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A Drug test is a process using some kind of biological matter taken from an individual to determine previous drug use. Drug testing is a subject of much controversy. Many have argued that it is an invasion of privacy. The accuracy and effectiveness of some tests are also in question, however, if proper steps are followed, including a GC/MS quantitative laboratory confirmation test, drug testing technology is highly reliable.

General information

Drug tests can be divided into two general groups. The first group is the kind most people are familiar with. This type of testing involves the donor giving a sample of some bodily fluid or hair to an employer, doctor, law enforcement official, or a medical testing center. This is normally a sample of urine, blood, hair, or saliva/ oral fluid. After collection from the donor, the sample is sealed with a tamper-evident seal and sent to a laboratory for analysis. The primary advantages of this type of test are accuracy, legal defensibility, and the ability to customize tests for a particular demographic group. The disadvantages are typically costs associated with the need for collection sites (urine, blood), and the delay in receiving results (up to 4 days.)

The second type of drug test is an on-site (workplace, school, or at-home) drug test that does not require a laboratory. These types of tests provide the advantages of lower cost and availability of results within minutes. Furthermore, if on-site tests, such as oral fluid-based or saliva tests are used, the problem of "beating the tests" (otherwise known as sample adulteration or substitution) can be virtually eliminated. On-site tests provide qualitative results, and when supplemented with laboratory-based confirmation tests, can be defended in a court of law.

This article will focus primarily on the first type of test, but will refer to the latter when appropriate.

The NIDA 5

Drug testing in the United States basically began in the late 1980's with the testing of certain federal employs and specified DOT regulated occupations. Drug testing guidelines and processes, in these areas exclusively, are established and regulated (by the Substance Abuse and Mental Health Services Administration, formerly under the direction of the National Institute on Drug Abuse or NIDA) require that companies who use professional drivers, specified safety sensitive transportation and/or oil and gas related occupations, and certain federal employers, test them for the presence of certain drugs. These test classes were established decades ago, and include five specific drug groups. They do not, unfortunately account for current drug usage patterns. For example, the tests do not include "synthetic opiates", such as oxycodone, oxymorphone, hydrocodone, hydromorphone, etc., compounds that are highly abused in America:

1. Cannabinoids (marijuana, hashish)
2. Cocaine (cocaine, crack, benzoylecognine)
3. Amphetamines (amphetamines, methamphetamine, speed)
4. Opiates (heroin, opium, codeine, morphine)
5. Phencyclidine (PCP)

While SAMHSA/NIDA guidelines only allow labs to report quantitative results for the "NIDA 5" on their official NIDA tests, many drug testing labs and on-site tests also offer a wider or "more appropriate" set of drug screens which are more reflective of current drug abuse patterns in the use. As noted above, these tests include synthetic pain killers such as Oxycodone, Oxymorphone, Hydrocodone, Hydromorphone, benzodiazepines (Valium, Xanax, Klonopin, Restoril) and barbiturates in other drug panels (a "panel" is a predetermined list of tests to run). The confirmation test (usually GCMS) can tell the difference between methamphetamine and ecstasy, and in the absence of detectable amounts of methamphetamine in the sample, the lab will either report the sample as negative or report it as positive for MDMA. What the lab reports to the client depends upon whether MDMA was included in the panel as something to be tested for.

Gamma-hydroxy-butyrate (GHB) was not routinely tested for in the early 1990s, but due to increasing use, some labs have added it as an optional test. GHB is rare in pre-employment screening, but is commonly checked for in suspected cases of drug overdose, date rape, and post-mortem toxicology tests. Ketamine (Special K) may or may not be tested for, depending upon the preferences of the entity paying for the test, though testing for it is uncommon. In general, the greater the number of drugs tested for, the higher the price of the test, so many employers stick to the NIDA 5 for financial reasons.

Other drugs, such as meperidine (Demerol), fentanyl, propoxyphene, and methadone are not commonly tested for in most pre-employment situations. These drugs are more likely to be included in tests for certain demographic groups (such as healthcare workers, drug rehab patients, etc.)

Hallucinogens other than cannabis and PCP, such as mushrooms (psilocybin), LSD, and peyote (mescaline) are rarely tested for.

Detection periods

The following chart gives approximate detection periods for each substance by test type. The ranges depend on 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 thus of blood. The only exception is THC. Oral fluid will likely detect THC from ingestion up to a maximum period of 18-24 hours. NOTE 2: Urine can not detect current drug use. It takes approximately 6-8 hrs. post-consumption for drug to be metabolized and excreted in urine. Simirlarly hair requires two weeks, and sweat, seven days.

Five common types of drug tests

Urine drug screen

Also known as urinalysis, this procedure requires that one provide a sample of urine. Either a test card is used on site for immediate results (see "General" section), or the sample is sent away to a lab to undergo gas chromatography/mass spectrometry (also known as GCMS), high performance liquid chromatography or immunoassay analysis. Sample substitution or adulteration have become a significant issue in the United States due to the prevalence of synthetic and/or drug-free urine and a wide range of adulterants on the internet. Some people attempt to defeat a urine test by drinking copious amounts of water, however, a sufficiently diluted sample may be rejected due to its clear color. Samples that are too clear may be flagged and tested for specific gravity. If the sample fails the specific gravity test, the sample is rejected and the dilution is reported to the entity that ordered the test. Some diuretics and herbal extracts, such as goldenseal, are marketed as a quick "detox" from controlled substances, but their efficacy is questionable. Some types of urinalysis can even detect the use of these "detox" products. One of the methods to test for adulterants is to add some amount of an actual drug to a small portion of the sample and then retest that portion. If a masking agent is present in the urine, the resulting drug test will have a negative result despite the fact that a drug was added. This situation is also usually reported to whoever ordered the test.

Hair drug screen

Hair testing is quite accurate and can go back 6 months or longer, showing any controlled substances used in a sort of timeline. As hair grows out, any drugs used are encased in the hair shaft, so the longer the hair, the longer back in the individual's drug history the lab can detect. Most legitimate testing facilities, however, only use hair within about 3-5 cm of the scalp, and discard the rest. This limits the detection history to about 90 days, depending upon the rate of growth of the individual's hair. Some people attempt to circumvent this through shaving their heads. In the absence of the required amount of hair on the scalp, body hair can be used as an acceptable substitute. Additionally, for pre-employment hair testing, the inability to obtain a sample may be grounds for not hiring the individual.

Blood drug screen

Blood testing is usually performed by employers or insurance companies, usually after some kind of accident, such as one in the workplace. Blood is preferable in this case because the degree of intoxication can be approximated based on the amount of substance in the blood. For this reason, blood is the preferable fluid in emergency room situations where a drug overdose is suspected. In addition, by comparing the ratio of metabolites to the parent drug, the time of drug use can be estimated. This type of test is helpful to employers when there is a workplace accident because judges and juries are unlikely to award damages if it can be proven that that a person was impaired at the time of the accident. Blood may contain pathogens and must be treated as a biohazard by the lab, and as such must be disposed of in a specific manner (by contrast, urine is considered sterile, and the excess may be poured down the sink after testing). For this and other reasons, this test is expensive to administer, and is not commonly used.

Another time this test is regularly used is in DUI cases where the individual refuses to give a urine sample or blow into a breathalyzer machine. Many states allow police officers to forcibly draw blood in this situation. Some police and sheriff's departments use urine samples exclusively (instead of blood) because they are cheaper and less difficult. This is a bad idea from a legal point of view, because any good defense attorney can make the case that their client used the alcohol or drug(s) before driving. Without a blood test to prove that the person was intoxicated at the time of an accident, such a case may well be dismissed.

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 can not be adulterated. Furthermore, on-site oral based tests in particular enable the implementation of random testing programs, proven to be the most effective type of drug free workplace drug screening. Oral fluid based tests are as accurate as urine and can be obtained from quality suppliers in the United States. 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 in the blood. The Victorian Police in Australia are also using random saliva-tests to detect drivers under the influence of amphetamines and cannabis, typically to be able to fine more drivers and create tax revenue for the state, which is a typical practise in Victoria. ^{[citation needed]}

Sweat drug screen

Sweat tests are patches attached to the skin to collect sweat over a long period of time (10-14 days). 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. The patches have security features that keep them from being covertly removed and then reapplied without the knowledge of the testing agency. At the end of the test period, the patch is removed by a social worker or parole officer and sent to a lab for analysis. If the person has used any drugs during the period that the patch was in place, they will test positive for that drug. This type of testing has fallen out of favor with government agencies due to documented problems with certain drugs.

Drug testing methodologies

Once the sample arrives at the lab for analysis, 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 lab 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 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 (EMIT for urine and blood, and ELISA for hair). The screening tests are typically less sensitive and more prone to false positives and 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.

Controversy

Drug testing has been a controversial subject ever since it was introduced in the latter half of the twentieth century. Opinions on drug testing range from the belief that drug testing is always a violation of an individual's personal privacy to the suggestion that all companies and schools should do random testing. Drug testing, however, has proven to be extremely effective if implemented properly and used as a deterrent to drug abuse. It's important to understand the various ways drug testing can be used.

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. Unfortunately, however, pre-employment testing is also the least effective form of drug screening, as it is known that over 70% of drug abusers are employed. Furthermore, 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. There are two major groups of people this type of test will catch. The first is the true drug addict that is unable to stop taking the drugs, even for a few days, and will thus fail this test every time. The second type of person normally caught by this testing regimen is the person who isn't informed enough, or for some other reason does not stop using the drug(s) before the test. In this second case, some employers consider this more of an intelligence test than anything else, since this second individual is presumably capable of quitting, yet doesn't do so before applying for the job.

Random drug testing

This is the most controversial type of drug testing regimen, however, is also the most effective at deterring drug abuse. It is usually used by corporations, drug rehabilitation centers, prisons, and more recently, schools. This method may also be used on teens by their parents. The point of a random drug test is deterrence, as the threat of detection is much higher vs. other testing methods. This has the advantages of catching most drug users sooner or later, and provides the best overall return on investment Companies use various ways of determining who gets tested, ranging from drawing names out of a hat, to using more defensible methods such as robust random number generators. The goal of this test is to discourage drug use among employees, inmates, or students by not telling anyone who or when they are to be tested in advance.

Post-incident drug testing

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 major 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 after some kind of event, such as an accident or suspected intoxication. companies are required to give employees a weeks notice before the test can be given.

Conclusion

Though drug testing is notably effective, each of these three testing regimens is unique in the way it is performed and its goals, and each also sparks different degrees of debate. Most people don't have a major problem with post-accident testing, since it is fairly rare, and will likely never happen to them. Both pre-employment testing and (especially) random testing can be hot-button issues for some civil libertarians. One argument against these tests is that they are invasive because people are sometimes required to urinate in front of others. A bigger point of contention is the question about whether it is ever appropriate for an employer to dictate what an individual can or cannot do in the privacy of their own home. For example, though illicit drug use is by its very nature illegal, the typical example is that of a person who occasionally uses a particular drug at home, perhaps in the evening or on weekends, but is otherwise a good employee. Some drugs, such as marijuana remain detectable for a week or more after one use, (in the case of urine tests) and by Monday morning the person is not intoxicated in any way, yet fails the drug test and loses his job as a result. The concern of civil liberty advocates is that one's employer should not be allowed to terminate an employee for non-work-related reasons. The use of a drug on the weekends would classify as such, provided the employee's performance on the job did not change as a result of drug use. Some samples types, such as oral fluid / saliva, however, can be used to eliminate this concern. Marijuana is only detectable for up to 18-24 hours via oral fluid. Some companies have taken this idea even further, by testing for nicotine, a legal substance, and terminating employees who test positive for it. The ultimate legality of testing for nicotine is still in question, since tobacco is legal for adults in most countries.

See also

Urinalysis

External links

• Oral fluid / Saliva Drug Screening
• Drug Testing: An Overview
• Official National Institute on Drug Abuse (NIDA) Website
• Drug testing kit
• Official Substance Abuse and Mental Health Services Administration (SAMHSA) Website
• Law Enforcement Against Prohibition (LEAP) Home Page
• Erowid Drug Testing Vaults: The Basics
• The Drug Testing FAQ (v.4.11)

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