Drug Testing – What About Panels?

Standard urine drug testing panels range from 5 drugs to 10 drugs. Specimen validity testing is available to detect adulterants or specimen substitution resulting from a donor’s attempts to mask drug use. Expanded profiles for Medical Professional monitoring are also available.

When implementing a drug testing program, it is important to discuss what you will be testing for. Both laboratories and instant testing distributors may offer a variety of test panels. With lab based urine testing, it makes sense to do a 10 panel test because it typically is the same price as a five panel test. Hair testing at a lab is typically limited to 5 panels. With urine based instant testing devices, you can actually test for anywhere from 1 to 12 panels. With oral fluid based instant testing you are limited to seven panels. It is important to determine which drugs your facility needs to test for and then purchase the appropriate panels from the laboratory or the instant test manufacturer.

  • A typical urine or hair five panel test includes: Marijuana (THC), Cocaine (COC), Amphetamine (AMP), Opiates (OPI) and Phencyclidine (PCP)
  • A typical urine ten panel test adds the following to the five panel: Benzodiazepines (BZO), Propoxyphene (PPX), Barbiturates (BAR), Methadone (MTD) and Methaqualone (MTQ)
  • Instant urine testing can also include: Ecstasy (MDMA), Methamphetamine (MET), Tricyclic Antidepressants (TCA), and Oxycodone (OXY)
  • Expanded panels for medical professional testing may include additional drugs such as Narcotics, antidepressants, stimulants, and other drugs
  • Instant oral fluid or lab based testing for oral fluid typically tests for five or seven panel:
    • Marijuana (THC), Cocaine (COC), Amphetamine (AMP), Opiates (OPI) and Phencyclidine (PCP), Ecstasy (MDMA), Methamphetamine (MET); some labs can also add Benzodiazepines (BZO) and Barbiturates (BAR).
  • Steroid testing gets even more complicated with many different testing options which can get very expensive, these can include: Anabolic Steroids, Stimulants, Diuretics, Beta Blockers, and Ephedrine
  • A typical steroid panel for school testing might include: Boldenone (Equipoise), Clenbuterol, Clostebol (Steranbol), DHEA (dehydroepiandrosterone), Epitestosterone, Fluoxymesterone, 6ß‐Hydroxyboldenone, 6ß‐Hydroxyfluoxymesterone, 3'‐Hydroxystanozolol, Methandrostenolone / Methandienone (Dianabol), 19‐Norandrosterone, Oxandrolone (Anavar, Bonavar), Oxymesterone, Stanozolol (Winstrol), Testosterone and THG (tetrahydrogestrinone)

* note that some labs or manufactures may use different abbreviations for the drugs listed above

With all of the various panels available and complex drugs to test for, it is important to choose a vendor who is knowledgeable and experienced. The cheapest price may not give you the best program.

The chart below gives approximate detection times for each substance by test type along with the screening cut off levels. Detection times vary depending on many factors including amount and frequency of use, metabolic rate, body mass, age, overall health, drug tolerance, and urine pH.

Drug Cut-Off Level Approximate Detection Time in Urine Approximate Detection Time in Saliva
Amphetamine (AMP) 1,000 ng/mL 2-4 Days 1-3 Days
Barbiturates (BAR) 300 ng/mL 4-7 Days -
Benzodiazepines (BZO) 300 ng/mL 3-7 Days -
Cocaine (COC) 300 ng/mL 2-4 Days 1-3 Days
Ecstasy (MDMA) 500 ng/mL 1-3 Days -
Methadone (MTD) 300 ng/mL 3-5 Days -
Methamphetamine (MET) 1,000 ng/mL 3-5 Days 1-3 Days
Opiates (MOR) 300 ng/mL 2-4 Days -
Opiates (OPI) 2,000 ng/mL 2-4 Days 1-3 Days
Phencyclidine (PCP) 25 ng/mL 7-14 Days 1-3 Days
THC (THC) 50 ng/mL 15-30 Days 6-12 Hours
Tricyclic Antidepressants (TCA) 1,000 ng/mL 7-10 Days -
Propxyphene (PPX) 300 ng/mL 1-2 Days -
Oxycodone (OXY) 100 ng/mL 2-4 Days -
Amphetamine (AMP300) 300 ng/mL 2-4 Days -
Cocaine (COC150) 150 ng/mL 2-4 Days -
Methamphetamine (MET500) 500 ng/mL 3-5 Days -

 

Drug Testing ‐ What is Chain of Custody?

"Chain of Custody" refers to the document or paper trail showing the seizure, custody, control, transfer, analysis, and disposition of physical and electronic evidence. For drug testing it is the course of action of documenting the management and storage of a specimen from the moment a donor gives the specimen to the collector to the final destination of the specimen and the review and reporting of the final result.

Any and all drug testing should incorporate a Chain of Custody form and process to insure the integrity of the specimen to be tested. This includes both laboratory and instant drug testing. A multipart Chain of Custody form and other supplies are used to complete the Chain of Custody process. These supplies would include packaging type, seals and other relevant information to be included for verification upon transport and turnover to the respective testing facility. The Chain of Custody form is added onto as the test specimen travels from person to person and this provides for specimen integrity and accountability of a test sample. The Chain of Custody form has been given a status of a legal document for it has the ability to invalidate a specimen that has been tampered with and that does not have the complete information written on it. A broken or mismatched seal on the specimen bottle will also invalidate the specimen being tested. Being a legal document, tampering or mishandling the Chain of Custody form is subject to investigation and subsequent penalization in accordance with the law.

Upon transport, the Chain of Custody form is again updated and again written to as it is received by the test laboratory. Upon reaching the laboratory, the specifics of the test that will be conducted with the time, date and signature of the person processing the sample are written. Upon the conclusion of the tests with the results finalized, this Chain of Custody document is copied and returned to the Medical Review Officer (MRO) for interpretation and conclusion. The MRO will record his final result on the completed Chain of Custody form and may also transport this result electronically using a particular result reporting software. Throughout the process a copy of the form may be retained by the specimen collector, the agency requiring testing, the donor, the laboratory and finally the MRO with this MRO copy having the final result recorded.

All of the processes involving the Chain of Custody document serve as assurance to the test subject that the specimen that was provided was handled and tested in the enumerated procedures outlined in the in the Mandatory Guidelines for Federal Workplace Drug Testing Programs. These guidelines are common to drug testing throughout the United States and provide standards for the testing process. All information including the Chain of Custody form are considered to be highly private and confidential for both federal and private employees, schools and other agencies that require testing. Even the results that are given by the MRO that are documented and reported are considered confidential as part of the stated regulatory guidelines. Specimen integrity and donor privacy are critical.

 

Hair Testing Available Since 1987

Pros:

There are a number of advantages that hair testing offers over alternative testing methods. They are as follows:

  • This is the only testing method that provides up to a 90‐day detection window of drug use, making it an ideal option for pre‐employment and random testing.
  • Our hair testing system is FDA‐cleared, and it is an accurate lab‐based test.
  • Specimen collection is observed, which significantly reduces the possibility of adulteration or substitution.
  • Fast turnaround times are available. Negative results are reported within 24 hours of specimen reception and positive results are confirmed within 48‐72 hours.

Compared with urine specimen testing, hair testing provides nearly twice the number of positive results due largely to a much longer detection window.

Cons:

There are also some disadvantages with hair testing, and it is always important to determine the client’s needs and what they are trying to accomplish. Drug Free Workplace policies need to be reviewed, as well as state laws, to make sure hair testing is included in the policy and not prohibited by state law. Some disadvantages of hair testing may include the following:

  • Hair testing will not pick up recent drug use up to seven days.
  • Hair testing is more expensive than traditional urine drug testing.
  • Specimen collection is not as readily available as traditional urine drug testing and can be more costly.
  • Donors with no hair pose a problem for hair testing.

Standard hair testing picks up the following drugs: cocaine, THC (marijuana), opiates (including heroin), amphetamines, methamphetamines, MDMA (ecstasy), and phencyclidine (PCP). Additional drugs can be added with special requests, these tests are more costly.

 

 

Drug Testing- Information on Random Drug Testing

Our drug testing compliance software treats Random tests differently than other types of tests. In other test types, you tell the computer who is participating. With random testing, however, the computer tells you who is participating. This is done through the Random Selection Process. This software is designed under the premise that the cornerstone of every substance abuse deterrence program is verifiable, unbiased random selection.

When choosing participants for a random test, the computer uses a basic and complete method to insure unbiased selections. It is a double-blind selection method--one in which neither the administrators nor the participants can predict or affect the outcome. The computer does not examine Participant IDs or length of service, nor does it take into account how many times, when, or whether participants have been tested in the past. It is possible that someone chosen for a random test may have just completed a periodic test the day before or was selected in the last random selection. The random element of chance is just what is implied--a random chance.

Sometimes participants challenge a particular random selection or even the entire process. This drug testing compliance software utilizes an exclusive system called RandSel Tracking that records actions that could affect the outcome of any random selection. The RandSel Tracking system has proven itself in every challenge to date.

Random selections are flexible enough for virtually any testing situation. You maintain complete control of the number selected by using a percentage or a fixed number. Reports include “Alternates,” “Notification Letters,” and “Certification Letters.” “Program Statistics” report informs you of YTD information such as average pool; number tested, shortages/overages, and tested percentage.

Our Random Program:

  • Provides a consortium feature that makes managing companies a snap-- from two companies to thousands.
  • Provides flexible and defensible random selections with detailed audit reports.
  • Meets the most stringent DOT reporting requirements, yet flexible and well suited for non-regulated testing.
  • Includes a complete set of professional-looking reports for all your reporting requirements.

Our system makes a record of each step taken setting up the random, prints audit trails, notification letters, stores each eligible pool for future statistical analysis. Even creating test results automatically, this secure system eliminates any possible bias that a human being could introduce.

Our Drug Screening provides random testing for your individual company or adds you to one of our random testing consortium pools whereby you are grouped with other smaller companies. The process is simple and turnkey:

  1. Insure your covered employees have a pre-employment test.
  2. Provide us with your list of employees to be added to the random testing pool
  3. We run the random selections and then provide you with notifications to each employee selected.
  4. You send the selected employees for testing

 

 

The Challenge of Dilute Specimens

A sample is 'dilute' when added fluid reduces the concentration of a drug or drugs. Fluid can be intentionally or unintentionally added to the body by drinking large amounts of fluid, or intentionally added to the sample by adding fluid to the sample after collection.

Most Laboratories will test for dilution by testing creatinine and specific gravity. Creatinine (a chemical waste molecule generated from muscle metabolism that is eliminated at a fairly steady rate) of less than 20 mg/dl and a Specific Gravity (a comparison between the density of the urine specimen and the density of plain water) of less than 1.003 is reported by the lab as 'dilute'.

NOTE:> A dilution should not be confused with adulteration. An adulteration is when a chemical is added directly to a specimen, such as bleach or soda.

Non-DOT Programs

When a urine specimen is "dilute", it is possible that drugs in their system may not be detected. We recommend that an employer have a section in their drug testing policy stating that another specimen be collected as soon as possible with minimum advance notice, this will help prevent intentional dilution. However, the employer may also elect to accept the negative result with the notation "dilute" from the lab. A positive dilute specimen is generally treated as a verified positive test. It is crucial the company policy be consistent and unbiased in all cases.

DOT Programs

A positive dilute is treated like any other positive test. You do not have the employee provide another specimen. There are 2 groups of creatinine and specific gravity for DOT Testing.

1) Creatinine > 5 mg/dl and < 20 mg/dl

The employer may require the donor to submit to another specimen collection. The re-collection cannot be done under direct observation.

If the employer adopts a policy of re-collection for negative-dilute results, all employees must be treated the same. However, the employer may elect to treat different types of tests differently (e.g. re-collect for pre-employment tests, but not for random tests).

2) Creatinine >= 2 and <=5 mg/dl

The employer must direct the donor to have an immediate re-collection under direct observation. This is called a Hyper-Dilute. The second test is the test of record.

For all dilutes, if the second test is also negative-dilute, the employer must accept that result and cannot request a third collection. The second test is the test of record. An applicant/employee's refusal to submit to a re-collection for a negative-dilute result is a refusal to test under the DOT rule.

NOTE: A Creatinine level of < 2 is considered 'Substituted'. If there is no medical explanation the result will be reported as 'Refused'.

 

 

The Reality of Turnaround Time

The amount of time it takes to receive a drug test result can depend on many factors. Negative drug test results typically take no longer than 1 business day from the time the specimen arrives at the laboratory. Non‐negative results typically take 3 ‐ 4 business days from the time the specimen arrives at the laboratory. Statistically, we find our average overall turnaround time for a client is less than 2 business days on negative results.

I use the term typically in order to be realistic, honest and frank ‐ there is lot of human interaction in this process and things can happen. Couriers are involved and the specimens travel via car and airplane as well as with common carriers like DHL, Fed Ex etc. In addition, although a result can be reported as negative it might have tested non‐negative first and had to go on for further testing. Time of collection, weekends, holidays etc also all effect turnaround time, for example a specimen collected at 4:50pm might miss the courier pickup and would not get to the lab for an extra day. A specimen collected on a Friday, might not be tested at the lab until Monday.

Most importantly is that one understands the process:

  1. Specimens are collected at a collection facility or on site at client facility.
  2. Specimens are transported to a laboratory usually reaching the lab after transport from a courier to a plane and arriving at the lab usually the next morning.
  3. Specimens are tested; negatives are released to the medical review office for review and reporting to the client ‐ which is typically the same day as released from the lab.
  4. Specimens testing non‐negative at the lab are sent for retesting under GC/MS confirmation ‐ this is done a day later. These specimens whether negative or positive are now released from the lab for review and reporting to the client ‐ and these that are negative are typically now reported the same day as released from the lab.
  5. On confirmed positive results the MRO must speak to the donor, turnaround time is now a variable of getting the donor to communicate with the MRO which is sometimes a challenge.

The MRO attempts contact with the donor several times each day and will also request assistance if having difficulties. Results received from the lab as positive may take 3 – 4 business days from the time the specimen arrived at the lab.

Every major vendor and every major lab basically perform the same way although some may make promises of quicker turnaround time which may not be the exact truth because of the human interaction involved.

When a result is delayed it is important to find how why so that any avoidable problems can be corrected and not occur in the future. Your drug testing vendor can help you with this, it is always important to have specific examples and details of a delayed result.

 

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