Drug Testing Policies

American Toxicology offers services in assisting clients in writing their drug testing policies. It is not uncommon to review a policy and find it deficient in a number of areas. Some are so deficient that it is recommended that the whole policy be rewritten. Unfortunately, some clients have paid a considerable amount of money for their policies which were written by someone else and marketed to be tailored to their needs. An employer, not knowing where to go, can be easily convinced with legal jargon and marketing hype that it is their best interest to buy a policy from someone “who knows what they are doing”.

Well, this is the American way and I can’t be too critical toward someone seeing an opportunity. However, selling drug testing policies is a relatively new enterprise. Some laboratories have been assisting employers with drug testing since the days of the Nixon Administration when it all began. I cannot specifically speak for other laboratories, but American Toxicology is willing to assist clients in this area at no charge. It is in our best interest to have clients with good drug testing policies.

Basically, a good policy must have two competent components – the company and the laboratory. No matter how competent one of them may be, if the other one is not, the policy will fail to give protection from liability. Drug testing is a team effort between the company and the laboratory. Unfortunately, some employers are very loose on this philosophy, until they get themselves into litigation. Then things change rather rapidly.

I have seen policies, especially in the gaming industry, where the competency of one or both of these components are lacking to the point that the drug testing conducted only works if it does not go to court. The main motivation for an employer to knowingly have such a program is to reduce costs. These companies literally operate on the edge. To them, drug testing is viewed primarily as a public relations expense. There is little fear of legal reprisal.

American Toxicology’s motto is that we only do that which we will win in court. We have had to make some tough decisions concerning this position. However, we feel it is a worthy standard to hold.

Why a Medical Review Officer (MRO) may not be beneficial to the employer.

By: Dan R. Berkabile

Nevada law requires any laboratory that tests human biological specimens to be regulated by the State as a medical laboratory. As such, the laboratory is required to report the results of its testing in a prescribed manner. For drug testing, the report must list the drugs screened for and their cutoff levels. Drugs reported positive or negative must refer to this list on the report. If the prescribed medication accounts for a drug reported positive, it can be noted on the report as, “the drug identified is consistent with prescribed medication, or language similar to this. Additional information may be given.

MRO’s are mandatory in federal drug testing. They are optional in private drug testing. I suppose private employers pay the additional const for a MRO thinking it will reduce their liability, not believing that following state guidelines is as sage. However, it must be remembered that the State is regulating their testing anyway.

In using the MRO, if an applicant was taking prescribed medication equal to a positive finding, the MRO would report the results to the employer as negative. The applicant would be hired without any knowledge to the employer about the prescription. The employer would have to depend entirely upon the applicant to reveal any possible interference the prescription medication may have on job performance and safety.

However, without the MRO, the laboratory report goes directly to the employer and none of this would be a concern. The notation on the report already shows that the laboratory conducted a medical review under its laboratory director a pathologist. The report would also be received sooner by the employer.

It is true that prescription medications are confidential. The American Disabilities Act (ADA) stresses this. However, I believe the intent of ADA is not directed so much toward abused drugs typical in pre-employment drug screening. If a person has a prescription for one of the abused drugs, I believe the employer should know about it. The possibilities are codeine, amphetamine, methamphetamine (speed), morphine (metabolite of heroin), and more recently, marijuana. (A good question would be: would a MRO exclude a positive finding for marijuana if the person showed that a doctor prescribed it?)

In the latest Nevada legislative session, a representative of a large labor union testified before a senate subcommittee concerning the passage of a proposed drug testing bill. I was presenting during this meeting. The following is a word by word transcription from public records of the portion of this individual’s testimony concerning medical review officers:

“We believe that in using a lab such as (the lab was named), thy have qualified people on staff including medical officer (I believe the meaning here is medical doctor or pathologist), and when we get the test results back from the lab, they have done their primary test, they have done their confirming test, they have looked at that, and any test that we have ever had challenged by an employee, and they have that option to challenge a test, not to retest, but to challenge it, have always come back in the positive. My concern would be if we were to interpret that MRO must be used one hundred percent of the time, we’re going to add an expense for that MRO testing. As an example, in one case lab charges an addition al $6.00 to have every test result review by an MRO. Additionally, if it’s post testing, now we’re adding time on that we’re going to have somebody out of a job until we get the test results back. Whatever that time may be, hours or days, it’s additional exposure to injury.” (The last sentence refers to a person remaining on the job.) The individual further mentioned the delay that MRO review brings about in hiring new workers.

In Nevada, a laboratory that performs drug testing must be licensed as a clinical laboratory. As such, the laboratory is directed by a licensed pathologist who is responsible for all results reported by the laboratory. Under these regulations another doctor in the system going over results is not necessary, and is only a waste of time and money, as the labor representative above explained.

Dan R. Berkabile

Forensic Chemist

Certifications and Accreditations

State of Nevada Licensed Laboratory Director, Gary Telgenhoff, M.S., D.O., is a board certified forensic and anatomical pathologist who serves as ATI’s Lab director. Additionally, ATI holds the following licenses, and permits:

• State of Nevada Licensed Laboratory
  
  
• Nevada State Corporation
  
  
• City of North Las Vegas Business License
  
  
• City of Las Vegas Business License
  
  
• City of Reno Business License
  
  
• Arizona State Corporation
  
  
• City of Bullhead Business License

Services Offered

Pre-employment Screening
American Toxicology offers a variety of tests & Panels for applicant screening. We can customize your testing & billing arrangements to best suit your needs.

Results
Results are delivered using a secure method designed to protect both the client and the laboratory. At the option of the client, results may be received by telephone, fax, mail, email, or delivery by courier under this design.

On-site training
American Toxicology offers free training for managers & supervisors designed for early identification of potential employee drug involvement. The training focuses on recognition of symptoms of drug use & detection when use or the effects of use is occurring on the job. Included in this is the right way to determine probable cause. The intent of the training is to provide management with a likely & reassuring drug free work environment.

Post Accident/Probable Casue Testing
American Toxicology can collect or receive a test sample on-site, at a hospital emergency room or urgent care clinic, or employees can be sent or brought directly to American Toxicology for collection. Samples for drug/alcohol testing include urine, blood, breath or saliva. All testing is performed at American Toxicology, in-house.

Random Testing
Random testing is available at any time with our Random Sampling Program. Collections can be obtained at the employer’s site or at any one of our collection facilities.

Services Offered

A list of drug tests we offer to our local Las Vegas clients, click on the image to see a larger version.

American Toxicology Mapped Locations

For Maps and directions to American Toxicology collection sites click on the links below.

North Side

South Side

East Side

Bullhead City

Reno

Drug testing methodologies

He is some information from Wikipedia about drug testing methodologies.

The different types of drug tests are tested in very similar ways. Before testing the sample, the tamper-evident seal is checked for integrity. If it appears to have been tampered with or was damaged in transit, the laboratory rejects the sample and does not test it.

One of the first steps for all drug tests is to make the sample testable. Urine and oral fluid can be used "as is" for some tests, but other tests require the drugs to be extracted from urine beforehand. Strands of hair, patches, and blood must be prepared before testing. Hair is washed in order to eliminate second-hand sources of drugs on the surface of the hair, then the keratin is broken down using enzymes. Blood plasma may need to be separated by centrifuge from blood cells prior to testing. Sweat patches are opened up and the sweat collection component is soaked in a solvent to dissolve any drugs present.

Laboratory-based drug testing is done in a two-tiered fashion using two different types of detection methods. The first is known as the screening test, and this is applied to all samples that go through the laboratory. The second, known as the confirmation test, is only applied to samples that test positive during the screening test. Screening tests are usually done by immunoassay (EMIT, ELISA, and RIA are the most common). A "dipstick" drug testing method which could at some future time provide screening test capabilities to field investigators has been developed at the University of Illinois.^[3] Screening tests are typically less sensitive and more prone to false positives and false negatives than the confirmation test.

After a suspected positive sample is detected during screening, the sample is flagged and tested using the confirmation test. Samples that are negative on the screening test are discarded and reported as negative. The confirmation test in most laboratories (and all SAMHSA certified labs) is performed using mass spectrometry, and is extremely precise but also fairly expensive to run. False positive samples from the screening test will be negative on the confirmation test. Samples testing positive during both screening and confirmation tests are reported as positive to the entity that ordered the test. Most laboratories save positive samples for some period of months or years in the event of a disputed result or lawsuit. For workplace drug testing, a positive result is generally not confirmed without a review by a Medical Review Officer that will normally interview the subject of the drug test.

Visit American Toxicology to see which methodologies we use.

Hair alcohol testing

As the hair grows, it absorbs special markers called fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG) into its structure, which remain in the hair indefinitely. These markers are only produced when there is alcohol in the bloodstream, such that the more markers there are, the more alcohol you have consumed.

Tests detecting both FAEE and EtG levels have been used by UK courts.

Trimega Laboratories were the first company to commercialise FAEE testing in UK courts.^{[citation needed]} Tricho-Tech were the first company to commercialise EtG testing in UK courts.^{[citation needed]}

Analysis of hair samples has many advantages as a preliminary screening method for the presence of toxic substances deleterious to health after exposures in air, dust, sediment, soil and water, food and toxics in the environment. The advantages of hair analysis include the non-invasiveness, low cost and the ability to measure a large number of, potentially interacting, toxic and biologically essential elements. Hence, head hair analysis is now increasingly being used as a preliminary test to see whether individuals have absorbed poisons linked to behavioral health problems.[2]

The use of hair alcohol analysis to establish and verify persistent alcohol abusers within the United Kingdom has steadily increased in recent years.

In contrast to other drugs consumed, alcohol is not deposited directly in the hair. For this reason the investigation procedure looks for direct products of ethanol metabolism. The main part of alcohol is oxidized in the human body. This means it is released as water and carbon dioxide. One part of the alcohol reacts with fatty acids to produce esters. The sum of the concentrations of four of these fatty acid ethyl esters (FAEEs: ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate) are used as indicators of the alcohol consumption. The amounts found in hair are measured in nanograms (one nanogram equals only one billionth of a gram), however with the benefit of modern technology, it is possible to detect such small amounts.

However there is one major difference between most drugs and alcohol metabolites (FAEE) in the way in which they enter into the hair: on the one hand like other drugs FAEEs enter into the hair via the keratinocytes, the cells responsible for hair growth. These cells form the hair in the root and then grow through the skin surface taking any substances with them. On the other hand the sebaceous glands produce FAEEs in the scalp and these migrate together with the sebum along the hair shaft (Auwärter et al., 2001, Pragst et al., 2004). So these glands lubricate not only the part of the hair that is just growing at 0.3 millimeters per day on the skin surface, but also the more mature hair growth, providing it with a protective layer of fat.

FAEEs (nanogram = one billionth of a gram) appear in hair in almost one order of magnitude higher than (the relevant order of magnitude of) Etg (picogram = one trillionth of a gram). It has been technically possible to measure FAEEs since 1993, whereas the technique for measuring (the relevant range of) Etg is still in its infancy.

In practice, most hair which is sent for analysis has been cosmetically treated in some way (bleached, permed etc.). It has been proven that FAEEs are (surprisingly) not significantly affected by such treatments (Hartwig et al., 2003a). So far no systematic investigations in this regard have been carried out for Etg

FAEE concentrations in hair from other body sites can be interpretated in a similar fashion as scalp hair (Hartwig et al., 2003b). Etg: no information available.

Extensive studies involving over 1000 donors have been carried out since 2000. These have enabled us to establish reliable reference ranges for FAEEs with respect to drinking habits of the various groups: non-drinkers <> 1ng/mg

There are no reliable reference ranges for Etg from comprehensive studies. Further investigations are in progress to examine the applicability of the method in practice of the detection of alcohol abuse.

Literature Pragst F., Balikova M.A.: State of the art in hair analysis for detection of drugs and alcohol abuse; Clinica Chimic Acta 370 2006 17-49.

Auwärter V.: Fettsäureethylester als Marker exzessiven Alkoholkonsums – Analytische Bestimmung im Haar und in Hautoberflächenlipiden mittels Headspace-Festphasenmikroextraktion und Gaschromatographie-Massenspektrometrie. Dissertation Humboldt-Universität Berlin 2006.

Pragst F., Auwärter V., Kiessling B., Dyes C.: Wipe-test and patch-test ror alcohol misuse based on the concentration ratio of fatty acid ethyl esters and squalen CFAEE/CSQ in skin surface lipids. Forensic Sci Int 2004; 143:77-86.

This helpful information was provided by Wikipedia.

Sweat drug screen

Although the sweat test is pretty cool, American Toxicology does not provide them. Here is some helpful information about the sweat drug test from wikipedia.

Sweat tests are patches attached to the skin to collect sweat over a long period of time (10–14 days). These are almost exclusively used by child protective services, parole departments, and other government institutions concerned with drug use over long periods, when urine testing is not practical. The patches have security features that keep them from being covertly removed and then reapplied without the knowledge of the testing agency. At the end of the test period, the patch is removed by a social worker or parole officer and sent to a lab for analysis. If the person has used any drugs during the period that the patch was in place, they will test positive for that drug. This type of testing has fallen out of favor with government agencies due to documented problems with certain drugs^[2].
This information was provided by wikipedia.

A BRIEF COMMENTARY ON URINE DRUG TESTING

Laboratories may be involved with testing biological samples for the presence of drugs for the diagnosis and monitoring of the overdosed patient (clinical testing) and for workplace drug testing (forensic testing). Even though the purpose of such testing is very different, the same methods are often used for both because the ability and ease of performance of immunoassays on automated instruments.

In the emergency department, physicians initially treat the signs and symptoms of the overdosed patient and rely on the laboratory drug testing results to confirm the diagnosis and to possibly monitor treatment. The National Academy of Clinical Biochemistry (NACB) practice guidelines for the use of laboratory tests to support poisoned patients recommends that the clinical laboratory provide two tiers of drug testing: a first tier of qualitative and quantitative tests available on a stat basis to support evaluation of acute toxicity for specific toxins for which an antidote or specific therapy is available, and a second tier (turnaround time of 24 hours or less) of more comprehensive testing of patients with continuing medical problems from exposure to other drugs and chemicals.

The 1888 Mandatory Guidelines for Federal Workplace drug Testing Programs and subsequent revisions mandate scientific and technical procedures for the drug testing process, including: collection, Transportation of specimens, testing procedures incorporating quality control, method evaluation, results reporting, and standards for laboratory accreditation by the National Laboratory Certification Program (NLVP). Although private-sector industries are not required to follow the guidelines develop for the federal program, many choose to do so.

Currently, urine is the specimen of choice for both clinical and workplace drug testing with certain exceptions (i.e., ethanol testing under DOT which breath, blood, or saliva matrices are acceptable). Urine offers the advantages of non-invasive collection and a relatively easy, cost-effective proven technology. Guidelines mandate a controlled collection and use of standardized Custody and Control Forms as the specimen requisition, chain of custody, and official report form.

A laboratory may only test for certain drugs (the “NIDA 5”) at specified cutoff levels for the federal workplace drug testing. Testing for other drugs (e.g., barbiturates, benzodiazepines, propoxyphene, methaqualone, etc.) and at other cutoff concentrations may occour fro non-regulated. State regulated, and clinical samples. Federal regulated tesging mandates initial screening by an immunoassay method and subsequednt conformation of all screening- positibve samples by gas chromatography mass spectrometry (GCMS). Clinical and non-regulated testing may utilize any combination of methods available.

Test Interpetation

Testing for amphetamines in regulated samples includes testing for only amphetamine and methamphetamine. Methamphetamine is metabolized to amphetamine, and a positive methamphetamine specimen must contain amphetamine at a concentration greater than 200 ng/mL, in addition methamphetamine at a concentration of greater than 500 ng/mL cutoff. Several prescription medications (Adderal®, Dexdrine®, Didrex®, Eldepryl®, etc.) Contain either amphetamine or methamphetamine or compounds that are metabolized to theses substances. For clinical and non-regulated testing, the detection of other amphetamine family substances, such as MDMA (Ecstasy) may be requests. The ability of the ability of the laboratory to detect such compounds is dependent on the specificity of the antibody and the type of immunoassay used for screening.

Screening immunoassays for cannabinoids detect multiple metabolites for marijuana with a cutoff

Concentration of 50 ng/mL used for regulated drug testing. GCMS conformation identifies and quantities the major metabolite, 11-non-tetrahydrocannabinol-9carboxylic acid (delta-9 THca). Using a cutoff of 15 ng/mL. chronic marijuana users may produce positive results for longer periods of time than acute users (up to several weeks) because of accumulation of cannabinoid metabolites in fatty tissues followed by slow release. Studies have shown that it is highly unlikely that a nonsmoking individual could inhale sufficient smoke by passive inhalation to result in a positive result when using a screening cutoff of 50 ng/mL. Immunoassays with cutoffs of 20ng/mL and 100 ng/mL are available for non-regulated and clinical testing, although NACB guidelines recommended that there is no clinical reason for routine cannabinoids testing in the over closed patient.

Cocaine is rapidly metabolized, and the major metabolite, benzoylecgonine, is the primary compound measured by cocaine (metabolite) immunoassays. There are no cocaine-containing prescription medications, but cocaine solutions are sometimes used as a topical anesthetic for various ear, nose, throat, bronchoscopic, and ophthalmologic procedures.

Urine Drug Testing

This procedure requires that one provide a sample of urine. Either a test card is used on site for immediate results (see "General" section), or the sample is sent away to a lab to undergo gas chromatography/mass spectrometry (also known as GCMS), high performance liquid chromatography or immunoassay analysis. The majority of tests administered in pre-hire and even most probate scenarios are of the immediate, and less accurate "at home" variety. Most "dip stick" type tests have higher thresholds for a positive than do the GCMS tests. If a positive result (drug presence indicated) is found, the sample is usually sent to a lab for GCMS confirmation. This is largely due to the costliness of GCMS labaratory testing and time it takes to process and receive results. The results of any urine test reflect factors including, but not limited to age, weight, race, and often these factors are what determines whether the test is valid or not.

The efficacy of urine testing is debatable due to systematic cheating. It is widely reported that sample substitution and adulteration occur frequently, and both are effective methods of avoiding would-be positive tests. There are a number of adulterant "masking" agents that are sold, though they are often nothing more than a simple diuretic and are rarely more effective than caffeine. Some people drink copious amounts of water to successfully dilute the concentration of drug metabolites in their urine below detectable thresholds. Often this results in clear samples that may be rejected on the grounds of being too dilute, although a complex B vitamin will make urine yellow despite this practice of waterloading. Specific gravity testing can be done to identify whether or not the sample is of dilute nature, though this is used infrequently on otherwise inconspicuous samples. The substance Niacin is also frequently used for its reported "flushing" effect, though this is also of disputable adeptness. Some types of urinalysis can detect the use of these "detox" products, though they are rarely used unless some facet of the sample is suspicious. Also, the wide availability of at home drug screens allows an individual to take their own test before they receive one, thus knowing the results ahead of time- giving the user further opportunity to dilute the sample or to find a substitute.

This helpful information was provided to us by Wikipedia.

American Toxicology is a full service drug testing laboratory in Las Vegas, Nevada. We are proud of our excellent service and our quality results. With our new online reporting we are able to provide results same day (for locals) within 2-6 hours!

KNPR - Student Athlete Drug Testing

http://www.knpr.org/audio2008/mp3/080701_drug-testing.mp3