Drug Detection

Drug detection plays a significant role in many applications and industries. Referring to the process of testing bodily fluids and other samples for the presence of narcotic, prescription, controlled, and other illicit substances, toxicology testing is critical in healthcare, employment, social services, and beyond.

Reasons for Drug Detection

The rationale for drug testing can vary greatly based on information desired and overall objectives. In some cases, drug screenings are preventative in nature, testing to ensure an absence of substance. In others, it’s proactive, working to ensure medical regimens are adhered to as necessary.

Employers

Employers in the United States commonly demand drug screenings for several purposes throughout the course of employment. First, some employers value a drug-free workforce and require clean drug panels prior to hiring. More stringent employers may continue to periodically test during an employee’s tenure, although this is less common. The reasoning for this may be for employee and client safety as well as liability reasons.

Accidents on a job site may also warrant drug testing, like a commercial truck driver who gets into an accident. In these situations, employers may choose to drug test to ensure intoxication was not a factor in damage to both employees and company property as well as to customers and the general public.

Prescription Adherence

In some circumstances, it is necessary to determine that a patient is adhering to a prescribed medication regimen. This is particularly true in the cases of mental health or for pain management patients at risk of substance abuse. Drug testing for prescription adherence is especially common for those who have been involuntarily committed, or who have been sentenced to time in a treatment center as a part of a criminal conviction. This type of testing can also be used in clinical trials to test levels of substances to confirm proper adherence and outcomes.

Substance Abuse Treatment

Drug testing in substance abuse treatment can occur in one of two ways: to ensure participants are not using drugs, or to confirm that a particular treatment regimen is being followed.

Many rehabilitation centers test on a regular basis, like once a day during detox or once a week during inpatient care. Tests are often performed at random so that participants can’t attempt to avoid drug detection. Tests can often be triggered under the assumption that a substance has been used (based on behavioral symptoms).

Tests may also be performed to ensure a particular regimen, like methadone, suboxone, or Antabuse, is being followed as a part of treatment.

Welfare

Drug testing for welfare recipients is highly controversial but does occur in some areas of the country. 15 states currently have laws on the books regarding drug testing before receiving welfare – Alabama, Arkansas, Arizona, Florida, Georgia, Kansas, Michigan, Mississippi, Missouri, North Carolina, Oklahoma, Tennessee, Utah, West Virginia, and Wisconsin – and others have strongly considered this form of testing to ensure welfare recipients are worthy of receiving benefits. In some cases, these policies have been struck down by a judge before going into effect, but other states have rolled out plans to lackluster results.

Despite the beliefs of those who have promoted these laws – that more welfare recipients in the U.S. have a drug addiction problem than the general population – that has not been proved to be the case. For example, Tennessee tested 800 applicants for state benefits and only one test came back positive for substance abuse.

How Testing Is Done

Drug testing isn’t a one-size-fits-all procedure, and testing is often performed in various ways based on the kind of test, the circumstances, and the situation.

Defining Drug Testing

The mechanisms of drug testing may seem straightforward – a sample is collected, and then processed for drugs – but there is actually more variation than is immediately clear. In fact, drug tests often fall into various classes, including confirmatory, definitive, screening and presumptive panels.

Presumptive

Many initial drug tests, like drugstore tests and basic lab tests, are of the presumptive variety. This means that they presume an outcome rather than definitively determine an outcome. They are not definitive, as they are only able to test a certain amount of chemicals with a lower level of certainty. These may be referred to as a screening test or a ‘POC’ (Point of Care) test, as they are administered on the spot and are able to yield a result. The results of a presumptive test are either:

  • The sample is definitely not positive for a particular substance, or
  • The sample could be positive for a particular substance

For example, if a doctor in an inpatient rehabilitation center believes that a patient is using heroin again, a presumptive test will be administered to determine whether or not this is a possibility. Presumptive tests are generally in a panel form, like a 12-panel test that screens for 12 of the most common substances. These often offer instant results, but do not provide absolute answers. From this presumptive test, the sample is very often sent on to a more specific and accurate test. This is especially the case if the test was positive but unable to be specific.

Reflex Test/Confirmatory

A confirmatory or reflex test is a drug test that confirms the results of a presumptive test. In most testing situations, a presumptive test is run for initial results, and can then be confirmed in a lab setting. For example, if a presumptive test is run under the assumption of heroin use, a confirmatory test will test for heroin and other opiates with a similar chemical structure. Captiva Lab offers comprehensive confirmatory testing for tests of all varieties and circumstances.

Confirmatory tests can be run with or without a presumptive test.

Definitive

Definitive tests, rather than subjecting a sample to a small panel of common drugs, apply a comprehensive test to the sample for detailed results on all available substance types. Rather than screening for a panel to rule a substance in or out or testing to confirm a particular substance, are exactly as the name implies: the definitive result for as many drugs as necessary using lab-grade processes. Definitive tests can be run on 100 or more substances at a time, ensuring an accurate result under any circumstances. Captiva Lab performs definitive testing on samples of all kinds and under all testing objectives.

Steps of Drug Detection

Testing for Substances vs. Metabolites

While the mechanics of a drug test imply that substances themselves are tested for, this is not necessarily the case. Some tests actually screen for metabolites, or the remnants of drugs once processed, or metabolized, by the body. Metabolites can last in the body longer than a substance itself, resulting in longer testing windows. For example, a test for cocaine may look for cocaine itself, or for its metabolite, benzoylecgonine. The presence of many drugs do not present themselves very long in a speciment (if at all), while the metabolites do.

Blood tests screen for actual substances, while urinalysis, hair tests, and saliva tests look for metabolites. This can explain the differences in detection chances between different forms of tests.

Sample Types

Samples for drug screens come in many different shapes and sizes and vary based on who is performing the testing, desired results, and the form of test in use. Each of the specimen types are useful, in degrees, for detecting the presence of drugs. Some, however, are more practical and best suited for widespread use.

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    Urine Testing

    Urine testing uses a sample of urine to screen for drug metabolites. Urine samples are often taken in private by the subject being tested due to the nature of collection, making urine tests among the most common targets for cheating. Urine tests may not accurately represent the effects of drugs on the subject at the time of testing, as chemicals must break down the chemicals before they appear in the urine. It is, however, the most common method and an excellent indicator of regular or long-term drug use.

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    Oral Fluid (Saliva) Testing

    Oral fluid testing, also known as saliva testing, is a common and precise form of screening that uses a simple cheek swab to collect samples for testing. Saliva testing is considered to be one of the most precise and accurate methods, in part due to the challenges in falsifying samples during collection. Oral fluid tests also screen for metabolites, much like urinalysis.

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    Blood Testing

    Blood testing is a less common drug test alternative in non-clinical atmospheres due to the challenges in safely obtaining a sample without trained personnel. Blood panels have shorter detection windows in virtually all circumstances; blood tests screen for the presence of physical drug elements and not metabolites, reducing the time present in the body.

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    Hair Testing

    Hair testing is an alternative to blood, urine, and saliva testing that is both convenient and effective. Hair samples can be obtained quickly and painlessly, and drug metabolites often last longer in the hair than in other areas of the body. However, hair testing is more costly to process and relies on a delay between use and testing. While saliva tests, for example, can detect use within hours, drug metabolites may take days to appear in the hair due to growth patterns. When hair samples are done, it is often in a confirmatory role for previously found results.

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    Breath Testing

    While not generally performed in a lab setting, breath testing is a possibility for some drugs. The best example of this is a breathalyzer test administered by law enforcement in traffic stop scenarios. Other substances, like amphetamines, can also be detected in the breath, but this method is not commonly used for routine testing. Technology is emerging that may make this method more common, however, it is not yet widespread.

Drug Detection Windows

Due to the differences in drug testing opportunities, drug detection windows can vary greatly. For example, in a blood test, evidence of use is generally available for up to 24 hours, while hair tests can provide results for up to 90 days.

Factors Affecting Testing

Testing method plays a large role in the outcome of a drug test, but it isn’t the only factor. There are numerous other elements that contribute to drug detection windows, including:

  • The amount of drug used
  • Frequency of use
  • The particular drugs used
  • Metabolism, genetic variations, and personal health
  • Fluid consumption after intake
  • Diet affecting drug presence
  • Accuracy of testing equipment

Fraud Attempts

The desire to tamper with drug tests is extremely common and has generated an entire industry promising to ‘beat the drug tests’. This is obviously more common among those who may be penalized if tests come back positive. Urinalysis tests are the most common targets for fraud due to widespread use of the nature of the test and it’s private collection, but almost any method can be tampered with. Common methods of tampering include:

  • Excessive water intake to flush the system
  • Cranberry juice and other detox formulas
  • Synthetic urine
  • Urine substitution
  • Detox shampoo
  • Hydrogen peroxide swallow or gum
  • Excessive mouthwash

A professional collection facility can safeguard against many types of fraud and a professional lab is well-equipped to detect samples that have been tampered with. Accurate screening for potential abnormalities identifies an invalid, illegitimate or falsified sample.

Effective Drug Testing

Drug testing can be an important part of everything from medical care to employment, serving an extensive array of issues under a wide variety of circumstances. At Captiva Lab, we are available to handle toxicology panels for all drug detection purposes, including confirmatory and definitive test results. Please contact us today to learn more.

Sources

  • http://www.canorml.org/healthfacts/drugtestguide/drugtestdetection.html
  • https://www.homehealthtesting.com/drug_test_detection_times.php
  • http://www.forensicsciencesimplified.org/tox/how.html

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