Transcript How to use a drug test

Drug Test
Training Guide
Contents
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How are drug tests made?
Accuracy
Which drugs can be tested for
Detection times
Testing methods
How to use a drug test – Urine
How to use a drug test – Saliva
Test results explained
Cross Re-activity
Alcohol Testing
Adulteration
Questions and Answers
How are drug tests made?
Immunochromatographic assays, also called lateral flow
tests or simply strip tests, have been around for some time.
The benefits of immunochromatographic tests include:
1. User-friendly format.
2. Very short time to get test result.
3. Long-term stability over a wide range of climates.
4. Relatively inexpensive to make.
These features make strip tests ideal for applications such
as home testing, rapid point of care testing.
Test urine is delivered into a sample site located at one end
of the porous membrane. When the drug is present in the
urine test sample, the drug or drug metabolite competes for
the limited antibody sites on the microspheres. When an
adequate amount of drug is present an attachment of the
coloured microspheres go to the probe site on the
membrane.
How are drug tests made?
Therefore, a positive urine
sample will inhibit the formation
of a precipitin line at the probe
area. A reference or control line
with a secondary antibody
reaction is added to the
membrane test to indicate that
the test is viable. This control
line should always be present
before making any test
interpretation.
How are drug tests made?
Normally, a negative urine sample will
produce two coloured lines (the
formation of a visible precipitin at the
test zone in addition to the control
line), and a positive urine sample will
show only one line (the control line).
Accuracy!
A side-by-side comparison has been conducted using the Multi-Drug One Step
Screen Test Panel (Urine) and commercially available rapid drug tests. Testing
was performed on approximately 300 specimens previously collected from
persons presented for Drug Screen Testing. The following results were recorded:
Accuracy!
Presumptive positive results were confirmed by GC/MS. The following results were recorded:
In conclusion to the above information the One Step Drug test has an average accuracy of 97.5%
Which drugs can be tested for
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AMP - Amphetamine
BAR - Barbiturates
BUP - Buprenorphine/Subutex
BZO - Benzodiazepines
COC - Cocaine/Benzoylecgonine
MDMA - Ecstasy
MET - Methamphetamine
MOP - Morphine
MTD - methadone
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OPI - Opiates
OXY - Oxycodone
PCP - Phencyclidine
PPX - Propoxyphene
TCA - Tricyclic Antidepressants
THC - Marijuana/Cannabis
KET – Ketamine
Detection Times and Cut – Off Levels
URINE DRUG SCREENS
Test Code
Type
Cut-off Level
Retention Times (Guide)
AMP
Amphetamines
1000 ng/mL
2 - 4 days
BAR
Barbiturates
300 ng/mL
1 - 10 days (Phenobarbital 14 days+)
BZO
Benzodiazepines
300 ng/mL
1 day – 10 weeks
BUP
Buprenorphine
10 ng/mL
3 – 5 days
THC
Cannabis
50 ng/mL
7 – 30+ days
COC
Cocaine
300 ng/mL
2 – 4 days
MTD
Methadone
300 ng/mL
1 – 4 days
Methamphetamines
1000 ng/mL
2 – 4 days
300/2000 ng/mL
2 - 4 days
MAMP/MET
MOP/OPI
Opiates
OXY
Oxycodone
100ng/mL
1 – 3 days
PCP
PCP
25 ng/mL
3 - 8 days
PPX
Propoxyphene
300 ng/mL
1 – 4 days
TCA
TCA
1000 ng/mL
1 – 9 days
KET
Ketamine
1000 ng/mL
1 – 7 days
Detection Times and Cut – Off Levels
ORAL SALIVA SCREENS
Type
Amphetamines
Cut off Level
Retention Times (Guide)
50ng/ml
10 minutes - 72 hours
Benzodiazepines
10 minutes - 72 hours
Cannabis
12ng/ml
10 minutes - 24 hours
Cocaine
20ng/ml
10 minutes - 24 hours
Methadone
30ng/ml
10 minutes - 48 hours
Methamphetamines
50ng/ml
10 minutes - 72 hours
Opiates
40ng/ml
Codeine: 1 hour – 7 hours, single dose
Opiate: 1 hour- 48 hours
PCP
10ng/ml
24 hours
Testing Methods
Person is
under the influence
Recent use
of drugs
Urine
Drug use suspected
to have occurred
Collection and
Adulteration /
substitution
Methods to be in
place
Hair
Long term drug
abuse suspected
Saliva
Choice of testing
method to be used
Testing methods - Urine
Urine testing has been an industry standard form of testing for
many years, so there is a wide range of products available
from many different manufacturers.
The reason why urine has been used for so long is that it sits
perfectly between saliva and hair testing. The main reason for
this is that with urine you will be able to get an idea as to
someone's drug use within the past week depending on the
drug of choice. This can help to determine if the patient has
taken anything other than their drug of choice, such as an
over the counter medicine or if they have changed their drug
of choice.
Testing methods – Oral/Saliva
Oral fluid consists of saliva plus many other fluids that enter
the mouth from the lungs, nasal passage and throat.
Oral fluid is very close to blood serum, so if the drug is in the
oral fluid it will also be in the blood. This means that the drug
will have passed into the brain so therefore the patient will be
impaired by the drug, so by using an oral fluid test you will be
able to detect if the patient has used within the past 24 to 48
hours.
The oral fluid collector that we provide will collect both saliva
and oral fluid.
Testing methods – Hair
Hair testing for drug of abuse is becoming more popular. The reason
for this is that you can get up to a 3 month drug use history. This form
of testing is really only used by the Police.
The way hair testing works is very simple. The drug goes into the
blood stream and gets trapped in the hair shaft as it grows in the root
follicle. Since hair is an inert protein, the drug/s remain trapped there
until the hair is cut. The earliest that you would be able to test for a
drug using hair would be about 7-10 days after the drug has been
taken. This will allow enough hair growth to be used as a sample.
The drug/s can not be washed out or effected by chemicals because
the drug/s remain locked away in the centre of the hair known as the
hair cortex.
How to use a drug test – Urine Panel
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Remove the test panel from the foil pouch (do not break the
seal of the foil pouch until you are ready to begin the test).
Using a plastic cup, obtain a urine sample from the individual
who is being tested.
Pull the protective cap off the bottom of the test panel to
reveal the absorbent testing strip/s, do not touch the strip/s
and do not throw away the protective cap.
Carefully dip the testing strip/s into the urine sample,
ensuring that the urine does not come into contact with the
plastic case of the test. Allow the test to absorb the urine for
about 10-15 seconds.
After 15 seconds, remove the test from the urine and replace
the protective cap.
Lay the test panel on a clean flat surface while the test lines
develop.
You can read negative results as soon as they appear but
positive results must be read at least 5 minutes after
removing from urine. All results should be read within 10
minutes, otherwise a false reading may occur.
How to use a drug test – Urine Cup
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Open the bag containing the plastic
drug cup and remove the cup.
The person to be tested for the
presence of drugs needs to urinate into
the drug cup. Ensure the specimen
reaches the minimum fill volume line
on the label. There is a temperature
bar on the label of the drugs cup. If the
temperature does not show a green
colour then the test may have been
tampered with. Human urine should be
between 90-100ºF.
Secure the cap on to the cup by
screwing the lid back on.
On a flat surface remove the pink
plastic clip and firmly push the key in.
When ready, peel off the label to view
the results. You can read the results
after 5 minutes. Do not interpret the
results after 10 minutes.
Drug test results explained - Urine
Read the results of each strip individually and independent of one another.
You will see two letters on the cassette or panel by the test strip/s, ‘C’ this is the control band and ‘T’, this is the
test band. A pink/red coloured line should appear on each strip of the control band (C), this confirms each strip
has worked properly.
If no line appears in the control band (C) that strip hasn’t worked properly and you may need to do a further test.
A second pink/red coloured line, no matter how faint should now appear in the test band (T), this is a negative
result. If no further line appears in the test band (T) then the individual has tested positive for that drug of abuse.
The labels on the test will tell you which drug each individual strip is testing for.
Remember a negative urine sample will produce two lines, and a positive urine sample will produce only
one line in the control band (C).
How to use a drug test – Oral Fluid (MTD)
Test procedure
1.
Remove the collection sponge and test cube from the sealed
pouch.
2.
Tear off the packaging around the collection sponge.
3.
Insert the sponge end of the saliva collector into the
mouth. Actively swab the inside of the mouth and tongue to
collect oral fluid for a total of 3 minutes (until the sponge
becomes fully saturated). Gentle pressing of the sponge
between the tongue and teeth will assist saturation. No hard
spots should be felt on the sponge when saturated. See step
2.
4.
Hold the test cube vertically and place the collection sponge
into the test cube. Make sure to fit the groove of the collection
sponge onto the guide rail inside the test cube. Now press the
sponge firmly down. See step 3.
5.
When you are completely happy that you have collected
enough saliva sample firmly press down on the lid till it is
tightly sealed. This will allow all of the saliva to be extracted
from the collection sponge. See step 4. Note: If the amount
of saliva pressed into the test cube is not adequate for
testing, collect more saliva by re-inserting the collection
sponge in the mouth and follow steps 2, 3 and 4 again.
6.
Wait for the coloured line(s) to appear on the test device.
Read results at 10 minutes. Do not interpret results after 1
hour. See step 5. Note: When carrying out the test the oral
cube must remain in a vertical position at all times.
Drug test results explained – Oral Fluid
You will see a letter at the top of the cassette ‘C’ this is the control band. The control line should appear on both
sides this indicates the test has worked correctly. If there is no control line (C) then the test is invalid. Insufficient
specimen volume or carrying out the procedure incorrectly is the most likely reason for the control line failing to
appear.
Negative:
If a second pink/red coloured line, no matter how faint appears next to each specific drug (e.g. COC), this is a
negative result.
Positive:
If no line appears next to any of the drug names then the individual has tested positive for that drug of abuse.
Remember a negative oral fluid sample will produce a line and a oral fluid sample will not produce any
line.
Cross Re-activity
A False Positive urine test result occurs when a sample initially tests
Positive, but is determined later that the individual had a legitimate and
legal purpose for ingesting the substance in question. This is otherwise
know as a cross reaction.
Drug test cross re-actions can occur for any of the following reasons;
Prescription Drugs: Many prescription drugs are used illegally and will be
detected by urine tests (primarily Amphetamines, Barbiturates, Opiates
and Benzodiazepines). There are times when the patient will test positive
but is being issued with prescription drugs.
On finding a result of this nature it is advised that you clarify this with
your patient first before coming to a decision. To help to remove any
embarrassment for you or the patient maybe ask the patient before hand
about medications.
Cross Re-activity
Administered Drugs: This includes drugs administered by a medical professional
during an office visit or surgery. For example, Morphine is often administered to
relieve pain during surgery or childbirth. Like prescription drugs, many administered
drugs are used illegally and will be detected by urine tests.
Over-The-Counter (OTC) Medications: In the past, Positives caused by OTC
medications were a great concern in this industry. Over the years, however, drug
testing technology has improved significantly and cross reactions caused by OTC
medications are now a lot lower. Some of the products that could cause a cross
reaction are as follows:
Codeine – Opiates e.g. 40mg tablets taken 4 x a day = 2000ng/mL (Cut-off level for
Heroin)
Valium - Benzodiazepines
Ranitidine – Methamphetamine
Vick's Inhaler – Methamphetamine
Poppy Seeds - Opiates
Alcohol Testing
UK Limits
The legal limit for alcohol levels in the body while in control of a vehicle vary
from Country to Country and can be defined by several different standards, the
following of which are the most common:
35 microgram's
80 mg/100mLl
0.35 mg/L - BrAC
0.08% BAC
There are two ways to express the alcohol content inside the body. They are
Blood Alcohol Content (BAC) and Breath Alcohol Content (BrAC).
Alcohol Testing
The relation between the Blood Alcohol Content (BAC) and the Breath Alcohol
Content (BrAC) is as follows;
BAC (in %) = BAC (in g/100ML) = BrAC (in mg/L) divide by 0.20
Example:
0.02%BAC = 0.02g/mL - BAC
0.02%BAC = 0.10mg/L – BrAC
The body absorbs alcohol into the blood stream through the digestive system. It
takes at least 30 minutes for the alcohol to be absorbed. From then on the blood
alcohol concentration will at it’s highest between 30 and 90 minutes. After this
time the level reduces approx. 0.1mg/mL to 0.2mg/mL per hour.
Alcohol Testing
The UK limit is expressed in the following measurements;
BAC Value (in mg/mL) – 0.08
BrAC Value (in mg/L) – 0.35
The most accurate form of testing alcohol is via Blood. This though is
costly and is not always the easiest option available.
For testing on site there are 2 types of test available;
Rapid Alcohol Saliva Test
AL-6000 ALCOSCAN
Each one will be explained in more detail on the following slides.
Alcohol Testing - Saliva
The unit of measurement
for the Saliva test is
BLOOD ALCOHOL
CONTENT (BAC).
If you were at the drink
drive limit in the UK your
result on the saliva test
would be as the colour
Blue/0.08% on the foil
pouch.
Alcohol Testing – Breath AL6000
The unit of measurement for the breathalyser test is BREATH
ALCOHOL CONTENT (BrAC).
Alcoscan AL-6000 is a hand held,
portable breath alcohol tester
to check subject's breath alcohol
concentration with reliable
accuracy and it is available to test
in Passive mode.
Breathalyser with Replaceable
Calibrated Sensor Module.
No Calibration Service
required!
Adulteration
Adulteration testing is done to check the quality of a urine specimen. You are advised to
carry out an adulteration before you carry out your drug test.
In drugs of abuse testing, it is important to insure that the samples are clean and free from
adulteration. Diluting a urine sample is probably the most common form of urine
adulteration.
Tests for adulterants, specific gravity and creatinine can aid in the detection of common
methods for defeating urine drug tests including dilution, or adulteration of the sample with
bleach, vinegar, visine, sodium bicarbonate, drano, soft drinks or hydrogen peroxide.
Since tests for adulterants, specific gravity and creatinine detect many of the above
common adulterants, some drug users are utilizing commercially available adulterants,
including UrinAid, Stealth, Urineluck, Stealth 51, and INSTANT CLEAN ADD-IT-IVE.
The active ingredient in UrinAid and other similar products is an aldehyde (glutaraldehyde).
Adulteration – What does it mean
Adulteration is the tampering of a urine specimen with the intention of altering the test results. The
use of adulterants can cause false negative results in drug tests by either interfering with the
screening test and/ or destroying the drugs present in the urine. Dilution may also be employed in
an attempt to produce false negative drug test results.
One of the best ways to test for adulteration or dilution is to determine certain urinary
characteristics such as creatinine, pH, and specific gravity and to detect the presence of
glutaraldehyde, nitrite and oxidants /pyridinium chlorochromate (PCC) in urine.
Adulteration – elements explained
•Creatinine is a waste product of creatine; an amino-acid contained in muscle tissue and found in urine.
1 A person may attempt to foil a test by drinking excessive amounts of water or diuretics such as herbal
teas to “flush” the system. Creatinine and specific gravity are two ways to check for dilution and
flushing, which are the most common mechanisms used in an attempt to circumvent drug testing. Low
creatinine and specific gravity levels may indicate dilute urine. The absence of creatinine (<5mg/dl) is
indicative of a specimen not consistent with human urine.
•Specific gravity tests for sample dilution. The normal range is from 1.003 to 1.030. Values outside this
range may be the result of specimen dilution or adulteration.
•Nitrite tests for commonly used commercial adulterants such as Klear or Whizzies. They work by
oxidizing the major cannabinoid metabolite THC-COOH.2 Normal urine should contain no trace of nitrite.
Positive results generally indicate the presence of an adulterant.
•Glutaraldehyde tests for the presence of an aldehyde. Adulterants such as UrinAid and Clear Choice
contain glutaraldehyde which may cause false negative screening results by disrupting the enzyme
used in some immunoassay tests.³ Glutaraldehyde is not normally found in urine; therefore, detection of
glutaraldehyde in a urine specimen is generally an indicator of adulteration.
•pH tests for the presence of acidic or alkaline adulterants in urine. Normal pH levels should be in the
range of 4.0 to 9.0. Values outside of this range may indicate the sample has been altered.
•Oxidants/PCC (Pyridinium Chlorochromate) tests for the presence of oxidizing agents such as
bleach and hydrogen peroxide. Pyridinium chlorochromate (sold under the brand name UrineLuck) is a
commonly used adulterant.³ Normal human urine should not contain oxidants or PCC.
Questions and Answers
How accurate are these types of tests?
Better than 99% (close to cut-off levels) and 100% (at higher levels), compared to
Laboratory Emit test machines. Every test is rigorously tested when manufactured,
thus giving an average accuracy of 97.5%.
Why is it so cost effective to use panel tests?
By using a panel or cup test, the need for laboratory test is removed because the test
results are shown there and then when the test is carried out. By using either our 10
Drug Panel all street drugs can be tested for at the same time and accurate results are
available within 5 minutes.
What does it mean if no test lines have appeared?
Make sure that the test has been dipped into the urine for long enough (10 - 15
seconds) and that the testing device was not dipped into the sample past the marker
line (above the marked area) otherwise the test will flood. If no test lines appear the
test is invalid and should be repeated using a new test kit.
Questions and Answers
What are cut-off levels?
All tests have a cut-off level – the point at which there is not enough substance that
can be detected. All levels are internationally agreed by SAMHSA
(Substance Abuse and Mental Health Services Administration). Concentrations
above the cut off levels are positive and concentrations below the cut off levels are
negative. The cut off levels ensure that there is no risk of false positives. Different
drugs have different cut off levels.
How can I prevent urine adulteration?
First, make sure that the donor has washed their hands before providing the
sample. Wear gloves when carrying out the test. Use a sample cup with a
temperature strip on it. This will help with identifying whether the urine sample is
fresh. If still in doubt then use an adulteration strip to ensure that the test is clear of
a number of different chemicals within the sample.