Potential samples: urine, blood, oral fluid, hair, finger/toe nails
Urine Testing and Blood Testing
Testing different samples may give different information. Blood testing is commonly done in emergency departments and hospitals. Urine testing is generally sufficient to detect recent abstinence from any given substance. Testing other specimens may be needed to further characterize extent, duration of use, or abstinence. Urine drug screens have been the most common method for analysis in employment settings and in drug treatments settings and studies because of ease of sampling; however, these assays are not perfect with respect to sensitivity or specificity or to assess past use. False-positive results of immunoassays can lead to serious medical or social consequences if results are not confirmed by secondary analysis, such as gas chromatography (GC)-mass spectrometry (MS). (For example, eating poppy seeds bagels can sometimes cause positive urine toxicology for opiates.)
Blood and urine drug testing can distinguish methadone from other opiates/opioids (heroin, morphine, codeine, etc).
Routine drug testing does not currently test for buprenorphine, but there are urine tests for buprenorphine.
Expanded Test – amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, ethanol, meperidine, methadone, opiates, oxycodone, phencyclidine, propoxyphene, tramadol
SAMHSA-5 (also known as the NIDA-5)
- Tests for amphetamines, cocaine metabolites, marijuana metabolites, opiate metabolites, phencyclidin
- Drugs can be tested for either individually or in pre-packaged panels (e.g., SAMHSA-5).
- Many companies offer drug test cups, test sticks, or test cassettes. Some examples include: OnTrak TesTcup, MEDTOX, MedimPex
Oral Fluid Testing
To date the main application of oral fluid testing has been to provide a non-invasive specimen for testing of possible drug-affected drivers and in some settings for workplace testing, particularly following a safety incident, to check for possible drug use. Hair is much more useful if a longer time frame of exposure is sought. However, if evidence of recent use (or abstinence) of drugs is sought then either blood or oral fluid are preferred specimens.
Can be used to detect past illicit drug use starting from 7-10 days prior to hair collection (use in the past week is usually not reflected in hair samples) and generally reflecting drug use within the past 90 days, but it cannot readily delineate when drug were used within that time frame. It is more difficult for persons to tamper with results than urine testing. Hair testing general relies on EIA testing with comfirmatory GC or MS testing.
Some companies that conduct hair testing for drugs:
- Psychemedics Corporation - testing for the SAMHSA-5 drugs
- Omega Laboratories - testing for SAMHSA-5 drugs, plus oxycodone (Oxycontin), hydrocodone (Vicodin), and hydromorphone (Dilaudid)
- Quest Diagnostics - testing for SAMHSA-5 drugs, plus codeine, morphine, oxycodone, hydrocodone, and hydromorphone, oxymorphone (Opana)
- Labcorp - testing for SAMHSA-5 drugs
- NMS Labs - testing for amphetamines, barbiturates, benzodiazepines, cocaine, methadone, opiates, phencyclidine, propoxyphene
Contact individual companies to negotiate rates, or to request whether they will conduct testing of other drugs not listed on their websites.
Drug testing can also be done on sweat, using a patch that is worn on the skin for 10 days or more. It can detect drug use during the period it is worn. The concentrations of drugs obtained in the patch are much lower than those in urine, making confirmatory testing a potential problem. The possibility of environmental contamination of patch before application or after removal exists and has implications for its use in forensic and employment settings, however, sweat testing patches provide a convenient alternative that avoids some of the problems with drug testing using urine or blood such as violations of privacy in observed urination and the discomfort of, an possibility of disease transmission in specimen handling.
Some companies that sell sweat patches:
- AlcoPro - testing for SAMHSA-5 drugs, option to add fentanyl
- PharmChek - testing for methamphetamine, amphetamine, cocaine, codeine, morphine, heroin, marijuana, PCP, fentanyl, norfentanyl, hydromorphone, hydrocodone, oxymorphone, and oxycodone
Blood can be tested for the current presence of alcohol. Blood testing detects current use, and can be used to measure/infer extent of current use. It does not provide information about past use.
Determination of blood alcohol concentration (BAC) is used in a multitude of situations, including in postmortem analysis, driving under the influence (DUI) and drug-facilitated sexual assault cases, workplace drug monitoring, and probation investigations. These analyses are carried out by direct measurement of ethanol concentrations as well as of metabolic by-products, such as ethyl glucuronide and ethyl sulfate.
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