures is very accurate and reliable” (anon1).

Lab Certification

Not all labs are NIDA/CAP certified. Some labs do not properly and thoroughly clean the GC/MS equipment. Some labs don’t even do a GC/MS confirmation! Some labs use cheap alternative methods to reduce expenses.

Many human errors occur in labs and cause inaccurate results. Some are careless or irresponsible errors, and some errors are accidents. Human error can ruin the results of ANY test, screening or confirmation GC/MS.

The only lab you should be concerned with is the one that is testing you. Only Federal jobs require NIDA standards. Your typical private employer may use any lab s/he chooses, which would very likely be the least expensive. Businesses don’t always choose NIDA labs that follow-up a positive screening test with a confirmation GC/MS.

Procedures used

In the workplace, an EMIT screening is typically used, with a CG/MS confirmation if the EMIT is positive. However, this is not a rule; employers can, and some do, use unusual procedures. Some employers use the RIA, and some use the hair test. The government uses RIA. They may or may not supervise the subject. Olympic athletes must be monitored by courier after a competition. The courier stays with the athlete until the athlete urinates, with a time frame of up to sixty minutes.

False positives

No laboratory process is completely free from error. The GC/MS test is virtually error free, but the EMIT is far from accurate. There are some false positives you should avoid if you’re getting an EMIT test. Take this seriously; false positives run high. If you know that there will be a GC/MS confirmation test, you can disregard this section. It would be too lengthy to list all of the false positives here. Jeff Nightbyrd’s “Conquering the Urine Tests” pamphlet lists a majority of the false positives in detail. (If you are clean, want to get back at the testing industry for conducting these absurd tests, and know that there will be a confirmation test, you could consume several false positives. This would force labs to pay for the high priced GC/MS test, eventually drive up test expenses. You will still pass the test as long as you didn’t use any true positives.)

Ibuprofen

Ibuprofen is a common pain reliever that (even in low dosages) used to cause a false THC positive on the EMIT test. The EMIT has been changed to use a different enzyme to eliminate false positives due to Ibuprofen. Ibuprofen in very high doses will still interfere with both the EMIT and the GC/MS. There is some conflicting data here because some sources say that the GC/MS tests can distinguish between Ibuprofen and THC (as well as other over-the-counter drugs).

Cold remedies, pain relievers, hay fever remedies, & diet pills

Decongestants and diet pills result in false positives for amphetamine use in one third of the test samples given to 40 of the countries leading laboratories. There are roughly 300 over-the-counter drugs that cause false positives on the EMIT.

Antibiotics

Certain antibiotics (like Amoxicillin) are claimed to cause a positive for heroin or cocaine. My expert source was unable to verify this, so I regret that there is some uncertainty here.

Melanin (black skin)

Melanin is the brown pigment that protects your skin from UV rays. It was raised as a discrimination issue in the 1980’s, and argued that melanin’s molecular structure is similar to that of a THC metabolite. Subsequent research revealed flaws in the data. Melanin was found to have no effect on THC metabolite testing.

DHEA

DHEA taken by AIDS patients will cause a false positive for anabolic steroid use.

Dental Treatment

Caine products (like novacaine) used in dentistry have been known to cause false positives for cocaine.

True positives (legitimate)

Some legal products actually contain small amounts of illegal chemicals. All tests, including the GC/MS, will test you positive because the metabolites derived from the true positive are identical to the metabolites of the illegal drugs. One exception: poppy seeds will not cause a positive GC/MS (explained below).

Poppy seeds

Poppy seeds, usually on breads, contain traces of morphine, and lead to positives for opiates. According to Dr. Grow, eating a pastry filled with poppy seeds will bring results showing that you are a *high level* opiate user. Harold Crossley, a nationally known chemical dependency expert, said you would have to eat 100 poppy seed bagels to score a positive on a drug test. When taken into account that very few poppy seeds are sprinkled on bagels, you can see that poppy seeds from a hundred poppy seed bagels will easily fill a single large pastry. Purim cookies, a Jewish food known as Hamantashen, may have five to six tablespoons of poppy seeds. A couple Purim cookies may cause a positive test. Poppy seeds can be distinguished from illicit drugs on the GC/MS test. Although poppy seeds have the same metabolites as opium, these metabolites are shown to have different patterns when viewed with the GC/MS.

Testosterone supplements

Orchic extract (found in bull’s balls) will give a positive for anabolic steroid use. It is a legitimate substance that causes the test to imply that you abuse steroids.

Types of Drug Testing

Drug testing can be performed in a number of situations for a number of reasons. We will look at a few below.

Pre-employment Drug Testing

This is by far the most common type of drug test used by businesses. 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. 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

Where's the trust?

This is both the most effective drug deterrence method and the most controversial type of drug testing. Random drug testing is mandated by the U.S. Department of Transportation, which means that many employers in the USA have no choice but to implement random drug testing programs. Even when random drug testing is not legally required, many organizations use small scale random drug testing as an effective deterrence. Random drug testing is not a violation of the Fourth Amendment to the United States Constitution which protects the right of citizens "to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures." The United States Supreme Court ruled in Skinner v. Railway Labor Assn., 489 U.S. 602 (1989) that random drug testing is permissible for employees in safety sensitive positions. Justice Kennedy, speaking for the majority, wrote: [T]he Government interest in testing without a showing of individualized suspicion is compelling. Employees subject to the tests discharge duties fraught with such risks of injury to others that even a momentary lapse of attention can have disastrous consequences based on the interest of the general public [...] While no procedure can identify all impaired employees with ease and perfect accuracy, the FRA regulations supply an effective means of deterring employees engaged in safety-sensitive tasks from using controlled substances or alcohol in the first place.

In the United States today, 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. This method may also be used on teens by their parents, or mandated to be performed on teens at school. The point of a random drug test is deterrence, as the threat of detection is much higher versus other testing methods. Various questionable methods are utilized to determine who gets tested, ranging from drawing names out of a hat, (Government mandated testing requires a scientifically provable method of selection.) to using more defensible methods such as robust random number generators. However, many random drug testing selection systems are legally indefensible because there is nothing to prevent users from targeting individuals by regenerating names with the random generator until the desired result is produced. (Computer generated random selection should have traceable data to validate the legitimacy of the selection.) Most systems have no tamper-proof audit trail (database records are easy to change, so employers or their testing agents must not have access to the audit trail records for the random selection to be defensible). Finally, hiring third parties to randomly select drug testing subjects is not legally defensible because there is no way of proving that there was no collusion to select a specific individual. (I don't believe this is true. A scientifically random selection process is legally defensible.) You are correct that many loopholes plague this system and many people have lost their jobs, reputations, college savings and their homes without as much as an apology from the drug testing giants and the government.

Many apparent conflicts-of-interest exist among service providers and government authorities. In fact, forbidden relationships thrive. The firewalls assuring separation and impartiality don't work. By cultivating relationships forbidden by the regulations the credibility of the entire government sponsored testing program is jeopardized.

Drug testing

Unfortunately, courts throughout the United States are divided on the issue of the right of individuals to bring lawsuits regarding violations of these regulations. In other words, if a laboratory failed to maintain quality controls and your specimen was contaminated at the lab, (this happens) resulting in your termination, many courts deny you and me a legal remedy. Some courts hold that the government created and published strict criteria for laboratories and all other service providers to follow to prevent this kind of failure, thereby giving us substantial "built-in" protection. Through the denial of a private cause of action in these kinds of cases, someone could sabotage your test intentionally with complete impunity. In Drake, after 10 years of legal battles, mostly pro-se, a New York appeals court concluded recently that the language of the 1991 Omnibus Employee Testing Act does not bar common law torts. This is a significant break through for the tested, at-will employee. It is just a beginning, but it is an important legal step in the direction of protecting innocent workers.

Eisenhower warned America of the dangers of a "military industrial complex." The same dynamics have created a collaboration between our government and the commercial drug testing industry.

The goal of random testing is to discourage drug use among employees, inmates, or students by not telling anyone who or when they are to be tested in advance. However, critics claim that random testing introduces a presumption of guilt, and is a violation of privacy if the user is not actually intoxicated during working hours. In addition, 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. Many people believe that this indirectly encourages the use of much more dangerous and harmful drugs that are excreted from the body faster.

Post-incident Drug Testing

Kee-RASH!

This 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 isn't 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 goal of these tests is to protect the entity from litigation, so they are only given on an as needed basis.

It should be noted that in most areas, blood testing is the only legally defensible means for detecting drug use after an incident, although saliva testing is gaining acceptance. 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. Laboratory tests (urine or blood) are the only legally recognized tests in most states as well as in most non-U.S. countries.

Return to Duty Drug Testing

Return to duty drug testing is typically given after a period of absence from your job. You may take an extended leave for personal reasons, there may be a temporary lay-off from employment, etc. Any long term absence may result in a return to duty drug test if your employer or their insurance company mandates it.

On the good side, most return to duty drug testing is usually mandated by general company policies (in other words they must give them to all employees, not just single some out), and you will generally have notification and time to prepare for this type of drug test.

Return to duty drug testing is typically a urine drug test with the results returned on site. The reasons for this are that urine drug tests are the cheapest forms of drug testing, on site testing provides the quickest results and your employer has no concrete reason to suspect drug use. The drug test itself is usually performed to satisfy your employers' insurance provider.

For Cause Drug Testing

Acting a little weird at work? Stumbling about or sleeping at your cubicle? Frequent tardiness at the start of your workday or returning from lunch?

These and many other reasons (actually about anything your employer can dream up), is 'For Cause' Drug Testing.

Pros and Cons of Drug Testing Methods

There is no perfect drug testing method. Each method has some advantages and disadvantages. What makes a drug testing method good or not so good is more related to the needs of the person.

Urine Drug Testing

Pros: Urine drug test kits are available as on-site tests, or laboratory analysis. Referred to as "the gold standard", urinalysis is the most common test type and used by federally mandated drug testing programs.

Cons: The main disadvantages of urine-based drug test kits is are (1.) the ease at which they can be "cheated" via sample 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 used in current society.

Saliva Drug Testing

Pros: 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 is great at detecting very 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. Results can be read in minutes and there is no need for a lab. Depending on the test, up to 8 (5 or 6 at a time) different drugs could be detected. This method is the best method for determining current use and impairment.

Cons: The main disadvantage of saliva based drug testing is lack of awareness in the market, as well as misinformation spread largely by laboratories and TPAs (third party administrators), who stand to lose money as saliva testing continues to replace traditional urine-based techniques.

Spray (Sweat) Drug Testing

Pros: Spray (Sweat) drug test kits are non-invasive and donor friendly. 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 weeks. These drug tests are relatively tamper proof since they are hard to manipulate. There is no need for a lab and you can get results in minutes.

Cons: 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 a little higher per test conducted. One main disadvantage of this testing method is the limited number of drugs that can be detected.

Hair Drug Testing

Pros: Hair Alcohol Testing can provide a much longer window of detection. Cons: Cannot be used if a donor has no hair. Expense of the hair drug testing process.

Blood Drug Testing

Pros: Blood drug testing has a very short detection time, normally within 12 hours which means blood drug testing can detect recent use unlike other types of drug tests.

Cons: There are many legitimate concerns about the collection process for blood drug testing. With the fear of blood borne infectious diseases, drug testing with blood is not usually the preferred method. Blood testing is the least used and recommended form of drug testing because of the invasiveness of the collection, the need for skilled sample takers and the extremely short detection period.

External Links

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See Also

Pass A Drug Test
Drug Testing
Drug Test
Drug Testing In The Workplace
Drug Test Detection Times
Types Of Drug Testing
Hair Drug Test
Urine Drug Test
Saliva Drug Test
Sweat Drug Test
Blood Drug Test