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Tricyclic antidepressants have mostly been replaced by newer classes of antidepressants such as SSRIs, SNRIs and NRIs, they are still widely prescribed.
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.
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.
One of the questions we are most often asked is if drug tests test for alcohol. The short answer is that no, drug 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.
Drug Test City Offers a separate ETG (Alcohol) urine test so you can maintain the CLIA waiver on your 12 panel test cup, but also determine if someone has drank alcohol recently.
You can get a 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 14 Panel drug tests drugs that include a test for alcohol, but . Alcohol is not CLIA waived, so these tests are for forensic use only.
Our 12 Panel drug test cup tests for cocaine, marijuana, opiates, oxycodone, benzodiazepines, methamphetamine, amphetamine, methadone, suboxone, barbiturates, ecstasy and PCP. 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.
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
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.
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”.
Sentiment
Number of Votes
No
183 (46%)
Yes
116 (29%)
Unclear
101 (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.
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.
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.
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.
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.
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.
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.
Checking 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 of creatinine 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.
How much water it takes to pass a drug test depends on several variables. These include the test type, cutoff levels, amount of drug consumption, your personal creatinine levels, and the length of testing window.
It is possible to dilute urine enough to pass a drug test in some circumstances. However, quality standards and adulteration detection make it difficult for a subject to drink enough water to pass, but not too much so a determination of dilution is found.
The most common drug test adulteration technique is drinking water to dilute a urine sample. The variation in water expelled in urine from person to person makes it hard to detect and since the urine still comes from the subject’s body, temperature strips and observation witnesses cannot detect water dilution unless the sample is clear.
Can Drinking Water Pass a Drug Test?
A heavy user that has only abstained from using drugs for one day will not be able to sufficiently dilute their urine enough to pass a drug test without raising suspicions. However if the user has abstained from use for several days and the levels in concentrated urine are sufficiently low, low levels of water dilution can lower concentrations below the cutoff level.
For someone attempting to dilute their urine to pass a test the real question is “how much water can I drink before my urine is clear or the concentration of creatinine is below 20ng/ml.
Detecting Water Dilution in a Drug Test Sample
The first check for water dilution in a drug test is observing color. Urine samples can be light yellow, but a clear sample will raise suspicions.
Laboratories and drug tests with adulterant strips check for creatinine levels to determine if a sample is sufficiently diluted enough to mark as invalid. The cutoff level for creatinine is 20ng/ml. If your sample falls under this cutoff it will be marked as adulteration and usually considered a failed drug test.
How Drug Tests Work
Drug test contain antibodies that attach to metabolites in the urine of the person being tested. The test determines if the amount of antibodies which correlate to a drug in the urine are over or under a specified cutoff level.
Other testing methods determine the exact quantity of metabolites as well as several other levels such as creatinine, protein and pH. In these more advanced laboratory tests the creatinine level in the sample is a clear indication of water loading and the sample will either be corrected and normalized based on the creatinine levels in your urine or will be marked a failure for dilution outright.
A gas chromatography / mass spectrometry test will yield a result for the ratio of drug metabolites to creatinine levels, which is a more accurate number for determining drug levels since every person consumes a different amount of water.
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Drug Test City drug tests are made to the same standards with the same cutoff levels as most drug tests used nationwide. Purchase our 12 panel cups to see for sure what is on a 12 panel drug test .
Past a certain point urine dilution will raise suspicions or lead to a failed test. Clear urine is the most common reasons for raising suspicions. However, for someone that doesn’t drink the recommended daily allowance of water under normal circumstances drinking water can significantly lower the concentrations of metabolites in your urine without turning the urine completely clear and without failing an analysis for low creatinine levels.
Did You Know?The average person urinates between 35-50 ounces every day and makes an average of 4-10 trips to the bathroom.
Federal Recommendations for Drug Test Cutoff Levels
Most drug tests use the federal recommendations for cutoff levels in drug testing. Each drug exits your body at a different rate. The potency of different drugs vary, and for this reason some tests need to be more sensitive. Manufacturers consider these two variables and generally design rapid urine tests to detect drugs for a window of 3-7 days.
THC 50 ng/mL
COC 300 ng/mL
OPI 2000 ng/mL
AMP 1000 ng/mL
MET 1000 ng/mL
BZO 300 ng/mL
MDMA 500 ng/mL
MTD 300 ng/mL
OXY 100 ng/mL
BUP 10 ng/mL
BAR 300 ng/mL
TCA 1000 ng/mL
How Much Water Can I Drink Before Drug Testing?
The average healthy adult has a bladder that will comfortably hold 16 ounces or 2 cups of liquid. Water loading works by increasing the excess water in your body so the bladder will refill with excess water before the normal mixture of byproducts and the normal level of water used to expel these byproducts accumulates back into the bladder.
The timeframe of ingestion matters as much as how much water you drink. It takes between 45-120 minutes for ingested water to start pushing urine out of your body.
Witnesses and technicians will expect to see some tint to your urine sample. A sample that is entirely clear is a big red flag, but even the slightest tint is acceptable in most cases.
Since a drug test captures a single photograph of your urine content, the goal of someone trying to adulterate their urine by water dilution is to have the optimum ratio of excess water and normal urine at the time they submit their test.
It is hard to say exactly how much water you can ingest before your urine starts to come out clear because there are so many variables, but in a 1-2 hour timeframe approximately twice bladder capacity plus the amount of water your body is expelling through sweat and cellular process results in clear urine. Roughly 32 ounces of water in a 1-2 hour period will bring your urine to the point it will start to be completely clear.
A study in the Annals of Pediatric Edocrinology Metabolism found that the maximum amount of water a person should ever drink is between 27-33.8 ounces per hour. This is the maximum amount of water a healthy human body can process without causing harmful effects to electrolyte ratios.
Cutoff For Drug Test Dilution Test
When a donor provides a positive sample or a sample that is suspected to be diluted, it will normally be sent to a lab for further analysis. If a sample has less than .20ng/ml of creatinine, it is considered dilute and is automatic fail.
How much water will it take to reduce metabolite concentrations under cutoff levels?
Now that we know the level of each drug metabolite your urine must be under you need to know the level of the metabolite currently in your urine. You could send a urine sample off for a laboratory gas chromatography and mass spectrometry test but that would be prohibitively expensive. The best most people can do is guess.
In one study Urinary Elimination of 11-Nor-9-carboxy- 9-tetrahydrocannnabinol in Cannabis Users found that out of the 60s subjects admitted to the test they were evenly spread out between the groups of <50ng/ml, 50-150ng/ml and >150ng/ml. The studied showed that higher concentrations took much longer to eliminate detectable levels from their system.
As you can show the metabolite for THC is detectable far longer for heavy users.
Users that were under the 50ng/ml cutoff at the beginning routinely started passing drug tests on the first or second day. All subjects that were under the 50ng/ml cutoff had eliminated all detectable THC metabolite (<5ng/ml) by day 8. It took 15 days for half the users between 50-150ng/ml to eliminate detectable THC metabolite. 80% of users that started over 150ng/ml level still had a detectable amount of THC in their urine at the end of 30 days.
The good thing for a user wanting to pass a drug test is that instant drug tests have a 50ng/ml cutoff. That means that light users will pass a normal test in 3-7 days and the average user that starts below 150ng/ml will be able to dilute their urine by half on the 2nd day and pass a test, which is the top of the range of how much water you can ingest without turning your urine totally clear.
Is Water Dilution Illegal or Unethical?
The god news is that the optimum water content of urine to have the best chances of passing a rigorous drug test is also around the normal recommended daily allowance for water. Since you do not want your urine to be totally clear you’re aiming for a pale straw coloration that is indicative of optimum water intake.
Most people do not drink the recommended amount of water, and it also causes their urine to have longer detection times than people that stay well hydrated.
If you drink so much water that your urine is clear and your body is passing urine with low levels of creatinine it is unethical and it could also lead to punishment depending on the circumstances of your drug test. Adulterating a drug test is illegal in many states and some prosecutors would make the argument that urine diluted by drinking an excessive amount of water is a clear case of adulteration.
As a business owner it can be hard to decide what drugs to test employees for. Different regions have different drug problems and considerations, but there may be a one size fits all solution. When deciding what drugs to test employees for you should consider these factors:
What drugs are popular in the area of operation?
Are any drugs popular in your industry?
Which drugs have the most potential to negatively affect your business?
Which drugs can be tested for legally, economically and effectively?
What tests are available that are accurate and cost effective?
Most Popular Drugs Among Employees
Most popular illegal drug used in the workplace is recreational Marijuana. Over 20% of respondents of the Drugabuse.com survey admitted to using recreational marijuana during work hours. The second most common class of drug used during work hours was opiate painkillers.
Overall drug use mirrors these findings, with 4.2 million Americans reporting marijuana use and 1.8 million admitting to using prescription pain relievers in a 2013 study conducted by the National Institute of Drug Abuse.
This graph from Drugabuse.com shows that besides alcohol marijuana is the most commonly abused drug on the job.
Over the last decade more people with full time employment have admitted to marijuana and prescription painkiller use than all other classes of drugs combined. The effects of most prescription painkillers are mild enough that employees can use them undetected.
Common Drug Tests Employers Use
The most common instant drug test used by employers in the US is the 12 Panel Drug Test Cup. There are currently only 13 drugs that have CLIA waivers available for rapid testing, so a 12 or 13 panel cup offers the most number of tests while staying in compliance for state and federal guidelines.
Many will use a Fentanyl strip (FYL) and ETG (alcohol) strip in addition to a CLIA waived 12 panel cup. These tests are for forensic use and any indication of a positive should be sent to a lab for confirmation. The fentanyl test is becoming more popular because it is commonly being used in fake pharmaceuticals and mixed with heroin to increase its potency.
Having a CLIA waived test is important because other tests will be considered high complexity and will have no legal standing whatsoever in the majority of workplaces.
CLIA Waived Drug Test Strips
Marijuana (THC)
Cocaine (COC)
Opiates (OPI)
Amphetamines (AMP)
Methamphetamines (MET)
Benzodiazepines (BZO)
Ecstasy (MDMA)
Methadone (MTD)
Oxycodone (OXY)
Buprenorphine (BUP)
Barbiturates (BAR)
Tricyclic Antidepressants (TCA)
Phencyclidine (PCP)
Some organizations must adhere to recommendations published by certain branches of the federal government. In the 1990s the NIDA required testing for at least 5 types of drugs to meet the requirements to be a “Drug Free Workplace”. These drugs became known as the NIDA 5 and have since been considered the bare minimum for employer drug testing.
If an organization depends on government contracts or is contracted directly with the federal government you should consult the NIDA, SAMHSA, and Drug Free Workplace acts.
At the very minimum a company should test for the 5 illicit drugs in the NIDA 5. Since it is so cost effective, there isn’t a good reason to not upgrade to the 12 panel test cup and screen for more drugs.
NIDA 5 Drug Tests
Marijuana (THC)
Cocaine (COC)
Opiates (OPI)
Amphetamines (AMP)
Phencyclidine (PCP)
In the years since the NIDA 5 was released pharmaceuticals and drugs such as methamphetamine have become much more popular while PCP has fallen out of use almost entirely. Most drug testing programs have implemented changes to reflect that.
Which Drugs Have the Biggest Effect on Business
As previously mentioned in 11 Reasons Why Employers Drug Test, the average drug user has 50% more absences than a regular employee. Employees with a prescription painkiller addiction miss 200% more often than a regular employee. When it comes to turnover 25% of people employed full time have had another employer in the previous year. 36% of average drug users have had another employer in the previous year, but that number climbs to 42% for people with a prescription painkiller addiction.
Over the course of employment opiate users cost a business more consistently, but users of drugs such as methamphetamine and cocaine are prone to have major incidents that have tremendous immediate and long term effects on a business.
Which Drug Tests Are Effective
You will notice that alcohol is often listed as the most abused drug by full time employees. There are tests that can detect alcohol, but the detection period is approximately 12 hours. Since alcohol is legal an employee that had a drink the night before isn’t technically doing anything wrong. Alcohol is also easily detected by coworkers if an employee is drinking on the job without the use of a test.
Synthetic opiates do not consistently show up on Opiate assays so Oxycodone, methadone, buprenorphine and fentanyl have their own specific tests.
In regions where pharmaceutical abuse is high these tests are almost always included in an employer drug test, but in some areas the number of people using prescription drugs legally outweighs those using illegally and companies see these as a nuisance to continuously cross check.
It is also much easier for an employee to obtain a prescription for narcotics in areas with lower rates of prescription drug abuse.
Legal Drug Use and Acceptable Use
Besides having a short detection period, alcohol is widely used legally by employees outside of work hours. It’s more culturally acceptable to drink alcohol than to abuse other illegal drugs.
Marijuana is gaining legal status in many states and is becoming more culturally acceptable in the US with every passing year. New York city recently passed a law that made it illegal to test for recreational marijuana use on a pre employment drug test.
New York City’s public advocate Jumaane Williams helped the resolution to ban pre employment drug testing for THC pass the City Council. The ban went into effect in March 2020.
Responsible alcohol use outside of work hours is usually considered a private matter. As marijuana becomes legal in more jurisdictions companies will need to look at their specific laws and situation and determine how to best address drug testing for THC going forward. If your company’s roles require employees to be brand ambassadors 24/7 it might be important to have a drug and alcohol policy that extends to an employee’s personal time.
What is the Best Solution for Employer Drug Testing?
We believe the best solution is to use rapid urine screens for pre-employment and random drug testing and use confirmations for any employee that has a positive result. You can also ask employees that admit to drug use to sign a waiver to save the cost of a confirmation.
This will keep drug testing costs low (our 12 panel drug tests are $2.70 per cup shipped when bought in bulk) while also having a very efficient and accurate drug testing policy. With a CLIA waived test almost any employee can conduct the test. By following on site drug testing guidelines you can eliminate most adulteration and reduce the cost of keeping your business drug free.
You were given a drug test recently and when the results came back you were positive for one or more drugs. You may have suspected you would fail, or in rare cases it’s a total surprise. What should you expect and what should you do when your drug test results come back positive?
Don’t Freak Out When Your Drug Test Results Come Back Positive
A positive drug test is not the end of the world. The first thing to do is settle your mind. You don’t need additional stress and worrying will have no effect on the outcome.
Consequences are hardly ever as severe as people expect, but people have done many things they regret immediately after receiving bad news. The worst thing you can do is continue using drugs.
What are the consequences of Failing a Drug Test?
Depending on what your drug test was for consequences can range from nothing to prison time. In the vast majority of cases people overestimate the consequences of failing a drug test, and in other cases they know exactly what to expect.
Unless someone has firsthand experience or knows someone that has been through the exact process with very similar circumstances, they will rarely have a totally accurate idea of the consequences of failing a drug test. Here are some likely scenarios by case.
Probation
If you fail your probation drug test it will most likely be sent to a lab for confirmation giving you several more days to worry. The consequences of a failed drug test will be different depending on your original crime, your time on probation, the drugs you failed for and your probation officer’s own discretion.
In most cases someone that has done well for a while and has their first infraction will be referred to a drug counselor and may be asked to attend rehab after an assessment. For someone that has failed multiple tests however you could have your probation revoked. People that do go to jail for a failed probation drug test often get out sooner than expected.
What Happens if You Fail a Drug test at a Job Interview?
If you fail a drug test during a job application, you will no longer be eligible for the position. Most companies will allow you to reapply after 6 months. Drug testing procedures and requirements must be covered in a company’s drug testing policy. Some states prohibit drug testing job applicants.
Random Drug Testing at Work
Many employers do random drug testing to comply with federal guidelines and meet insurance requirements. For small businesses the result of a positive drug test will mostly be up to the discretion of the owner. Your work history and importance will likely play a big part in how it turns out.
Larger corporations almost always have a drug treatment policy where employees that have a positive drug screen are given the opportunity to attend treatment and accept terms of a more strenuous testing program to continue their employment. A violation of this program will usually result in termination.
Post-Accident Drug Test
Employers are required to do a post-accident drug test of all involved parties when an on-the-job accident occurs that causes serious injury or death. This is probably one of the most serious drug tests. You and your company could face lawsuits and even jail time for negligence or manslaughter.
If you drive a vehicle or work around dangerous equipment, consider this before taking drugs even outside of work.
Medical Patient
Healthcare facilities drug test patients for many reasons. The most common is when prescribing narcotics. These tests are to inform the doctor about any drugs you may take or addictions you may have and depending on your treatment you may get a prescription anyway. In most cases during a healthcare screening you need to show positive for any drugs you are prescribed and negative for all other drugs. Any other result is a good reason for your Doctor to withhold a prescription or even discharge you from care.
Who Tells You if You Fail a Drug Test?
In most cases an MRO (medical review officer) or the laboratory that conducted the test will contact you if there is a positive result. You will be asked if you have a prescription that could have caused the result. You will not be given a chance to re-test. Sometimes they will just mail you the results.
Can You Retest if You Fail a Drug test?
You will rarely be allowed to re-test if you fail a drug test. If you suspect there was an error or faulty test, the provider will usually offer to re-test a portion of the original sample they saved. This will most likely provide the same result.
What to Do If Your Drug Test Comes Back Positive
If your drug test comes back positive the first question you need to ask yourself is why you failed the test. If you used drugs accept that it’s your fault and admit guilt; probation officers and employers are more likely to help if you are honest and they will know you’re lying when the confirmation comes back.
If you have not used drugs you should request a confirmation. Make a list of all the medications you have taken in the last month and a list of any unusual foods you may have consumed. Educate yourself about false positives on a drug test and stay confident that it will be worked out at the lab.
If someone was injured on the job, you should retain legal counsel and not answer any questions unless instructed to by your lawyer. You should get a quantitative blood screen as soon as possible to document the levels of any drugs in your system. You may be able to use this as evidence in court if your impairment was truly not the cause of the accident.
Immediately quit taking drugs. In many cases you will face suspension or other consequences until you can pass a drug test.
If you have a drug problem seek help. The longer you use drugs the harder it is to quit and there are many benefits to living a drug free life.
The consequences for trying to tamper with a drug test are usually more severe in the legal system and healthcare, and identical to failing in an employment setting. Never attempt to adulterate a test because it will negate any opportunity for leniency or forgiveness.
Dealing With Positive Drug Tests
I cannot stress enough that failing a drug test is not the end of the world and in most cases the consequences are never as dire as people expect.
For organizations and individuals giving drug tests I would like to remind you that everyone deserves respect and just because someone fails a drug test does not make them a bad person. They are likely under a lot of stress and you can really help their state of mind by being understanding. Please do not use drug testing as a tool for personal revenge.
For anyone taking a drug test I’d like to remind you that the person in charge of your test is just doing their job and following procedure. They do not want to see you fail a drug test and it causes them a lot of stress knowing that you may lose your job or suffer other consequences as part of their job.
