Urine drug testing can improve workplace safety, keep track of medication observance and identify drug abuse. Conducting these tests needs familiarity with testing modalities, detection timing of specific drugs, and clearly distinguish the false negative/positive results.
Who needs to be screened at workplace?
Urine drug screening is required as workplace mandate for –
- Pre-employment drug test
- Return to work after unexplained absence
- Federal regulations
- Accidents at workplace causing injury or death due to negligence
- Random testing for continuous license or employment
Safety is sensitive in several sectors, so urine screening is needed.
- Mass transit
- Oil & gas pipeline
Situations that suggest screening is compulsory –
- Sports participation
- Legal criminal scenarios like parole or post accident testing
- Health reasons like pain management, monitoring treatment adherence, determine death cause
- Patient behavior
- Mandates & regulations
Urine drug screening for health reason
Patients suffering from chronic pain are at risk to misuse drugs, so they need to be monitored for drug compliance and screening. It allows the patient to use appropriate dosage of drugs for pain management. Sometimes patient may deflect from prescribed drugs into illegal drug usage, which can damage their health adversely. Therefore, it is necessary to perform screening on such patients.
- Immunoassay tests – Antibodies are used to identify drug presence like marijuana, cocaine, phencyclidine, amphetamines, and opiate. It is a speedy process but accuracy of positive results needs to be followed by confirmatory testing at labs.
- Chromatography – Chromatography tests are very costly and time consuming but accuracy is unquestionable. Gas Chromatograph separates the molecules and mass spectrometer analysis the ionized fragments to identify its mass: charge ratio. Precision of this method has made it a forensic criterion standard.
Determining test results
False positive/negative results are possible, so physicians select a test panel on the basis of substances they seek to detect.
- Routine opiate test detects morphine metabolites
- Expanded opiate panel identifies commonly used narcotics like hydrocodone, fentanyl, methadone, buprenorphine, oxycodone, and tramadol
- Heavy Marijuana usage gets detected after several weeks but results are positive if screened within 1 to 3 days of use
- Heroin presence gets confirmed only for a few hours after ingestion
False negative results are a concern, when the test is conducted for prescribed treatment compliance. The main reason is that adherence can be covered by time since ingestion, dilute urine, quantity used or labs established threshold limits.
It is good to discuss adherence with patients, but testing for specific medication is essential to resolve issues of deflecting a prescribed drug. A negative result in a sample of dilute urine makes interpretation tricky.
Prevent and identify sample adulteration
Many ways a patient can circumvent urine testing like consuming excessive water, eat substances that hinder testing, and substitute clean urine sample. Therefore proper sample collection techniques and test integrity can decrease tampering risk.
Certified Medical Review Officer is legally liable for receiving, reviewing and evaluating test results for employee’s drug tests. CMRO determines genuine explanation for unanticipated test results and protects patient’s confidentiality.