Testing Urine, Blood, Hair, Saliva, Breath, Etc. To Detect The Use Of Alcohol And Other Drugs
Related:
- Table: Recommended Cut-Offs, Metabolites, and Cross-Reactors in Urine Drug Tests
- Table: Recommended Cut-Offs for Substances and Metabolites in Hair to Identify Drug Use
Page last updated May 25, 2023 by Doug McVay, Editor.
1. Positivity Rates of Workers in the US Subjected to Drug Use Testing, by Category According to Quest Analytics, the positivity rates in 2021 of workers in the US who were subjected to drug use testing in the context of employment are: Quest Diagnostics (2022). Drug Testing Index and Industry Insights: 2022 Annual Report and Industry Insights. |
2. Definition of Drug Metabolite "A drug’s metabolite is the compound produced when the body processes a particular drug. Identifying these compounds is the focus of workplace drug testing analysis. Marijuana possesses the greatest total number of detectable metabolites at 31 but fewer major components. For amphetamines, no metabolites are identified because these substances normally pass through the body essentially unchanged in chemical structure." "Drug Retention Times," Prepared for US Dept. of Energy Office of Security Policy, by the Center for Human Reliability Studies (Oak Ridge, TN: Oak Ridge Institute for Science and Education, May 2007), p. 1. |
3. Prevalence of Employment-Related Testing for Use of Alcohol or Other Drugs "While almost two-thirds of respondents drug test all candidates, the remainder of companies drug test only candidates for specific positions. The percentage of companies with a policy to test all candidates dropped by 12% since our 2018 survey." Companies That Subject Workers to Tests for Alcohol or Other Drugs: "Employment Screening Benchmark Report, 2019 Edition," HireRight, Inc., 2019. |
4. What Urine Drug Testing Can and Cannot Measure "Urine drug tests, which are the least expensive and most frequently used form of drug test, can generally detect marijuana use within the past week; cocaine, heroin and other 'hard' drugs used within the past two days; and alcohol use within the past several hours (though alcohol is not often included in drug screens). Drug tests cannot measure frequency of use, nor do they indicate the severity of impairment or whether an individual has a substance use disorder that requires treatment. In addition, without medical review and confirmation testing on initial positive results, 20 urine screens also cannot distinguish between the illicit use of street drugs and the legitimate use of certain prescription and over-the-counter drugs. For instance, a drug test cannot distinguish between prescribed Tylenol with codeine and illicit opiates. Improper testing procedures and mishandling of samples can also produce inaccurate results." "ASPE Issue Brief: Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Dept. of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), p. 4. |
5. Positivity Rate for Marijuana Use Among US Workers Subjected to Drug Testing "Positivity rates for marijuana in the general US workforce based on more than 6 million urine tests continued an upward climb, increasing 8.3% (3.6% in 2020 versus 3.9% in 2021), the highest positivity rate ever reported in the DTI. Over 5 years, positivity for marijuana in the general US workforce increased 50% (2.6% in 2017 versus 3.9% in 2021). "Overall positivity in the federally mandated, safety-sensitive workforce based on nearly 2.7 million urine drug tests stayed even year over year (2.2% in 2020 and 2021) and was 4.8% higher than 2017 (2.1% in 2017 versus 2.2% in 2021). In the general US workforce, positivity increased 1.8% (5.5% in 2020 versus 5.6% in 2021) and was 12% higher than in 2017 (5.0% in 2017 versus 5.6% in 2021) and up each of the last 5 years." Quest Diagnostics (2022). Drug Testing Index and Industry Insights: 2022 Annual Report and Industry Insights. |
6. Drug Test Positivity Rates for Cocaine Among Workers in the US Subjected to Drug Testing "The positivity rate in urine testing for cocaine increased for the fourth consecutive year in the general U.S. workforce and for the second consecutive year in the federally-mandated, safety-sensitive workforce. Cocaine positivity increased 12 percent in 2016, reaching a seven-year high of 0.28 percent, compared to 0.25 percent in 2015 in the general U.S. workforce, and seven percent among federally-mandated, safety-sensitive workers to 0.28 percent, compared to 0.26 percent in 2015." "Quest Diagnostics Drug Testing Index™ Full year 2016 tables," Quest Diagnostics, Table 2, last accessed Nov. 13, 2017. |
7. Positivity Rates for Methamphetamine Among People in the US Subjected to Drug Use Testing in the Context of Employment "Amphetamines (which includes amphetamine and methamphetamine) positivity continued its year-over-year upward trend, increasing more than eight percent in urine testing in both the general U.S. and federally-mandated, safety-sensitive workforces compared to 2015. Throughout the last decade, this rise has been driven primarily by amphetamine use which includes certain prescription drugs such as Adderall®. "Although methamphetamine positivity in urine testing declined between 2005 and 2008, the positivity rate plateaued between 2008 and 2012, and has increased steadily since. Between 2012 and 2016, it climbed 64 percent in the general U.S. workforce and 14 percent among federally-mandated, safety-sensitive workers. In oral fluid, methamphetamines positivity increased 75 percent between 2013 (0.24%) and 2016 (0.42%)." "Quest Diagnostics Drug Testing Index™ Full year 2016 tables," Quest Diagnostics, Table 2, last accessed Nov. 13, 2017. "Increases in Illicit Drugs, Including Cocaine, Drive Workforce Drug Positivity to Highest Rate in 12 Years, Quest Diagnostics Analysis Finds," Quest Diagnostics, May 16, 2017. |
8. Drugs Screened for Under Federal Mandatory Guidelines "The Federal mandatory guidelines recommended that the initial screening test identify the presence of the following commonly abused drugs or their metabolites (SAMHSA, 2008): "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: US Department of Health and Human Services, 2012), HHS Publication No. (SMA) 12-4668, p. 4. |
9. Possible Masking Agent: Zinc Found to Produce False Negatives in ELISA [Enzyme-Linked Immunosorbent Assay] Tests "We conclude that zinc ion (Zn2+) is a potential adulterant in urine samples tested for drugs in routine workplace drug screening under the NIDA-5 panel using ELISA. Its effect in causing potential false-negative results in drug testing is robust and reproducible. This effect appears independent of the mode by which zinc is made available in urine. Although the exact mechanism by which zinc interacts with different components of the ELISA assay is unknown, the enhanced ELISA signal increases in a dose-dependent fashion. As a consequence, it is our conjecture that zinc ion increases the binding of drug conjugate to which the active horseradish peroxidase enzyme is attached, thereby increasing the final output signal. Abhishek Venkatratnam and Nathan H. Lents. Zinc Reduces the Detection of Cocaine, Methamphetamine, and THC by ELISA Urine Testing. Journal of Analytical Toxicology (July/August 2011) 35(6):333-340 doi:10.1093/anatox/35.6.333. |
10. Effectiveness of Drug Testing vs. Management and Supervision "While the inquiry team could see a role for employee drug testing within safety-critical areas (although even here they were far from convinced that such drug testing was effective), there was deep scepticism as to the value of such testing more broadly. Indeed, the inquiry team noted that ‘For the most part, it is unclear that anything can be achieved through drug and alcohol testing that could not be done better through other managerial and supervisory processes’" Lloyd, Charlie and McKeganey, Neil, "Drugs Research: An overview of evidence and questions for policy," Joseph Rowntree Foundation (London, United Kingdom: June 2010), p. 54. |
11. Drug Testing of Arrestees in the US "Illegal drugs are widely used among the arrestee population. Two thirds of all arrestees tested positive for at least one substance in their system at the time of arrest and 15 percent or more in all sites test positive for more than one substance. The most common substances in all but three sites are marijuana, cocaine, opiates and methamphetamine." Office of National Drug Control Policy. ADAM II Annual Report (Arrestee Drug Abuse Monitoring Program). Washington DC: Office of the President. p. 37. |
12. Cost of TANF Drug Screening Programs "The estimated cost of drug testing TANF applicants and recipients varies by State and proposed law, depending on the proposed number of individuals who would be tested and the range of activities for which costs were estimated. Aggregate cost estimates of proposed welfare drug testing legislation were identified for twelve States (see Appendix C for details). The estimated costs in these States ranged from $92,487, for drug testing 20% of recipients and treating 2% of those tested in Louisiana, to $20 million, for just the testing of all public assistance applicants and recipients in New York. Other estimates include the cost of increasing staff to monitor or administer the tests, as in Maryland and "Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), pp. 6-7. |
13. Testing Costs "None of the State cost estimates identified for this paper showed net savings resulting from proposed drug testing programs, though these are all legislative cost estimates rather than rigorous cost?benefit analyses. Also, none of the State cost estimates identified described anticipated unit costs of drug testing programs. However, an article from a magazine published by The Society for Human Resources Management reported in 2005 that, “testing an applicant or employee ranges from $25 to $44 for urinalysis... [while] hair follicle testing costs $75 to $150 per test.”35 News reports regarding the implementation of Florida’s new drug testing policy have cited an estimate of $30 per TANF recipient for the drug tests being required of applicants,36 though the State’s drug testing pilot program in the early 2000s cost $90 per test once staff costs and other program costs were included.37 Testing costs among the Indian Tribes that currently administer drug tests in their TANF programs ranges from $15 per client to $89 per client, with most reporting unit costs in the range of $30 to $50.38" "Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), p. 7. |
14. TANF Drug Testing Legislation "During 2010 and the first half of 2011, legislators in 31 states have proposed 82 bills that would require drug tests of TANF applicants and/or recipients.31 There was also one proposal each in the U.S. House of Representatives and Senate." Note: The source for this fact also contains a list of 2010 and 2011 federal and state legislative proposals concerning TANF drug testing and legislative cost estimates from 12 states. "Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), p. 5. |
15. Possibility of Positive THC Test Through Exposure to Hemp Products "Results of the hemp products tested indicate the amount of THC present in commercially available products is significantly less in products available today than those reported in the past (15-22). As a result, the probability that these products will produce urine THC metabolite levels greater than the DoD and HHS confirmation cutoff of 15 ng/mL is significantly reduced and should not be considered as a realistic cause for a positive urine analysis result." Holler, Justin M., Bosy, Thomas Z., et al., "Delta9-Tetrahydrocannabinol Content of Commercially Available Hemp Products," Journal of Analytical Toxicology, Vol. 32, July/August 2008, p. 431. |
16. Hemp and Detection of THC Through Urinalysis "Hemp seeds represent the manufacturing starting point for the vast majority of hemp products marketed since the mid-1990s. Hemp seeds are a good source of essential fatty acids, primarily alpha-linolenic acid (omega-3) and ]inoleic acid (omega-6). They are also found in fish, flaxseed, rapeseed oil, pumpkin seeds, and sunflowerseeds. Essential fatty acids (EFA) are necessary fats that humans cannot synthesize, so they must be obtained through diet. EFAs support the cardiovascular, reproductive,immune, and nervous systems. The human body needs EFAs to manufacture and repair cell membranes, enabling the cells to obtain optimum nutrition and expel harmful waste products (9). THC found in manufactured products is present via contamination from resin produced in the leaves and buds that come into contact with the seed shell. Seed decontamination and manufacturing processes including wash steps and cold pressing for hemp products have improved since the mid-1990s, leading to the much lower THC concentrations currently found in today's commercial products. Holler, Justin M., Bosy, Thomas Z., et al., "Delta9-Tetrahydrocannabinol Content of Commercially Available Hemp Products," Journal of Analytical Toxicology, Vol. 32, July/August 2008, pp. 428-429. |
17. Testing in the Context of Drug Courts "For a drug court program, drug testing is conducted primarily to monitor a defendant’s progress in treatment — to determine whether he or she has been using drugs and, if so, the type and quantity of substances being ingested. The drug test result may be used as a basis for imposing sanctions and/or enhancing treatment services, on the one hand, or reducing treatment service requirements, on the other. Drug test results may also indicate a participant’s progress in reducing drug use when he or she has not eliminated it altogether. Robinson, Jerome J. and Jones, James W., "Drug Testing in a Drug Court Environment: Common Issues to Address," part of the Drug Court Resource Series, Drug Court Clearinghouse and Technical Assistance Project of American University (Washington, DC: Office of Justice Programs, U.S. Department of Justice, May 2000), p. 2. |
18. DRUID Project Evaluation of Oral Fluid (Saliva) Testing Devices for DUI Enforcement "Using the above model of evaluation it can be seen that the DrugWipe 5 delivers the best results for sensitivity (91%) whilst also performing very highly in terms of specificity (95%). However the margins of error (95% confidence interval) displayed in Figure 43 show that this value could vary between 78-97%, this margin of error would seem to be due to the size of the study population (135 tests performed) since the device was only tested in Finland. The strong results for this device probably reflect largely on the device?s high performing individual amphetamines test in a country with a relatively high prevalence for amphetamines. However, this overall sensitivity is still higher than the individual sensitivity of the amphetamines test for DrugWipe 5 (87%) indicating that the device was successful in screening for other drugs. Both DrugTest 5000 and Rapid STAT also performed strongly in this evaluation both for sensitivity (85% and 82% respectively) and specificity (86% and 88% respectively), which is a reflection of their generally relatively good performance for each individual substance test. The sensitivity error margins are also somewhat narrower for these two devices that were tested on a greater number of subjects (220 and 342 tests performed respectively). The OrAlert device also performs at a high level of sensitivity (81%) in this evaluation, however the specificity is somewhat lower at 70% - which is the lowest score for any of the devices. The sensitivities of the other four devices included in the study range between 64% and 32%, which are quite low values. The specificities are, however, very high, or excellent, at between 93% and 100%. The relatively large error bars for the Oratect III device and BIOSENS can be attributed to the number of successful evaluations (58 and 25 respectively)." Tom Blencowe, Anna Pehrsson and Pirjo Lillsunde, Editors. "Analytical evaluation of oral fluid screening devices and preceding selection procedures." Project Funded by the European Commission under the Transport RTD Programme of the 6th Framework Program, Project No: TREN-05-FP6TR-S07.61320-518404-DRUID (National Institute For Health and Welfare, Finland, Sept. 2010), pp. 93-94. |
19. Post-Accident Drug Testing As A Disincentive to Accident Reporting "Occupational safety and health stakeholders we interviewed and occupational health practitioners we surveyed told us that primary factors affecting the accuracy of injury and illness data include disincentives that affect workers’ decisions to report work-related injuries and illnesses and employers’ decisions to record them. Stakeholders most often cited workers' fear of job loss and other disciplinary actions as disincentives that can affect workers' decisions to report injuries and illnesses. Occupational health practitioners concurred: 67 percent reported observing worker fear of disciplinary action for reporting an injury or illness, and 46 percent said that this fear of disciplinary action has at least a minor impact on the accuracy of employers' injury and illness records. Workers’ fear of disciplinary actions may be compounded by policies at some worksites that require workers to undergo mandatory drug testing following incidents resulting in reported injuries or illnesses, regardless of any evidence of drug use. Several labor representatives described mandatory drug testing policies as a disincentive that affects workers’ decisions to report injuries and illnesses, and 67 percent of health practitioners reported they were aware of this practice at the worksites where they treated workers in 2008." "Report to Congressional Requesters: Workplace Safety and Health: Enhancing OSHA’s Records Audit Process Could Improve the Accuracy of Worker Injury and Illness Data" United States General Accountability Office, (Washington, DC: October 2009), pp. 17-18. |
20. DRUID Project Evaluation of Oral Fluid (Saliva) Testing Devices for DUI Enforcement "It is disturbing that the sensitivities of the cannabis and cocaine tests were all quite low, although further testing of the cocaine tests is desirable due to the low prevalences and the low concentrations encountered in this study. There are several countries in Central and Southern Europe for which these two substance classes are of special interest. On the other hand, it seems the sensitivities of the devices are generally better for amphetamines, a frequently encountered drug class among the DUI drivers in the Nordic countries. The suitability of the device for the intended national DUI population should also be considered, for example, PCP is rarely, if ever, found in Europe, therefore at the current time utilising a PCP test is unnecessary. Since the on-site tests are relatively expensive the suitability of all the individual substance tests incorporated in the device should be considered. Tom Blencowe, Anna Pehrsson and Pirjo Lillsunde, Editors. "Analytical evaluation of oral fluid screening devices and preceding selection procedures." Project Funded by the European Commission under the Transport RTD Programme of the 6th Framework Program, Project No: TREN-05-FP6TR-S07.61320-518404-DRUID (National Institute For Health and Welfare, Finland, Sept. 2010), p. 95. |
21. Accuracy of Certified Labs Not Verified "The accuracy of certified labs has never been tested. Not a single study of the accuracy of HHS certified laboratories has ever been conducted. The National Academy of Sciences and other experts have urged HHS to conduct such tests,6 but HHS has never done so. Nor has HHS allowed independent researchers to see its data. HHS’ failure to conduct or allow accuracy studies of certified labs is especially troubling in light of the federal government’s assurances that the labs it used were reliable prior to the CDC study. Maltby, Lewis, "Latest Research Reveals New Problems with Drug Testing," National Workrights Institute (Princeton, NJ: March 2012), p. 2. |
22. Drug Testing and Other Pre-Employment Screening Performed by Sheriff's Departments "Nearly all officers were employed by a sheriff’s office that used criminal record checks (99%), personal interviews (98%), background investigations (98%), and driving record checks (95%) (figure 4). More than 4 in 5 officers were employed by an office that used medical exams (87%), and drug tests (85%). More than two-thirds were employed by one using psychological evaluations (72%) and credit checks (69%). More than half of officers worked in sheriffs' offices using written aptitude tests (58%) and physical agility tests (54%)." Hickman, Matthew J. and Reaves, Brian A., "Sheriffs' Offices 2003" (Washington, DC: USDOJ, Bureau of Justice Statistics, May. 2006), NCJ 211361, p. 8. |
23. Testing for Drug Use by Drivers "Evidence-gathering technology for drugs is not as advanced in terms of ease of use and noninvasiveness as it is for alcohol. Until recently, no simple test police officers could administer to obtain an indication of drug use similar to the preliminary breath test for alcohol has been available. Rather, samples of urine or blood typically must be sent away for laboratory analysis to determine the presence of drugs and their quantification. Screening tests using urine, which can be used by officers in the police station, have been field tested by NHTSA. The technology is also developing for using saliva, sweat, and hair samples to detect drug use (Hersch, Crouch, & Cook, 2000). Lacey, John, Brainard, Katharine, and Snitow, Samantha. (2010). Drug Per Se Laws: A Review of Their Use in States. (DOT HS 811 317). Washington, DC: National Highway Traffic Safety Administration, pp. 5-6. |
24. Ethyl Glucuronide (EtG) and Urine Testing for Alcohol "After years of research, Ethyl Glucuronide (EtG) and Ethyl Sulfate (EtS) were found to be a direct metabolite of the alcohol (ethanol). EtG/EtS has emerged as the marker of choice for alcohol and due to the advances in technologies is now routinely available. Its presence in urine may be used to detect recent alcohol consumption, even after ethanol is no longer measurable using the older methods. The presence of EtG/EtS in urine is a definitive indicator that alcohol was ingested. Other types of alcohol, such a stearyl, acetyl and dodecanol, metabolizes differently and will not cause a positive result on an EtG/EtS test. "The EtG/EtS test has become known as the “80 hour test” for detecting any amount of consumed ethyl alcohol. This is a misnomer. It is true that EtG can be detected in chronic drinkers for 80 hours or even up to 5 days but not from a person that only consumed 2 or 3 drinks. During the period of chronic use, the EtG level can exceed 100,000 ng/mL. A level of 1.25 million was found in one sample. Two primary factors to determine the window of detection is based on volume of alcohol consumed and the time between each drink. A person that consumes 3 drinks can only have a detectable level of EtG for approximately 20 to 24 hours. The level peaks at approximately 9 hours with an EtG level around 15,000 ng/mL. "The presence of EtG and EtS in urine indicates that ethanol was ingested. "EtG/EtS is stable in urine for more than 4 days at room temperature. Recent experiments indicate that heating urine to 100 degrees C actually increased the stability. Therefore, heat does not cause the breakdown of EtG/EtS. In addition, no artificial formation of EtG/EtS was found to occur following the prolonged storage of urine at room temperature fortified with 1% ethanol. "EtG/EtS is a direct metabolite of alcohol (ethanol), and its detection in urine is highly specific, similar to testing for other drugs. The typical lab utilizes the most sophisticated, sensitive, and specific equipment and technology available, LC/MS/MS, to screen, confirm, and quantify EtG/EtS. This methodology provides "EtG/EtS is only detected in urine when alcohol is consumed. This is important since it is possible to have alcohol in urine without drinking. Alcohol in urine without drinking is due to the production of ethanol in vitro. Ethanol in vitro is spontaneously produced in the bladder or the specimen container itself, due to fermentation of urine samples containing sugars (diabetes) and yeast or bacteria. Since the ethanol produced is not metabolized by the liver, EtG/EtS will not be produced and will therefore not be detected in a urine containing alcohol as a result of fermentation. "Tests show that “incidental exposure” to the chronic use of food products (vanilla extract), hygiene products, mouthwash, or OTC medications (cough syrups) can produce EtG/EtS concentrations in excess of 100 ng/mL. However, if EtG is detected in excess of 250 ng/mL, then this is very strong evidence that beverage alcohol was consumed." Jim Turnage, "Innovations in Substance Abuse Testing (Updated March 2012)," presented for the State Bar of Texas (Dallas, TX: Forensic DNA & Drug Testing Services, Inc., April 26-27, 2012). |
25. Sensitivity and Specificity of Ethyl Glucuronide (ETG) Test In Heavy Drinkers "The present study sought to test the validity of a commercially available uEtG test to detect past day drinking, past day binge drinking, past 3-day drinking, and past 3-day binge drinking in a sample of heavy drinkers. We found that while uEtG was reasonably able to detect past day alcohol use and past day binge drinking, detection of drinking and binge drinking in the past 3 days was poor. These findings were consistent with a recent study examining the utility of uEtG testing among women of childbearing age, which found poor sensitivity to detect light-to-moderate drinking beyond a 12-hour window (Graham et al., 2017). These preliminary results call into question the validity of commercially available urine EtG tests at the manufacturer recommended detection cutoffs as means of validating alcohol abstinence and binge drinking in clinical research. It is important to consider the sensitivity of detection window as the current uEtG was commercially sold to detect alcohol use in the past 80 h, yet was only accurate for detecting past 24 h’ alcohol use. As false positives are common with uEtG tests (Costantino et al., 2006; Wurst et al., 2015), researchers should be aware of the limitations of urinary EtG using the manufacturer recommended detection threshold of 500 ng/ml and should not rely on commercial uEtG alone as verification of past alcohol use, particularly when using conservative detection thresholds. Breath alcohol concentrations (BrAC) should be used in conjunction with physiological biomarkers and self-report in order to accurately capture recent alcohol intake." Grodin, Erica N et al. “Sensitivity and specificity of a commercial urinary ethyl glucuronide (ETG) test in heavy drinkers.” Addictive behaviors reports vol. 11 100249. 17 Jan. 2020, doi:10.1016/j.abrep.2020.100249 |
26. Drug Tests Using Urine "Urine is the most rigorously evaluated and most commonly used matrix for drug testing (Watson et al., 2006). All results are affected by laboratory test or point-of-care test (POCT) cutoff concentrations. Therefore, practitioners should always consult with laboratory staff when ordering laboratory tests or carefully read POCT package inserts before using the test. Numerous POCTs are available for urine drug testing. "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Department of Health and Human Services, 2012), p. 51. |
27. Drug Testing Using Hair "Testing of hair rather than urine is often promoted because it is less invasive and can detect drug use over longer time periods. Hair tests cannot detect very recent drug use but do detect use that has occurred between (approximately) 10 and 90 days prior to the test (depending on the length of the hair). In addition to being more expensive than urine testing, however, hair testing raises several important concerns. As compared with urine drug tests, hair testing may more frequently result in positive results because of external (i.e. passive) exposure to drugs or chemicals. Hair treatments, such as coloring or straightening, can also affect the results of hair tests, making it more difficult to detect drug use. In addition, hair testing is not used in some Federal criminal justice proceedings because there is some evidence that naturally dark hair (e.g. that of African Americans and Asians) is more likely to test positive than lighter hair, leading to concerns of racial bias in the effects of testing programs." "Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), p. 4. |
28. Evaluation of Draeger DrugTest 5000 for Detecting Drugs Through Oral Fluid "DrugTest 5000 screening results were evaluated against Quantisal confirmation data to determine TP [True Positive], TN [True Negative], FP [False Positive], FN [False Negative], diagnostic sensitivity and specificity, and efficiency at various cutoffs (Tables 1 and 2). When compared to THC alone, the diagnostic sensitivity and specificity and efficiency were 86.2%–90.7%, 75.0%–77.8%, and 84.8%– 87.9% at the 5-μg/L cutoff and 75.9%–92.7%, 76.0%–100.0%, and 78.8%– 86.4% at the 10-μg/L DrugTest 5000 cutoffs. Overall, the DrugTest 5000 performed better with the 5-μg/L screening cutoff, with diagnostic sensitivity and efficiency above the DRUID-recommended 80%. There were few FP and FN tests, and when they occurred, concentrations were at or near the confirmation cut-off. A limitation of this study was the inclusion of a small number of TN samples, only 6 –12 with the 5-μg/L DrugTest 5000 and 1- and 2-μg/L confirmation cutoffs, to adequately evaluate diagnostic specificity. On the basis of previous reports, more TN samples were expected over the 22-h collection period. Detection rates were highest and windows of detection were longest when we confirmed for THC alone (Fig. 1 and 2). However, the recent report of THC concentrations in OF following 3 h of passive exposure to cannabis smoke advocate for the inclusion of THCCOOH in confirmation criteria, because this analyte is not present in cannabis smoke and was not found in any OF [Oral Fluid] samples following passive exposure (18)." Nathalie A. Desrosiers, et al., "On-Site Test for Cannabinoids in Oral Fluid," Clinical Chemistry, Oct. 2012, 58(10):1418-25. |
29. Race, Hair Types, Equity, and Biased Results in Hair Testing "Additional controversies exist about whether biophysical attributes affect hair analysis. Studies have shown that concentrations of drugs in hair can be affected by variations in hair structure, growth rate, melanin content, hygiene, and cosmetic hair treatments, such as bleaching (Dasgupta, 2008). Although there have been a limited number of human clinical controlled studies, data show that higher concentrations of some drugs (e.g., codeine, cocaine, amphetamine) are found in dark hair compared with concentrations found in blond or red hair (SAMHSA, 2004). Cone and Joseph (1996) reviewed several articles and found that hair testing may be biased toward some hair types. Drugs of abuse bind more readily to Africoid and Mongoloid types of hair compared with Caucasoid hair. Cosmetic hair treatments also affect the binding of drugs to hair. For example, bleaching of the hair can reduce drug content, but it also can damage the hair to the extent that bleaching may increase binding of the drug to the hair (Skopp, Pötsch, & Moeller, 1997). Some drugs (i.e., THC) do not differentially distribute into hair based on melanin content (Smeal, 2007). Therefore, hair testing may not be the most equitable drug testing matrix. Hair rinses, bleaches, and shampoos that claim to interfere with drug tests are advertised on the Internet and in magazines." "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Departent of Health and Human Services, 2012), p. 22. |
30. Hair Detection "Window" "An advantage of drug testing with hair is the longer window of detection compared with other matrices (Boumba, Ziavrou, & Vougiouklakis, 2006). The detection period for hair is limited only by the length of the hair sample and the degree of deposition in the hair. Cannabinoids have been shown to deposit less readily than basic drugs in hair (Huestis et al., 2007). Some laboratories typically restrict analysis to a hair segment representing about 3 months of growth. However, this long window period is also a disadvantage; hair testing is not useful in substance abuse treatment or monitoring opioid pain or other addictive medications when frequent (weekly or monthly) drug testing is desired. Because the timing of the drug use is difficult to determine by testing hair, it is not very useful clinically." "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Department of Health and Human Services, 2012), p. 22. |
31. Disadvantages for Drug Testing Using Hair "Disadvantages for testing for drugs in hair are the high costs and the longer time needed to obtain results, compared with the time required by other matrices. Analysis of the hair specimen is a complex process that involves breaking down the hair to free the drugs trapped in it. This chemical process requires a longer time of analyses than other matrixes. It can be done only in a laboratory; no POCTs [Point Of Care Tests] are available for testing hair samples." "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Departent of Health and Human Services, 2012), p. 22. |
32. Oral Fluid (Saliva) Testing "The parent drug is usually found in oral fluids, although the metabolite(s) may be present and quite useful. The parent drug is generally found in higher concentrations in oral fluids than are drug metabolites. Compared with urine specimens, oral fluid specimens present fewer opportunities for adulteration or substitution (Dams, Choo, Lambert, Jones, & Huestis, 2007). Use of commercial adulterants or mouthwashes were not found to interfere with the immunoassay (Bosker & Huestis, 2009), or they did not affect test results if the products are used more than 30 minutes before specimen collection (Drummer, 2006; Niedbala, Kardos, & Fries, et al., 2001; Niedbala, Kardos, Fritch, Cannon & Davis, 2001). The window of detection for oral fluid is narrower than it is for urine, and drug concentrations are generally lower (Warner, 2003). In general, drug testing of oral fluids detects drug use during the previous 24–48 hours, regardless of the route of administration (Cone, 2006), although the selection of cutoffs plays an important role in the length of the detection window. "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Department of Health and Human Services, 2012), p. 20. |
33. Breath Testing for Other Drugs in DUI Enforcement "The results of this investigation provide further support to the possibility of using exhaled breath as a readily available specimen for drugs of abuse testing. There is a possibility that exhaled breath will develop into a new matrix for routine drug testing and present an alternative to already used matrices like urine, blood, oral fluid, sweat and hair. Each matrix may have its specific advantages and disadvantages. Since exhaled breath may be as easy to collect as in alcohol breath testing, it may present a new, more accessible matrix than blood at the roadside and elsewhere when the sampling procedure is an obstacle. We previously observed that exhaled breath methadone increases after intake [2]. If a correlation to blood concentration can be shown for exhaled breath levels, it may become a substitute matrix for monitoring impairment. One advantage of exhaled breath may be the detection of 6-AM, which is problematic in blood." Olof Beck, et al., "Detection of drugs of abuse in exhaled breath using a device for rapid collection: comparison with plasma, urine and self-reporting in 47 drug users," Journal of Breath Research, 7 (2013) 026006 (11pp), http://dx.doi.org/10.1088/175… |
34. Oral Fluid Test Evaluations for DUI Enforcement "It is disturbing that the sensitivities of the cannabis and cocaine tests were all quite low, although further testing of the cocaine tests is desirable due to the low prevalences and the low concentrations encountered in this study. There are several countries in Central and Southern Europe for which these two substance classes are of special interest. On the other hand, it seems the sensitivities of the devices are generally better for amphetamines, a frequently encountered drug class among the DUI drivers in the Nordic countries. The suitability of the device for the intended national DUI population should also be considered, for example, PCP is rarely, if ever, found in Europe, therefore at the current time utilising a PCP test is unnecessary. Since the on-site tests are relatively expensive the suitability of all the individual substance tests incorporated in the device should be considered. Driving under the Influence of Drugs, Alcohol and Medicines (DRUID Project) 6th Framework Programme, "Analytical evaluation of oral fluid screening devices and preceding selection procedures," Deliverable 3.2.2 (Finland: National Institute for Health and Welfare, March 30, 2010), p. 95. |
35. Testing for Alcohol Using Breath (Breathalyzer) "The body metabolizes alcohol rapidly, but alcohol will be detectable in breath as long as it is present in blood. The detection period for ethyl alcohol itself is hours (not days) after the last alcohol use. The metabolism of alcohol varies considerably by the person’s gender, age, physical condition (especially the condition of the liver), and weight. "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Department of Health and Human Services, 2012), p. 23. |
36. Drug Testing Using Finger and Toe Nails "Like hair, fingernails and toenails are composed of a hard protein called keratin. Drugs are incorporated into nails from the blood stream and remain locked in the nail as it grows. Nails grow in both length and thickness. Drugs enter the nail from the base (cuticle end) as the keratin is formed and via the nail bed that extends under the full length of nail. Turnage, Jim, "Innovations in Substance Abuse Testing," presented for the State Bar of Texas (Dallax, TX: Forensic DNA & Drug Testing Services, Inc., April 17, 2011), p. 16. |
37. Drug Tests Using Sweat "Several collection devices have been manufactured for collecting sweat specimens. The two most common are the patch and the swipe; however, the sweat patch is the only device approved by the U.S. Food and Drug Administration (FDA). The quantity of sweat collected is determined by the length of time the patch is worn and the physiology of the person wearing the patch. The patch should be worn for at least 3 days, but no longer than 7 days, although most drugs will have been excreted within the first 48 hours (Barnes et al., 2009; Huestis et al., 2008; Kacinko et al., 2005; Schwilke et al., 2006). This ensures that a sufficient amount of sweat is collected for testing. The sweat collected with the patch detects drug use that occurred shortly before the patch was applied and while the device remains on the skin." "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Departent of Health and Human Services, 2012), p. 21. |
38. Sweat Test Accuracy "Because sweat can be collected only in limited quantities, there may not be sufficient specimen for repeat or confirmatory testing. Sweat is less susceptible to tampering or adulteration than is urine. The accuracy of sweat testing is not standardized. Its accuracy remains somewhat controversial (Watson et al., 2006). However, the sweat patch is used extensively in the criminal justice system, and its use to identify relapse or violations of conditions of probation has been upheld by the courts." "Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Departent of Health and Human Services, 2012), p. 22. |
39. Psychological Testing "There is no psychological test that can reliably screen for substance abuse. The MAC-R Index on the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) detects only addiction potential, not current use. If someone has been addicted in the past but is currently living a sober lifestyle, that person is still likely to test positive for addiction potential as this is more a personality style instead of a measure of current status (Friedman, Lewak, Nichols, & Webb, 2001). The idea behind the Substance Abuse Subtle Screening Inventory (SASSI) (Miller, 1994) is a good one. Essentially, it is an attempt to identify substance abuse through a self-report of symptoms that are associated with substance abuse without directly asking the central question. The Michigan Alcohol Screening Test (MAST) (Selzer, 197 1) is considerably less subtle, asking questions more directly. NCS also has an Alcohol Use Inventory (Horn, Wanberg, & Foster, 1987) that it markets." Schleuderer, Claude and Campagna, Vicky, "Assessing Substance Abuse Questions in Child Custody Evaluations," Family Court Review (Madison, WI: Association of Family and Conciliation Courts, April 2004) Vol. 42, No. 2, p. 380. |
40. Drug Testing vs Impairment Testing
"Few employers have used impairment testing, and information concerning that experience is very limited and extremely difficult to obtain. The available information, however, indicates that impairment testing is not just a better answer on paper, but in practice as well. Employers who have used impairment testing consistently found that it reduced accidents and was accepted by employees. Moreover, these employers consistently found that it was superior to urine testing in achieving both of these objectives." National Workrights Institute, "Impairment Testing: Does It Work?" (Princeton, NJ: NWI, undated). |
41. Limited Use, Availability of Impairment Testing "Collecting information about the performance of impairment testing proved extremely difficult because the field is so small. Only a handful of companies have ever marketed impairment testing systems and there is no list of their names. However, the Institute conducted an extensive networking program based on our contacts in the field that identified what we believe to be every company that has ever marketed impairment tests. There are only 10 such companies. Of these, only 6 manufactured systems for employers. Three of these 6 are now out of business. This means that there are only 3 companies currently in business that provide impairment testing systems for employers. National Workrights Institute, "Impairment Testing: Does It Work?" (Princeton, NJ: NWI, undated). |
42. Federal Rules Allowing or Mandating Drug Testing "The federal government does not impose rules regulating or prohibiting testing in the private sector and instead gives direct governance to specific agencies for employees under their jurisdictions and to the states. Two federal departments (Department of Transportation and Department of Defense) require random drug testing for contractors and employees holding certain jobs and in certain circumstances (e.g., after an accident). In addition, there is a federal law (the Omnibus Transportation Employee Testing Act, Pub. L. No. 102-143) that requires testing for specific types of transit operators. For private industries, state laws cover drug testing for both job applicants and employees. The details of laws across states vary: Random testing may be explicitly prohibited but may also be required for certain jobs, such as school-bus drivers. Some states also have conditions detailing the confidentiality afforded to test results or the policies and procedures for conducting such tests (ACLU, 2000)." Ramchand, Rajeev; Pomeroy, Amanda; Arkes, Jeremy, "The Effects of Substance Use on Workplace Injuries" (Santa Monica, CA: RAND Corporation, Center for Health and Safety in the Workplace, 2009), pp. 26-27. |
43. Constitutional Issues Involving Drug Testing as a Condition of Receiving Federal Benefits "Based on the case law analyzed above, state or federal laws that require drug tests as a condition of receiving governmental benefits without regard to an individualized suspicion of illicit drug use may be susceptible to constitutional challenge. Drug tests historically have been considered searches for the purposes of the Fourth Amendment. The reasonableness of searches generally requires individualized suspicion, unless the government can show a special need warranting a deviation from the norm. However, governmental benefit programs like TANF, SNAP, unemployment compensation, and housing assistance do not naturally evoke the special needs that the Supreme Court has recognized in the past. Carpenter, David H., "Constitutional Analysis of Suspicionless Drug Testing Requirements for the Receipt of Governmental Benefits," Congressional Research Service (Washington, DC: Library of Congress, January 19, 2012), p. 12. |
44. Drug Testing, Alcohol Testing, and the ADA "Although most laws concerning drug testing are at the state level, federal law must be considered when employers do test for ethanol (i.e., alcohol). The Americans with Disabilities Act (ADA) (Pub. L. No. 101-336) protects individuals with disabilities from discrimination in the workplace. Individuals with current alcohol-induced impairments and past alcohol problems are covered under the ADA. Thus, applicants cannot be tested or questioned about alcohol-use disorders until after a job offer has been made, and, even then, the law restricts when and under what conditions employees can be tested for alcohol use and other alcohol-use disorders. Moreover, employment decisions, particularly negative ones, cannot be based on these test results unless the employer can establish impairment caused by alcohol use (Hartwell, Steele, and Rodman, 1998). On the other hand, use of illegal drugs and of prescribed drugs used illegally and the drug-use disorders associated with such use are not covered under the ADA." Ramchand, Rajeev; Pomeroy, Amanda; Arkes, Jeremy, "The Effects of Substance Use on Workplace Injuries" Center for Health and Safety in the Workplace (Santa Monica, CA: RAND Corporation, 2009), p. 27. |
45. Drug Testing as a Condition of Receiving Federal Benefits "The Supreme Court, on a number of occasions, has held that government-administered drug tests are searches under the Fourth Amendment.14 Therefore, the constitutionality of a law that requires an individual to pass a drug test before he may receive federal benefits likely will turn on whether the drug test is reasonable under the circumstances." Carpenter, David H., "Constitutional Analysis of Suspicionless Drug Testing Requirements for the Receipt of Governmental Benefits," Congressional Research Service (Washington, DC: Library of Congress, January 19, 2012), p. 2. |
46. Impact of Drug Testing for TANF Benefits "Few proposals [to drug test applicants and recipients of TANF - Temporary Assistance for Needy Families] suggest child well-being improvements as a result of drug testing, though provisions for protective payees for children’s benefits are intended to ensure funds are spent on children’s needs. Proposals that sanction families by definition reduce the income available to the family and may therefore decrease child well?being. Sanctions and benefit decreases have been shown to increase the risk that children will be hospitalized and face food insecurity.42 An Idaho analysis also suggests that children may be harmed unintentionally by drug testing programs because parents may refuse to apply for benefits knowing they will face drug testing or may refuse to complete treatment.43 On the other hand, deterrent effects of drug testing may lead welfare applicants to reduce drug use, with potential positive effects for children." "Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), p. 8. |
47. Drug Testing of Pregnant People and Ferguson v City of Charleston "Ferguson v. City of Charleston (2001) is an important case in the family law domain because MUSC’s [Medical University of South Carolina] policy of testing pregnant women for illegal drugs raises issues at the intersection of public health and constitutional law. The public-health aspects concern the very real and significant risks to maternal, fetal, and societal well-being of drug use during pregnancy; in addition, the policy raises constitutional questions about what constitutes a reasonable search and seizure and women’ s privacy right to reproductive autonomy. Ultimately, the case addresses how best to strike the sometimes competing interests between mothers and their unborn children. "Although the policy was discontinued before the Supreme Court’s ruling and the Court held the policy to be unconstitutional, all the components of the decision—majority, concurring, and dissenting opinions—point to ways in which a similar policy could be designed so as to avoid the constitutional pitfalls encountered by the policy in Ferguson (2001). The petitioners won, but their victory is likely to be short lived. Recent developments in a number of states, combined with ongoing public concern about drug abuse, especially by pregnant women, suggest that despite Ferguson’s outcome, pregnant women should not feel too secure from state intervention when receiving prenatal care. Such interventions are likely to have significant consequences for pregnant women’s legal rights, as well as for their health, their fetuses’ health, and their behavior during pregnancy." Bornstein B. H. (2003). Pregnancy, drug testing, and the fourth amendment: legal and behavioral implications. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43), 17(2), 220–228. doi.org/10.1037/0893-3200.17.2.220 |
48. Lab Certification Requirement "In response to well documented quality problems in labs that were previously considered reliable, the federal government established certification programs. The U.S. Department of Health and Human Services has a program to certify laboratories.3 And the U.S. Department of Transportation has a program.4 Testing conducted by federal agencies or required by federal law must be conducted by certified labs." Maltby, Lewis, "Latest Research Reveals New Problems with Drug Testing," National Workrights Institute (Princeton, NJ: March 2012), p. 1. |
49. Effect of Workplace Drug Testing on Productivity In a study of high tech industries, researchers found that "drug testing programs do not succeed in improving productivity. Surprisingly, companies adopting drug testing programs are found to exhibit lower levels of productivity than their counterparts that do not. The regression coefficients representing potential effects of drug testing programs on productivity are both negative and significant. Both pre-employment and random testing of workers are found to be associated with lower levels of productivity." Shepard, Edward M., and Thomas J. Clifton, Drug Testing and Labor Productivity: Estimates Applying a Production Function Model, Institute of Industrial Relations, Research Paper No. 18, Le Moyne University, Syracuse, NY (1998), p. 1. |
50. Emphasis on Drug Use Ineffective "An evaluation of a Florida drug testing pilot found that those welfare recipients who tested positive for drugs had similar employment outcomes as others on TANF. Florida’s drug screening and testing pilot for TANF was implemented from January 1999 to May 2001. A total of 8,797 applicants and recipients were tested and 335, or 3.8%, tested positive for a controlled substance. Florida State University conducted an evaluation of the pilot and found that there was very little difference in employment and earnings between those who tested positive versus those who tested negative and concluded that the cost of the program did not justify the outcomes achieved and the program did not warrant full implementation.44, 45 The study’s a review of the research evidence concluded that drug use is not a major barrier to employment for welfare recipients.46 The authors of the Florida study caution that a disproportionate emphasis on drug use as a barrier to employment could be ineffective if other major barriers, such as physical and mental health problems, lack of job skills, and lack of transportation, are ignored." "Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), p. 8. |
51. Recommended Cut-Offs, Metabolites, and Cross-Reactors in Urine Drug Tests
(1) "Drug Retention Times," Center for Human Reliability Studies (Oak Ridge, TN: Oak Ridge Institute for Science and Education, May 2007), pp. 2-4. |
52. Recommended Cut-Offs for Substances and Metabolites in Hair to Identify Use
Cooper, Gail; Kronstrand, Robert; and Kintz, Pascal, "Society of Hair Testing guidelines for drug testing in hair," Forensic Science International (Oxford, United Kingdom: Elsevier, January 2011), p. 4. |