Common Questions About Drug Testing

  

What is the role of drug testing in treatment and recovery?

Oftentimes, in cases of Substance Use Disorder or even suspected drug use, trust without proof is no longer possible. Individuals under the influence of addiction will regularly employ deceit – of others as well as of oneself -- as a defense mechanism. And adolescents and teenagers, in particular, can be very manipulative.

Parents are in tune with their kids, and usually they will know when something is up. That “something” could be many things -- depression, other mental illness, a crisis of identity, questions surrounding sexuality, or substance use. Drug testing can help pinpoint the cause.

If a drug test comes back positive, that can help get the individual into treatment sooner, which increases the chances of a successful outcome. The longer someone uses drugs under the radar, the more the brain is becoming compromised. By the time the symptoms are pronounced, the disease has taken its hold, and treatment work could be 5-10x more difficult at that point.

Beyond the initial diagnosis of a problem, drug testing also plays an important role throughout treatment and recovery. Testing either (A) verifies the patient’s reported progress and affirms and reinforces (rewards) his/her efforts; or (B) serves to correct inaccurate self-reports and modify the counseling plan when unreported substance use is uncovered. Both these forms of feedback are crucial to forward movement and progress in treatment. 

Once the initial treatment phase is complete, the intermittent and random use of substance use testing also has a great deal of value into recovery, as a way to safeguard health, reinforce accountability, and protect gains made. If this is going to be done, groundwork has to be in place for it; in other words, it needs to be understood from early on that continued testing will be used, infrequently and unannounced, for a time, until it's mutually agreed it is no longer valuable. This can be set as a goal, i.e., “after one year of random negative drug tests, we will end this part of our work on this.” There might be an added incentive attached to reaching this goal if that is a helpful motivator. (Back to Top)

 

What’s the difference between a lab test and an instant test you can buy at the drugstore?

A drug screen performed in a clinical laboratory is much more accurate than an instant-read test that you can purchase at a drugstore or obtain in a doctor’s office. While POC tests use reliable chemistry, the design of the tests both (A) increases the likelihood of a false-positive and (B) makes it difficult to read the result accurately every time.

Most instant cups test for 6 or 12 drugs at a time, and the combination of chemical reagents used in the multi-test cups creates a high likelihood of cross-reactivity. For some drugs, such as cocaine, that false-positive rate can be as high as 30%.

In addition, those test results appear on very small strips of test paper on the back of the cup, located very close together, that must each be read within a very particular timeframe that’s specific to that drug. (So if a cup tests for opiates as well as cocaine, those two test-strips must be read at different times.) That can be very difficult even for a doctor or nurse to interpret, not to mention for an individual who has never used a drug test before.  

On the other hand, a screen or confirmation test performed in a laboratory uses sophisticated instrumentation and highly trained technicians to run the tests and to read -- and double-check -- the results. (Back to Top)  

 

How accurate is drug testing?

There are two types of drug testing – screening and confirmation.

A screening test is accurate for the class of drugs (ie, opiates), not for specific substances (ie, oxycodone). The likelihood of false negatives is very low, but false-positive results can still occur, depending on the class of substances being tested.

For example, a false-positive result in a cocaine screen is very rare, because there are only a few substances that could cause the test to be positive, and they are all legitimate by-products of cocaine use. Amphetamines, on the other hand, have a higher rate of false positives because that screen also picks up energy drinks.

So while we can’t put a hard figure to “how accurate” a drug screen is, we do caution our clients that any screen that comes back positive should be considered a “presumptive positive,” which should be followed up by a confirmation test to verify the result.

Confirmation tests are very sensitive and very specific, able to identify each drug – not just “class of drugs” – with certainty. (Back to Top)

 

Can all drugs be detected by a drug test? Are there any (e.g., synthetics) that you can’t yet test for?

Naturally-occurring drugs (such as cocaine, morphine and marijuana) can all be easily detected by standard drug tests. But synthetic drugs – those that are man-made and created in a laboratory -- definitely present a challenge for drug-testing labs. The most common and most problematic synthetic drugs in use right now are synthetic cannabinoids and “bath salts.” The producers of these synthetic drugs are constantly innovating the chemical formulations to stay one step ahead of both Federal regulations as well as the chemical reagents that are available for drug-testing labs to use in testing. Each time the formulation of a drug is changed, Federal regulators have to re-write the laws to render the new substances illegal, and then the chemical companies have to reformulate their reagents so that labs can test for them. (Back to Top)  

 

What are the detection windows for common drugs – marijuana, benzodiazepines, opiates, stimulants, etc.?

The chart below indicates how soon, after taking a drug, there would be a positive drug-test result.   

Drug Detection Window
Amphetamines
Methamphetamines
4 – 6 hours

Barbiturates

2 – 4 hours

Benzodiazepines

2 – 7 hours

Buprenorphine

1 – 6 hours

Cannabinoids/THC

1 – 3 hours

Cocaine (Crack)

2 – 6 hours

Ethanol

1 – 12 hours

MDMA (Ecstasy)

2 – 7 hours

Methadone

3 – 8 hours

Opiates (Heroin)

2 – 6 hours

Oxycodone

1 – 3 hours

PCP (Angel Dust)

4 – 6 hours

Tricyclic Antidepressants

8 – 12 hours

 (Back to Top)

 

Is it possible to cheat on a drug test?

It is certainly possible to try to “beat” a drug test, and there are several strategies for doing so. Whether an individual can be successful in cheating that test depends on the way the sample was collected (was the collection observed or unobserved? Scheduled in advance, or done unannounced, at random?) and whether the test included “validity” parameters, which are designed to flag attempts to alter a urine sample. (Instant cup tests do not include validity parameters; however, laboratory tests generally do. For more information on validity tests and how they catch cheating, click here.)

One common cheating method is urine substitution, where an individual will swap out someone else’s drug-free urine for their own. If the urine collection is scheduled and unobserved, this is obviously much easier to pull off, but it can also be done in an observed collection, using a bag hidden under the clothes, a catheter, or a balloon-like device inside the vaginal or anal areas. Specially designed devices for this purpose are readily available online.

A second strategy is for the person to add a substance to their urine after collection that will break down any drugs that are present. Household products like bleach, ammonia, baking soda, detergent, lemon juice or vinegar, and commercially-available “flush kits” containing oxidizing chemicals, can either degrade the drugs present in the sample, or interfere with the enzyme immunoassay analysis of a specimen, or both.

A third strategy is to drink large quantities of water and/or take diuretics before the test. Drugs are present in the urine in proportion to the urine concentration. When the urine is less concentrated (ie, diluted), there is also a lower concentration of drugs; so if someone can dilute their urine enough, they can also bring the concentration of drugs below the cutoff level for a positive result. 

However, added substances and intentional dilution can usually be caught in laboratory testing by looking at the validity parameters. For more information on those parameters, click here. (Back to Top)

 

My family member’s drug screen came back positive. What does that mean?

First, it’s important to realize that there are two different types of drug tests that can be run. One is a “screen,” which only gives you a qualitative (yes/no) result for the drug(s) being tested. In other words, a drug screen for opiates will only tell you if the individual had opiates in their system (positive result) or did not have opiates in their system (negative result). A screen will not tell you what kind of opiates were present (oxycodone vs heroin vs buprenorphine), or in what quantity.

For that information, you would need to order a “confirmation test,” which gives you complete quantitative information on the substance(s) being tested. A confirmation test for opiates, for example, would tell you that it was oxycodone in the person’s system, and how much of that substance was present.

All this being said, a screen might tell you what you need to know – or it might not. It’s possible that, after receiving a positive screen, you may need to go back and order a confirmation test on the same sample to get all of the details you need to help that individual make the best decision for treatment. For instance, knowing whether that “positive” result came from a quantity just barely over the cutoff level – perhaps indicative of one-time experimentation -- or whether a drug was present in a high amount, suggesting heavy or sustained use over time -- might be a critical factor in determining a course of treatment. (Back to Top)

 

Test results are often determined “clean” or “dirty.” Does this contribute to stigma?

Absolutely. As more research is being done about the causes and the manifestations of addiction, science tells us that addiction is not a moral failing, but rather, a condition much like diabetes or depression. A combination of genetic pre-disposition, environmental factors (childhood abuse, family structure, mental illness) and access to addictive substances puts an individual at risk. Those with true Substance Use Disorder (approximately 10% of those who ever experiment with drugs or alcohol) soon lose complete control over their lives, as their brain chemistry is actually altered by the substances that they continue to take compulsively, even though they are aware of their destructive power.

So, if we know that drug addiction is not an individual moral failing, it doesn’t make sense to use pejorative terms such as “addict,” “junkie,” or “dirty” to refer to someone struggling with this condition. Instead, the treatment industry is starting to use more positive and sensitive language, such as “person with addiction” and “positive drug test,” and these are more appropriate. (Back to Top)

 

If I suspect my teen is using drugs, how can I get them to agree to drug testing?

When suspicion rises to a certain level, a parent or guardian has to be willing to recognize and exercise their parental authority. However, drug testing shouldn’t be the very first response. The first step should be a conversation, followed by (perhaps) restrictions and/or a referral to counseling. A parent should always be ready to leverage the resource of counseling, and to insist upon it. Consider giving the child a choice between two counselors, if you want to encourage buy-in.

When a teen accuses their parent of not trusting them, it can be particularly hard for parents to take. But parents can’t back down. It’s often helpful to present factual reasons for the suspicion (I found drug paraphernalia in your room, you’re sleeping all the time, your grades are slipping, and so on). Make it clear that your suspicions are based on evidence, not a lack of trust, and you are following up on your suspicion because you love them and are worried about them.

These conversations can also go much more smoothly if it doesn’t appear to your teen to be a completely unexpected “ambush.” This is where regular, preventative conversations between a parent and a young child are helpful. If you’ve talked to your child during times of transition (starting a new school, gaining more independence, meeting new people) and prepared them for some of the dangers out there (not just substances, but sexual pressures, general peer pressure, and so on) -- you’ve hopefully set the stage for open communication and trust. You may even want to end these preventative conversations with something like “In the future, if I ask you questions about where you were or who you were with, don’t take it personally; it’s all because I love you.” Have this conversation several times. If possible, get a recognition or acknowledgement from your child: “ok, I understand.” Then, when the time comes to use your parental authority and really pry, there is something to reference. (Back to Top)