Why is drug testing so important?
Drug abuse in the workplace costs many billions of dollars each year. It also has a negative effect on the security of the work environment. Drug and alcohol abuse has become such a growing concern that law enforcement agencies and hospitals routinely test as part of assessing the overall condition of an individual. Due to the fact that drug users miss more days of work and are late for work more often than non-drug users, some employers include a drug screening test as part of the application process.

When might an employer consider asking an existing employee to submit to a drug test?
Employers may ask an employee to submit to a drug test if there is a suspicion that the employee may be using or abusing drugs or alcohol. The employee might suddenly be exhibiting episodes of short-term memory loss, slow learning, confusion, anxiety and what appears to be toxic delirium. Also, some employers will perform a drug test if the employee is being considered for a promotion.

What drugs are being tested for?
Predominantly, the drugs of abuse being tested for include: marijuana, cocaine, barbiturates, amphetamine, methamphetamine (Ecstasy), Oxycontin, opium, heroin, morphine, methadone, phencyclidine, angel dust (PCP) and valium.

What kinds of test kits are used for drug testing?
There are a number of FDA-approved, relatively low-cost urine drug testing kits available for purchase by individuals or professionals. These tests follow the guidelines of the National Institute on Drug Abuse and the U.S. Department of Health and Human Services. There are a numerous urine test kits, some of which test only for one drug and others which can test for up to as many as ten different drugs. Other means of drug testing are the sweat patch, hair tests and saliva tests.

How reliable are the urine drug tests?
The one-step test kits can be used to detect various traces of drugs and their metabolites with up to 99% accuracy, but they provide only preliminary analytical results. A more specific scientific method (gas chromatography/mass spectrometry) must be used to confirm the results. In other words, when drug of abuse preliminary test results are positive, clinical consideration plus professional judgment should be used for verification.

What are the dip strip urine drug testing kits like?
The dip strip urine drug test kits contain a THC test cassette, a disposable sample dropper and instructions for use. Other items required but not provided in the kit are a specimen collection container and a clock or timer. The subject of the test collects a urine specimen in the container. Then the tester removes the test strip or test disk (depending on the kit) from its foil pouch. Have the subject collect a urine specimen in the container. The tester either dips the test strip into the urine specimen or places the test disk on a dry, flat surface and uses the dropper to drop two drops of the urine specimen into the well located on the disk.
Results can be interpreted in 3 to 5 minutes.

What is the urine drug testing kit using the split cup like?
This test provides a high-quality screening method with 99% accuracy. There is no need for any additional materials and the tester does not have to handle the urine sample. The subject of the test collects a urine sample in the cup. The tester only has to turn the key to activate the drug test cup. The test cup also includes an adulteration test to check the integrity of the urine. With this drug test cup, the tester can read the results at his or her convenience.
What is the sweat patch test like? With this test, a patch (similar to a band-aid) is attached to the subject’s skin, usually the upper arm. The patch collects sweat for seven to fourteen days and is then tested in a lab for drug residue. This test is generally used in criminal and child custody cases to determine whether the user has been rehabilitated. This test is not that reliable because the patch is susceptible to contamination from environmental sources. In other words, a false positive result can be caused by drug molecules adhering to the patch when the wearer is near other people.

What about hair tests?
When 1.5 inch long strands of hair cut close to the scalp are lab analyzed, a drug history covering 90 days can be obtained. However, hair testing is a very controversial new technology because of concerns that it might be considered discriminatory and the results can be wrong due to environmental contaminants. The National Institute of Drug Abuse (NIDA) has done studies which show that some drug molecules are attracted to the pigment melanin and adhere more strongly to dark hair than they adhere to light hair.

What about saliva testing?
Drugs show up in saliva faster than they show up in urine, hair and sweat. Saliva testing may reveal whether a person is high, making it a useful post-accident test. Saliva testing is just beginning to be used, so its effectiveness is yet to be determined.

What is drug addiction?
Drug addiction is a complex brain disease. It is characterized by compulsive, at times uncontrollable, drug craving, seeking, and use that persist even in the face of extremely negative consequences. Drug seeking becomes compulsive, in large part as a result of the effects of prolonged drug use on brain functioning and, thus, on behavior. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence.

How quickly can I become addicted to a drug?
There is no easy answer to this. If and how quickly you might become addicted to a drug depends on many factors including the biology of your body. All drugs are potentially harmful and may have life-threatening consequences associated with their use. There are also vast differences among individuals in sensitivity to various drugs. While one person may use a drug one or many times and suffer no ill effects, another person may be particularly vulnerable and overdose with first use. There is no way of knowing in advance how someone may react.

How do I know if someone is addicted to drugs?
If a person is compulsively seeking and using a drug despite negative consequences, such as loss of job, debt, physical problems brought on by drug abuse, or family problems, then he or she is probably addicted. Those who screen for drug problems, such as physicians, have developed the CAGE+ questionnaire. These four simple questions can help detect substance abuse problems:
1. Have you ever felt you ought to Cut down on your drinking/drug use?
2. Have people ever Annoyed you by criticizing your drinking/drug use?
3. Have you ever felt bad or Guilty about your drinking/drug use?
4. Have you ever had a drink or taken a drug first thing in the morning to steady your nerves or get rid of a hangover (Eye- opener)?
+ Adapted from: Ewing JA. Detecting Alcoholism: The CAGE Questionnaire. JAMA, 252:1905-1907, 1984.

What are the physical signs of abuse or addiction?
The physical signs of abuse or addiction can vary depending on the person and the drug being abused. For example, someone who abuses marijuana may have a chronic cough or worsening of asthmatic conditions. THC, the chemical in marijuana responsible for producing its effects, is associated with weakening the immune system which makes the user more vulnerable to infections, such as pneumonia. Each drug has short-term and long-term physical effects, stimulants like cocaine increase heart rate and blood pressure, whereas opioids like heroin may slow the heart rate and reduce respiration.

What is detoxification, or “detox”?
Detoxification is the process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal. It is often the first step in a drug treatment program and should be followed by treatment with a behavioral-based therapy and/or a medication, if available. Detox alone with no follow-up is not treatment.

What is withdrawal? How long does it last?
Withdrawal is the variety of symptoms that occur after use of some addictive drugs is reduced or stopped. Length of withdrawal and symptoms vary with the type of drug. For example, physical symptoms of heroin withdrawal may include: restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. These physical symptoms may last for several days, but the general depression, or dysphoria (opposite of euphoria), that often accompanies heroin withdrawal may last for weeks. In many cases withdrawal can be easily treated with medications to ease the symptoms, but treating withdrawal is not the same as treating addiction.

What are the costs of drug abuse to society?
It is estimated that in 2000 illegal drug use cost America close to $161 billion:
- $110 billion in lost productivity
- $12.9 billion in healthcare costs
- $35 billion in other costs, such as efforts to stem the flow of drugs.
For more details on the economic cost of drug abuse, click here.

Beyond the raw numbers are other costs to society:
a. Spread of infectious diseases such as HIV/AIDS and hepatitis C either through sharing of drug paraphernalia or unprotected sex
b. Deaths due to overdose or other complications from drug use effects on unborn children of pregnant drug users
c. Other effects such as crime and homelessness.

If a pregnant woman abuses drugs, does it affect the fetus?
Many substances including alcohol, nicotine, and drugs of abuse can have negative effects on the developing fetus because they are transferred to the fetus across the placenta. For example, nicotine has been connected with premature birth and low birth weight as has the use of cocaine. Scientific studies have shown that babies born to marijuana users were shorter, weighed less, and had smaller head sizes than those born to mothers who did not use the drug. Smaller babies are more likely to develop health problems.

Whether a baby’s health problems, if caused by a drug, will continue as the child grows, is not always known. Research does show that children born to mothers who used marijuana regularly during pregnancy may have trouble concentrating, even when older. Our research continues to produce insights on the negative effects of drug use on the fetus.

Drug testing has become a standard and frequently practiced application. The need for testing has become much greater than before, because testing in the workplace has become so commonplace. Corresponding to the increasing need for drug testing, the availability has also improved. Because of the fundamental need and availability of drug testing, a consumer, such as yourself, has to know what the typical test involves and which one will you benefit from the most. Testing varies based on the type of substance that is being tested, the particular drug that is being tested for, as well as the convenience of the test. Drug testing providers offer tests that look for drugs in the all common drug of abuse categories.

Overview of regulatory guidance documents

Several regulatory guidance documents mention forced degradation or stress testing of drug substances and/or drug products (1, 6-16). A summary of these has been published (2). To enable a good interpretation of the available guidance documents and to provide the reader with a comprehensive overview, the text of the relevant paragraphs of these guidance documents is provided in the sidebar, "Overview of stress-testing guidance documents."

The ICH stability guideline Q1A(R2) defines stress testing for drug substances and drug products. For drug substances, these tests are studies undertaken to elucidate the intrinsic stability of the drug substance. Such testing is part of the development strategy and is normally carried out under more severe conditions than those used for accelerated testing. For drug products, stress tests are studies undertaken to assess the effect of severe conditions on the drug product. Such studies include photostability testing (see ICH Q1B) and specific testing on certain products (e.g., metered-dose inhalers, creams, emulsions, and refrigerated aqueous liquid products).

In addition to investigating drug substance or drug product stability, stress testing studies may also provide information about degradation pathways and the selectivity of the applied analytical methods. According to the ICH and FDA guidance documents, stress testing is conducted to fulfill three main purposes: to provide a stability assessment of the drug substance or the drug product; to elucidate the possible degradation pathways of the drug substance or the active pharmaceutical ingredient in the drug product; and to investigate the stability-indicating power of the analytical procedures applied for the drug substance and the drug product.

Although the regulatory guidance documents listed in the sidebars define the concept of stress testing, they do not provide detailed information about a stress testing strategy. The experimental conditions to conduct stress tests are described in a general way and the exact stress conditions to be applied are not described. Some guidelines emphasize that the experimental conditions of stress tests depend on the nature of the drug substance and the drug product (1, 9).

The available guidance documents also do not state the extent to which stress tests should be carried out--that is, how much stress should be applied or how much degradation should be aimed for. It is recognized, however, that during stress testing, degradation products can be observed that are not formed during accelerated or long-term stability studies. Hence, these degradation products need not always to be examined (1, 9).

It can be concluded that the available guidance documents allow for performing stress tests on a sound scientific basis. The experimental conditions should be realistic and lead to "purposeful degradation" That is, stress tests should generate representative samples to assess drug substance and drug product stability, provide information about possible degradation pathways, and demonstrate the stability-indicating power of the analytical procedures applied.

There are several types of body substances that can be used to test for the presences of drugs. The most common types are urine, hair, saliva and blood. The Urine Test is considered to be fairly inexpensive as well as convenient and easy to use. Results can be altered by stopping consumption for a period of time before the test. The Hair Test is more expensive than the urine test, it also detects the presence of substance use over longer period of time. It requires a sample of hair about the diameter of a pencil and 1.5 inches long, therefore more than a single stand of hair is needed. The hair test usually does not detect use of substance within the past week. Results are not influenced by brief periods of abstinence from substances. The Saliva Test is believed to be a relatively unobtrusive method of drug testing as well as being the most convenient way to test for presence of a substance. The Blood Test is considered the most obtrusive method of testing and the most accurate, but it is also the most costly.

Marijuana and Youth, What you could do with it?

Talk with your kids about Alcohol?

The following chart provides estimated detection periods for various substances by the use of the hair, urine or blood test types. The ranges can be affected by the body mass of an individual, the amount and frequency of consumption, as well as other factors

ILLICIT SUBSTANCE OF ABUSE	HAIR FOLLICLE DRUG TEST	URINE DRUG TEST	BLOOD DRUG TEST
Alcohol	n/a	6-24 hrs	unknown
Amphetamine	up to 90 days	1-4 days	unknown
Barbiturates	unknown	1-21 days	unknown
Benzodiazepines	unknown	1-42 days	unknown
Cannabis (single use)	up to 90 days	48-72 hrs	2-3 days
Cannabis (habitual use)	up to 90 days	up to 12 wks	2 weeks
Cocaine	up to 90 days	4-5 days	unknown
Codeine/Morphine	up to 90 days	2-4 days	unknown
Heroin	up to 90 days	8 hrs	unknown
Methamphetamine	up to 90 days	3-5 days	1-3 days
PCP	up to 90 days	3-7 days	1-3 days

All kind of Saliva Drug Testing Kits have the average detection period between 24 and 72 hours. But from the other hand, drug screening through saliva or Oral Fluid has a very important plus, it is almost impossible to cheat the test.

DRUG TESTING—TRENDS

The writer of this article was in a local health food store several months ago, talking to the sales clerk. A woman walked in, told the clerk that she would soon be required to have a pre-employment drug screening test (presumed to be a urine test), and proceeded to ask him what products the store carried that could be used to fool the test. In other words, she wanted to know about what she could take to throw the test off. The clerk told her about a couple of products that could be used. She didn’t purchase anything at the time, but she now had the information she requested.

Beginning next year, but only after new guidelines are developed and public comments are received, federal employees will be required to take tougher drug screening tests. This may have the effect of influencing other businesses to change to harder to fool drug screening tests. Of course, this will probably extend to schools, some of which conduct routine random drug testing, and other organizations that test for drug use due to the nature of the work (such as the military, bus company drivers, and truck drivers). The new tests will include sweat, saliva, and hair testing—tests that are considered more accurate than urine drug tests.

Saliva Test. A saliva test is good for detecting whether drugs were used within the past one or two days. The tester must make sure that there has been nothing in the subject’s mouth for at least five minutes before performing the test. The test pouch must be brought to room temperature before the tester opens it. Then the tester removes the saliva collection swab from the pouch, being careful not to contaminate it. The foam end of the swab is placed into the subject’s mouth for approximately two minutes so that enough saliva is collected to saturate it. Then the swab is removed and placed inside the plastic tube included in the kit and four drops of saliva have to be squeezed out of the tube into the well of the testing device.

Hair Test. Hair testing can detect three months of drug use. A clipping of hair is taken from the back of the subject’s head and sent to a lab that has the proper GC/MS equipment to analyze the hair shaft. Results are generally available within 48 hours of receipt by the lab.

Sweat Patch Test. Sweat tests require the person being tested to wear a patch (similar to a band-aid) on his or her upper arm for two consecutive weeks. The patch is then removed and sent to a lab for GC/MS testing. This test is primarily used in probation, drug court or child custody cases. The test is also used on individuals returning to work after receiving drug treatment.

Sweat SprayTest. This test can detect two weeks’ drug use. It is a relatively tamper-proof test because it is hard to manipulate. The test is performed by using a special drug wipe to touch the suspected surface and then spraying the wipe with the aerosol spray included in the kit. No lab is needed and results are obtained in seconds.

Despite the trend toward using alternative tests, some organizations will continue to use the urine tests even though they can be fooled. Use of these new tests has received criticism due to the fact that, for example, hair tests sometimes produce false positives because hair can absorb drugs near the person. Also, dark colored hair tends to absorb more drug byproducts than does light hair. The other tests can produce false positives as well, also due to environmental factors.

Companies such as Georgia-Pacific Corp., Anheuser-Busch and Kraft Goods Inc. have adopted these types of alternative testing, while other companies are waiting for guidelines and standards to be developed and implemented by the federal government. Police departments and casinos were some of the first employers to use hair tests for pre-screening potential employees.

Sources for this article: alcoholism.about.com; bna.com; Drug Testing Advisory Board; Craig Medical web site; Xalex website; minutes of SAMSHA Drug Testing Advisory Board – Open Session – June 1, 2005 (posted on Internet).