Testing Services FAQ

1) The donor’s specimen sat out all weekend on the counter-top unrefrigerated, is it still okay for testing?

2) What are common methods used to substitute “clean” urine for “dirty” urine?

3) How do I know that after collection a sample has not been tampered with or mixed up with another sample?

4) Will commonly ingested substances such as vitamins, penicillin, aspirin, caffeine, and acetaminophen (Tylenol) cause a false positive test result?

5) Will over-the-counter medications cause a confirmed false positive test result?

6) Will prescription medications cause a confirmed false positive test result?

7) Can having sex with a drug user cause a person to come up positive on a urine drug test?

8) What is GC/MS?

9) Do we need to order a GC/MS confirmation whenever a positive drug test result would lead to a probation revocation hearing?

10) What does THC mean?

11) Will “passive inhalation” of marijuana smoke cause a positive urine drug test?

12) Why is the result from a THC-Quantitative screen so much higher than the THC result from the GC/MS on the same sample?

13) My client got a cocaine by GC/MS result of 2000 ng/ml. Does this mean that the donor took a large amount of the drug?

14) How long after cocaine use can it be detected in the urine?

15) My client has recently been to the Dentist – Will the test result for cocaine be positive?

16) What are the so-called Date Rape Drugs and how do they work?

17) Is it possible for a drug test to be positive for alcohol as a result of diabetes?

18) Will eating poppy seed food products cause a false positive for opiates?

19) What is the difference between morphine, heroin and codeine?

20) What prescription drugs could interfere and cause a positive morphine (opiates) test?

21) What is the difference between Methamphetamine and Amphetamine?

22) What is Ecstasy?

23) What does PCP mean?

24) What are drug test sensitivity cut-off levels established as standard by the NIDA, WHO and SAMHSA for the different drugs of abuse?

25) What is an MRO?

26) Are instant-answer, onsite testing devices accurate?

27) Is Hair Testing a good option?

28) Why is laboratory drug testing favored by so many organizations?

 

 

Q1: The donor’s specimen sat out all weekend on the countertop unrefrigerated, is it still okay for testing?

 

A: Yes, but we advise testing an unrefrigerated specimen within seven days of collection. It is known that the concentrations of some drugs and their metabolites decrease gradually in room temperature urine. Refrigeration can slow this process somewhat and freezing will preserve a sample indefinitely. Usually the decrease is not dramatic, but in the worst-case scenario, a borderline positive level might drop below the detection threshold. An unrefrigerated specimen would never cause a false positive, with one important exception. Alcohol may form in unrefrigerated urine due to fermentation, if the urine sugar (glucose) is elevated, such as in diabetes. We recommend that alcohol screens be shipped promptly, and we check for the presence of glucose in all positives. TOP

Q2: What are common methods used to substitute “clean” urine for “dirty” urine?

A: Substitution of “clean” urine for ones own is difficult when the urine collection is observed, however, some creative donors go to great lengths to cover-up their drug use. Lifelike male prosthetics that dispense smuggled urine can be purchased and females can insert tubes containing clean urine sealed with cellophane into their body cavity that can be pierced to release the “clean” urine. Some donors have even introduced another person’s urine into their own bladder by injection or catheterization. More commonly, when the collection is not observed, donors smuggle a hidden container of clean urine into the collection room. Checking the urine temperature immediately after collection indicates substitution when the counterfeit sample has not been brought to body temperature. Compounding the matter, guaranteed drug free urine can be readily purchased on the Internet. TOP

Q3: How do I know that after collection a sample has not been tampered with or mixed up with another sample?

A: All samples are carefully labeled at the collection site and contain a tamper-evident seal that is placed over the specimen cup. Additionally, the specimen cup is placed in a tamper-evident bag, along with any chain of custody forms. Upon arrival at the laboratory every sample is examined to ensure that the tamper evident seals are still intact and that the identification numbers on the sample and the chain of custody match. Following the above procedure ensures the legal defensibility of the chain of custody procedure. TOP

Q4: Will commonly ingested substances such as vitamins, penicillin, aspirin, caffeine, and acetaminophen (Tylenol) cause a false positive test result?

A: No. The tests are drug and drug metabolite specific. Because these commonly ingested substances are chemically and structurally different from the drugs being tested for, they will not interfere with or compromise test results. TOP

Q5: Will over-the-counter medications cause a confirmed false positive test result?

A: No. Some over-the-counter medications may cause a positive test result on our EMIT screening test, which is the first test performed on the sample to determine if drug is present. Specimens that test positive on the screening test are called “presumptive positives” and are immediately scheduled for a second test called a confirmation test. The confirmation test will determine definitively if the drug present is an over-the-counter medication or a drug of abuse. TOP

Q6: Will prescription medications cause a false positive test result?

A: No, The vast majority of prescribed medications will not cause a positive urine drug test result. However, some prescribed drugs are widely abused and will be detected during our initial EMIT screening test, generating a “presumptive positive” result. It is important to note that this is not a situation of a “false positive” finding, but is in fact an accurate test result. If you have a Physician’s prescription for the drug detected there will be no action taken, and the test will be reported as “negative”. TOP

Q7: Can having sex with a drug user cause a person to come up positive on a urine drug test?

A: This question has been posed many times but always with respect to cocaine use. Is it possible? Yes, but only in a very unlikely situation. A typical dose of cocaine is about 200 mg. Of that dose, most is eliminated in the urine as metabolites and only a small percentage is incorporated into bodily tissues and fluids. Although it is possible that cocaine might be detected in a drug user’s semen, the amount would be too small to cause a sex partner to subsequently test positive. If a man was to apply cocaine to his penis in order to decrease sensation and thereby prolong erection, the partner could possibly test positive. TOP

Q8: What is GC/MS?

A: One of the most precise procedures for detection of drugs of abuse in urine is a combination of gas chromatography (GC) and mass spectrometry (MS), abbreviated GC/MS, which provides an exact molecular identification of substances. Compounds are separated by GC and are then introduced, one at a time, into a mass spectrometer. As the sample constituents enter the MS, they are bombarded by electrons, which cause the compound to break up into molecular fragments. The fragmentation pattern is reproducible and characteristic, and is considered the “molecular-fingerprint” of a specific compound. Gas chromatography/mass spectrometry is considered to be the most definitive method for confirming the presence of a drug in the urine. TOP

Q9: Do we need to order a GC/MS confirmation whenever a positive drug test result would lead to a probation revocation hearing?

A: APPA guidelines suggest two methods for using positive test results for the purpose of revoking probation. First, if the donor tests positive by immunoassay screen and admits to using the drug, then no further testing is required. The admission is all that the court needs to revoke. If the donor denies using the drug, then a confirmation test is required. The universally accepted confirmation test is Gas Chromatography Mass Spectrometry (GC/MS). TOP

Q10: What does THC mean?

A: THC is an abbreviation for 11-nor-delta9 Tetrahydrocannibinol-9-carboxylic acid, the primary metabolite of Marijuana. Marijuana is a hallucinogenic agent derived from the leaves, flowers or seeds of the hemp plant. In general, the production and “curing” of the marijuana plant into its useable form closely resembles that of tobacco. Marijuana is almost always smoked and inhaled into the lungs where it is quickly metabolized (or changed) by the body into 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid, which is excreted in the urine. TOP

Q11: Will “passive inhalation” of marijuana smoke cause a positive urine drug test?

A: No. Urine concentrations of THC above the cutoff level, meaning a positive result, are not possible by exposure to second hand smoke. Scientific studies have tested non-smoking individuals under conditions where other individuals are heavily smoking marijuana, and have determined non-smokers will not test positive. Other studies have used extreme and unrealistic conditions that have required study individuals use goggles to protect their eyes from the harsh marijuana smoke. However, these conditions that result in exposure to significant amounts of marijuana smoke are the same as using marijuana directly. With a cutoff level of 50 ng/mL, an excuse of “second hand smoke” causing a positive urine test for marijuana is not accepted today in our legal system. TOP

Q12: Why is the result from a THC-Quantitative screen so much higher than the THC result from the GC/MS on the same sample?

A: The THC in marijuana is broken down into at least five different metabolites, which are excreted in the urine. The THC-Quant test is performed by immunoassay and is sensitive to all the marijuana metabolites, whereas the GC/MS test is specific for only the most abundant metabolite, THCC. The rule of thumb is that the level measured by GC/MS should be about one third of the level measured by immunoassay. TOP

Q13: My client got a cocaine by GC/MS result of 2000 ng/ml. Does this mean that the donor took a large amount of the drug?

A: Not necessarily. The urine drug level does not correlate well with the initial dose. A positive result simply means that there has been use. Two or more serial determinations may be helpful in determining new verses prior use. Cocaine clearance is so rapid (two to four days) that this is rarely necessary. TOP

Q14: How long after cocaine use can it be detected in the urine?

A: Cocaine is excreted in the urine primarily as the metabolite benzoylecgonine in a short period of time. Benzoylecgonine can be generally detected for 24 to 60 hours after cocaine use or exposure. Exact clearance rate times can’t be determined since the metabolic rate is individualized depending on weight and other factors. TOP

Q15: My client has recently been to the Dentist – Will the test result for cocaine be positive?

A: No – the local anesthetics used in dentistry are synthetic and structurally not the same as cocaine or crack cocaine and will not be detected by our EMIT screening test. TOP

Q16: What are the so-called Date Rape Drugs and how do they work?

A: Rohypnol and GHB. Rohypnol is a very potent tranquilizer similar to Valium, but much stronger. Rohypnol falls in the general drug class of benzodiazepines. Rohypnol, like all benzodiazepine drugs, produces a sedative effect, amnesia, muscle relaxation and a slowing of psychomotor responses. The drug is often distributed on the street for $2.00 to $4.00 per tablet and in its pharmaceutical packaging, which makes it appear legitimate and legal. Rohypnol side effects begin approximately 20-30 minutes after taking the drug and peak within two hours. The half-life of system induced Rohypnol, dependent on dosage is up to 8 hours. Symptoms of Rohypnol use include decreased blood pressure, black outs (memory loss), disorientation, blurred vision, aggressive behavior, loss of inhibitions, and extreme anxiety. Rohypnol is known as a rape drug because perpetrators reportedly slip it into a victim’s drink causing them to blackout. Rohypnol takes away a victim’s normal inhibitions, leaving the victim helpless and blocking the memory of a rape or assault.

GHB (Gamma-hydroxybutyrate): Originally developed as an anesthetic, GHB is sold in powdered, liquid or capsule form. GHB usually is tasteless, but may be recognized sometimes by a salty taste. GHB was formerly sold by health-food stores and gyms as a sleep aid, anabolic agent, fat burner, enhancer of muscle definition and natural psychedelic. In the last few years it has been gaining popularity as a “recreational” drug offering an alcohol-like, hangover free “high”. GHB side effects are usually felt within 5 to 20 minutes after ingestion and they usually last no more than two to three hours. The effects of GHB are unpredictable and very dose-dependent. Sleep paralysis, agitation, delusions and hallucination have all been reported. Other effects include excessive salivation, decreased gag reflex and vomiting in 30 to 50 percent of users. Dizziness may occur for up to two weeks post ingestion. GHB can cause severe reactions when combined with alcohol, benzodiazepines, opiates, anticonvulsant and allergy remedies. TOP

Q17: Is it possible for a drug test to be positive for alcohol as a result of diabetes?

A: Yes, it is possible for a drug test to be positive for alcohol as a result of diabetes. Individuals who suffer from diabetes commonly exhibit renal malfunction that results in an excessive amount of glucose and protein in their urine. In the presence of yeast or bacteria, urinary glucose can be converted to alcohol by fermentation. Thus, a person with diabetes and who has a urinary tract infection might have alcohol in their urine in spite of an absence of alcohol consumption. A laboratory should test every specimen that is positive for alcohol for the presence of glucose and report the results of the test. When glucose is detected it is possible that the alcohol is a result of urinary glucose fermentation and not consumption. In the absence of the test for glucose or for bacteria, a simple procedure should be employed to test for fermentation; leave the specimen at room temperature for several hours and retest it. If the level increases, the specimen is undergoing fermentation. It is possible (although unusual) that the glucose is completely consumed by fermentation. This usually results in an extremely high urine alcohol level (>1%), pressurization of the specimen container and the smell of yeast. Urine specimens that exhibit an alcohol level of greater than 0.5% should be checked for evidence of fermentation. TOP

Q18: Will eating poppy seed food products cause a false positive for opiates?

A: Poppy seeds do contain small amounts of opium, and eating foods with poppy seeds may cause a sample to screen positive for opiates at a 300 ng/mL cutoff level. However, upon confirmation tests by GC/MS, the laboratory and/or the Medical Review Officer (MRO) can look at the ratios of the component opiates (morphine, codeine) and their metabolites to report the correct result.

Additionally, if the cutoff level of the test is the revised standard of 2000 ng/ml for opiates, this is not possible. Sensitivity standards were raised in the year 2000 from 300 ng/mL to 2000 ng/mL to eliminate the possibility of false positive results that were possible from consumption of large quantities of poppy seeds or poppy seed paste at the lower sensitivity level. TOP

Q19: What is the difference between morphine, heroin and codeine?

A: Chemically, nothing. All three of these drugs are derived from opium or the opium chemical structure and are in the opiate class of drugs. The difference is primarily in the manner in which opium is refined or synthetically manufactured and the form and method of delivery. Heroin is quickly metabolized to morphine. The body also changes codeine (used in some cold medicines) to morphine. Thus, the presence of morphine in the urine indicates heroin, morphine and/or codeine use. TOP

Q20: What prescription drugs could interfere and cause a positive morphine (opiates) test?

A: Codeine and Meperidine are structurally related to morphine therefore causing positive results. Codeine is a commonly prescribed pain medication and is also the active ingredient in some prescription cough medicines. These forms of codeine can also be addictive and abused. A confirmation of a positive EMIT opiates screen can determine if heroin use is indicated. TOP

Q21: What is the difference between Methamphetamine and Amphetamine?

A: Both amphetamine and methamphetamine are potent symphathomimetic agents. Methamphetamine is the parent drug. It metabolizes (or is converted) into amphetamine in the body. Methamphetamine and/or amphetamine are excreted in the urine. A positive result for Amphetamine can also be interpreted as a positive test for methamphetamine. TOP

Q22: What is Ecstasy?

A: Ecstasy (MDMA) has recently become a popular recreational drug among teenagers and young adults. Ecstasy is refined processed form of amphetamine with a chemical structure closely resembling methamphetamine. TOP

Q23: What does PCP mean?

A: PCP is an abbreviation of phencyclidine, which chemically is an arylcyclohexylamine. The most common street name is “angel dust”. TOP

Q24: What are drug test sensitivity cut-off levels established as standard by the NIDA, WHO and SAMHSA for the different drugs of abuse?

A: The table below indicates the standardized threshold concentration levels for immunoassay tests established by regulating authorities. These levels are reviewed and updated periodically to conform to new data on drug development, technology and testing statistics. Concentration is expressed in nanograms per milliliter of fluid.

  Symbol Target Drug/Metabolite
Concentration
  THC marijuana/cannabis
50 ng/ml
  COC cocaine/benzoylecgonine
300 ng/ml
  PCP phencyclidine
25ng/m
  OPI opiates/morphine 2000 ng/m
  MET methamphetamine 1000 ng/ml
  AMP amphetamine 1000 ng/ml
  MTD methadone 300 ng/ml
  BAR barbiturates 300 ng/ml
  BZO benzodiazepines 300 ng/ml

TOP

Q25: What is an MRO?

A: A Medical Review Officer (MRO) is a licensed Medical Doctor who has special training in the area of substance abuse. All positive test results will be sent to the MRO who will then review the results, confirm that the chain-of-custody procedures were followed, and contact the donor to make sure there are no medical or undisclosed reasons for the positive result. It is only after this review that the test result will be sent to the employer. TOP

Q26: Are instant-answer, onsite testing devices accurate?

A: No. The commercial “instant answer” drug testing devices currently being sold produce both “false positive” and “false negative” results. Studies have determined that these products may not identify Methamphetamine, Ecstasy, Dilaudid, or Vicodin or other common drugs of abuse. TOP

Q27: Is Hair Testing a good option?

A: No, not at this time. Hair testing is becoming more popular as a less embarrassing and invasive sample matrix (specimen) to test for drugs of abuse. There are several concerns regarding hair testing currently being discussed in scientific and legal forums: 1) Unlike forensic drug testing (FDT), a drug testing method that has been around for close to forty years, laboratories providing hair testing services are not accredited by a national accreditation program; 2) there is scientific concern regarding whether the drug(s) detected by hair testing are incorporated INTO the hair (from actual use) or are simply ON THE SURFACE of the hair (due to environmental contamination or from “passive” exposure) 3) hair grows at approximately one-half inch per month. Therefore, three inches of hair can contain a one-half year record of drug use. If an individual has been through drug rehabilitation, but still has drug in their hair, they may be accused of drug use while actually being drug free and protected under the Americans with Disabilities Act (ADA); 4) scientific studies in peer reviewed literature have indicated a racial difference in how drug is incorporated into hair and therefore hair testing may be racially biased. 5) lack of universal acceptance in the scientific community and legal circles in a manner similar to that of urine drug testing, which has been around for close to forty years. TOP

Q28: Why is laboratory drug testing favored by so many organizations?

A. A person’s liberty or family unit is at stake! In these instances, it is crucial that accurate results derived from testing in a controlled environment with strict quality control measures. A certified-laboratory provides the ideal environment for quality-controlled analysis enabling you to be confident in the accuracy and robustness of the results. TOP