This page contains questions and answers about drugs of abuse home Some over-the-counter medications will produce the same test This is important because with most test kits, the result must be visually read within a. Home drug-testing kits sold on the Internet may make it easy for parents to test their children for drugs, but that approach may not be the best. Drug Tests at Walgreens. and view current promotions and product reviews on Drug Tests on cialispanettet.top Bring Photo ID or your email to the photo counter - it's that easy! Price and inventory may vary from online to in store. . $10 off with card HomeDNA Healthy Weight, Food & Pet Sensitivity or Paternity Test Kit.
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The various windows of detection for a number of commonly used substances are shown in Table 1 [ 10 ]. These various tissues and bodily fluids exhibit different rates and durations of excretion that result in different detection windows for substances, as demonstrated in Figure 1.
However, most laboratories analyze the amount of hair equivalent to 3 months of growth. When substances are ingested, they are absorbed in the gastrointestinal tract and distributed to tissues of the body [ 9 ]. Substances that are injected, inhaled or snorted bypass gastrointestinal absorption and are delivered immediately to tissues. Since many drugs are lipid soluble, they must undergo metabolism in the liver to render them water soluble which then allows them to be eliminated in urine.
Blood and breath reflect moment-to-moment serum levels of an ingested substance, and offer the earliest and shortest windows of detection for substances [ 8 ]. Sweat and saliva reflect the presence of a drug within the body several hours later.
Urine offers a somewhat longer window of detection for substances, usually varying from one day after consumption to several weeks. Hair and meconium offer the longest windows of detection weeks to months. Advantages and disadvantages of different matrices for drug testing are shown in Table 2. Advantages and disadvantages of various matrices i. Of all the matrices, urine is the most commonly used for adolescent drug testing and is the most thoroughly studied [ 9 , 11 ].
However, for an adolescent patient, its collection is somewhat invasive since it requires either a sophisticated collection protocol which is not readily available in medical offices or direct observation e. Compounding this, many pediatricians are unfamiliar with proper collection procedures and with the limitations of urine drug screening [ 11 ].
Currently, the most commonly used urine drug testing approach involves automated immunoassay either alone as a point-of-care test or as an initial screen for a 2-step testing procedure [ 7 , 8 ].
Results from IA are qualitative i. If any substances are positive on the initial IA, a separate quantity of the same sample is then subjected to GC-MS as a confirmatory test for those same substances, with negative results on the IA disregarded. GC-MS provides a quantitative result to help guide the clinician, which can be used to follow serial samples and determine whether the metabolite concentration is rising or falling, which may suggest ongoing use or abstinence, respectively.
Even still, caution is warranted as levels may vary with urine concentration, the amount of drug used, and time since last use, thus making an absolute determination regarding whether use is ongoing difficult. IA is often used as a point-of-care test given its convenience, low cost, and relatively rapid results although results are often not available quickly enough to guide clinical management in emergent situations [ 7 ].
Most home urine drug test kits use IA. Although IA has high sensitivity, it has poorer specificity than GC-MS owing to cross-reactivity, whereby compounds in the biologic specimen other than the actual substance or its metabolite bind to the assay and trigger a false-positive result.
For example, PCP assays can turn positive if an individual consumes dextromethorphan, a common component of cough syrup.
Additionally, IA drug tests performed in isolation do not distinguish among drugs within a class i. GC-MS is not performed as a point-of-care test and usually must be sent to a laboratory, resulting in a delay [ 7 ]. Newer but less widely used technologies include liquid chromatography-mass spectrometry and tandem mass-spectrometry, which can be used to bypass the initial screening IA and identify a larger number of substances and metabolites [ 8 ].
Often, laboratories report the urine creatinine, which helps the clinician correct for the relative concentration or dilution of the urine. Concentration of the urine by the kidneys results in elevated levels of drug metabolites; therefore, urine concentrations of certain drugs and their metabolites are usually divided by the urine creatinine.
An example of this is THC, whose excretion in the urine can continue for up to one month after most recent use in heavy users [ 13 ], and urine samples positive for THC must be carefully interpreted to distinguish ongoing excretion from new use.
Urine THC concentration should be divided by the urine creatinine concentration in order to determine whether the creatinine-normalized THC concentration is increasing or decreasing with consecutive urine samples [ 14 ] and these ratios can then be compared to nomograms of THC excretion in order to make a clinical interpretation [ 15 ].
Practical issues, such as timing of the urine sample collection, specimen collection techniques, validation of the sample, and result interpretation are covered later in this chapter. Drug testing of blood samples is usually only performed in emergency situations, and due to the invasiveness of obtaining a blood sample, the need for specially trained phlebotomists, and the expense of blood drug testing, it is rarely performed in primary care settings [ 7 , 9 ].
An additional limitation is that obtaining blood samples requires venipuncture and locating venous access among injection drug users can be very difficult [ 9 ]. Unlike urine samples, blood samples generally detect alcohol and drug compounds themselves rather than their metabolites. Blood testing typically detects substance use that occurred within 2 to 12 hours of the test [ 7 ]. Oral fluid testing is less commonly used but oral samples represent a convenient, promising matrix for many settings.
Unlike urine samples, oral samples are not easily tampered with, and can be collected with minimal invasion of privacy [ 15 , 16 ]. Oral secretions contain either the original drug compound or its metabolite for approximately hours after last use [ 9 , 15 , 16 ].
Importantly, use of breath sprays, mouthwash or other oral rinses containing alcohol does not affect drug testing result as long as they are not used within 30 minutes of sample collection [ 17 ]. To collect an oral sample, a swab is placed adjacent to the lower gums against the inner cheek and left in place for several minutes before being inserted into a vial for transportation to the laboratory [ 9 ].
Point-of-care oral testing is also available in some settings [ 18 ]. Hair drug tests have the advantage of detecting substance use days to months, or in some cases, years, later [ 9 , 19 ]. Drug metabolites are present in hair as early as one week after most recent use, and because metabolites remain trapped in the core of the hair as it grows, hair provides a rough timeline of use over an extended period [ 9 , 20 ].
Hair grows at a rate of approximately one-half inch per month, and so the standard 1. Conversely, hair testing is not helpful in detecting sporadic use when weekly or even monthly drug testing is required as part of a drug treatment plan [ 9 ].
Additionally, drug use often must relatively heavy in order for testing to detect levels in hair. Other limitations of hair testing include that individuals can surreptitiously remove the sample through shaving, that sweat production can cause drug metabolites to travel proximally up the hair shaft thus affecting drug test interpretation, and that drugs can be incorporated into hair through simple exposure from second-hand smoke [ 23 , 24 ].
An additional potential consideration is that drug concentrations can be affected by the melanin content of hair, resulting in potentially higher concentrations of certain drugs in dark hair as compared to blond or red hair [ 15 , 25 ]. Bleaching or coloring the hair may also alter concentrations of metabolites [ 26 ].
The hair sample is typically cut from the back of the head using scissors, cutting as close to the scalp as possible to estimate most recent drug use [ 9 ]. For patients who are bald or who have shaved their head, hair can be taken from the armpit, face, or other unshaven part of the body, so long as a sufficiently long enough sample can be taken. No point-of-care hair drug testing currently exists. Breath testing provides an accurate measure of the actual blood alcohol content at that moment in time, and is more frequently used in law enforcement or in emergency departments than in primary care.
The US Department of Transportation maintains an active list of approved breath testing devices for the interested reader https: The US Food and Drug Administration FDA has approved a patch for collection of sweat for drug testing that is placed on the skin for days prior to being sent to a laboratory for interpretation [ 8 , 9 ]. Sweat testing checks for substances and their metabolites in the bloodstream in the hours before and during the time that the patch is applied [ 8 , 9 ].
Patches that pucker or show other evidence of interference when removed have been designed in attempt to reduce tampering [ 8 ]. Meconium is obtained from newborns and used as a measure of maternal substance use in the third trimester [ 8 , 12 , 28 , 29 ]. Meconium testing is used as a screen in the newborn nursery or neonatal intensive care unit when maternal substance use during pregnancy is suspected, and can have critical legal consequences for guardianship of the child [ 30 ].
Meconium testing can also inform clinical management of neonatal abstinence syndrome and other newborn withdrawal syndromes. Indications for adolescent drug testing are explored here.
Drug tests are commonly used in emergent situations, such as when an adolescent presents with altered mental status [ 7 , 8 ]. Some common clinical scenarios include attempted suicide, motor vehicle injury or other injury in which substance use may have been a contributor, unexplained seizures, syncope, arrhythmia, or toxidromal signs that suggest a particular intoxication or withdrawal pattern [ 7 ].
In such cases, consent for the drug screen is inferred, and its results may be used to guide clinical management. However, drug testing results are generally not available immediately and cannot reliably be used early in emergent management; therefore, initial decisions, such as whether to provide naloxone for suspected opioid overdose should be made by the clinician based on presenting signs and symptoms [ 7 , 8 ].
Additionally, because highly sensitive drug testing may detect substances at limits far lower than therapeutic doses, drug screens may identify additional substances that are present but not contributing to the acute intoxication or withdrawal picture and may therefore be misleading [ 7 ]. Once the patient is stabilized, however, drug testing results may be helpful in determining subsequent management, particularly once confirmatory testing results are available. In primary care or mental health care settings, substance use by an adolescent may be suspected as underlying or complicating symptoms of depression, anxiety, inattention, hyperactivity, or other broader concerns such as a school failure or interpersonal difficulties [ 7 , 9 ].
In these situations, voluntary drug testing i. A positive drug screen might indicate substance use that an adolescent previously denied, leading to an opportunity for an honest conversation [ 7 ]. However, as highlighted below in the discussion of interpretation of results, there are a number of limitations in drug testing that might result in a negative result despite clinically significant substance use by an adolescent. Drug testing is performed as a routine component of outpatient adolescent substance use treatment [ 7 , 9 ].
It serves multiple roles, including preventing adverse effects of pharmacotherapy e. In residential substance use treatment, drug testing helps support the drug-free therapeutic environment [ 8 ]. In monitoring for illicit drug use during treatment, testing should be performed at random times, as discussed below, since adolescents are often knowledge of the short window of detection in urine for many substances and might otherwise simply abstain from use for the several days leading up to a scheduled test [ 7 , 9 ].
Testing should also be performed frequently enough e. A positive drug screen should never serve as grounds for termination from the substance use treatment program, but rather should prompt a careful conversation between the adolescent and clinician to reconsider the current treatment plan [ 7 , 8 ]; multiple positive drug tests may indicate the need for a higher level of care, for example [ 8 ].
Contingency management, which relies on incentives to encourage ongoing abstinence for adolescents with a substance use disorder, often uses drug testing for monitoring [ 31 ]. In many settings, the value of prizes increases incrementally with each successive attended visit or negative drug screen, which further improves the efficacy of treatment [ 31 , 33 , 34 ].
A number of other potential settings for adolescent drug testing exist. Workplace drug testing is federally mandated by the Department of Transportation DOT for private-sector transportation workers, and many of the current standards for workplace testing have emerged from these regulations [ 9 ]. Some adolescents and young adults may find themselves seeking or maintaining employment in settings where drug screening is routine [ 7 ].
Drug screens from non-federal employers can and often do expand their drug testing panels to include substances in addition to those on the SAMHSA-5 [ 9 ].
Many policies regarding when, where and how employers can test their employees are set by states; a full review is beyond the scope of this article but a complete, up-to-date listing of relevant policies is available at a cost from the Drug and Alcohol Testing Industry Association DATIA , an independent industry organization [ 35 ].
Some jurisdictions have proposed drug screening in school. However, this approach is opposed by the AAP due to insufficient evidence that it discourages adolescent drug use, difficulty in correctly interpreting results, and potential adverse consequences such as disciplinary action, decreased participation in sports and other school activities, breaches of confidentiality, and increased use of substances not included in the drug testing panel used [ 36 ].
Use of over-the-counter drug screens is distinguished from formal drug screens collected at home under the guidance of a clinician to be sent to an approved laboratory, which is frequently recommended as part of drug treatment. Youth involved in the criminal justice system are typically routinely drug tested and the specifics of this practice vary from state to state [ 8 ]. Once a practitioner feels that drug testing usually urine would be helpful clinically, he or should have a careful discussion with both the adolescent and parent regarding the potential benefits i.
Any questions should be addressed, and then the clinician should communicate to the adolescent the recommendation for drug testing, emphasizing the potential benefits confirming a history of no recent substance use, improving trust with parents, etc.
Assent should always be obtained from the adolescent, and permission to share results of any drug tests with his or her parent should be sought. In addition to the usual privacy provisions dictated by the Health Insurance Portability and Accountability Act of HIPAA , programs providing substance use diagnosis, treatment, or referral for treatment are subject to stricter confidentiality requirements under federal regulations [ 9 ].
As always, if emergent clinical care for the adolescent is required, consent is implied and written permission need not be obtained. Many readers of this chapter are unlikely to be affected by Part 2 regulations. The age at which an adolescent can independently seek, consent for, and receive substance use treatment services varies from state to state [ 37 ]. Readers are encouraged to seek out regulations in their own states; the National District Attorneys Association NDAA compiles a list of relevant state laws and regulations that providers can review [ 38 ].
The clinician should also carefully consider what tests should be included in a drug screen. The SAMHSA-5, though widely available, notably misses a number of commonly used substances, including alcohol, opioids and synthetic cannabinoids, among other drugs and their metabolites [ 39 ]; clinicians should ensure that the laboratory they work with is able to broadly test for these commonly used substances. In fact, where prevalence is low, a positive PCP screen is likely to be false, having been triggered by cross-reactivity by with another compound e.
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