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A History of Drug Testing in the US

JP Martin Nobel Prize Chormatography

It may surprise you to know that even though humans have been using drugs for 6,000 years drug testing is a relatively new invention. Our history of drug testing really didn’t start until the 1980s when a handful of workplace accidents spurred the federal government to take a closer look.

The earliest recorded use of drugs was by the early Egyptian dynasties. The medical and religious use of marijuana can be traced back nearly 5,000 years in China.

The Rigveda (ancient canonical text of Hindu) mentions Soma more than 3500 years ago, a drink that was extracted from a plant that was said to produce immortality. Historians and researchers believe it was a plant extract that resembled ephedrine or other stimulants.

It wasn’t until the 19th century when cultures started purifying, synthesizing and altering organic substances that drugs became more powerful and the negative effects of drug use started to become apparent.

Earliest Drug Testing in the Equine Industry

The first drug testing was used in horse racing. European horse trainers brought the techniques of doping horses with them to America which was soon adopted by many American horse trainers in the early 1910s. The first horseman that was suspected publicly of doping horses was John Oliver Keene, better known as Jack Keene, the developer of Keeneland.

While racing in Russia he began dominating the circuit. Russian trainers became suspect and devised a plan to test the horse’s saliva after they suspected Keene had fed drugs to the horses by force feeding the horse saliva to frogs. The frogs began acting erratically and soon Jack Keene was banned from horse racing in Russia.

Once back in America where he founded Raceland park and eventually Keeneland.

 

Jack Keene
Jack Keene, the founder of Keeneland, was subject to an early form of equine drug testing in Russia were horse saliva was force fed to frogs.

 

From 1930-1950 several drug testing labs for the equine industry were set up across the country. They mostly tested the saliva of horses using microcrystalline testing.

Saliva samples were mixed  solvents and then combined with reagents. Once the solvents evaporated the crystalline residues that were left were examined under a microscope and compared with crystals produced by known drugs used by equestrians.

In the 1950s chromatography was substantially improved by Archer John Porter Martin and Richard Laurence Millington Synge who both won the Nobel prize in chemistry for their work. Chromatography quickly became the primary technique for drug testing over the next decade.

 

 

Thin Film Chromatography
Chromatography is a process were samples are dissolved in a solvent and then subjected to multiple test phases which result in the components being separated and measured.

 

Early practitioners used thin film chromatography which was soon replaced by gas chromatography.

History of Drug Testing in the Workforce: Ford Sociological Department

It is now widely accepted that drug testing employees increases productivity and safety and reduces employee turnover, but management noticed this trend long before data was collected or published about it.

In the 1910s Henry Ford’s automobile business was booming. The increase in sales meant that he needed to keep approximately 15,000 workers manning his assembly lines.

At the time auto work was a dangerous, tedious and low paying job that had a high turnover rate. In 1913 Ford had hired a total of 52,000 workers even though there were never more than 15,000 on the payroll at one time.

 

Early Ford Assembly Line
The assembly line was crowded and relied on moving the heavy automobiles between stations. This new technique was dangerous and was made even more dangerous by employees that were drunk or intoxicated. It became important for Ford to identify and remove employees that were a danger to others.

 

In 1914 Henry Ford doubled the hourly rate for his employees from $2.34 to $5. The increased salary came with strings attached. Employees had to be continually employed by Ford for 6 months before receiving their raise, and they also had to submit to the Ford Sociological Department.

Ford wanted his employees to become model citizens. Shift leaders had long suspected that employees that drank and gambled were not as productive, and such a large increase if pay afforded the company the opportunity to intrusively monitor their employees for degenerate behavior.

Besides the increase in pay Ford offered workers that signed up for the Sociological department many other incentives. These included:

  • An English School for immigrants
  • Assistance with transitioning from rentals to home ownership
  • Low cost loans for housing and furniture
  • Access to lawyers on staff
  • Free access to medical care for employees and their family

The program was paternalistic, intrusive and expensive. Most workers whole heartedly bought in however because the benefits were so great that the invasion of their privacy seemed minimal.

 

Ford Sociological Department Results
These photos from the Henry Ford archive show the increase in living standards for Ford employees during the program. The photos on the left are prior to the program, the photos on the right are during the program.

 

The program was also successful. Turnover fell from 370% in 1913 to just 16% in 1915. Due to controversy, economic cost and a reorganization of the company Ford’s Sociological Department ended in 1920. Even Henry Ford himself disagreed with many of the intrusions the department brought with it. In Ford’s 1922 autobiography he said so himself.

“paternalism has no place in industry. Welfare work that consists in prying into employees’ private concerns is out of date. Men need counsel and men need help, often special help; and all this ought to be rendered for decency’s sake. But the broad workable plan of investment and participation will do more to solidify industry and strengthen organization than will any social work on the outside.”Henry Ford , My Life and Work-An Autobiography of Henry Ford

Even though drug testing itself wasn’t a part of Ford’s sociology experiment, the whole program was an early 20th century equivalent to drug testing which has been distilled down to a single scientific test that lacks the controversy of an intrusive spy ring. The results were similar and were in line with the drive to increase productivity and worker efficiency by auto manufacturers of the day.

History of Drug Testing in the 1980s: Employment

Beginning in 1980 there were several high profile workplace accidents that were linked to on the job drug use.

In 1981 an accident aboard the USS Nimitz left 14 sailors dead and 48 injured. Property damage was estimated at $150 million and when autopsies were performed it was found that six sailors tested positive for marijuana.

The Department of Defense acted quickly adopting several new policies for drug testing and drug use in the military.

In 1987 a Conrail train crashed into an Amtrak passenger train north of Baltimore after running a warning signal. During the NTSB investigation that followed it was found that engineer Ricky Gates tested positive for marijuana and PCP. The brakeman Eddie Cromwell also tested positive for PCP but was given immunity for testifying that the crew was smoking marijuana just before the accident.

Sixteen people died in the Conrail crash and 174 were injured. The NTSB ruled that drug impairment was the root cause of the disaster.

 

 

Ricky Gates was charged with manslaughter and was released after spending 4 years in prison. During a subsequent interview with the Baltimore Sun Gates said that the accident would not have happened if he hadn’t been smoking marijuana. He said the drug threw his perception of speed and time off and that he had skipped critical safety measures in his rush to get back to Baltimore and get high.

Drug Free Workplace and Omnibus Acts

As drug use and on the job accidents attributed to drugs continued to rise it became a common story in news media.

In 1986 Ronald Reagan used his executive powers as President to issue Executive Order 12564 which required mandatory drug testing for federal employees.

In response Congress passed the Drug Free Workplace Act of 1988 which outlined drug testing regulations for businesses that received federal contracts, but also informed the drug policy of businesses across the country.

Discounts to workers compensation plans and corporate insurance lead many companies to institute their own drug free workplace policies even though they were not subject to the same federal oversight.

It became clear that the biggest dangers of workplace drug use was in the transportation industry. In 1991 Congress passed the Omnibus Transportation Employee Testing Act which requires drug testing for all safety sensitive employees in the transportation industry. The Department of Transportation oversees mandatory random drug testing and pre-screening for employees in trucking, railroads, aviation, pipeline, public transit and other transportation related industries.

Widespread Adoption and Drug Testing Advancements

During the 1980s immunoassays were developed with increased sensitivity that were necessary to detect highly potent drugs. The pinnacle of early immunoassay testing was enzyme linked immunosorbent assays (ELISA).

In 1988 with the expanding role of independent labs in testing employees subject to the drug free workplace policy the government standardized laboratory oversight with the CLIA amendment. Laboratories were subject to CLIA since the initial law was passed in 1967, but the new amendments helped clarify the regulations and policies regarding the different complexities.

In the early 1990s laboratories started using gas chromatography with mass spectroscopy (GC/MS) to confirm drug test results. This new technology brought sensitivity and accuracy to new levels.

Since more and more businesses were integrating drug free workplace policies and drug testing employees scientists developed rapid drug tests that could be used on site and give near instant results for employers.

A laboratory will now have multiple methods for testing samples for drug use and the sensitivity is many orders of magnitude smaller than isolating crystals from horse saliva. Labs can also test several different samples including blood, urine, saliva and hair.

Rapid testing has improved to the point many companies administer their own drug testing on site and only involve a lab when there is a positive or inconclusive result.

Since the 2000s new equipment that utilizes liquid chromatography with mass spectrometry (LC/MS) and triple stage mass spectrometry (LC/MS/MS). The latest advancements use what is called ultra high performance liquid chromatography with high resolution mass spectrometry (UHLC/HRMS).

While even the best LC/MS equipment was mostly used for confirmations because the number of molecules that could be tested was small and once data is collected the test could not be replayed to seek out other molecules. The new UHLC/HRMS equipment scans over a much larger range and can identify hundreds of molecules. Once the test is run the collected data can be analyzed afterward to screen for additional compounds.

 

Drug testing techniques sensitivity comparison
This table shows the increasing sensitivity of drug testing with each new iteration of drug testing technology.

 

Dealing With COVID and Rising Drug Use

As 2020 began COVID 19 caused many businesses to implement work from home programs and suspend random drug testing for employees to limit contact. Many researchers theorized that drug abuse would increase and as inflated numbers of overdose deaths started to come in across the country it seemed their prediction was accurate.

It came as a shock when it was reported that positive employment drug tests were at their highest levels since 2003, and that the data for that statement was from 2019 and not during the pandemic.

 

2019 Drug Test Positivity Rate
This map shows the percentage of areas that had positive drug test results performed by Quest Diagnostics. Areas in the northeast and northwest were especially hard hit by increased employee drug use.

 

As the pandemic winds down and employees return to their offices it’s likely we will see another increase in positive drug test results.

If the history of drug testing has taught us anything it’s that when employees use drugs productivity and workplace safety suffers while turnover and liability increases. The National Council on Alcoholism and Drug Dependence (NCADD) estimated that 70%, or over 10 million of Americans who use drugs are employed and cost employers a total of $81 billion annually. It has never been more important for employers to adhere to a drug free workplace program.

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What is FYL On a Drug Test?

What is FYL on a drug test

FYL on a drug test stands for Fentanyl.

What is FYL On a Drug Test?

FYL stands for Fentanyl. Fentanyl is a powerful opioid that is used in the treatment for severe pain, but is also becoming widely abused. It is often mixed with Heroin to increase potency and lower cost for drug dealers. This trend has caused a dramatic rise in Fentanyl related overdose deaths. Fentanyl is 100 times stronger than morphine.

Fentanyl has a rapid onset and short duration. Withdrawl effects are more severe than heroin. Fentanyl use can be detected for up to 3 days with a fentanyl drug test.

For pain management cancer patients are often prescribed transdermal Fentanyl patches that extend the release of the drug to the blood stream. The dosage of a fentanyl patch is 25-100 micrograms per hour. Common brands are Duragesic, Abstral and Subsys.

 

Fentanyl Patch
Fentanyl 25mcg patch is placed on the patient’s body and provides pain relief for 72 hours.

 

Drug addicts defeat the extended release by cutting the patches open, mixing the contents with water and injecting the solution.

Fentanyl is also available in buccal tablets, sublingual tablets and lozenges. Besides cancer patients it is sometimes used as a treatment for breakthrough pain for patients that have a high opiate tolerance.

In street form fentanyl is a gray/white powder that is often mixed with doses of heroin. In 2017 the number of heroin overdose deaths that contained fentanyl and other synthetic opioids surpassed the number of overdose deaths from heroin alone.

 

Heroin and Fentanyl Comparison
This photo shows the lethal doses of heroin, fentanyl and carfentanil which is a Fentanyl analogue. As you can see it takes a much smaller amount of fentanyl to kill the user.

 

Patients that have a positive drug test for fentanyl may be using diverted pharmaceuticals, but it’s more likely they are using heroin that has fentanyl or one of its analogues mixed in.

Dangers of Fentanyl

A therapeutic level of fentanyl and a dangerous amount is very small which makes using fentanyl as a recreational drug very dangerous. Naloxone injections used by EMTs are effective in combating fentanyl overdose, but recently EMTs have reported using 3 or 4 injections to revive patients because the amount of fentanyl or the strength of the analogues were so great a normal dose had no effect.

Besides being mixed with heroin and sold in powder form fentanyl is also pressed into counterfeit pharmaceuticals that resemble popular street opiates. The most common form is counterfeit 30mg oxycodone pills, but drug dealers also have been busted with counterfeit xanax, counterfeit OxyContin and several other types of pills that are pressed with molds.

 

fake oxycodone fentanyl pills
The bottom M box 30mg pill is counterfeit. Regular drug users can sometimes identify counterfeits because of the color and irregularity. Users will roll and bounce the pill along with a verified authentic pill to compare how it reacts. Drug dealers are getting better at passing off their counterfeits as the real thing.

 

Drug dealers aim to include enough fentanyl to mimic the high that the user would feel from taking the pill they are counterfeiting, but due to the potency of fentanyl the result is usually much weaker or much stronger than the pill it is based on.

Fentanyl and its analogues are being studied and sometimes deployed tactically by military and law enforcement. On October 23, 2002 during the Moscow Hostage crisis Russian authorities used a fentanyl analogue gas to subdue Chechan terrorists and resolve the incident. The gas ended up kiling approximately 137 of the more than 800 hostages that were being held.

Side Effects of Fentanyl

Fentanyl’s side effects are much like the side effects of other powerful opioids.

  • abdominal or stomach pain
  • blurred vision
  • chest pain
  • clumsiness or unsteadiness
  • confusion
  • constipation
  • decreased urine
  • dizziness
  • drowsiness
  • dry mouth
  • headache
  • increased thirst
  • irregular heartbeat
  • lightheadedness
  • loss of appetite
  • mood changes
  • muscle twitching or jerking
  • nausea
  • numbness or tingling in the hands, feet, or lips
  • pale skin
  • rapid breathing
  • respiratory depression
  • sneezing
  • sunken eyes
  • swelling
  • tightness in the chest
  • unusual tiredness or weakness
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Drug Testing Remote Employees

drug testing remote employees

With many companies electing to allow employees to work remotely during the pandemic, businesses are interested in the best methods of drug testing remote employees. Fortunately there are several options available for drug testing remote employees depending on your company’s specific situation.

Have Remote Employees Report to The Office for Drug Testing

The easiest method of drug testing remote employees is to have those employees come in for staff meetings or performance reviews on a regular basis. You can select employees to be randomly tested at their next meeting or call employees at random.

The primary benefit of having your employees report the office is that you do not have to change your drug testing regimen if you were drug testing on site before the pandemic.

One drawback is that once an employee has been made aware of their next appointment they can prepare to possibly be drug tested. Most people that use drugs are aware of drug testing procedures and they will be suspicious about any request to report to the office whether you mention a drug test or not.

If a company’s workforce is local to the business location and there is a skeleton staff still at the office this is by far the easiest, cheapest and most convenient option.

Since multiple employees will be entering your building you will need to escalate sterilization practices and institute procedures to safeguard everyone from viral infections.

 

wearing a mask in the office
Any contact between remote employees and employees at the office must be handled with care. Require masks and check everyone’s temperature that enters your place of business.

 

This will include measures like taking everyone’s temperature, mandating protective equipment, having everyone use hand sanitizer, keeping an appropriate distance between employees and possibly installing sneeze guards in rooms where an employee reporting for drug testing will interact with the employee administering the test.

Keep employees exposure limited with an efficient process and sterilizing areas that could possibly be infected between appointments.

Outsource Drug Testing to a Local Laboratory or Drug Testing Company

Another option that could work well if to temporarily outsource drug testing to a third party. Employees could be notified by phone and given a set time limit to report to the lab for testing.

Some benefits of outsourcing is that a company specializing in drug testing will have more experience administering drug tests. They may catch more people trying to cheat, they will be liable for any legal issues and it removes any question of an employee of your company showing favoritism to others.

The primary drawback of outsourcing your drug testing is the cost. It can cost 10x-100x more per employee for a drug testing company or lab to administer testing. In addition to the cost drug testing facilities are prone to corruption.

In March of this year a supervisor at a drug testing facility in Las Vegas was charged with accepting bribes from federal probationers in exchange for concealing their positive and missed drug tests. The employee, Billy Joe West, plead guilty in June. In December of 2018 a drug tester in Waldorf Maryland was charged with similar crimes after accepting a bribe during an undercover sting.

Corruption in drug testing companies is rarely investigated and employees are often paid low wages. If employees that have the responsibility of testing federal parolees are so easily coerced, how easy would it be to bribe an employee that is handling employment tests?

You can always switch back in an in house drug testing program after the pandemic subsides and it could be helpful to have this option as a backup for any future issues.

Test Patients During Telehealth Screenings

One of the more adaptive clinicians we have spoken with, George L. Swanberg, a Licensed Clinical Social Worker and Licensed Substance Abuse Treatment Practitioner, and the Executive Director of Life Line Counseling Center in Warrenton Virginia, has developed a procedure for alcohol testing through Zoom meetings.

Using Alco-Screen strips and observing the patient closely he has them follow these instructions:

  1. In view of the camera the client rips open the packet, removes the strip, and shows me the beige end.
  2. Then, I watch him/her put it on the saliva laden tongue for about 30 sec. 
  3. Then they remove it and show it to the camera for about 30+ seconds. 

Very important: I then have them place a drop of alcohol hand sanitizer on the pad and show it to me. 

If it turns green I’ve not only tested the client but tested the veracity of the test so I know they did not defeat the enzyme process by sticking it in the microwave or through another method first. 

COVID restrictions have allowed practitioners leeway in how they handle screening. It is better to develop some sort of testing guidelines than to suspend testing entirely. It is up to clinicians to set their own precedents and develop their own procedures when operating under undocumented circumstances.

DNA Verified Samples

A technology that isn’t well known in the drug testing industry is using DNA verification for laboratory samples. This would be an interesting option for companies that have remote employees scattered across the country.

The company mails the employee their urine screen with directions and the employee provides the sample at their convenience and ships it to the laboratory. An express shipping option with signature confirmation is used to strengthen the chain of custody.

The laboratory uses a one time mouth swab in combination with a sealed urine cup and can match the urine sample to the employee that is supposed to be the donor. The gas chromatography confirmation techniques used would be adjusted to specifically look for any type of adulteration as well.

Gentox lab’s NextGenUDT product is one of many DNA confirmation products available in the United States. Gentox’s CEO claims that their DNA verification definitively authenticates samples, reveals mislabeling errors, and detects urine sample substitutions.

 

Verified DNA Drug Test
A DNA verified drug test comes with a mouth swab that will later be used to match the subject’s DNA to the DNA of the urine donor.

 

The major drawback to this type of testing is the cost. DNA verification in addition to even the most basic laboratory test drug test would be much more expensive than an internal drug testing program. However this is an elegant solution and for some companies the benefit will justify the cost.

The benefits are that a licensed lab will be conducting the most thorough lab testing available, it would be very convenient for your employees and it reduces the risk of adulteration through substitution.

Suspend Your Drug Testing Program for a Short Time

Federal regulatory agencies have given businesses more leeway with meeting their guidelines due to the unprecedented nature of the pandemic. Many doctors offices have been allowed to schedule patients for telemedicine appointments and courts have even postponed trials.

You could contact your lawyer and ask about how a temporary suspension of your drug testing policy would affect your legal responsibilities. The American Society of Addiction Medicine has published guidelines for the unique considerations medical professionals are facing during this time.

Always consult a legal professional before taking any action that could affect your business’s adherence to your drug free workplace policy. You could be held liable down the road and even an act of God like a pandemic may not be a good enough excuse.

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What Is TCA On a Drug Test

What is TCA on a drug test

TCA on a drug test stands for Tricyclic Antidepressants.

Customers usually recognize the obvious abbreviations on 12 panel drug tests, but some are confused by pharmaceuticals.

What is TCA on a Drug Test?

TCA stands for tricyclic antidepressants. Tricyclic antidepressants is a group of drugs used to treat bi-polar disorder, depression, insomnia, OCD, bedwetting and several other conditions or symptoms.

Tricyclic antidepressants have mostly been replaced by newer classes of antidepressants such as SSRIs, SNRIs and NRIs, they are still widely prescribed.

 

TCA Elavil
Elavil is one of the most commonly prescribed TCAs (Tricyclic antidepressants).

 

TCAs were discovered in the 1950s and have been in use ever since. Besides patients that are prescribed TCAs for legitimate diagnosis, drug abusers that use cocaine and other stimulants will sometimes use tricyclic antidepressants to come down and sleep.

List of TCAs

  • Amitriptyline (Elavil, Endep)
  • Doxepin (Adapin, Sinequan)
  • Clomipramine (Anafranil)
  • Imipramine (Tofranil, Janimine, Praminil)
  • Trimipramine (Surmontil)
  • Desipramine (Norpramin, Pertofrane)
  • Nortriptyline (Pamelor, Aventyl, Norpress)
  • Protriptyline (Vivactil)
  • Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)
  • Amoxapine (Asendin)
  • Maprotiline (Ludiomil)

TCAs No Longer Available in the US

  • Lofepramine (Lomont, Gamanil)
  • Dosulepin (Prothiaden)
  • Tianeptine (Stablon, Coaxil, Tatinol)
  • Melitracen (Deanxit, Dixeran, Melixeran, Trausabun)

TCAs Widely Taken Out of Use

  • Dibenzepin (Noveril, Victoril)
  • Nitroxazepine (Sintamil)
  • Noxiptiline (Agedal, Elronon, Nogedal)
  • Pipofezine (Azafen/Azaphen)
  • Amineptine (Survector, Maneon, Directim)
  • Opipramol (Insidon, Pramolan, Ensidon, Oprimol)

TCAs No Longer Available

  • Butriptyline (Evadyne)
  • Demexiptiline (Deparon, Tinoran)
  • Dimetacrine (Istonil, Istonyl, Miroistonil)
  • Fluacizine (Phtorazisin)
  • Imipraminoxide (Imiprex, Elepsin)
  • Metapramine (Timaxel)
  • Propizepine (Depressin, Vagran)
  • Quinupramine (Kevopril, Kinupril, Adeprim, Quinuprine)
  • Iprindole (Prondol, Galatur, Tetran)

Detection Time for TCAs (Tricyclic Antidepressants)

The normal detection time for TCAs on a drug test is 1-5 days. TCAs have similar biological effects and a similar chemical structure, which is why there are so many that can be identified in a single drug test strip.

One of the reasons PCP was taken off so many 12 panel drug tests and replaced with TCAs is because TCAs can cause false positives for other drugs. Having the TCA strip makes it easier for doctors to identify the cause of false positive, and since they’re known to be used as downers by cocaine users it can be additional evidence of an active cocaine addiction if the subject fails the test for both.

These drugs have been known to cause false positives for TCA:

  • Seroquel (quetiapine fumarate)
  • Trileptal (oxcarbazepine)
  • Benadryl (diphenhydramine)
  • Flexeril (cyclobenzaprine)
  • Thioridazine
  • Thorazine (chlorpromazine)

Side Effects of TCAs (Tricyclic Antidepressants)

    • anxiety
    • apathy
    • blurred vision
    • changes in appetite
    • confusion
    • dizziness
    • drowsiness
    • dry mouth
    • constipation
    • hallucinations
    • hives
    • hypersensitivity
    • hypotension
    • irregular heart rhythms
    • low blood pressure
    • muscle twitches
    • nausea and vomiting
    • rash
    • restlessness
    • sweating
    • tachycardia
    • twitching
    • weakness
    • weight gain or loss
    • increased heart rate

Additional Precautions for TCA

The differences between TCAs have to do with their varying effects on the different neurotransmitters (serotonin, norepinephrine and acetylcholine). Some only affect one neurotransmitter while others affect multiple. They also have varying strengths; Elavil for instance causes more sedation than most other TCAs.

Tricyclic antidepressants pose  high overdose risk due to their high morbidity and the fact that they’re so widely prescribed. There is an increase in suicidal thoughts and behaviors associated with TCAs. If you or someone you know are having an increase in suicidal thoughts or behaviors contact the National Suicide Prevention Lifeline , you can also call 1-800-273-8255.

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Do 12 Panel Drug Tests Test for Alcohol

do 12 panel drug tests test for alcohol

One of the questions we are most often asked is if 12 panel drug tests test for alcohol. The short answer is that no, 12 panel tests usually do not test for alcohol.

There are exceptions to this rule and many drug tests will include a separate alcohol urine test, but an alcohol test strip is not normally found on 12 panel tests themselves.

The most common drugs included on a 12 panel test are cocaine, marijuana, opiates, oxycodone, benzodiazepines, methamphetamine, amphetamine, methadone, suboxone, barbiturates, ecstasy, tricyclic antidepressants and PCP.

Do 12 Panel Drug Tests Test for Alcohol

You can get a 12 Panel drug test configured with any combination of testing strips you want. However unless you are running a sophisticated laboratory that is capable of high complexity testing most professionals need a test that is CLIA waived to meet state and federal regulations.

There are currently 13 drugs that have CLIA waived status so for your cup or cassette to be CLIA waived it can have any combination of those 13 drugs. Alcohol is not CLIA waived.

 

12 Panel Drug Test Cup Strips shown
Our 12 Panel drug test cup tests for cocaine, marijuana, opiates, oxycodone, benzodiazepines, methamphetamine, amphetamine, methadone, suboxone, barbiturates, ecstasy and tricyclic antidepressants. This is the most common combination for a 12 panel test.

 

Lots of people use drug testing in a forensic capacity. If you suspect someone of being drunk on the job you can request that the employee take an ETG test. If the test is positive it is probably cause to send the employee for more thorough testing or to send them home. So even though alcohol tests aren’t CLIA waived they can still be useful.

The solution most organizations use is to use 12 panel CLIA waived drug tests for the bulk of their testing and supplement those tests with single dip cards for additional drugs and alcohol. By doing it this way the majority of drugs are covered by a CLIA waived test and the additional tests can be deployed on an as needed basis.

Why You Should Test For Recent Alcohol Use

Since alcohol is legal for consumption in the U.S. alcohol urine tests are most often used for people in drug and alcohol recovery or for people that are prescribed medications that are not supposed to be taken with alcohol. The detection time is roughly 8-24 hours so a urine alcohol test is practically a test for recent alcohol use.

55.3% of people admit to drinking in the past month and 70% admit to drinking in the last year. Alcohol is by far the most commonly abused drug on the job, almost 3 times as common as marijuana which is the second most commonly abused drug at work.

 

Substances Used at Work
This graph from Drugabuse.com shows that alcohol is the most commonly abused drug on the job.

 

Alcohol tests can also be a useful tool as evidence against employees that may be drinking on the job.

We recently covered a multitude of reasons why employers drug test. It is clear that active drug and alcohol users are less productive and get in more accidents, but it’s also worth noting that their accidents are more costly and dangerous.

According to Bradford Health Services Workplace accidents caused by inebriation or hangover are 5 times as likely to injure someone. 40% of all workplace fatalities are caused by substance abusers.

Addressing Employment Related Alcohol Abuse

Younger male workers, tradespersons, and lower skilled workers are more likely to abuse alcohol both on and off the job. Company culture can play a big part in an individual’s pattern of behavior, especially when it comes to alcohol consumption. Entertaining clients and working in an environment where alcohol is freely available are factors in on the job alcohol consumption.  Some industries are at an increased risk for abuse alcohol. These include:

  • Hospitality
  • Mining
  • Agriculture
  • Retail
  • Manufacturing
  • Construction
  • Financial services

Some contributing factors to employees that abuse alcohol are:

  • Isolation
  • Long Hours
  • Relationships with employees
  • Company culture
  • Inadequate supervision
  • Employee morale
  • Poor working conditions

It is everyone’s responsibility to monitor alcohol use and abuse in and around the workplace, but the Occupational Health and Safety Act of 1994 obligate employers to respond to alcohol use and any related harm in the workplace. Every employer should maintain a drug free workplace policy. It is prudent to randomly include alcohol urine screens in random drug tests and always test for alcohol in a post-accident screening. Besides recent alcohol use testing employers can

  • Promote health and fitness in the workplace
  • Offer more education and training programs
  • Provide access to treatment and counseling services
  • Draft a fitness for work policy that addresses alcohol specifically

 

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Drug Tests for Welfare Recipients

Drug Test for Welfare

Do drug tests for welfare recipients save money or have any positive effects on society? Most of the data published has echoed the sentiments of the organization that published it. It’s not easy to quantify the success of these programs because the number of welfare applicants change as the economy improves and declines.

In a study conducted and touted by Think Progress they found that only 1% out of the 263,000 applicants that could have been subjected to drug testing were rejected. Think Progress is a liberal organization that sets out to oppose drug testing for welfare recipients.

Their claim is somewhat misleading; the 263,000 number is included in almost every mention of the study but it doesn’t have a whole lot to do with the results. Also states enacting drug testing expect it to deter applicants that wouldn’t be able to pass a screening.

 

Drug Tests for Welfare in 2018
Thinkprogress showed that overall a lot of money was spent to have only a small percentage of applicants test positive.

 

For example Utah spent $30,000 in 2013 on their drug tests for welfare program, but only 12 people tested positive. 250 others did not meet testing requirements however and Governor Brad Wilson stated that denying benefits to those people alone saved the state $350,000. Brad Wilson has a vested interested in the success of the program because he promoted it.

It would be hard to calculate the number of people that did not apply because they knew they had a drug habit and did not want to subject themselves to testing.

In another instance of organizations pushing their agendas the Florida Civil Liberties union found that Florida’s welfare drug testing program cost the state $45,000 more in testing than it saved in welfare payments. After a Florida judged blocked the bill and made the state pay out benefits retroactively the conservative Foundation for Government Accountability showed that costs grew quickly which suggests that the law was saving money.

Arguments for Drug Testing

There have been several arguments made for mandatory drug tests for welfare recipients. The primary motivation for voters is that they believe their tax money should not be given out in entitlements that subsidize behavior they disapprove of.

Some of the primary goals of welfare drug test programs are

  • Referring people that test positive to treatment
  • incentivizing recipients to abstain from drug use
  • reduce spending on welfare
  • identifying custodians of minors that use drugs
  • denying benefits to people that would subsidize their drug habit with them

Proponents point out that most employers drug test their employees and think that it isn’t fair that welfare recipients do not work and aren’t subjected to the same scrutiny.

Arguments Against Drug Testing

The primary arguments against drug testing recipients are

  • The cost outweighs the savings
  • drug addicts on welfare are deterred from seeking treatment
  • such laws unfairly target poor and minority citizens
  • it’s a violation of the 4th amendment

32 proposed bills focused on drug tests for welfare recipients in 2009 and 2010 but none of them made it to a legislative vote because they mostly focused on testing every applicant as a requirement for receiving benefits.

A 2003 court of appeals case Marchwinski v. Howard found that subjecting every welfare recipient to drug testing with no reasonable suspicion was unconstitutional. However the federal government does require any employee that works for a company that competes for federal contracts to be subjected to random drug testing under the Drug Free Workplace Act.

Opponents of these laws say that the premise itself is discriminatory because it suggests that welfare recipients are more likely to use drugs. In the vein of the Drug Free Workplace Act you could look at it as anyone that accepts federal or state funds is subject to higher scrutiny.

Public Sentiment

Public sentiment is divided about drug testing welfare recipients, but it’s not divided along party lines as much as other mainstream topics of political discussion.

Since we could not find a published study that didn’t seem to have a political bias at its core we decided to do our own survey about the public’s opinion on drug testing welfare applicants and recipients.

In a study we conducted of 400 random Kentucky residents 183 said they did not support drug testing welfare applicants, 116 said they did support drug testing welfare applicants, and 101 had a mixed opinion and did not definitively choose. I expected the results to be closer to an even split, but it was clear that overall the majority of the public doesn’t clearly support welfare drug testing legislation.

We hoped that the participants would correspond to political affiliation and income levels nationally, but we had a higher level of lower income individuals.

A surprising aspect is that the group that most likely supported drug testing welfare recipients were recovering drug addicts. There was also a level of bi-partisan support on the basis of “if I have to be drug tested to work my job they should be drug tested to receive my taxes”.

 

SentimentNumber of Votes
No183 (46%)
Yes116 (29%)
Unclear101 (25%)

 

Some of the reasoning we received from people surveyed was very interesting. Here is a sample of some of the more interesting remarks.

No Voters

“I’m a hater of government assistance but I still don’t see any fairness in requiring drug tests for benefits. We don’t drug test business owners that get tax breaks or subsidies.” – M.B.

“A lot of these same folks would end up homeless, clogging the streets, increasing crime, and cost even more money long term. What’s the better alternative?” -M.G.

“No. It’s become increasingly difficult to even get benefits as it is. Single adults without kids must have a job or do community service to even receive SNAP now. Someone with no job that just wants to get free assistance won’t get anything anyway.” – C.M.

“Nope. If they start testing then all government (state and federal) employees should be tested as well.” -J.C.

Yes Voters

“I’m tested every time I start a new job and am subject to random testing. It’s a requirement for my paycheck, why should it be any different when it comes to using my taxes for people on welfare. I’m certainly not against welfare, and am a firm believer that it’s a good thing when used as it was intended.” – J.P.

“Yes cause odds are if the parents are on drugs they are trading food stamps for money to get drugs so children aren’t getting the food they need anyway and children should go to someone else that will feed and take care of them properly.” -C.R.

“I think yes! People are saying children are involved and will go without food, but so would the children of parents loses their job due to a failed drug test. People on drugs get way too many free passes and handouts yet not getting any real help offered to them, like rehab, counseling.” – S.J.

Unclear Voters

“There’s good and bad in it. We get tested to work so they should get tested to draw. At the same time what do we do with the people getting cut that become homeless? What about the children who were barely eating before? They should be tested, but we need a plan to negate the negatives before it can be considered.” – M.J.

“Hard question because the kids gotta eat it isn’t their fault. But who’s to say the parents use the welfare for food?” – K.J.

“If they get tested, they would have to test levels. Because even if they get prescribed the medicine they can still abuse it.” – K.J.

Welfare Drug Testing Laws by State

Alabama – 2014 passed a law that requires welfare recipients with a drug conviction in the last 5 years to submit to drug testing.

Arkansas – 2017 Arkansas passed SB 123 making their drug testing program permanent.

Florida – 2011 passed a law HB 353 requiring all applicants for TANF benefits to be tested. Florida courts struck down the law as unconstitutional.

Georgia – 2012 passed legislation requiring drug tests for all applicants for Temporary Assistance for Needy Families.

Kansas – 2013, Kansas enacted legislation to require drug testing for applicants and recipients suspected of using controlled substances.

Maine – 2015 passed a law requiring welfare recipients that had a prior drug conviction to submit to drug testing.

Michigan – Governor Rick Snyder signed HB 4118 and SB 275 into law on December 24, 2014. The bills require the Department of Human Services to establish and administer a suspicion-based drug screening and testing program in at least three counties.

Missouri – 2011 passed HB 73 requiring the department to require a urine drug test for all applicants and recipients of TANF for whom they have reasonable cause to believe based on screening that they are engaged in illegal use.

Mississippi – 2014 Governor Phil Bryant signed HB 49 into law on March 24, 2014. The bill requires all applicants for Temporary Assistance for Needy Families (TANF) to complete a written questionnaire to determine the likelihood of a substance abuse problem. If the results indicate a likelihood the person has a substance abuse problem, the applicant must submit to a drug test.

North Carolina – 2013 passed HB 392 which included a provision to require drug testing of welfare applicants or recipients based on reasonable suspicion.

Oklahoma – 2012 passed HB 2388 requiring DHS to screen all adult applicants for Temporary Assistance for Needy Families (TANF) to determine if they are engaged in illegal use of controlled substances.

Tennessee – 2012 approved a bill to require the department to develop a plan for substance abuse testing for all applicants.

Utah – 2012, passed HB 155 requiring individuals applying for cash assistance to complete a written questionnaire screening for illegal drug use. If there is reason to believe the person has a substance use disorder or is engaging in illegal drug activity, the applicant must take a drug test.

Wisconsin – 2015 budget bill (SB 21) included a provision to drug test individuals participating in the Wisconsin Works and the Transform Milwaukee Jobs program and work experience programs for non-custodial parents. The bill also included a provision to test applicants for the Supplemental Nutrition Assistance Program which was challenged by the Federal government.

West Virginia – 2016 Governor Tomblin signed SB 6 on March 23, 2016, which creates a 3-year pilot program to screen welfare applicants for substance abuse issues. If the caseworker has reason to believe the applicant is abusing drugs, a drug test will be ordered.

 

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Requirements for Conducting Legal Random Drug Testing

Requirements for legal random drug testing

Random drug testing is an important part of maintaining an effective and safe workforce. Many large companies outsource drug testing because they believe the requirements are too costly. Let’s break down the requirements for conducting legal random drug testing for your business.

Identify Requirements for Legal Random Drug Testing

Most large corporations use the Drug Free Workplace Act of 1988 as a starting point for their random drug testing program. It is required that all businesses that seek federal contracts abide by the drug free workplace act and SAMHSA provides a comprehensive toolkit for meeting all the requirements.

If you have a large business and expect to apply for federal contracts anytime soon I suggest hiring a consultant and studying the SAMHSA provided information in detail.

 

Drug Free Workplace Notice
One of the requirements of the Drug Free Workplace act was that employers must display a sign like this in their business where all employees can see it.

 

For a random drug testing program to consider the law as much as possible it will need to be part of a larger drug free workplace policy that covers everyone working for your business. Your drug free workplace policy will be comprehensive and will outline all drug testing that your organization plans on conducting.

Your business may be subject to additional regulations and laws depending on your industry and the states you operate in, but the Drug Free Workplace Act is a good starting point. Some industries also have more strenuous requirements like companies that are subject to DOT regulations.

Which Drug Tests are Legal?

You can use any drug test you want for random testing as long as the staff are trained and certified in conducting and interpreting them. The FDA separates in vitro tests into 3 categories

  • High Complexity
  • Moderate complexity
  • CLIA Waived

To use high complexity or moderate complexity tests from a legal standpoint you have to meet some very strenuous requirements, so strenuous that it really isn’t feasible for a business that isn’t an actual laboratory with an executive director that is a PHD specializing in chemical tests.

Since the additional cost is minimal and it takes care of many legal issues, you will need to make sure you are using a CLIA waived multi drug test like our 12 Panel drug test cup. This also solves the problem of deciding what drugs to test employees for because all of the drugs that have a CLIA waiver in place are included.

When drug testing employees always follow best practices for employee drug testing especially when it comes to maintaining a chain of custody and verifying positive results with a confirmatory screening.

Basic Guidelines for a Legal Random Drug Testing Program

Written Drug Free Workplace Policy

The first thing you need to do is create an internal document outlining your drug free workplace policy. It is a good idea to consult an employment attorney when drawing up your procedures, penalties and policy.

 

Drug Free Workplace Policy Signature Page
Every employee should have a signature page from your drug free workplace policy on file. This is proof that the employee was aware of and agreed to your policy.

 

Employees should sign a copy and be given their own copy of your drug free workplace policy when they submit an application. This will deter heavy drug users and will make it clear to others that you take drug use seriously. You can use the Drug Free Workplace Act as a basis for your own policy.

Clearly Identify Penalties

Every employee should know what the penalties for violating your drug free workplace policy are and what to expect if they fail a drug test. Be as detailed and specific as possible in regards to penalties and be consistent with enforcement.

A company policy is far less questionable than the judgement of a manager. This is your opportunity to be as lenient or as strict as you’d like in regards to how you handle policy violations.

Outline Drug Testing Guidelines

Explain who will be tested, when they will be tested and be a detailed as possible.

For example, you will want to clearly identify that employees can be tested for pre-employment, post accident, and random drug testing at a minimum. If you include instances such as suspected drug use you will need to have your supervisors trained and certified to identify impairment.

The more specific you are in your outline the better your will be protected in case of a dispute. For instance if you say that 50% of the workforce will be randomly selected for testing every 12 months and then follow those guidelines an employee can’t accuse the company of discrimination as easily.

Provide Training

The more training you have for your employees involved in a drug testing program the better. There are certifications for everything from administering drug tests to identifying impairment.

At the very least employees involved in carrying out your drug free workplace policy should have in house training and semi annual retraining for their particular roles.

In larger companies a Medical Review Officer will be employed with specialized medical training in handling samples and following structural guidelines. In smaller companies an employee in HR will usually handle screening in addition to other duties.

Drug Testing

There are many benefits to drug testing employees, and it will be the center of your drug free workplace policy. Drug testing will help lower your insurance rates, improve workplace safety and reduce costs. Most business will employ 3 primary types of drug testing:

  • Pre employment drug tests
  • Post Injury drug tests
  • Random drug tests

You can legally send an employee for a drug test if you suspect they are high on the job, but you need to have trained persons make that judgement call and be prepared to back it up in court. It is actually very rare for someone that fails a drug test to fight it in court after the fact, but as a business owner you want to prepare for the worst.

Employee Education for Drug abuse

It is often considered a duty of an employer to help educate their staff about drug abuse and encourage them to abstain from illegal substances.

Provide education and training that reinforces healthy  behaviors and spreads awareness about the effects substance abuse can have on health and employment.

You can do this by bringing in a medical expert annually for continuing education, or by meeting with each employee individually.

Supervisor Training

The staff member that supervises your Drug Free Workplace policy is a very important cornerstone for the entire program.

Depending on the size of your business the supervisor may be the sole administrator of the Drug Free Workplace Program or they may supervise a staff of several different professionals.

Supervisors should be intimately familiar with every detail of the program and be able to thoroughly document everything in a fair, systematic and unbiased way. The supervisor is responsible for identifying possible legal issues and tracking state and federal laws that affect your policy.

Employee Assistance & Rehabilitation

No business wants to lose a good employee to drug abuse. Gainful employment is one of the biggest incentives for a drug user to stay clean, and studies have shown that employees that are in recovery may be even better than average employees; they miss fewer days and have a 21% lower turnover rate.

Part of a drug free workplace policy is offering employees a second chance when they violate the rules.

Always document violations clearly and have the employee and their supervisor sign off. If you have documentation to back up that your employee has repeatedly violated a company policy then there is very little room to misinterpret a company’s actions.

Additional Tips for Avoiding Legal Action

Protect Employee Privacy

Protecting employee privacy is one of the key requirements for legal drug random drug testing. Since drug testing is considered a medical test there is an expectation of employee privacy. Test results are confidential and only the appropriate personnel should have access to them.

You should never comment on an employee’s drug use as it pertains to your drug free workplace policy. Do not gossip with your family and do not discuss it with employees. Violating an employee’s privacy could potentially lead to significant legal hurdles so it’s better to adopt a zero tolerance policy and be safe rather than sorry.

Do Not Rush to Judgement

Enforcing a drug testing policy requires a professional and systematic approach. It is very easy to let emotions become involved when you believe an employee has endangered your business and co workers through reckless behavior, but you need to strictly stick to your policy to afford yourself the most protection.

In a worst case scenario one of your managers dislikes a subordinate and decides to drug test them. The manager gossips to others that the employee is a drug addict and it gets back to them. They end up passing the test, but now at the very least you have a difficult situation between two employees and at worse your employee has a case for slander and your company violating a policy they developed. It could also make future termination proceedings very difficult because there is now a record of your company seemingly targeting them for termination.

Be Consistent

A drug free workplace policy has no room for playing favorites or discriminating against employees you no longer like. Rules need to be enforced across the board and if you say you’re going to do 25 random drug tests per year you need to do exactly 25.

If you go 4 years without doing a random drug test and then one day drug test 5 employees and 1 is dirty, it could seem like you targeted that employee specifically.

 

 

 

 

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What is Creatinine?

The most popular and consistent test for adulteration of drug tests is creatinine. Many people confuse this with creatine, but what is creatinine and how does it indicate that a drug test has been tampered with? Creatinine concentration is checked during standard urine drug tests.

What is Creatinine?

Creatinine is the primary metabolite of creatine that is produced when creatine is broken down in muscles. It is then expelled in the urine.

Since creatine is produced by the body at a consistent rate and it’s almost entirely removed from the blood stream by our kidneys it can be used to tell if our kidneys are functioning properly and also as a benchmark for the dilution of a urine sample.

Creatinine cycle
This graphic details the generation, filtering and expulsion from creatinine in the human body.

What is a Normal Level for Creatinine Testing?

The amount of creatinine in urine varies depending on a person’s age, sex, muscle mass, water intake, activity level and overall health. Individuals with more muscle mass will produce more and so will individuals with higher activity levels.

The normal range for human urine is measured in milligrams per 24 hours. The expected range is 955 to 2,936 milligrams (mg) per 24 hours for males, and 601 to 1,689 mg per 24 hours for females. For medical testing a patient is often asked to capture their urine for a 24 hour period to get a more precise reading. For drug test adulteration testing the creatinine level is just a snapshot from a single sample.

For a urine adulteration test the cutoff level for creatinine is usually very low, often <5mg per deciliter. Levels in urine lower than this cutoff are not consistent with human urine and usually indicate an individual has engaged in water loading before being tested.

creatinine activity table
This table shows the average difference in test results for individuals with varying levels of activity.

Usually for a sample that fails an adulteration test the urine will be clear and the urine sample will also have a specific gravity that falls outside the normal range (1.003 to 1.030). Some of the color can be replaced by ingesting a high level of vitamin B12, but not enough.

Levels in Blood

If a physician finds creatinine levels in someone’s urine to be abnormally low and they do not suspect adulteration they will schedule other tests to determine the cause. If levels in the blood are high this usually means there is an issue with kidney function.

The normal range for a blood test is 0.84 to 1.21 milligrams per deciliter.

Causes of Abnormal Creatinine Levels

Several diseases and scenarios can cause abnormal readings.

  • Diabetes
  • High Blood Pressure
  • High protein diet
  • Kidney infection
  • Kidney Failure
  • Kidney Stones
  • Muscular Dystrophy
  • Myasthenia Gravis
  • Kidney Damage

When testing levels physicians will instruct patients to stop taking certain medications including Cefoxitin, Trimethoprim, and Cimetidine.

There are several supplements and activities that can alter levels.

Increase Creatinine Levels

  • Vigorous Exercise – Exercise increases creatinine levels in the blood stream and urine, at least temporarily.
  • Creatine Supplements – Creatine supplements are used to fuel muscles and slow down the production of pyruvic acid. More creatine leads to more creatinine by product.
  • High Protein Diet – High protein intake has been shown to increase creatinine levels.

Reduce Creatinine Levels