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Do 12 Panel Drug Tests Test for Alcohol

do 12 panel drug tests test for alcohol

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

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

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

Do 12 Panel Drug Tests Test for Alcohol

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

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

 

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

 

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

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

Why You Should Test For Recent Alcohol Use

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

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

 

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

 

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

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

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

Addressing Employment Related Alcohol Abuse

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

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

Some contributing factors to employees that abuse alcohol are:

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

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

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

 

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Faint Lines on Drug Tests Explained

It is very common to have faint lines on drug tests. Most at home drug tests explicitly state that a faint line is a negative result, but customers still assume that it means there is some level of the drug present.

Faint Lines on Drug Tests Are Negative

Faint lines are always negative. The purpose of a drug test is to determine whether there is less or more of a certain concentration of metabolite present in the urine. You should interpret all Drug tests on a pass / fail basis. Drug testing cups are not quantitative and cannot indicate the amount of a drug that is present in the sample.

 What Causes Faint Lines on a Drug Test?

Keep in mind on a 12 panel drug test you are actually performing 12 assays at once. Each test uses its own regeant and calibration. THC tests are notorious for having faint lines even for donors that have never smoked in their lives.

 

Faint Line drug test
THC tests are more likely to have faint lines because of components of the test itself as well as more natural substances interacting with the regeant.

 

Tests are designed for consistent results display, but each assay is never going to have identical line darkness. It would be more accurate to compare the darkness of strips testing the same drug than different strips on a multi-panel cup.

Variations in Urine Makeup

Urine is a complex substance that varies in makeup from person to person. The chemical makeup of urine alone can lead to test lines showing lighter or darker from one person to the next. Researchers published a database showing over 3,100 small molecule metabolites that can be found in urine. 1,500 compounds are created by the body alone and an additional 2,300 compounds come from diet, cosmetics, drugs and the environment.

 

Chemical makeup of human urine
This graph shows the components of human urine. In addition to these components there are hundreds of trace substances included in “other” section as well as thousands of trace contaminants.

 

External Variables

There are also dozens of variables that exist outside the laboratory that play into drug testing results.

  • Temperature of the room
  • Temperature of the urine
  • Humidity
  • Urine dilution
  • Age of the test
  • Amount of urine in the cup
  • Amount of time the cup has sat before reading results

Cross Reactivity

There are many substances that can lead to false positives, and in a similar vein many substances can cause a faint line on a drug test. People take more prescription medication, over the counter medication, supplements and vitamins these days. Rapid drug tests are testing for metabolites that those drugs are broken down into and not the drug itself . Our bodies naturally produce about 4 grams of alcohol every day.

Trace Levels

Finally trace levels of the metabolite can cause a minor fading of the assay line. It’s always the first instinct of someone to believe trace levels are what causes faint lines on drug tests, and in some cases that’s true. The target metabolites are far more reactive than any other substance that could be found in the urine. However a faint line is still a line and indicates a negative result.

Addressing Faint Lines on Drug Tests

Even though you will always have to deal with faint lines you can do things to make sure your results are as accurate as possible.

  • Tightly control independent variables during testing and storage, especially temperature.
  • Consistently read results at the 5 minute mark.
  • Discard expired tests.
  • If possible test first thing in the morning before the subject can ingest water.
  • Have subjects report all medications, supplements, and energy drink consumption.

 

 

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Home Drug Test vs. Lab Drug Test: What’s the Difference?

home drug test vs. lab drug test

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).

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.

 

Imunoassay
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.

 

Lab Drug Testing Instrument
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, https://commons.wikimedia.org/w/index.php?curid=425348

 

 

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.

 

 

 

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What is the CPT code for Drug Testing 2020?

doctor administering a drug test

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.

 

CPT code for drug testing
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.

 

 

 

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Employee Drug Testing Guide

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

  1. Donor provides urine specimen in the cup and screws the cap on.
  2. Operator checks the cap for tightness, starts timer
  3. Remove peel off label
  4. Check temperature strip on back. A green color will appear to indicate the temperature, proper range is 90°-100°F
  5. At 5 minutes read the results. Presence or absence of drugs is indicated by the colored bands in the results area.
12 panel drug test results lines
The 3 results of a 12 panel drug test: negative, positive and invalid.

 

Tips for Successful Employee Drug Testing

Set Standard Drug Testing Procedures

When starting an employee drug testing program you need to begin with a consistent operating procedure that is detailed in a manual. Outline whether drug testing will be completed on a random basis or whether the company will only drug test employees after accidents and when they’re suspected of being intoxicated on the job.

During the hiring process management or human resources should have every new employee sign a Drug Testing Compliance form that clearly 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 Urine 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 a drug screen then you can never definitively 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 specifically designed for observing drug screens. Toilet water will be dyed blue, doors will be removed from stalls, sink access will be restricted, and a mirror will be placed 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 is meant to lower the cost of a company drug testing program, but was never intended to replace confirmation from a licensed laboratory.

A drug testing cup can only indicate 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 and their sample should be sent to a lab for confirmation. Besides the fact that a point of care test only indicates quantities of a metabolite above or below a designated cutoff, the possibilities of a false positive or faulty test means that you run 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 are responsible for making sure that the sample is not adulterated 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 the sample is properly packaged 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 their innocence can be proven by the lab.

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 so the only variable being tested was directly related to the hypothesis you were trying to prove. In drug testing the uncontrolled variable is the amount of drugs each subject has consumed recently; all other variables need to be tightly controlled.

Extremely 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 our tests are stored at 70 degrees Fahrenheit in our facilities and choose the quickest shipping methods to limit exposure to uncontrolled temperatures during transport. Even in a controlled environment be careful not to store tests in direct sunlight which can raise the temperature of the tests even though the room is controlled.

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. If a subject has urine that is completely clear it is acceptable to ask that they give another sample in 2-4 hours while not consuming more liquids.

 

urine color drug test chart
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.