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This website is intended to assist with patient education and should not be used as a diagnostic, treatment or prescription service, forum or platform. Always consult your own healthcare practitioner for a more personalised and detailed opinion. To screen for drug abuse, to monitor someone with a substance abuse problem, to monitor compliance with prescribed medications, or to detect and evaluate drug intoxication or overdose. Sometimes required prior to the start of a new job or insurance policy; randomly for workplace drug testing or athletic drug testing programs; as mandated when court-ordered; as indicated when ordered by a health practitioner to monitor a known or suspected substance abuse patient; sometimes when you are pregnant, will be receiving an organ transplant, when you are prescribed pain medication, or when you have symptoms suggesting drug intoxication or overdose. A random urine sample; sometimes a blood sample drawn from a vein in your arm; hair, saliva, or sweat. Testing detects substances not normally found in the body, with the exception of some hormones and steroids measured as part of sports testing. Most laboratories use commercially available tests that have been developed and optimized to screen urine for the 'major drugs of abuse. For most drugs of abuse testing, laboratories compare results of initial screening with a predetermined cut-off. Anything below that cut-off is considered negative; anything above is considered a positive screening result. In addition, labs might perform testing for masking agents adulterants. These may either interfere with testing or dilute a urine sample. Among drugs of abuse, each class of drug may contain a variety of chemically similar substances. Legal substances that are chemically similar to illegal ones can produce a positive screening result. Positive screening tests are considered presumptive. Substances that are not similar to the defined classes can produce negative results even though they are present. Some drugs may be difficult to detect with the standardized assays, either because the test is not set up to detect the drug, such as methylenedioxy-methamphetamine MDMA, also known as Ecstasy or Molly , fentanyl, methadone, oxycodone Oxycontin , meperedine, or buprenorphine, or because the drug does not remain in the body long enough to be detected, such as gamma-hydroxybutyrate GHB. For sports testing of hormones and steroids, each test performed is usually specific for a single substance and may be quantitative. Athletes, especially those at the national and international levels, are tested for illegal drugs and are additionally prohibited from using a long list of substances called 'performance enhancers. Groups of drug tests are typically ordered for medical or legal reasons, as part of a 'drug-free workplace,' as part of a sports testing program, or to determine compliance with prescribed pain medications. People who use these substances ingest, inhale, smoke, or inject them into their bodies. How much of these drugs the body absorbs and their effects depend on the substances, how they interact, their purity and strength, their quantity, timing and method of intake, and an individual's ability to metabolize and eliminate them from the body. Some drugs can interfere with the action or metabolism of other medications, or have additive effects, as in the case of taking two drugs that both depress the central nervous system CNS. Drugs may also have competing effects, as can happen when one drug that depresses the CNS and another that stimulates it are taken. Urine is the most frequently tested sample in drug abuse screening. Other body samples, such as hair, saliva, sweat, and blood, also may be used but not interchangeably with urine. Urine and saliva are collected in clean containers. A blood sample is obtained by inserting a needle into a vein in the arm. Hair is cut close to the scalp to collect a sample. A sweat sample is typically collected by applying a patch to the skin for a specified period of time. Certain prescription and over-the-counter drugs may give a positive screening result. Examples of false-positive screening results: Vicks nasal spray can test positive for amphetamines; poppy seeds can produce a false-positive for opiates. Drugs of abuse testing is used to screen for and confirm the presence of several drugs in a person's sample, such as urine, blood or hair. Drug testing is used so that a person may receive appropriate medical treatment or be screened for or monitored for illegal drug use. Medical Screening Medical screening for drugs of abuse is primarily focused on determining what drugs or combinations of drugs a person may have taken so that the person can receive proper treatment. A drug's overall effect on a particular person depends on the response of the person's body to the substance, on the quantity and combination taken, and when it was taken. For instance, MDMA also known as Ectasy or Molly is initially a stimulant with associated psychedelic effects but later causes central nervous system CNS depression as it is metabolized and cleared from the body. If someone drinks ethanol during this time period, the person will have two CNS depressants in their system, a potentially dangerous combination. Legal or Forensic Testing Drug testing for legal purposes primarily aims to detect illegal or banned drug use in a variety of situations. Sample collection procedures for this type of testing are strictly controlled and documented to maintain a legal 'chain-of-custody. Specific chain-of-custody paperwork then accompanies the sample throughout the testing process. This creates a permanent record of each step of the process. For additional information on this type of testing, see the article on The World of Forensic Laboratory Testing. Employment Drug Testing Employment drug testing is a specific type of forensic testing see above. It may be done prior to employment, on a random basis, following an accident, or if the employer has a reasonable suspicion that an employee is using illegal drugs. Employment drug testing is commonplace. It is required in some industries, such as those that involve the U. Department of Transportation, the military and federal employees, and is an accepted practice in many other industries. As with legal or forensic drug testing, the sample collection and testing procedures for employment drug testing are often strictly controlled and documented to maintain a legal 'chain-of-custody. On a local level, sports testing may be limited, but on a national and international level, it has become highly organized. WADA has a written code that establishes uniform drug testing rules and sanctions for all sports and countries and that includes a substantial list of prohibited substances. Athletes are responsible for any banned substances found in their body during testing. Most compounds are prohibited in any quantity, while others, such as caffeine, are only prohibited when they are present in large amounts. Some of the substances, such as anabolic steroids testosterone and peptide hormones such as erythropoietin, growth hormone, and insulin-like growth factor-1 are banned but are difficult to measure because the body also produces them naturally. Testing methods must be able to distinguish between endogenous that produced by the athlete's body and supplemented compounds. Screening programs randomly perform out-of-competition drug tests on athletes during the training season to look for anabolic steroids, such as testosterone, that promote increased muscle growth. During competitions, testing is frequently done both randomly and on all winners. Testing includes categories such as stimulants, narcotics, anabolic agents, and peptide hormones. WADA bans use of beta blockers in archery, golf, shooting, freestyle skiing, and snowboarding because they decrease blood pressure and heart rate and have a calming effect that can enhance balance and steadiness of the hands. Those professional athletes who also take part in the Olympics, however, are subject to Olympic regulations. Monitoring Pain Medication Use Drug screening in urine is the method of choice for monitoring adherence to prescription pain medications in patients treated for chronic pain. Urine drug screening provides tools for tracking patient compliance and exposing possible drug misuse and abuse. A health practitioner may periodically order drug testing for patients treated for chronic pain for two purposes: 1 ensuring compliance by patients who are using the prescribed pain medications, and 2 monitoring the use of non-prescribed or illegal substances. Elements of a urine drug screen may include specific gravity, temperature at the time of sample collection, pH, creatinine concentration, and confirmatory testing. Compliance monitoring of pain medications is crucial for eliminating or significantly curtailing abuse e. Urine drug screening is considered one of the mainstays of adherence monitoring in conjunction with prescription monitoring programs and other screening tools. Drug testing is performed whenever a health practitioner, employer, legal entity, or athletic organization needs to determine whether a person has illegal or banned substances in his or her body or is compliant with prescribed medications. It may be ordered prior to the start of some new jobs and insurance policies and at random to satisfy workplace, court-ordered, adherence monitoring, or athletic drug testing program requirements. Drugs of abuse testing may also be ordered by a health practitioner to monitor a known or suspected substance abuse patient or whenever a person has signs and symptoms that suggest drug use. Depending on the drug or drugs involved, these may include, for example:. A positive initial drug screening means that the person tested has a substance in his or her body that falls into one of the drug classes and is above the established cutoff level. If secondary testing confirms a positive result, it means that the person has indeed taken this drug. In some cases, this result indicates a window of time in which the person took the substance and its approximate quantity, but in most circumstances, that information is not necessary. Interpretation of when and how much drug was consumed can be challenging because the concentration of many drugs varies, as do people's rates of metabolism. If testing reveals no drugs, or drugs in amounts below the established cutoffs, then the results are usually reported as 'not detected' or 'none detected. A negative result does not necessarily mean that the person did not take a drug at some point. The drug may be present but below the established cutoff, the drug may have been already metabolized and eliminated from the body, or the test method does not detect the particular drug present in the sample. Different types of samples are often used for specific purposes. For instance, hair samples may be used as an alternative to urine testing for employment or accident drug testing. Sweat testing may be used as a court-ordered monitoring tool in those who have been convicted of drug use, while saliva is often used by the insurance industry to test insurance applicants for drug use. Blood is most frequently used for alcohol testing. Interpretation of sports testing results for hormones and steroids should be done only by laboratory professionals who are familiar with particular test methods. A negative result indicates that there is a 'normal' amount of the substance present in the body. Positive results reflect the presence of the substance above and beyond what is normally produced by the athlete's body. These results can be complicated by the fact that each person will have his or her own normal baseline concentration and will produce varying amounts of hormones and steroids, depending upon the circumstances. Symptoms associated with drug abuse and drug overdose will vary from person to person, from time to time, and do not necessarily reflect drug concentrations in the body. Ethanol may be measured in both the blood and the breath. This is the basis for the breathalyzer test used by law enforcement. For some types of testing, such as workplace testing of federal employees, there are many regulations that cover the test from collection through interpretation and reporting of results. It is important for the ordering physician, law enforcement representative, forensic professional, government entity, insurance agent, employer, and sports organization as well as for the person being tested to understand what exactly is included in the testing, how it is done, and how the results may or may not be interpreted. This process is not nearly as simple or straightforward as collecting a sample and requesting 'drug testing. Prescription drug monitoring programs incorporate urine drug testing as part of the process of monitoring adherence to prescription pain medications. Magubane Physician. Release Version: Beta. Back Blood-tests Explained. Disclaimer: This website is intended to assist with patient education and should not be used as a diagnostic, treatment or prescription service, forum or platform. The Test Sample What is being tested? Some of the most commonly screened drug classes are listed in the table below. The Test How is it used? When is it ordered? What does the test result mean? Is there anything else I should know? How is it used? Some of the most commonly screened drugs include: Amphetamine and methamphetamine Barbiturates such as phenobarbital, secobarbital and pentobarbital Benzodiazepines such as diazepam, lorazepam and oxazepam Marijuana Cocaine Methadone Opiates, such as heroin, codeine and morphine Phencyclidine PCP See a more comprehensive list of drug classes and drugs of abuse. 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Depending on the drug or drugs involved, these may include, for example: Dilated or small pupils Drowsiness Slow or slurred speech Agitation Nausea Difficulty breathing Delirium Seizures Changes in blood pressure or heart rhythm. Tests of different body samples reveal drug use within varying windows of time. For example: Urine testing shows drug use over the last 2 or 3 days for amphetamines, cocaine, and opiates. Marijuana and its metabolites, cannabinoids, may be detectable for several weeks. Methadone, barbiturates and benzodiazepines can be detected for about a week. Hair samples, which test the root end of the hair, reflect drug use within the last 2 to 3 months but not in the amount of time it takes for the hair to grow, the most recent 2 to 3 weeks. Saliva detects which drugs have been used in the last 24 hours. Samples of sweat may be collected on an absorbent patch worn for several days to weeks and therefore can indicate drug use at any point during that extended period of time.

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