A drug test is a technical analysis of a biological specimen - urine, hair, blood, sweat, or oral fluid / saliva - to determine the presence or absence of specified parent drugs or their metabolites.
General information about drug testing in the United States
Drug tests in the United States can be divided into two general groups, federal mandated and general workplace. Federal mandated drug testing started when President Ronald Reagan enacted via executive order, that federal workers refrain from using illegal substances. Subsequent federal legislation required drug testing within the executive branch of government as well as "safety sensitive" occupations within the trucking, mass transit, rail, airline, marine, and oil and gas pipeline sectors. Drug testing guidelines and processes, for federally mandated drug testing, are established and regulated (by the Substance Abuse and Mental Health Services Administration/ SAMHSA, formerly under the direction of the National Institute on Drug Abuse / NIDA. Referred to as the NIDA-5, or standard SAMHSA five panel test, the laboratory based urine test includes marijuana, opiates (codeine and heroin), amphetamine/methamphetamine, and PCP. Unfortunately, these test classes were established decades ago, with little major revision, and do not account for current drug usage patterns. For example, SAMHSA / DOT tests exclude semi-synthetic opioids, such as oxycodone, oxymorphone, hydrocodone, hydromorphone, etc., and other prescription pain medications widely abused in the United States.
While SAMHSA/NIDA guidelines only allow laboratories to report quantitative results for the "NIDA-5" on their official NIDA tests, many drug testing laboratories and on-site tests now offer a wider or "more appropriate" set of drug screens which may be more reflective of current drug use patterns. As noted above, these tests include semi-synthetic pain killers such as Oxycodone (Oxycontin, Percocet), Oxymorphone, Hydrocodone (Vicodin), Hydromorphone; benzodiazepines (Valium, Xanax, Klonopin, Restoril) and barbiturates.
Other drugs, such as meperidine (Demerol), fentanyl, propoxyphene, and methadone are not commonly tested for in most pre-employment situations, however, are being increasing included in random testing.
A confirmation test (usually GC/MS, or LC/MS/MS) can tell the difference between chemically similar drugs such as methamphetamine and methylenedioxymethamphetamine (MDMA or ecstasy).
Detection periods
The following chart from LabCorp gives approximate detection periods for each substance by test type.
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
- 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.
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.
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 cheating (adulteration and/or substitution of the specimen). Sample substitution and adulteration occur frequently, and both are effective methods of avoiding would-be positive tests. While most laboratories performing drug screens test for adulterants routinely, they can not keep pace with the various forms of adulterants available.
Adulterants can be classified into two categories. The first category includes classic adulterants comprising household substances and other chemicals such as chlorine bleach, liquid drain cleaner, white vinegar, glutaraldehyde, sodium nitrite, and pyridinium chlorochromate. The second category includes commercial adulterants, which can be purchased from certain specialty stores (so-called “head shops”), through magazine advertisements, or via the Web. This second class of adulterants includes brand names such as Urine Luck version 6.3, Stealth, Clean-X, Klear, Purafyzit, Instant Clean, Krystal Kleen, and UR’n Kleen. Some of the commercial adulterants represent a repackaging of classic adulterants. One adulterant, for example, Klear, is made of nitrite and affects the tetrahydrocannibinol (THC) confirmation process but not the immunoassay process. Urine Luck 6.3 is actually hydrofluoric acid, which is an oxidant not generally available in the classic adulterants category because of its corrosive nature. Stealth is an enzyme system that generates hydrogen peroxide.
Users can also drink 1 to 2 liters of water to successfully dilute the concentration of drug metabolites in their urine below detectable thresholds, without risking detection. While this results in clear samples that may be rejected on the grounds of being too dilute, the practice is typically successful. A B vitamin will make urine yellow despite this practice of waterloading. Specific gravity testing can be done to identify whether or not the sample is of dilute nature. Vitamin B 3 (niacin) is also frequently used for its reported "flushing" effect, though this is also of disputable adeptness.
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.
Also, the wide availability of at-home drug screens allows an individual to take their own test before they receive one, thus knowing the results ahead of time- giving the user further opportunity to dilute the sample or to find a substitute. At-home drug screens are often Diastix, where the urine is applied directly to the actual drug test. Various tests and various drugs will result in different thicknesses and color intensity . Any line whatsoever indicates a negative test. If there is no line at all, the test is positive for the substance being tested.
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
As the hair grows, it 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, foo
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