Drug Abuse Testing

Q What is drug screening?

Drug screening is a general term used for the examination of samples for the presumed presence of one or several drugs. The screening methods are usually easy to perform, as well as being both reliable and accurate.

Q What is the most appropriate test sample?

Urine is most frequently used for testing since it is easy to obtain, does not require the pretreatment process associated with serum specimens, and it retains traces of the drug and its metabolites for long periods of time.

Q How do I get a drug screen?

Crestwood Medical Center performs drug testing 24 hours per day, 7 days per week and offers the testing quite economically. Since a physician's order is not necessary, the Outpatient Registration Department will register you and forward you to the laboratory. The laboratory staff is prepared to guide you in the selection of an appropriate panel, or group of drugs to test for. Any selection and number of drugs may be tested. Your panel may be customized according to your preferences. Frequently used combinations include the following panels:

5 drug screen:

Amphetamines, Cannabinoids, Cocaine, Opiates, and Phencyclidine

10 drug screen:

Amphetamines, Barbiturates, Benzodiazepines, Cannabinoids, Cocaine, Methaqualone, Opiates, Phencyclidine, Methadone, Propoxyphene

The laboratory will then collect the urine specimen and perform the testing. Results for chain of custody specimens will be available in 24 to 48 hours. (See "What is Chain of custody?" below.) Negative results should be available within 24-36 hours. Positive results will be re-tested for confirmation using a second methodology with higher specificity, and will require an additional 24-48 hours.

Testing for specimens not requiring chain of custody can be available within a few hours. Again, positive results will be re-tested for confirmation using a second methodology with higher specificity, and will require an additional 24-48 hours.

Please call the Crestwood Medical Center lab director, at 880-4165 for details.
What is chain of custody?

Chain of custody refers to the procedure established by the testing laboratory for the handling of specimens. It ensures that sample identification and integrity are maintained from specimen collection through testing.

Yes, in legal cases. Chain of custody is desirable since it documents each individual who handled the sample as well as the ongoing condition of the sample. This procedure helps to eliminate the possibility of sample tampering.

No, Each drug has a different rate of metabolism and pattern of excretion into the urine. Therefore, results can be positive for varying periods of time, depending on the drug in question. It is extremely difficult to estimate the time a drug was taken or the amount of the drug that was originally ingested based upon a urine drug screen.

This means that urine drug testing may detect drugs long after they have been ingested. Therefore, caution must be exercised in interpreting the meaning of a positive result. A positive urine value means only that the drug has been taken in the recent past but does not indicate that the person was necessarily impaired at the time the sample was collected.

Q Is it possible to determine the level of impairment with a blood sample?

Blood samples provide an accurate measure of the physiologically active drug that is present in a person at the time the sample is drawn. Although blood samples are a better indicator of recent consumption than urine samples, there is still a lack of published data correlating blood levels and impairment with the degree of certainty that has been established for alcohol.

Q How do the terms sensitivity and specificity relate to drug screening tests?

Sensitivity is the ability to detect a drug, if the drug is present. Specificity is the ability to distinguish between the drug being tested for and other drugs, or interfering substances.
How accurate is drug testing?

Drug screening procedures are highly accurate. Nevertheless, difficulties with specificity may occasionally produce a false positive result. That is why we strongly recommend, and many states require, confirmation of all positive screens with a different method of higher specificity.

Urine testing has become an emotionally loaded term for many, triggering visions that range from a police state to a drug-free paradise, depending on one's perspective. These reactions are unfortunate and can be damaging because, in the heated arguments over invasion of privacy, social responsibility and liability, the purpose and appropriate use of drug testing in the workplace is often obscured.

"To test or not to test" is never the opening question nor the primary issue. It is rather one method among many that may be used to address drug abuse prevention, treatment, and control. Alternatives may include an Employee Assistance Program or other personnel or medical services. Constraints might include pre-existing labor contracts or available financial support for rehabilitative services. Urine drug testing can be an effective option if it is used properly.

The misuse of drugs in the workplace is well publicized. In 1981, drug use among a civilian workforce of some 108 million may have cost employers $16.4 billion.

There are three primary contributing factors to this cost: loss of productivity, medical expenses, and workplace crime related to drug abuse. The Alcohol Drug Abuse and Mental Health Administration, an agency of the Federal Government, estimates that reduced productivity due to alcohol and drug abuse cost the U.S. nearly $99 billion in 1983. Most, of these expenses are shouldered by American business.

While statistics show how pervasive the problem is, one must also understand the impact that drug abuse can have on the workplace, including the "bottom line." Drug abuse leads to increased absenteeism, higher turnover, and decreased productivity. Drug abusers can suffer from impaired memory, lethargy, and reduced coordination, which may be, in turn, responsible for performance problems. Marijuana and alcohol, for example, interfere with driving ability and negatively affect other skills needed to operate equipment safely and effectively. Drugs have been implicated in railway collisions and derailments, bus and heavy equipment accidents, and poor product assembly.

The problems of drug abuse are not isolated to a few types of companies. They are as prevalent on Wall Street as on the construction site. And it is not confined to just the use of illicit drugs; alcohol, as well as prescription drugs such as barbiturates, pose the same potential problems as marijuana, cocaine, or PCP.

There are three frequently cited reasons that constitute grounds for conducting drug testing. The first is public safety. This is of the utmost concern in businesses where employees are directly responsible to the well-being of large numbers of people, e.g., airlines and other modes of transportation.

Employee safety is another good reason to test because accidents can lead to injuries. The failure to remove drugs from the workplace could lead to possible legal action for liability and negligence.

Fitness for duty is the third issue, and it concerns all employers. Failure to produce properly made products can endanger the reputation of a company.

Recognizing the severity of the problem, many companies now have programs for routine testing of both prospective and current employees. Today, more than 30% of the Fortune 500 companies already administer some type of mandatory test for drugs.

By far, the most prevalent use of drug testing is for pre-employment screening. The goal is to control the influx of individuals who are drug abusers. Companies using this procedure report that it helps protect them from problems later on by weeding out many prospective employees who use drugs. In addition, urine testing gives a job candidates and current employees a clear message about the organization's position on employee drug use.

Urine testing also can be used on a random basis with selected employees who hold sensitive jobs involving public safety or public trust. The purpose here is not only to prevent drug abuse but to identify users as early as possible so the public is not jeopardized because of drug-related impairment.

Urine testing also can be used when job performance problems have been observed or accidents/incidents occur which result in a supervisor referring an employee to Employee Assistance, medical or safety/security personnel for evaluation. In these cases, the urine test can be an important diagnostic tool in uncovering the source of the employee's problem and indicating the direction referral should take.

To develop a policy on drugs of abuse, it is usually recommended that a company first assess and identify the impact of substance abuse and then begin the drafting process. The final policy must be clearly defined before testing begins. This policy must be nondiscriminatory and be universal in application without exception.

Once approved by legal counsel, the policy should be proclaimed and posted for all employees. It should be spelled out clearly so that employees understand the company's position. The proclamation usually includes the consequences for violation of the policy. Issues addressed in a company policy include drug possession and use as it relates to job function.

What does Crestwood Medical Center offer in the way of drug screenings?
The laboratory at Crestwood Medical Center offers a full array of drug screening procedures. We are open 24 hours per day, 7 days per week and chain of custody urine specimens may be collected for testing at any time.

Most companies prefer using an industrial account which may be set up with the laboratory for use with their employees. The company will then be billed at the end of each month.

Negative reports should be available within 24-36 hours. Positive results will be re-tested for confirmation using a second methodology with higher specificity, and will require an additional 24-48 hours.

Any selection and number of drugs may be tested. Your panel may be customized according to your preferences. Frequently used combinations include the following panels:

5 drug screen:

Amphetamines, Cannabinoids, Cocaine, Opiates, and Phencyclidine

10 drug screen:

Amphetamines, Barbiturates, Benzodiazepines, Cannabinoids, Cocaine, Methaqualone, Opiates, Phencyclidine, Methadone, Propoxyphene

Please call the lab director at Crestwood Medical Center, at 429-5166 for details.