Drug Test

What is a drug test?

A drug test uses a biological sample (such as blood or urine) to detect the presence or absence of a legal or illegal drug. Drug tests are ordered and performed in a variety of settings with a variety of techniques.

Drugs include legal substances such as alcohol and tobacco, as well as over-the-counter medications, prescription medications and illegal substances. A single drug test can’t determine the frequency and intensity of substance use and, thus, can’t distinguish casual substance use from substance use disorders.

Your body metabolizes (breaks down) various drugs at different rates, so the timeframe for detecting certain drugs in your system can be very specific and vary widely from substance to substance.

Urine drug testing (UDT) is the most common test for detecting drugs.

When would I need a drug test?

You may need a drug test for several reasons. The most common use of drug testing is in the workplace. Employers may require a drug screening for various reasons, including:

• Before hiring an applicant.
• During someone’s employment — an employer may randomly or periodically require drug testing after they hire an employee.
• When drug use is suspected based on signs and symptoms observed in the workplace.
• After an employee has an accident or incident while working.

Another common use of drug testing is for the diagnosis, treatment and monitoring of alcohol use disorder and substance use disorder. As a tool for monitoring, drug testing can help determine treatment adherence, monitor abstinence and detect early relapse.

You may need this testing for court-ordered treatment programs, as a term of probation or while participating in a substance use disorder treatment program.

Other uses for drug testing include:

• Medical testing and diagnostics: People may be tested for drug use to help determine the cause of their symptoms or in emergencies when healthcare providers suspect a potential drug overdose or poisoning.
• Legal testing: There are several reasons drug testing may be required for legal purposes, including collecting potential evidence of a crime, investigating cases of child abuse or endangerment and determining if a person is under the influence of alcohol or other substances while driving.
• Monitoring for prescription drug misuse: If you take a prescription drug with high addiction potential and/or the potential for misuse, such as opioids for pain, your provider may request a drug test to check the amount of the drug in your system.
• Athletic testing:Professional athletes often have to take a drug test to screen for drugs or other substances considered performance-enhancing.

What are the types of drug tests?

There are several kinds of drug tests based on the biological sample they use and the types of drugs they detect.

Different types of drug tests based on the sample used include:

• Urine drug testing (UDT): This is the most common drug test. It requires a sample of your urine (pee). Urine drug tests are most commonly used to detect alcohol, amphetamines, benzodiazepines, opiates/opioids, cocaine and marijuana (THC).
• Blood drug testing: Healthcare providers mainly use this type of test in emergencies. It’s also typically used to detect alcohol (ethanol) levels because it can provide a precise level.
• Hair follicle drug testing: A hair sample can provide information on substance use over time. Scalp hair has a detection window of three months, while slower-growing body hair has a detection window of up to 12 months. The results can vary based on the characteristics of each person’s hair. Hair testing can detect the use of cocaine, phencyclidine (PCP), amphetamines, opioids and 3,4-Methylenedioxymethamphetamine (MDMA).
• Breath drug testing: This is primarily used to detect recent alcohol consumption. The result is called a breath alcohol concentration (BrAC). Officials often use it to estimate a person’s blood alcohol content (BAC). However, BrAC can sometimes overestimate or underestimate the BAC. Recent research has focused on the potential use of breath testing for detecting cocaine, marijuana, benzodiazepines, amphetamines, opioids, methadone and buprenorphine.
• Sweat drug testing: Sweat testing involves wearing an absorbent pad on your skin that’s collected and tested after a certain amount of time. The results provide information on how much of a substance the person consumed over the entire time that they wore the pad. Sweat testing gives a detection window of hours to weeks.

What will a drug test detect?

When a drug enters your body, your gastrointestinal tract absorbs and distributes it to the rest of your body. Your liver and other organs metabolize the drug (break it down). Metabolic processes cause the drug to turn into different chemicals, called metabolites. After a certain amount of time, the drug and/or its metabolites leave your body, mainly through your urine.

A drug test screens for certain drugs and/or their metabolites in a biological sample (such as urine or blood).

The metabolic processes happen at different speeds for different drugs. Because of this, each drug and its metabolites have a different timeframe in which a drug test can detect them.

For some drugs like amphetamines, the main (parent) drug will be detected in urine. For most other drugs, metabolites will be detectable for a longer time than the main drug.

A drug test may look for only one drug, but most drug tests often test for multiple drugs with one sample. Although the drugs included in a drug panel test vary based on the reason for the test, the most common panel used to evaluate people for illegal drug use detects the presence or absence of five substances:

• Amphetamines.
• Cocaine.
• Marijuana.
• PCP.

Other commonly tested substances include:

• Alcohol (ethanol).
• Antidepressants.
• Barbiturates.
• Benzodiazepines.
• Fentanyl.
• Heroin.
• Hydrocodone.
• Methadone.
• Methamphetamine.
• Morphine.
• Nicotine and cotinine.
• Oxycodone.

Are at-home drug tests available?

Yes. Some kits can test urine samples in the privacy of your own home. Some kits may use breath, saliva or hair instead. The accuracy of these products is variable. They generally are less sensitive than the formal tests done in a laboratory. This means that a home test could be negative, but a laboratory test could be positive with the same sample.

The American Academy of Pediatrics cautions parents against drug testing their children at home. Research studies have shown that at-home testing doesn’t reduce drug use. At-home testing also comes with the potential for misinterpreting results, which may negatively affect the relationship between children and parents.

How do I prepare for a drug test?

There’s nothing you need to do to prepare for a drug test.

Drug testing can be an emergency test, a scheduled test or it may be conducted randomly (for example, to meet ongoing employment requirements).

Depending on the circumstances, you may be asked to identify medications or supplements you’re taking.

What should I expect during a drug test?

Drug testing can be performed from small samples of your blood, hair, saliva, breath or, most commonly, your urine (pee).

For a urine sample, you’ll pee into a clean container provided to you. In some instances, you may need to provide your urine sample in the presence of a nurse or technician to make sure that the sample did indeed come from you.

For a blood sample, a phlebotomist will draw a small amount of blood from a vein in your arm or hand.

After the provider has collected the sample, they’ll send it to a laboratory for analysis

When should I know the results of a drug test?

The time it takes to get the results of a drug test varies based on the reason for the test (for example, if it’s for an emergency or employment screening) and the type of drug test.

Urine and blood drug tests usually have a quicker turnaround time for results than hair drug testing.

Ask the institution that requested the drug test about when you can expect results.

What type of results do you get from a drug test?

Drug test results are typically reported as positive or negative.

A positive result indicates that a drug was detected at or above the reference range for that test. A negative result indicates that the drug wasn’t detected or was below the threshold for a positive test result.

What do the results of a drug test mean?

There are several considerations to remember when understanding a drug test’s results.

Understanding a positive drug test result

A positive result on a drug test simply means that the person had a detectable amount of a substance present during a certain window of time. A positive result doesn’t necessarily mean that the person is currently intoxicated or experiencing the effects of the substance. A positive result also doesn’t necessarily mean that the person has a substance use disorder.

Positive results on an initial drug test usually need to be confirmed with additional testing. Confirmatory testing uses a different type of drug test. It improves the accuracy of the overall drug testing by reducing the risk of false-positive results (when someone tests positive for a drug even though they never used it).

Medications and certain foods may produce false-positive results. For example, consuming poppy seeds can cause a positive opioid test result, and taking over-the-counter cold medicine can cause a positive result for PCP.

Understanding a negative drug test result

A negative result on a drug test simply means that the particular substance couldn’t be detected. This could be because its level wasn’t sufficient enough to be detected or that the substance use didn’t happen during the detection window. A negative result doesn’t, however, rule out recent substance use or a substance use disorder.

False-negative results (when a person tests negative for drugs despite drug use or misuse) can happen for several reasons, including:

• Improper sample collection or testing.
• The person attempted to falsify a drug test (for example, by using someone else’s urine sample).
• A drug isn’t evaluated in a specific test (for example, amphetamine testing doesn’t test all types of amphetamines).