DRUG TESTING and SUBSTANCE ABUSE PROGRAMS

Introduction

Drug Testing programs are designed to assist your Company to: 

1. Ensure employee fitness for duty
2. Assure public safety and trust
3. Increase productivity and employee morale
4. Reduce health insurance costs
5. Reduce absenteeism 

Preventive*PLUS provides a wide range of substance abuse programs and activities tailored to your unique work environment.  Our programs are designed to take into account a broad range of legal considerations, from handicap discrimination to invasion of privacy. 

Preventive*PLUS will design, implement, and manage a comprehensive specimen collection and drug testing program that meets all Federal Requirements, including those of the Department of Transportation.

§ 40.87   What are the cutoff concentrations for initial and confirmation tests?
(a) As a laboratory, you must use the cutoff concentrations displayed in the following table for initial and confirmation drug tests. All cutoff concentrations are expressed in nanograms per milliliter (ng/mL). The table follows:

NIDA/DOT Drugs of Abuse Screen

Type of Drug or Metabolite	Initial Test	Confirmation Test
Marijuana metabolites (i) Delta-9-tetrahydrocannabinol-9-carboxylic acid (THC)	50	15
(2) Cocaine metabolites (Benzoylecgonine)	300	150
(3) Phencyclidine (PCP)	25	25
(4) Amphetamines (i) Amphetamine (ii) Methamphetamine	1000	500 500 (Specimen must also contain amphetamine at a concentration of greater than or equal to 200 ng/mL.
(5) Opiate metabolites     (i) Codeine     (ii) Morphine     (iii) 6-acetylmorphine	2000	2000                       2000                         10 Test for 6-AM in the specimen.  Conduct this test only when specimen contains morphine at a concentration greater than or equal to 2000 ng/mL.

Categories

Pre-employment testing
Post-accident testing
Random testing
Reasonable suspicion testing
Return-to-duty testing
Follow-up testing

Specimen Collection

The specimen collection processes is performed by medical technicians who follow strict procedures as outlined:

 Follow DHHS approved urine protocol

1. Initiate Chain of custody form
2. Check for picture identification
3. Have donor empty their pocket and remove any outwear
4. Request donor wash hands
5. Have them choose a container from a group of similar container
6. Check and record urine temperature and note any other signs or evidence of adulteration
7. Transfer urine from collection container to laboratory specimen containers and seal each with individual initialed tape
8. Instruct and direct individual to complete chain of custody form
9. Complete chain of custody form and distribute appropriate copies
10. Package specimen containers and appropriate copy of chain of custody form in transport container, and advise courier for pick-up
11. Maintain control of package until courier signs with the date and time
12. Forward MRO appropriate supply of chain of custody form

Medical Review Officer

A Preventive*PLUS Medical Review Officer (MRO) is a licensed physician whose function is to ensure that people who test positive for drugs, for reasons other than illicit use, are not characterized as drug abusers.  The MRO performs the following in the review of a drug test:

1. Receives test results from laboratory
2. Requests, if needed, a quantitative description of test results
3. Receives a certified copy of the original chain of custody form
4. Reviews and interprets positive test results
5. Informs the tested individual.
6. Conducts a medical interview with the tested individual, if necessary
7. Reviews the individual’s medical history, or any other relevant biomedical factors, if necessary
8. Gives the individual an opportunity to discuss test results, but not necessarily face to face
9. Orders a reanalysis of the original sample in a different certified laboratory, if necessary
10. Consults with others if questions of accuracy arise
11. Consults with laboratory scientists, as necessary
12. Cancils tests if the urinalysis results that do not comply with DHHS guidelines
13. Not verify an opiate positive urine test as positive result without clinical evidence
14. Determines whether the result is scientifically sufficient
15. Determines whether a positive result is consistent with legal drug use
16. Forwards report to the designated Company official empowered to recommend or take action

Breath Alcohol Services

On January 1, 1995 the Department of Transportation regulations were expanded to include alcohol testing. Preventive*PLUS is equipped to provide alcohol testing using NHTSA certified breath alcohol testing devices.

Hair Testing for a 90-Day Drug Use History

Hair testing for drugs of abuse is the only drug-testing method available that provides up to a 90-day drug use history. This makes hair testing an ideal solution for pre-employment and random testing protocols.

Using FDA-cleared testing reagents, this lab-based test offers the advantages of easy specimen collection and highly accurate results that meet the same reference standards as urine testing. In addition, there are no known methods for sample adulteration (hair washing will not dilute the sample). Because specimen collection can be directly observed, the risk of adulteration is even further reduced.

 Negative results are reported within 72 hours of receipt at the laboratory, and positive results are confirmed using gas chromatography/mass spectrometry (GC/MS) or gas chromatography/mass spectrometry/mass spectrometry (GC/MS/MS) within 72-96 hours. Hair testing is also forensically defensible.

When compared with urine specimen testing, hair testing provides up to 2.5 times the number of positives and a longer detection window.

Hair testing can test for the following classes of drugs:

Analyte		Screen Cutoff		Confirmation Cutoff
Amphetamines   Cocaine   Opiates   PCP   THC   THC-COOH		300 pg/mg   300 pg/mg   500 pg/mg   300 pg/mg   N/A   1 pg/mg		300 pg/mg   300 pg/mg   500 pg/mg   300 pg/mg   5 pg/mg   0.1 pg/mg

How does hair analysis compare to urine drug test? 

The primary difference is the wider window of detection with hair.  Cocaine, methamphetamine, opiates and PCP are rapidly excreted and usually undetectable in urine 72 hours after use.  Rather than the hours or days covered by a body fluid test, a hair test covers a period of months, ensuring that a drug user cannot evade the test by simply abstaining for a few days. Additional advantages include: non-intrusive collection procedures, virtual elimination of test evasion through substitution or adulteration, and greater accuracy through test repetition capability.  The combination of an increased window of detection and resistance to evasion makes hair testing far more effective than urine testing in correctly identifying drug users. 

How soon after use can a drug be detected in hair?

It takes approximately 5-7 days from the time of drug use for the affected hair to grow above the scalp. 

What is the shortest time period that can accurately be evaluated? 

In most situations the minimum time period is approximately one month. 

How sensitive is hair testing in detecting drug users? 

Comparison studies have proven that Hair testing is up to 5-10 times more effective in identifying drug users than urine testing.  In other words, 85% of the drug users identified by a Hair testing could get through a urine screen and enter the workforce.