So you were given a drug test a recently and when the results came back your were positive for one or more drugs. You may have suspected they would, 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 think 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 are extremely positive about the outcome.
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.
If you fail your probation drug test it will most likely be sent to a lab for confirmation giving you several 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.
Pre Employment Testing
If you fail a drug test when applying for a job 99% of the time you will not be hired and that will be the end of it. Many employers have a statute about how long a failed drug test will affect hiring, so you may be able to re apply in 6 months to 1 year.
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 and 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.
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 any other drugs. Any other result is a good reason for your Doctor to withhold a prescription or even discharge you from care.
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 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.
Most people are familiar with false positives on drug tests, but are unaware of false negatives. What is a false negative on a drug test, what can you do to prevent them and what should you do if you identify one?
What is a False Negative Drug Test?
A false negative is any time that under normal circumstances a drug test would be positive for an individual but for some reason results are negative. An example would be a patient that is prescribed Oxycodone that takes his medication consistently as prescribed, but has a negative drug test during his doctor visit.
In most cases this is caused by the patient either purposefully or accidentally altering their urine sample. The most common false negative drug test is due to water loading.
False Negatives From Water Loading & Adulteration
Water loading is the process where a person drinks an excessive amount of water prior to giving a sample. Urine that is clear with no yellow tint is usually indicative of water loading. You will need to perform separate adulterant tests for Creatinine, pH and protein levels to prove that a test has been diluted by a subject ingesting excessive amounts of water.
Without adulteration testing pure water will show negative on a drug test assay because the tests are only meant to detect the presence of a certain drug or metabolite in a substance, not to detect if the substance is a valid sample. Subjects can simply add water to their urine, but to fool a witness they will ingest an excessive amount of water to dilute the urine that comes from their own body.
There are several products available that claim to help users pass urine drug screens. These products range from nothing more than fortified tea that dilutes your urine to products that claim to seal in fat cells for several hours. Many of these products will speed up the timeframe which a person can pass a urine screen even if it’s for no more reason than they’ve diluted their urine.
Improper Drug Test Selection
A mistake made by organizations conducting drug tests is improper test selection. Every organization will have their own considerations when choosing a testing device, but some drug tests will not detect every illicit substance that people assume.
Many times a doctor prescribes their patient oxycodone or another semi-synthetic opiate, but uses a 5 panel drug test that only has a test for opiates. The doctor has seen positive tests for opiates from his patients that are prescribed oxycodone, but his new patient tests negative. One study found that oxycodone was detected in 12% of opiate immunoassay tests, and many other synthetic or semi-synthetic opiates also require a special test for accurate results.
Most assays for benzodiazepines detect their presence in the urine by testing for nordiazepam and oxazepam, the main metabolites of most benzodiazepines. Agents that follow a different metabolic pathway, such as triazolam, alprazolam, clonazepam, and lorazepam, have poor cross-reactivity with the assay due to the absence of these metabolites and thus frequently produce false-negative results. Some doctors prescribe diazepam, oxazepam, and temazepam instead to reduce lab confirmations.
False Negatives From Very High Cutoff Levels
If your drug tests have high cutoff levels it is more likely for a user that has recently ingested drugs to produce a negative result.
Even though the federal government publishes their own guidelines laboratories and manufacturers can create products that use whatever cutoff level they deem appropriate and the federal guidelines do change from time to time.
For example opiates and morphine have two widely used cutoff levels since the early 2000s because so many people were failing employment tests because the popularity of poppy seed muffins. The recommendation soared from 300ng/ml to 2000 ng/ml. The majority of tests will use this recommendation to stay compliant with as many federal regulations as possible, but the high sensitivity tests are still available.
In practice there is no right answer. Some regions may have popular restaurants that sell poppy seed muffins, and some industries may have a high percentage of clients that anticipate testing and use gray-hat adulteration methods to get their levels under the cutoff.
We advertise our drug tests as being 99% accurate, but in any situation that involves a human there is a possibility of introducing human error. A technician could mislabel tags, forget to confirm the temperauture on a sample or give a patient an opportunity to switch out a sample altogether.
Human error is even more likely in a laboratory where a technician has to prepare an assay, control variables, process and record information and interpret results. Never count out human error entirely and implement procedures that can help reduce the likelihood of human error.
Since the consequences of a failed drug test can be so severe t here is a great deal of work and investment that goes into quality control for drug test devices. Still there are always some faulty tests or batches of tests that slip through.
If you have several tests in a row give unexpected results you should consider that the tests may be faulty. It’s very cheap and easy to use a 2nd drug test if a subject says that their results aren’t accurate.
Our drug test cups are designed to alert the user when there is a problem with the device itself. The control line can alert you to tampering, a faulty test and some forms of improper collection.
Keep in mind that a 12 panel drug test is actually 12 individual tests; most of the time a faulty device means only one of the strips is faulty. A certain percentage of faulty tests is expected in this industry, which is why we offer a 100% satisfaction guarantee that covers any faulty devices and any additional tests you use to troubleshoot a possible faulty test.
There are times when all of the devices are functioning properly, everyone did everything they were supposed to do and a sample is valid in every way and still there is a false negative drug test result.
The Hook Effect
One rare cause which has been addressed by manufacturers in recent years is the “hook effect” where there is so much of a drug present in the urine that there are no more binding sites left on the antibody. This can cause a lower apparent level which can lead to a negative result if it’s below the cutoff level.
One benefit of using a drug test cup is that the receptacle is also the test. There is no lapse in time between collection and testing. In a busy medical office technicians may become distracted or intentionally multi task when working on test results.
When shipping to a lab it could be even more time between collection and testing. The time in transit and any time that the shipment sits in the lab without proper refrigeration is more time for the sample to naturally degrade.
Most metabolites are stable for the short periods common in drug testing, but others are not stable especially when subjected to temperature changes or extremely high temperatures.
One example is 6-monoacetylmorphine (6-MAM), a metabolite of heroin. In the body heroin is metabolized to 6-MAM, which then metabolizes to morphine. 6-MAM lacks stability, is subject to in vitro hydrolysis and also continues to metabolize into morphine even after the urine leaves the body. One study showed that within 7 days at room temperature a urine sample that was positive for 6-MAM had hydrolyzed completely into morphine.
Limiting False Negatives on Drug Tests
Understanding that a false negative is a possibility and the likely causes is the first step in stopping them. Collecting and storing data can be an important part of investigating unexpected or suspicious results.
With enough knowledge and proper analysis many drug test results that are contradictory to expectations can be reconciled and explained. Here are some other tactics you can use to limit the likelihood of false negatives in your drug testing program.
Institute procedures and policies to combat water loading and adulteration
Use a 12 panel drug test to cover many of the synthetic and semi-synthetic opiates
Understand the cutoff levels and detection times for the tests you use
Institute policies and procedures that decrease the likelihood of human error
Report faulty tests to the manufacturer or retailer
When people fail drug tests they often claim that it was faulty or there is some mistake. In most cases this is a ruse and the individual is dirty, but false positives on drug tests are real and many innocent patients have failed a drug test only to be vindicated later on by a confirmation. So what exactly is a false positive on a drug test and when is it just another attempt at subverting drug test results?
What is a False Positive on a Drug Test?
A false positive is a drug test result that is not accurate due to another substance mimicking the target metabolite.
The majority of false positives are caused by medications, foods, and supplements that are well known to cause false readings on a drug test.
Some people have gotten a false positive from second hand marijuana smoke. The most common false positives are for benzodiazepines, amphetamine, methamphetamine, marijuana and opiates.
A presentation given at the American Psychiatric Association’s annual meeting in 2010 by a researcher at the VA Medical Center in Black Hills South Dakota, Dwight Smith, 5 to 10 percent of all drug tests result in false positives and 10 to 15 percent result in false negatives.
My anecdotal research at a healthcare facility where I tested hundreds of patients each month did not support these high numbers, but we did experience a 1 to 3 percent occurrence of false positives.
Most studies show that second hand smoke from marijuana and crack cocaine do not cause false positives but there have been anecdotal cases. The growing popularity of CBD products and confusion about which products contain trace amounts of THC have cause some false positives.
Many drugs have multiple identified metabolites and different immunoassays and equipment use different technologies to bind antibodies. The regeants in multi-drug test cups are generally the most stable and prominent metabolites of each drug.
Some substances will cause a false positive on a specific test under specific circumstances, but will show as negative when retested for different metabolites or using different equipment.
Legitimate false positives are rare unless a patient is prescribed a drug that is well known for causing false positives.
What Should testing Programs Do About False Positives?
Always acquire a thorough list of all the patient’s prescription, over the counter and herbal medications prior to testing. Interview the patient to find out if they drink energy drinks or eat any products that are known to cause a false positive.
Discuss adherence to medications and instruct them about how much water to ingest prior to testing to keep from diluting a sample.
A good practice is to ask an individual that just failed a drug test if they are positive for the substance. Encourage an honest answer and let them know that lying about it will only damage their desired outcome. Many people will admit to a mistake.
Always send contested drug test results to a lab for confirmation. Let the individual know that their sample will be sent to a lab that can confirm exactly what substance triggered the positive result.
When you receive the results back schedule a consultation with the individual and give them another chance to admit to their drug use before revealing the lab results.
Many courts have started programs where criminals that are alcoholic are given home incarceration on non-violent charges if they install a phone that has a breathalyzer built in. Probationers and prisoners that sign up for these programs agree that even if a positive reading comes from using mouth wash that is doesn’t matter and they will be violated as an offence.
A lot of our customers send all positive tests to a lab for confirmation, but also make decisions for care and treatment based on the results of the instant drug test.
Always instruct your clients that false positives are treated as a failed test until a lab returns the confirmation results and it is their responsibility to educate themselves about substances that could possibly affect their test results.
Things That Can Cause a False Positive on a Drug Test
One study found that gentle baby soaps Johnson &Johnson, CVS Nighttime Baby Bath, Aveeno Soothing Relief Creamy Wash, and J&J Bedtime Bath caused false positives for THC for infants being tested due to their mother’s suspected drug use.
Since drug testing is used so frequently in so many applications many organizations conduct studies about false positives. Still there are so many substances humans ingest and interact with that we couldn’t possibly identify them all.
Below is a list of medications and other substances that are known to cause false positives in urine drug screens. Some will often cause an inaccurate result while others almost never do.
Once a possible cross contamination is identified use multiple confirmation methods and research the history of that medication in causing false positives. Most of these medications were identified through scientific research, but a few are from anecdotal observations at medical facilities.
Marijuana (THC) False Positives
In a study conducted to find if second-hand marijuana smoke would cause a false positive 3 non-smokers were exposed to 8 marijuana smokers who smoked 32 joints in total in a 10×10×8-ft enclosed room. No samples from the nonsmokers exceeded the federal mandated threshold. However marijuana has increased in potency since this study.
The metabolite of THC is metabolite 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). Even though excessive intake of several substances have caused a false positive for THC, the only drug that is likely to cause a false positive is Efavirenz (Sustiva). Other known false positives are very unlikely.
In a study to find if being exposed freebase crack cocaine vapors would cause a false positive, 6 volunteers in an 8×8×7-ft enclosed room were exposed to 200 mg freebase cocaine vapor; none of their urine samples exceeded the federal threshold.
Individuals that work in a jobs such as law enforcement and medicine that handle cocaine are at risk for testing positive. Cocaine can be absorbed through the skin.
A study of crime lab technicians showed 33% of subjects tested positive after analyzing solid dosage forms of cocaine. Levels in two criminologists working with large amounts of cocaine in a small room were measured up to 278 ng/mL when wearing a face mask and gloves and up to 1,570 ng/mL when wearing gloves only.
In a study of physicians administering cocaine to a patients, one physician in the group not wearing gloves had a positive test with 53 ng/mL of the cocaine metabolite in his test eight hours following exposure. Results were negative in the group wearing gloves. Another physician in this study was asked to handle cocaine for two minutes and wait 15 minutes before hand washing every two hours. This physician had a positive test of 245 ng/mL 18 hours after exposure.
Many public surfaces have been shown to be contaminated with cocaine. An analysis of 234 banknotes from 18 different US cities found that 90% contained traces of cocaine. 85% of bills in Canada had traces of cocaine and 80% of bills from Brazil. They contained up to 2,350 micrograms.
Scientific studies have found no evidence that Lidocaine or norlidocaine can cause a false positive on standard cocaine tests, but there is anecdotal evidence it is possible.
Opiates False Positives
In 1998, the federal government increased the threshold defining a positive screen for urine morphine and codeine from 300 to 2000 ng/mL to reduce spurious reports of opiate-positive tests from poppy seed consumption.
Synthetic and semi-synthetic opiates are sometimes detected in an opiate drug test, but sometimes are not. One study found that oxycodone was detected in 12% of opiate immunoassay tests.
Given this inconsistency separate tests have been developed for semi-synthetic opiates oxycodone, hydromorphone, oxymorphone, levorphanol, buprenorphine and synthetic opiates fentanyl, methadone, propoxyphene, meperidine, tramadol, pentazocine. The most common pharmaceutical opiates are included in some multi panel tests while others must be performed separate.
Tricyclic Antidepressants replaced PCP on many multi drug screens because so many TCAs cause a false positive for other drugs. Having the TCA strip on your multi-panel drug test can help identify cross-reactions with other drugs.
Seroquel (quetiapine fumarate)
Barbiturate False Positives
PCP False Positives
Dextromethorphan (Robitussin, Delsym)
LSD False Positives
False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review
Alec Saitman, Hyung-Doo Park, Robert L. Fitzgerald Journal of Analytical Toxicology, Volume 38, Issue 7, September 2014, Pages 387–396
Analysis of the cocaine metabolite in the urine of patients and physicians during clinical use
Bruns AD, Zieske LA, Jacobs AJ. Otolaryngol Head Neck Surg. 1994; 111: 722-6
Occupational exposure to cocaine involving crime lab personnel
16. Le SD, Taylor RW, Vidal D, Lovas JJ, Ting E. . Journal of Forensic Science. 1992; 37(4): 959-68.
Almost all point of care drug tests are advertised as CLIA waived. Customers often want to know what does CLIA waived mean, and why is it so important?
CLIA stands for Clinical Laboratory Improvement Amendments. CLIA is a set of guidelines and regulations that are jointly enforced by the CDC (Center for Disease Control), CMS (Centers for Medicare and Medicaid Services) and FDA (Food and Drug Administration).
In its most basic form the FDA categorizes all diagnostic tests according to complexity. There are 3 levels of complexity:
CLIA Waived Drug Tests
For a test to be waived it must :
Require minimal scientific and technical knowledge to perform the test and the knowledge must be easily obtained through on the job instruction with minimal training.
Regeants must be pre-packaged, reliable, stable and require no special handling, precautions, or storage.
Operational is automatic or easily controlled.
Calibration, Quality Control & external proficiency testing materials must be readily available and stable.
Test system troubleshooting is automatic or self correcting, or clearly described and requires minimal judgement.
Minimal interpretation and judgement are required to analyze results.
Have been issued a CLIA waiver and number by the FDA.
Basically a CLIA waived test is a test that can be performed by anyone at home or in any setting without special raining or certification. Besides the requirements for being fool proof, a test must apply and receive a CLIA waiver or be amended onto an existing CLIA waiver with updated inserts and labeling. Someone can build a drug test identical to our CLIA waived 12 Panel Test and it wouldn’t be considered CLIA waived until they were issued the waiver by the FDA.
For a multi-panel drug test each strip and the device must be covered under the waiver, however enforcement is carried out at the state level and many states do not strictly enforce this. Every strip on the test must be CLIA waived for the test to be CLIA waived. Most states have employees within their state health departments that are contracted directly with the CMS as CLIA surveyors.
Some states have their own licensure and infrastructure for enforcing CLIA. Their regulations are usually more stringent, but at the very least meet the federal requirements.
For a test to be CLIA waived the FDA must inspect the facility where it is manufactured. During the Coronavirus pandemic the FDA suspended drug and medical device inspections. For the majority of drug tests an existing CLIA waiver is amended for slight changes to labeling and recently waived tests are produced by facilities that are already producing CLIA waived drug tests.
Just because a drug test is advertised or labeled as CLIA waived does not mean it really is. The only sure way to check is to see if the test and all its component strips are listed correctly in the FDA CLIA medical device database.
According to Alicia Williams, a CLIA Surveyor for the state of Oklahoma, many drug test cups that are re-labeled do not file the appropriate paperwork with the FDA and even though they are advertised as CLIA waived they do not meet the guidelines. Suppliers often sell these tests for months and potentially thousands of labs, healthcare facilities and other businesses are using tests that they believe are CLIA waived but aren’t.
Reasons You May Need a CLIA Waiver
You will need a CLIA waiver if you plan on charging someone for testing and do not have an employee that is properly certified in conducting moderate or high complexity tests.
You will need a CLIA waiver if you charge insurance for drug testing at a medical practice.
You will need a CLIA waiver to test employees if you do not have staff properly certified in conducting moderate or high complexity tests.
CLIA waivers are not available for all types of drugs and it can take years for a facility to get new drugs issued for existing or new waivers. In this case tests can be used “for forensic use only”. For example it currently isn’t possible to get a fentanyl test that is CLIA waived, but the drug is becoming more popular. Some professionals will order a single panel fentanyl strip in addition to a CLIA waived 12 panel cup so they can send a sample for laboratory confirmation if it fails for fentanyl, but for all other purposes their testing is covered by CLIA.
For a laboratory to perform high complexity tests the Executive Director has to be a certified pathologist or have a P.H.D. with related board certification and each technician has to have an Associates Degree minimum.
Even though a test is very simple if the distributor does not complete the required filings and their tests are not listed on the FDA’s CLIA medical device database you still need the infrastructure and certifications that a high complexity lab would need.
“Oklahoma CLIA surveyors can be contacted through email and cell phone. We encourage laboratories or potential laboratory personnel to ask questions. We believe in a partnership between the laboratory and the CLIA State Agency to deliver accurate laboratory test results.”
–Alicia Williams, BS, MS, MLS (ASCP)
Clinical Health Facility Surveyor
Oklahoma State Department of Health
The personnel on staff in your state are usually happy to help with any questions you have. According to Alicia Williams, a clinical health facility surveyor for the state of Oklahoma, “Oklahoma CLIA surveyors can be contacted through email and cell phone. We encourage laboratories or potential laboratory personnel to ask questions. We believe in a partnership between the laboratory and the CLIA State Agency to deliver accurate laboratory test results.”.
One of the most recent trends in tampering and adulteration of drug testing is people using fake pee as a substitute for their own sample. Subjects have been using other people’s clean urine for decades, but have sometimes been surprised when the urine they brought failed for more drugs than their own urine would have. More and more people ask us “can fake pee be detected in a drug test?” because it would be a more convenient method of defrauding tests for them.
Using fake pee is more convenient and more trustworthy for someone trying to tamper with their drug test. It’s developed to match the composition and appearance of real urine as closely as possible.
Can Fake Pee Be Detected in a drug test?
Fake pee is easily detected in a drug test. Since more people are using fake pee to tamper with their drug test labs have started testing for analytes that are found in human urine but aren’t found in fake pee. Uric acid for example isn’t a common ingredient in much of the fake urine available.
Have you ever forgot to flush after urinating and came back later to an awful smell coming from the toilet? Uric acid and certain bacteria present in urine are left out of fake pee so it has a longer shelf life. Fake pee wasn’t designed to completely fool lab equipment, so it will likely always be detected when your sample is sent to a lab for confirmation. Besides uric acid there are approximately 12 other analytes that are expelled in human urine that would not be stable in a product that needs to be stored more than a few days.
We suggest that companies and medical practices perform visual confirmations on their drug tests. This means an employee will confirm that the sample originated from the donor as a witness.
It would be very challenging for someone to substitute fake pee for their own urine with a proper visual confirmation. Prosthetics are made to help trick employees, but they have been known to malfunction and are easily noticed by most witnesses.
There are also belts available that have a reservoir and tubing to help trick a witness. The belt uses body heat to keep the temperature of the urine warm enough to activate a temperature strip. Again, these devices are fairly easy to identify especially if the witness has been trained to catch people smuggling clean urine.
So can fake pee be detected in a drug test? It can easily be detected in a drug test and a witness can negate people’s ability to defraud simpler tests.
Does Fake Pee Ever Work?
Fake pee was originally developed as a control tool for scientists and lab technicians to use for testing. It helped eliminate variables such as dilution, composition, and contamination during experiments that required human urine. It could be stored for longer periods without refrigeration.
If you are trying to cheat on a drug test the likelihood of being caught is directly related to the policies of the organization testing you. The more time and money they invest on stopping adulteration the harder it will be for you to tamper with a test.
As far as a home test cup goes there are basically 2 categories. Cups with adulteration strips and cups without adulteration strips. Most fake urine available will pass on both cups because they are engineered to have perfect readings on most adulterant tests. Urine adulteration checks include:
However all it takes is for the person who is giving you the drug test to watch you pee and you won’t get a chance to substitute your fake pee for your sample.
Both types of cups usually have a temperature strip however, and a sample that doesn’t register will likely trigger suspicions.
If the witness isn’t paying attention and you have taken measures to keep your fake pee warm enough to register at body temperature then you might get away with it. The real question is, are you willing to get caught?
Risks and Consequences of Using Fake Pee
The investment in combating adulteration is often directly correlated to the consequences of catching someone tampering with their drug test. A person on probation will face a zero tolerance policy and tampering with a urine sample will result in immediate jail time. A patient that is prescribed narcotics may not be watched as closely but will be expected to produce a sample that is positive for the drugs they are prescribed. Most doctors will refuse to prescribe and note it on their chart if a patient is ever caught tampering with a drug test.
Employment tests vary, but most of the time they either outsource their testing to a company that has strict guidelines for identifying adulteration, or they run their own program and probably put a lot of effort into making sure it’s not wasteful. An exception would be a company with relaxed guidelines that only drug tests to satisfy an insurance guideline.
In any case, it would put a company in a position of liability if they hired a potential employee that tampered with their drug test. In almost every case you will not be hired, and in some cases you could be blackballed by an entire industry for tampering with a drug test. Tampering with a drug test is in many ways worse than failing one.
Boeing fired CNC Machinist Michael Kelly after catching him trying to substitute a liquid for his own sample during a drug test. Kelly sued Boeing for wrongful termination, but lost the suit and could not have won even it was proved he did not tamper with the drug test because Boeing acted in good faith.
The consequences of attempting to defraud a drug test are becoming more serious. Several states have passed laws that make it illegal to use, possess, sale, manufacture or distribute fake pee. In many of those states there are sections that stipulates that if a technician catches someone using fake pee or attempting to defraud a drug test they must report it to the authorities or risk being penalized themselves.
Synthetic Urine Bans by State
In the United States there is currently no federal law banning the sale or use of fake pee, but 19 states have enacted legislation regarding synthetic urine.
Alabama’s SB111 prohibits the manufacture, marketing, sale, distribution, use, and possession of synthetic urine or a urine additive. 1st offense is a class B misdemeanor.
Oklahoma Code §63-7002 is a comprehensive bill covering fake urine and popular adulterants. The penalty is a misdemeanor.
Arkansas Code § 5-60-201is a comprehensive bill covering fake urine and popular adulterants. The penalty is a class B misdemeanor.
South Carolina Code 16-13-470 is a comprehensive bill covering fake urine and popular adulterants. First offense is a misdemeanor, second offense is a felony.
Mississippi H.B. 1080 the popular “Urine Trouble Act” is a comprehensive bill covering fake urine and popular adulterants. The penalty is a misdemeanor with a 6 month jail sentence and $1,000 fine.
Tennessee § 39-17-437 makes it illegal to use, possess or sale synthetic urine. Use or possession is a class A misdemeanor, sales is a class C misdemeanor.
Florida Statute 817.565(b) doesn’t mention fake urine specifically, but makes it illegal to sale, use, distribute, manufacture or advertise substances intended to defraud a drug test.
Wisconsin 2015 AB658 criminalizes the use, possession, manufacture, distribution and advertisement any substance or device meant to defraud, circumvent, interfere with or provide a substitute for a bodily fluid sample.
Wyoming § 6-3-614is a comprehensive bill covering fake urine and popular adulterants. First offense is a misdemeanor, second offense is a misdemeanor.
Michigan Article 23 employees are barred from interfering with any test procedure or tampering with any test sample
So in conclusion, can fake pee be detected in a drug test? Yes it can, and you’re even more likely to be caught by a witness or technician. It can be detected and penalties are getting stiffer for people that get caught.
What is the difference between a 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 cup 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 drug test 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).
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.
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.
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.
Which is Better?
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.
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.
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.
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.
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.
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.
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, 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.
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.
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.
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 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, 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 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.
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.