What is the difference between an at home drug test vs. a lab drug test? A lot of customers assume that when a they go to a physical location to take a drug test that it’s more accurate. That’s not always the case, but there are some differences between a home drug test vs. lab drug test.
Home Drug Test vs. Lab Drug Test
Many organizations use home drug testing kits that are CLIA waived because lab costs are so high and so any employee can administer the test. They are relatively accurate and give results within a couple minutes. Usually positive tests are then sealed and sent to a lab for confirmation. Laboratories charge by the drug so it is much cheaper to confirm the presence of 1 drug than it is to test for 12 drugs using complex laboratory equipment.
Other organizations that run a lot of drug tests and have a high rate of failure send all their tests to a lab. Some facilities will even build their own lab. Usually the cost of lab testing is subsidized in some way (either the customer pays for it or insurance pays part of the cost). Medicare and most insurances will only pay for 1 type of drug test per visit so they will not pay for a standard 12 panel drug test and a confirmation.
Home Drug Testing
Drug Testing you do at home will generally use a cup or cassette with different strips for each drug. The strip contains reagents which is the scientific term for compounds that react to metabolites produced by the drug in your body.
When you perform a drug test with a cup like our 12 Panel test cup at home you are testing for a chemical reaction between the reagent on your strips and a known quantity of metabolites in the subject urine. It’s almost like a small science lab in your house!
The biggest difference between a test that is sold to the public is whether or not it is CLIA waived.
CLIA waived means that the FDA has determined that the test is simple and accurate enough to be performed by an untrained person with a simple set of printed instructions.
Drug tests that you can use at home are considered qualitative and presumptive, meaning that they cannot tell you exactly how much drugs are present in the sample and that a positive result means that the donor likely used drugs recently.
Lab Drug Testing
Drug testing at a lab can be accomplished a number of different ways. In some cases a lab may used the same type of reagents that are used in home drug tests to do testing. They may or may not use CLIA waived tests because their technicians are likely certified in forensic drug test analysis.
Usually it is assumed that if someone sends a sample to be tested at a lab that they will at the very minimum use a presumptive drug testing method that is interpreted with the use of an instrument. This usually means they are using a drug test much like ours that is inserted into a machine that reads the results. This step takes out human error and subjectivity.
The primary reason to send a sample to a lab is to get a confirmation that uses imunoassay, mass spectrometry or chromatography. Some of these instrument chemistry analyzers are capable of detailing the quantity of metabolite in the sample. You can make deductions with this information (such as the subject is a light user or the subject had not used that day).
Imunoassay
Immunoassay is basically the same method used by a home drug test. A reagent that binds to the analyte is mixed with the sample and the contents are measured. A home drug test has the reagents configured in a manner that is easy to use and it’s calibrated to variables determined at the time of manufacture.
An immunoassay run in a lab can be much more detailed. The sample can have its components separated to make the reagents bind to the analytes easier. The reagents can be added multiple times to make sure nothing is missed. Each test is calibrated at the time of testing to a control solution to account for variables.
A typical Immunoassay test.
In the home drug test the reagent uses a control and detection line as a signal. In a lab performed immunoassay the signal can be a number of things. The most common is linking a chemical that changes color when the reaction takes place. Other more accurate tests use radio isotopes that can be measured precisely with additional instrumentation.
Chromatography & Mass Spectrometry
With mass spectrometry a sample is bombarded with electrons which separate the sample into ionized fragments. The components sometimes separate, but even if they do not they can still be measured by an instrument capable of detecting charged particles. The instrument cycles through an intensity spectrum which correlates to mass; the results are recorded on a graph and correlated to known masses of molecules that are being detected.
Chromatography makes use of a fluid to separate a substance into its components. Various constituents travel through the liquid at different speeds causing them to separate. This is called the mobile phase of chromatography. A structure or chemical is used to stop the component particles in a stationary position. Chromatography got its name from the different colors created by the constituent particles of plants.
This Gas Chromatography / Mass Spectrometry instrument combines the two techniques to give the most accurate analysis of a urine sample. By Polimerek – Own work, CC BY-SA 4.0
The most definitive laboratory test for drug testing uses a combination of gas chromatography with mass spectrometry to first separate and then accurately measure the metabolites present in a sample. By combining gas chromatography with mass spectrometry a lab technician can get a definitive measurement on the quantity of metabolites in a sample. While this testing is more accurate, it’s also very costly especially if testing for multiple drugs. Most confirmations a lab will only test for drugs that were indicated positive by presumptive testing.
How Long Does it Take for a Urine Panel to Come Back?
Urine drug tests can be completed by a laboratory very quickly. Generally turnaround times for urine screens is 1-5 business days. Negative screens are faster because a positive screen is generally confirmed.
Are Lab Tests More accurate?
Lab urine tests are generally considered more accurate than instant drug screens, however instant drug screens are up to 99% accurate. Lab tests are quantitative, meaning that they provide the quantity of drugs in a sample. Urine tests can sometimes report samples that are slightly below the cutoff as positive, so you may fail an instant test and pass a lab test.
The bottom line is that testing done with experienced technicians using expensive equipment in a controlled laboratory is more accurate. You just need to make sure than when you pay hundreds of dollars for complex testing using expensive tools that that’s the kind of testing you’re getting.
The accuracy of a CLIA waived test cup is so good though that the added cost isn’t justified in most cases. When it comes to a home drug test vs. a lab drug test, in most cases a home drug test is the right tool for the job. Laboratory drug tests are always available though if you need a confirmation, need the presence of drugs quantified or need the most accurate option. The cost of most drug tests is so little that they make a great option for a transport container, so even if you opt to have all drug tests sent to a lab you could have an immediate presumptive result with a drug test cup.
For most uses a home drug test is the best option considering price, accuracy, purpose and immediacy.
When parents and employers purchase drug tests they usually recognize the abbreviations for common illicit drugs such as THC for Marijuana. It is common for one or two abbreviations to stump them. Methadone is not a gateway drug, it is primarily used for Methadone Maintenance Treatment. Methadone is almost always included on 12 panel drug tests.
What is MTD on a Drug Test?
MTD stands for Methadone. Methadone (MTD) is an opioid originally developed as a treatment for pain during World War II by German scientists Gustav Ehrhart and Max Brockmuhl. It was developed as part of a program aimed at easing the demand on the raw materials used in morphine production.
Originally patented under the trade name Dolophine, Methadone (MTD) is still used as a maintenance pain reliever often prescribed in conjunction with other opioids for breakthrough pain. It is thought to be more effective against neuropathic pain and takes longer to build a tolerance to because of its inactivity on the NMDA receptor.
40 mg Methadone (MTD) Wafer tablet. These tablets are often mixed with 4 oz of water before ingesting.
Since the 1970s Methadone (MTD) has been used in detoxification and opiate maintenance programs.
The half life and effects of Methadone (MTD) are significantly longer than other opioids. Persons addicted to heroin or other opiate based painkillers can often substitute Methadone and live productive and fulfilling lives.
Methadone (MTD) is widely used as a detox drug in hospitals. Some Medical Doctors prefer Morphine because Methadone’s withdrawal symptoms are protracted and it’s sometimes harder on the patient. Methadone maintenance programs are controversial, but almost all patients that are successful in a maintenance program say that it has dramatically improved their life.
Methadone (MTD) is a schedule II drug in the United States.
Methadone (MTD) Test Detection Time
In a presumptive urine drug screen the detection time for Methadone can vary from 3-9 days depending on use and the patient’s metabolism.
Side Effects of Methadone
Sedation
Constipation
Flushing
Sweating
Heat intolerance
Dizziness or fainting
Light Headedness
Weakness
Chronic fatigue, sleepiness and exhaustion
Sleep problems such as drowsiness,trouble falling asleep (Insomnia),and trouble staying asleep
Constricted pupils
Dry mouth
Nausea and vomiting
Low blood pressure
Hallucinations or confusion
Headache
Chest Pain
Elevated Heart Rate
Abnormal heart rhythms
Slow or shallow breathing
Loss of appetite
Weight loss
Weight gain
Memory loss
Trouble Focusing
Stomach pains
Itching
Difficulty urinating
Swelling of the hands, arms, feet, and legs
Restlesssness
Mood swings
Euphoria
Disorientation
Anxiety
Blurred vision
Decreased libido
Skin rash
Seizures
Sleep apnea
Additional Precautions
As a drug used in maintenance programs Methadone (MTD) is often prescribed in high dosages and is mixed with water by the dispensing clinic. There have been several instances of children being poisoned by consuming medicine that was meant for their parent.
Methadone can also be prescribed as a liquid. Larger Methadone clinics dispense flavored liquid that is similar to a dose of cough syrup.
Sources:
Nicholson, AB. October 2007. “Methadone For Cancer Pain”
Why do employers drug test applicants? Even though the benefits are obvious to most, job seekers often ask us about the reasons drug testing has become ubiquitous. Here are 11 benefits employers and employees gain from drug testing.
At the end of the day running a business is about making money. It boils down to taking raw materials, adding labor and creating a marketable product that people want. Anything a company can do to increase the amount of work that is completed in the same amount of time will increase profits.
According to the National Safety Council workers with a substance abuse disorder miss 50% more days than average workers, and workers with pain medication use disorder miss 300% more days.
An older study showed a 59.3% increase in absences that became progressively worse as time went on.
In extreme cases opiate users will sleep on the job. Drug use makes employees inconsistent at best, and downright dangerous and counterproductive in some cases.
A classic study outlined in “Under The Influence? Drugs in the American Workforce.” found that identified drug users had a 64% higher rate of receiving disciplinary warnings and were 5 times as likely to receive poor performance evaluations from their supervisors.
This graph from “An Evaluation of Pre Employment Drug Testing” published in the Journal of Applied Psychology showed applicants with a positive pre employment drug screen had significantly higher disciplinary infractions all around.
An employee that uses drugs will often use on the job. Their breaks are longer and they take longer to regain focus when returning. You also need to contend with the possibility of days when the employee has taken too much drugs and days when they are suffering withdrawal. Most recovering drug addicts admit that withdrawal made them useless at work. Employees that have a prescription for a narcotic drug avoid many of the ways drug use can affect production, but are still subject to negative impacts caused by the effects of the drug.
Opioids can impair thinking and reaction time. Marijuana has been proven to affect reaction time and short term memory. Stimulants such as cocaine and methamphetamine affect self awareness and risk analysis. All drugs affect an individual’s capacity for judgement.
A 2017 study suggested substance abuse costs employers $100 billion annually. These figures show rates of substance abuse across industries.
Insurance purposes
Some employers drug test because they have to. Many insurance companies will not even sell insurance to an organization that doesn’t have an employee drug use policy in place. Some types of insurance offer a discount for organizations that have a strict and extensive policy regarding employee drug use.
Anyone company that receives a federal grant or is contracted by the federal government is required to maintain a drug free workplace which is outlined in the Drug-Free Workplace Act of 1988. Several states offer a discount on workers compensation premiums to companies that maintain the same guidelines. These States are:
State Discounts for A Drug-Free Work Place
As of October 2018, 13 states had laws that provide a discount on workers compensation insurance to employers that implement a drug-free workplace.
Alabama codes §25-5-330 – §25-5-340 provides a five percent discount to employers that establish a drug-free workplace.
Arkansas code §11-14-101-112, employers with drug-free workplace programs may qualify for a five percent discount on workers’ compensation premiums.
Florida State code §440.102 provides a five percent reduction in premiums to employers that implement and maintain an insurer-certified drug-free workplace program in accordance with the standards set forth in the Act.
Georgia §33-9-40.2 & §34-9-412 provides a 7.5 percent discount on workers compensation premiums to employers that have implemented a drug-free workplace program that is certified by the state Board of Workers’ Compensation. Employers must submit their certificate to their insurer annually.
Idaho Sections 72-1701 through 72-1716 of the Idaho code provide that public employers who conduct drug and alcohol testing of all current and prospective employees shall qualify for and may be granted an employer Workers’ Compensation premium reduction.
Kentucky State regulations 803 KAR 25.280 allow employers that implement a drug-free workplace program a 5% reduction of their insurance premium.
Mississippi Under Mississippi Code, Sections 71-3-201 through 71-3-225, employers that establish a drug-free workplace program may submit an application to their insurer for a 5 percent reduction in their workers’ compensation premium.
Ohio Program established via O.A.C. 4123-17-58. Employers may enroll in the Drug-Free Safety Program offered by the Ohio Bureau of Workers’ Compensation. Employers that fulfill the requirements may receive a discount of four to seven percent on their workers compensation premium.
New York Part 60 of Sect. 134 of WC created the Workplace Safety and Loss Prevention Incentive Program. Employers with an experience modifier of less than 1.30 and an annual WC premium of at least $5,000 are eligible for a voluntary program. They may receive a separate credit (typically 2%) for each of the following: safety, return-to-work, and drug and alcohol prevention.
South Carolina §38-73-500 provides 5 percent discount on workers compensation premiums to employers that voluntarily establish a drug-free workplace program.
Tennessee State codes §50-9-101 to §50-9-114 provide a 5 percent discount on premiums if employers establish a drug-free workplace program as outlined in the law.
Virginia §65.2-813.2 provides a 5 percent premium discount for employers who institute a drug-free workplace program. The program must satisfy requirements established by the insurer.
Wyoming Under §27-14-201, employers that implement a drug-testing program may qualify for a base rate discount up to 10%. This program is offered by the Wyoming Department of Workforce Services.
Reputation
With the increased adoption of social media customers are quicker than ever to emotionally lash out at a company in an online review for even the smallest offense. People getting fired for a single tweet has become an everyday occurrence.
Every employee is a reflection of the business they work for. When an employee shows themselves to be insensitive or unaware the public accuses their employer of the same charge.
The same associations apply to employees on drugs. Even employees that hide their drug use very well on the job may be more open in their private lives. A single employee that presents a persona of drug use can make everyone that meets them or views their social media associate that persona with their employer.
Illegal drug use doesn’t need a whistleblower. It was the Santa Cruz county coroner that shed light on the culture of drug use in Silicon Valley when Google executive Timothy Hayes died from a heroin overdose in 2014. As reporters probed colleagues and employees at other tech companies they found that hard drug use (including methamphetamine and heroin) was above average and drug testing was almost non-existent in Silicon Valley.
It is more critical than ever for businesses to brand themselves as a positive contributor to their community. In most cases any association with drug use suggests negative connotations that are easily attached to a brand, but very difficult to address.
It’s important to stay compassionate and give employees a chance to address their problems. A great example of a drug addict cleaning up their act and enjoying positive PR is Robert Downey Jr. After a few episodes of bad press Robert went into rehab, came our clean and went on to star in one of the most profitable movie franchises ever. A community focused company makes encouraging positive behavior and compassion part of their mission.
Robert Downey Jr. has enjoyed enormous popularity and success after recovering from bad PR associated with drug use.
Encourage Drug Users to Seek Help
Even though substance abuse can be a big problem for employers, employees that are in recovery miss fewer days than average workers and have a 21% lower turnover rate. Gainful employment at a company that drug tests is one of the biggest incentives for drug users to get clean.
Since the incentive to get clean is tied so closely to employment, this is an opportunity for businesses to give back to the communities they serve. Identifying drug use through testing doesn’t have to be all about the benefits for the business. Even though recovery is hard and it takes most addicts several attempts and a strong will to succeed, instigating a successful recovery is a very rewarding part of drug-free-workplace policy.
Most reputable companies offer employees that fail a drug test the opportunity to attend an in-patient program. Most employer insurance plans do pay for in patient treatment, and since the Affordable Care Act all drug treatment programs are supposed to be covered by insurance.
As I mentioned before the promise of secure gainful employment is one of the biggest incentives for drug users to get clean. It’s also the biggest incentive for drug users to stay clean.
Most of the recovered addicts we have met through this business used getting a job as their first step forward in recovery. This led to many starting families, adopting hobbies and making new friends. At some point the idea of losing your income is worse than avoiding drug use and many addicts fall into a normal routine.
Companies associated with addiction treatment and rehabilitation are especially known for having great success hiring recovering addicts. Since recovering addicts miss less work and are more likely to stay loyal to a company, this could be as self serving a reason as it is an altruistic one.
Joe Arndt, the Vice President of Delta Lighting recruits employees that are in recovery. He has found that people in active recovery tend to be better employees.
Joe Arndt, Vice President of Delta Lighting, has been recruiting recovering addicts for several years. When asked why he said, “They’re tremendously loyal to us, and they just work harder because they realize that they don’t necessarily have a lot of other options which is kind of sad,”.
“They’re tremendously loyal to us, and they just work harder because they realize that they don’t necessarily have a lot of other options which is kind of sad,”
-Joe Arndt, VP of Delta Lighting on hiring addicts in recovery
Despite the fact that many studies show recovering addicts make better employees and several initiatives developed to help those in recovery find a job, the unemployment rate of drug addicts in recovery is approximately twice as high as the national unemployment rate.
Lower Costs
Healthcare costs for substance abuse treatment programs were about $35 billion in 2015. Another $85 billion is spent treating illness, injuries and infections related to substance abuse. Employers that offer health insurance will almost definitely pay higher premiums even if their employees do not report substance abuse.
The cost of retraining the least skilled employee is often tens of thousands of dollars. With drug users having more absences, getting in more accidents and being less productive in general companies often find themselves in an endless cycle of replacing people if they cannot weed out applicants that use drugs during the hiring process.
When you start to add up productivity losses, higher workers comp and insurance premiums, employee absences, higher healthcare costs and the cost of on site incidents, it’s hard to believe an employer can afford not to drug test their employees.
Avoid Lawsuits.
A positive drug test can turn a common workplace accident into costly negligence lawsuit. Negligent hiring and retention lawsuits are becoming more common and judges are more frequently ruling against employers. Plaintiffs prefer to file against a corporation or small business that has deeper pockets and lawyers are more likely to present the weaker case with the hopes of getting a bigger settlement.
As previously mentioned, drug users are 3.6 times more likely to injure themselves or others and 5 times more likely to file a workers compensation claim. OSHA has deemed post injury drug testing to be retaliatory in nature and it can expose a company to worker’s compensation retaliation tort claims, so it is important to identify and address the possibility before it becomes a reality.
A few examples of lawsuits that found the company responsible for the drug or alcohol use of their employees:
Chesterman v. Barmon: The Oregon Court of Appeals ruled that an employer’s liability for the criminal actions of an employee who was taking mescaline and amphetamines was a question for the jury to decide.
Otis Engineering Corp. v. Clark: A drunk machine operator was sent home by his employer. On the way home he caused an automobile accident killing himself and two occupants of another car. The Texas Supreme Court held the employer liable.
Brockett v. Kitchen Boyd Motor Co.: An employee left an office Christmas party after having too much to drink. The employee caused an automobile accident and the employer was held liable for injuries suffered by third parties.
Gather Evidence
The goal of post accident drug testing is to find the truth and either exonerate or convict the person involved in the accident. Regardless of the circumstances a positive drug test can affect a company’s liability to an employee that is injured on the job.
A positive drug screen is also grounds for termination in most states. Most companies will try and avoid having a claim on their unemployment insurance if possible and a positive drug screen is almost iron clad.
It’s important to stay educated on drug tests and their admissibility in court if you plan on using results for more than coercing an employee to resign on their own. It’s also important to understand the legal guidance for drug testing in the workplace.
For instance OSHA recently issued a memorandum on workplace safety incentives and post accident drug testing. Their guidance is primarily meant to keep employee drug testing consistent and avoid any type of unfair targeting. For post accident drug testing
“Post-incident drug testing should be conducted consistently on any employee whose conduct may have contributed to the accident, and not merely the employee who was injured in an accident.”
So during an investigation of a fork-lift driver hitting another employee both employees should be drug tested and not just the driver.
Improve Work Environment
Theft, crime and violence all increase with levels of employee drug use. Company morale drops quickly when a co worker that has a substance abuse problem isn’t doing as much work, isn’t coming in on time and isn’t being disciplined for it.
Drug use is often a major aspect of a user’s life. Thoughts of getting drugs and using drugs are frequently on their mind even at times when they should be focused on their work.
It’s not fair to other employees that drug addicted co workers use up more of a company’s resources. It’s also not fair that an employee would need to worry about her personal belongings being stolen at work because a co-worker is feeding their drug habit.
It’s important to consider company culture when drafting drug testing policies. Some companies have experienced pushback and negative reactions when instituting company wide drug testing policies.
Some people see it as an invasion of their privacy. Studies have shown that when jobs are more dangerous employees are more open and even supportive of strict drug testing policies. Whether drug testing aligns with employees’ political stance, everyone wants a safer work environment, higher morale and peace of mind not having to worry about thievery and other drug related property crimes at work.
Avoid Extreme Issues That Cause Problems on All Levels
Some incidents that could have been entirely avoided by drug testing have such a high cost that they’re hard to classify in this list. For instance in 2014 a McDonald’s employee was arrested for selling heroin in Happy Meals. The employee would include a bag of heroin in the happy meal box if a customer said “I’d like to order a toy” when placing their order. Besides the lost revenue from an employee running an illegal drug dealing operation out the restaurant instead of working, besides the obvious safety issues associated with putting hard drugs in a meal designed for children, you cannot create a fictional headline more damming from a public relations perspective.
Even though a drug test may not have identified the criminal, it would have likely uncovered widespread drug use among the staff. Other employees had to have been aware of the scheme and more than likely were given drugs to ignore it.
In another episode a customer is suing McDonalds after he ingested a soft drink spiked with Buprenorphine. Buprenorphine is widely prescribed as a maintenance drug. A post accident drug test of the staff would have likely found the culprit.
The recent Netflix documentary “How to Fix a Drug Scandal” tells the story of Sonja Farak, a lab chemist that was found to be stealing drugs and getting high at work. In this case her actions led to 24,000 cases being overturned by the state of Massachusetts. The total costs and repercussions associated with this example cannot be measured. It could have all been avoided with a $2.50 12 panel drug test.
It’s even more astonishing that the state of Massachusetts had just dealt with a similar issue. Annie Dookhan had faked test results and adulterated others in a bid to win over her superiors. The state’s entire policy should have been revised and the most obvious tactic, random drug testing employees, should have been added.
So why do employers drug test?
Considering all the disadvantages and damages that are likely to be caused by employee drug use and considering the obstacles involved with reacting to a drug related problem in the workplace it should be clear why employers drug test their employees. Any business that does not currently have policies addressing employee drug use should start planning the implementation of pre-employment and random drug testing immediately. We are happy to help readers with their plans and answer questions about our products and the industry. Feel free to contact us for additional information.
The average person that’s unfamiliar with drug use doesn’t usually know how to tell if someone is high. Still, drug use has become a pervasive part of everyday life and over the last 2 decades prescription drugs have brought drug use into more homes and businesses than ever before.
According to the National Survey on Drug Use and Health 38% of adults battled a substance abuse disorder. Drug users are becoming more sophisticated at concealing their behavior. To help parents, law enforcement, employers and friends Drug Test City has put together a definitive guide on how to tell if someone is high.
Physical Signs That May Indicate Someone is High
The body gives away its secrets if you listen. When proactively identifying drug or alcohol impairment I like to start at the top of the head and work my way down.
Drug Impairment Indicators of the Eyes
The preferred field sobriety test of Law Enforcement is the Horizontal Gaze Nystagmus Eye Test because the eyes are the most obvious physical indication of impairment and it’s the only indicator associated with the eyes that will hold weight in court.
The test for eye nystagmus is a complex and lengthy test that checks for involuntary jerking when the eye moves to a certain angle, but this is useless for the average person trying to covertly make a determination. Parents and other authority figures however may be able to perform sobriety testing or even a drug test to get more definitive answers. Other indicators are more obvious, non intrusive and easily noticed.
Redness
Glassiness
Constricted or dilated pupils
Involuntary or rapid eye movement
Avoiding eye contact
Watery or dry eyes
Excessive blinking
Tired eyes
Examples of Eye Indicators
This girl was high on opiates and marijuana. Her eyes are almost closed they ae so heavy and tired. Combined with her euphoric smile, it is obvious she is impaired.
High on marijuana, this man used Visine eye drops in his right eye to show the effectiveness of visine.
This man’s eyes are glassy and constricted from methamphetamine use.
Olfactory Drug Impairment Indicators
Depending on the route of administration drug use can case runny nose, redness, bloody nose and dry sinuses.
Users that snort drugs have a hard time concealing the drug residue that can become caked in their nostrils or lightly color one nostril’s hairs.
The most obvious olfactory indicator that someone is high or recently used drugs is your nose, not theirs. Alcohol and marijuana both have a pungent odor that is hard to mask. The majority of traffic citations issued for marijuana use cite the smell as probable cause. Careful users will carry cologne or perfume in their car and try to conceal the smell. If someone smells like fresh perfume after every break and coming back from lunch I would have strong suspicions of drug use. These smells will be easier to notice when the user is moving around or speaking.
Drug Impairment Indicators of the Mouth
The mouth may be the most affected part of the body by drug use. Bad oral hygiene can indicate long term drug use, but several other symptoms an suggest that a person is currently under the influence.
Dry mouth: Several classes of drugs dehydrate the body and cause dry mouth. Everything from marijuana to methamphetamine can lead to dry mouth.
Lip smacking and Licking Lips: This is a common reaction to dry mouth.
Teeth clenching: Many stimulants will cause users to clench their teeth.
Bad breath: Users that are high functioning on a maintenance drug such as Methadone or Suboxone may do a good job at hiding outward signs and symptoms of their drug use, but they will still usually suffer from dry mouth which causes bad breath over time.
Pot / Alcohol breath: Less careful users will often emit the smell of their preferred drug when they speak. More careful users may try and cover it up with excessive mouthwash.
Excessive talking: Most stimulants and many narcotic pain relievers cause euphoria and excessive talking. If someone has excessive bouts of talkativeness it’s very likely to influence of drugs.
Appetite: Drug use most often decreases appetite, although it can also increase it. Some drugs like Methadone cause users to crave sweets. A change in appetite coupled with other signs can be a strong indicator.
Slurred or rushed speech: Most drugs will have an effect on the user’s speech. Be aware of anything that is unusual in speech pattern or dialect.
Other Physical Signs of Drug Impairment
Exhaustion: Either from drug use or an associated lack of sleep. Fatigue can manifest itself physically in several different ways .
Track marks: IV drug users sometimes leave visible signs on their arms and hands. Others will noticeably attempt to hide their arms from plain view. It isn’t normal for someone to wear a jacket on hot summer days, wear a wrist band around their elbow or have makeup on their arm.
Burns on hands and lips: Crack and meth users handle hot pipes and often burn their hands and lips.
Sores: Using drugs itself rarely causes sores, but instead addicts will scratch and pick at their faces and arms.
Behavioral Signs Used to Tell When Someone is High
A person’s behavior can reveal a lot about themselves, especially any recent drug use. While it’s easy to notice exaggerated movements of a methamphetamine addict or a heroin junkie in a nod, subtle clues are harder to notice but just as hard to conceal. Reading someone’s behavior to suggest drug use is just another form of deception detection.
Movement: Stimulants can cause users to move erratically and spastically. Other drugs like marijuana can slow reaction time and delay movements.
The video below shows a woman high on flakka outside an apartment complex. This type of behavior isn’t common, but less exaggerated movements are common in most stimulant users.
Speech: Slurred speech is the hallmark of many narcotics and alcohol. Prescription pills like benzodiazepines and stronger narcotic pain relievers can cause slurred speech. As I mentioned before stimulants and opiates can cause euphoria and talkativeness. One of the most common indicators in a high functioning drug user, look for a person to have an episode of higher energy at specific times of day.
Energy level: Drug use is like a roller coaster of motivation and energy. Although some mental health diagnoses mimic this pattern, consider the subject’s indicators as a whole.
Confidence: A euphoric high will increase a person’s confidence. Specifically look for major shifts that are recurring.
Mood Swings: Newer users especially are affected by mood swings. Anger is the most common, but withdrawal from many drugs causes uncontrollable depression during the onset. The euphoria that accompanies a high is just as quickly replaced by lethargy later in the day.
Memory: Many drugs are associated with forgetfulness. Short term memory loss has long been noted as a side effect of marijuana use. Benzodiazepines such as Xanax can cause even more severe memory loss. Almost all drugs will cause some level of loss of focus. In the corporate world and college smart drugs have become popular, which have the opposite effect. Adderall can help students study for an exam, but it’s important to remember that it’s an amphetamine and is just as dangerous and addictive as a street drug.
Subtle Cues of Intoxication
Most of the time heavy drug users and those that exhibit obvious symptoms are easily spotted. You’re going to use this guide to identify the not-so-obvious ones.
Drug addicts need to work and live life too. They’ve been hiding their drug use for a long time and learning to work around people noticing. An advantage to being high everyday is that people recognize your behavior as normal.
If you have reasonable suspicion that an employee, child or subordinate is impaired you should drug test them immediately. If it’s a colleague or superior, you will want to verify your suspicions as much as possible before reporting them or making an accusation. People in higher positions are more likely to be higher functioning.
You will need to pay closer attention to observe mild symptoms and associate unrelated symptoms with each other. The biggest thing is unusual behaviors or fluctuating moods. Since many of the milder signs are common in the general population you should track observation of symptoms and look for patterns. Consider giving others the benefit of doubt though; it’s just as easy for them to make accusations and find an aspect of your life or work to draw attention to.
If someone that is actively concealing drug or alcohol use suspects you have noticed they may become nervous. Watch for signs like:
Avoiding eye contact
Shaking
Elevated heart rate
We hope this list helps you identify intoxication when it is a danger to you or those around you. Always use a drug test to confirm suspicions before issuing punishments or taking administrative actions against someone. We should all try and be more compassionate toward those with substance abuse issues, feel free to contact the staff at Drug Test City if you would like guidance on dealing with a friend, family member or co-worker that you believe has a substance abuse problem.
The AMA CPT code for drug testing using our 12 panel drug test cups, which is the code used for Medicare B and most other insurers in 2023, is 80305.
The American Medical Association (AMA) CPT code for drug testing 80305 replaces older codes used for presumptive drug testing read by direct optical observation. 80305 is now recognized as the CMS HCPCS code in place of G0477. Provider must include sample validation (observing specimen donation and confirming temperature) at the time of collection.
The codes for onsite drug testing were changed from an earlier healthcare standard in 2019 and haven’t been changed since. Not all insurance companies will reimburse for drug testing. Medicaid will not reimburse.
CPT Code for Drug Testing
The AMA text of the presumptive drug testing code reads as follows
CPT code 80305: Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g. immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.
Medicare does not pay out for this code because they do not consider it to be medically necessary. A physician is sill responsible for determining that narcotic drugs are not being abused, misused or trafficked.
Private insurance pays up to $21 for this service (office fees on average are approximately $60). The office fee for a presumptive drug test read optically including sample validation should be higher (one office charged a fee of $290), but reimbursement is usually about $22.
This new code 80305 replaced 80300 & G0477 and has been in effect since January 1, 2017.
The AMA adopted CPT code 80305 for drug testing to simplify coding for this set of procedures, and to replace the G code used by CMS.
Other Valid CPT Codes for Drug Testing
The other valid codes for drug testing patients are 80306 & 80307.
AMA CPT code for drug testing 80306 is for a presumptive test with specimen validation that is read by instrument assisted direct optical observation. Some suppliers sell machines that are used with their tests to provide a presumptive result to assist in human interpretation.
AMA CPT code for drug testing 80307 is for a presumptive drug testing through the use of instrument chemistry analyzers. This includes immunoassay, chromatography, and mass spectrometry.
Any patient that has a prescription for a narcotic or heavily abused non-narcotic drug should be given a urine drug screen prior to prescribing. It is up to the doctor which method is appropriate. The advantages to using point of care drug tests that are CLIA waived and can be read by staff and the results are immediate.
We suggest that positive tests are sealed and sent to a lab and confirmed with the use of instruments.
According to Palmetto GBA providers may ONLY perform and report one type of presumptive urine drug testing per patient. If you have a positive result send the sample in the cup for confirmation and charge for the appropriate CPT code for that service.
Tips for Successful Claim Submission for Drug of Abuse Testing
Include supporting documentation that shows the provider asking for a drug screen.
The patient’s medical record must support the use of all treatment codes.
The ordering physician must maintain documents indicating the medical necessity for performing a drug test.
Observe specimen donation to validate the authenticity of the sample.
Make sure your cups are CLIA waived, or that your employee administering the tests has proper certification
Make sure the wording for the service reported on the claim matches wording for the service ordered by the physician.
Each code represents all drugs and can be reported only once per date of service no matter how many devices were used.
A maximum of one presumptive urine drug test may be submitted and paid for each date of service. You cannot charge for an optically read test and again for a lab’s confirmation.
Specimen validity testing is not eligible to be separately billed under any procedure code, and is expected to be completed as part of testing.
Use our employee drug testing guide to help inform your policies and procedures when testing new hires, and completing random drug testing in house.
Procedure
Donor provides urine specimen in the cup and screws the cap on.
Operator checks the cap for tightness, starts timer
Remove peel off label
Check temperature strip on back. A green color will appear to indicate the temperature, proper range is 90°-100°F
At 5 minutes read the results. Presence or absence of drugs is indicated by the colored bands in the results area.
The 3 results of a 12 panel drug test: negative, positive and invalid.
Tips for Successful Employee Drug Testing
When starting an employee drug testing program, begin with a consistent operating procedure that is detailed in a manual. Decide if drug testing will be completed randomly, or whether the company will only drug test employees after accidents and when they’re suspected of being intoxicated on the job.
Check your local, state and federal laws for guidelines on drug testing.
During the hiring process management or human resources should have every new employee sign a drug testing compliance form that outlines the rights and responsibilities of every employee as it pertains to the company drug testing policy. This will help in the unlikely event a terminated employee engages in legal action.
Always Observe Employee Drug Screens
When your patient or employee knows they are going to fail a drug test they will try anything to get around it. If you aren’t observing drug screens, then you can never say that your subject didn’t substitute a clean sample for their own urine. One study found that when staff at an outpatient rehab started witnessing drug screens positive results almost doubled from 25% to 42%.
Most facilities that do frequent point of care drug screening will have a bathroom that is designed for observing drug screens. Technicians dye the water in the toilet, remove doors, and restrict sink access. Place a mirror for an observer to confirm that the sample did indeed come from the patient and not a small bottle concealed in their underwear.
Always Send Positive Drug Screen Samples to a Lab
Point of care drug screening lowers the cost of a company drug testing program, but isn’t intended to replace confirmation from a licensed laboratory.
A drug testing cup can only show that a subject has levels of a certain metabolite in their urine that is above a designated cutoff. It doesn’t give any indication of the amount of that metabolite, the time frame when drug use likely occurred, the amount of drugs used or even the source of the metabolite.
A positive drug screen in your office just means that subject has likely used drugs in the past few days. You should send their sample to a lab for confirmation. The possibilities of a false positive or faulty test increases the liability of making a bad decision based on evidence that doesn’t meet a burden of proof.
Maintain a Secure Chain of Custody
From the time you collect the sample from an employee you make sure that the sample is not adulterated, contaminted, or otherwise tampered with until a laboratory can confirm the results.
Take the employee to a designated waiting area where you can set the collection cup and wait for the test strips to indicate whether a sample is positive or negative. It is important to have the employee wait with you so they can confirm that you have not tampered with their sample.
If the sample comes back positive you will need to seal it, package it and fill out paperwork to send it to a lab. Until someone packages the sample you should not let it out of your sight, and do not leave the package unattended until you pass custody on to the shipping agency.
It’s very unlikely that an employee that had a legitimate positive drug screen will pursue legal action, but you should treat every case as if you plan on being deposed in court. An employee that is the victim of a false positive will appreciate your diligence in maintaining strict control of their specimen so the lab can prove their innocence.
Store Unused Drug Tests in a Cool Controlled Environment
Test strips depend on chemicals present in the strips to react to metabolites of the target substance.
If you remember your science class in high school, every experiment called for a high level of control of different variables. In drug testing the uncontrolled variable is the amount of drugs each subject has consumed recently; all other variables need to be tightly controlled.
High or low temperatures can cause the chemicals in the test strips to alter their molecular structure which will lead to a different reaction to the target metabolites.
We take special precautions to make sure that we store our tests at 70 degrees Fahrenheit in our facilities and choose the quickest shipping methods to limit exposure to uncontrolled temperatures during transport. Be careful not to store tests in direct sunlight which can raise the temperature of the tests.
Detect Dilution of Urine Samples
One of the most common techniques employees and patients use to alter drug screen results is diluting their urine in their own body by drinking excessive amounts of water or tea prior to testing. This can cut detection times down tremendously.
Doctors have long recommended that adults drink 4-8 glasses of water everyday; a healthy adult male should have urine that is colored like light lemon juice – a slight yellow tint. A uine sample that is completely clear it should be sent to the lab to test for dilution.
This chart shows how shades of urine relate to dehydration. When analyzing drug test samples, some color is preferable because urine that is completely clear cannot be distinguished from water without further testing.
Instruct any subject that consistently provides diluted samples that further dilution will result in a failed screen, or use an alternate sample (blood, saliva or hair follicle) at the employee’s expense.
What is the Most Common Pre-Employment Drug Test?
The most common type of employment drug test is urinalysis, usually a drug test cup. The most common test is a 10 panel drug test, which is specifically designed for pre-employment applications. Mouth swab drug tests are becoming more common because they’re non-invasive and have shorter detection times.
