"A drug’s metabolite is the compound produced when the body processes a particular drug. Identifying these compounds is the focus of workplace drug testing analysis. Marijuana possesses the greatest total number of detectable metabolites at 31 but fewer major components. For amphetamines, no metabolites are identified because these substances normally pass through the body essentially unchanged in chemical structure."

"Urine drug tests, which are the least expensive and most frequently used form of drug test, can generally detect marijuana use within the past week; cocaine, heroin and other 'hard' drugs used within the past two days; and alcohol use within the past several hours (though alcohol is not often included in drug screens). Drug tests cannot measure frequency of use, nor do they indicate the severity of impairment or whether an individual has a substance use disorder that requires treatment. In addition, without medical review and confirmation testing on initial positive results, ²⁰ urine screens also cannot distinguish between the illicit use of street drugs and the legitimate use of certain prescription and over-the-counter drugs. For instance, a drug test cannot distinguish between prescribed Tylenol with codeine and illicit opiates. Improper testing procedures and mishandling of samples can also produce inaccurate results."

"Amphetamines (which includes amphetamine and methamphetamine) positivity continued its year-over-year upward trend, increasing more than eight percent in urine testing in both the general U.S. and federally-mandated, safety-sensitive workforces compared to 2015. Throughout the last decade, this rise has been driven primarily by amphetamine use which includes certain prescription drugs such as Adderall®.
"Although methamphetamine positivity in urine testing declined between 2005 and 2008, the positivity rate plateaued between 2008 and 2012, and has increased steadily since. Between 2012 and 2016, it climbed 64 percent in the general U.S. workforce and 14 percent among federally-mandated, safety-sensitive workers. In oral fluid, methamphetamines positivity increased 75 percent between 2013 (0.24%) and 2016 (0.42%)."

"The Federal mandatory guidelines recommended that the initial screening test identify the presence of the following commonly abused drugs or their metabolites (SAMHSA, 2008):
• Amphetamines (amphetamine, methamphetamine)
• Cocaine metabolites
• Marijuana metabolites
• Opiate metabolites (codeine, morphine)
• Phencyclidine (PCP)
"These substances are generally called the “Federal 5,” but over the years they have also been called the 'NIDA 5' and 'SAMHSA 5.'"

"While the inquiry team could see a role for employee drug testing within safety-critical areas (although even here they were far from convinced that such drug testing was effective), there was deep scepticism as to the value of such testing more broadly. Indeed, the inquiry team noted that ‘For the most part, it is unclear that anything can be achieved through drug and alcohol testing that could not be done better through other managerial and supervisory processes’"

"The estimated cost of drug testing TANF applicants and recipients varies by State and proposed law, depending on the proposed number of individuals who would be tested and the range of activities for which costs were estimated. Aggregate cost estimates of proposed welfare drug testing legislation were identified for twelve States (see Appendix C for details). The estimated costs in these States ranged from $92,487, for drug testing 20% of recipients and treating 2% of those tested in Louisiana, to $20 million, for just the testing of all public assistance applicants and recipients in New York. Other estimates include the cost of increasing staff to monitor or administer the tests, as in Maryland and
Missouri. Idaho’s estimate includes the cost of making programming changes to the State’s information system. Florida’s law and Alabama’s proposal require the applicant or recipient to pay for the up?front costs of the drug test, though both would reimburse those who test negative. Most estimates do not incorporate costs relating to increased substance abuse treatment utilization or to increased child welfare interventions."

"During 2010 and the first half of 2011, legislators in 31 states have proposed 82 bills that would require drug tests of TANF applicants and/or recipients.³¹ There was also one proposal each in the U.S. House of Representatives and Senate."
"The legislative proposals identified differ in the populations that would be subject to drug testing. Of the bills, 50 State bills plus the two congressional bills would require that applicants be tested, 35 State bills would require suspicionless testing of current recipients, and an additional 26 would test current recipients for cause. In addition, while nearly all bills focus on testing adult applicants or recipients, a small minority of State bills would require youth aged 13 or older be tested and proposed legislation in one State would require that all benefit recipients, including children under 12, be tested."

^{Note: The source for this fact also contains a list of 2010 and 2011 federal and state legislative proposals concerning TANF drug testing and legislative cost estimates from 12 states.}

"Hemp seeds represent the manufacturing starting point for the vast majority of hemp products marketed since the mid-1990s. Hemp seeds are a good source of essential fatty acids, primarily alpha-linolenic acid (omega-3) and ]inoleic acid (omega-6). They are also found in fish, flaxseed, rapeseed oil, pumpkin seeds, and sunflowerseeds. Essential fatty acids (EFA) are necessary fats that humans cannot synthesize, so they must be obtained through diet. EFAs support the cardiovascular, reproductive,immune, and nervous systems. The human body needs EFAs to manufacture and repair cell membranes, enabling the cells to obtain optimum nutrition and expel harmful waste products (9). THC found in manufactured products is present via contamination from resin produced in the leaves and buds that come into contact with the seed shell. Seed decontamination and manufacturing processes including wash steps and cold pressing for hemp products have improved since the mid-1990s, leading to the much lower THC concentrations currently found in today's commercial products.
"The presence of THC in these products has been a source of concern for the military and other workplace drug-testing programs. Ingestion of hemp products has been historically used as a defense in military and civilian trials for many years and continues today despite decreased concentrations of THC in hemp products (10-12). The Division of Forensic Toxicology, Armed Forces Institute of Pathology is often asked to analyze hemp products to determine their THC content in addition to rendering an opinion as to whether or not this THC concentration could be a reasonable cause for a positive THC metabolite urine analysis result."

"Occupational safety and health stakeholders we interviewed and occupational health practitioners we surveyed told us that primary factors affecting the accuracy of injury and illness data include disincentives that affect workers’ decisions to report work-related injuries and illnesses and employers’ decisions to record them. Stakeholders most often cited workers' fear of job loss and other disciplinary actions as disincentives that can affect workers' decisions to report injuries and illnesses. Occupational health practitioners concurred: 67 percent reported observing worker fear of disciplinary action for reporting an injury or illness, and 46 percent said that this fear of disciplinary action has at least a minor impact on the accuracy of employers' injury and illness records. Workers’ fear of disciplinary actions may be compounded by policies at some worksites that require workers to undergo mandatory drug testing following incidents resulting in reported injuries or illnesses, regardless of any evidence of drug use. Several labor representatives described mandatory drug testing policies as a disincentive that affects workers’ decisions to report injuries and illnesses, and 67 percent of health practitioners reported they were aware of this practice at the worksites where they treated workers in 2008."

"It is disturbing that the sensitivities of the cannabis and cocaine tests were all quite low, although further testing of the cocaine tests is desirable due to the low prevalences and the low concentrations encountered in this study. There are several countries in Central and Southern Europe for which these two substance classes are of special interest. On the other hand, it seems the sensitivities of the devices are generally better for amphetamines, a frequently encountered drug class among the DUI drivers in the Nordic countries. The suitability of the device for the intended national DUI population should also be considered, for example, PCP is rarely, if ever, found in Europe, therefore at the current time utilising a PCP test is unnecessary. Since the on-site tests are relatively expensive the suitability of all the individual substance tests incorporated in the device should be considered.
"The evaluation showed that none of the evaluated tests is on a desirable level (>80% for sensitivity, specificity and accuracy) for all of the separate tests that they comprised. However, there were tests that performed already on a promising level for one or more substance classes. The DrugTest 5000 had the best overall results. The next best device was Rapid STAT, which performed at a similar level, except for the cocaine test which was somewhat less sensitive. Clearly the best device in terms of sensitivity for amphetamines was the DrugWipe 5."

"The accuracy of certified labs has never been tested. Not a single study of the accuracy of HHS certified laboratories has ever been conducted. The National Academy of Sciences and other experts have urged HHS to conduct such tests,⁶ but HHS has never done so. Nor has HHS allowed independent researchers to see its data. HHS’ failure to conduct or allow accuracy studies of certified labs is especially troubling in light of the federal government’s assurances that the labs it used were reliable prior to the CDC study.
"The only relevant study actually indicates that certified labs are not reliable. In 2007, the United States General Accountability Office (GAO) studied 23 labs, all of whom were federally certified. The GAO found that not one of these labs consistently followed federally mandated procedures for lab accuracy.⁷"

"Urine is the most rigorously evaluated and most commonly used matrix for drug testing (Watson et al., 2006). All results are affected by laboratory test or point-of-care test (POCT) cutoff concentrations. Therefore, practitioners should always consult with laboratory staff when ordering laboratory tests or carefully read POCT package inserts before using the test. Numerous POCTs are available for urine drug testing.
"Window of Detection
"The window of detection for urine falls in the intermediate range, compared with the detection period or window for other matrices. Many factors influence the window of detection for a substance. Factors include, but are not limited to, the frequency of use (chronic or acute), amount taken, rate at which the substance is metabolized, cutoff concentration of the test, patient’s physical condition and, in many cases, body fat. Some hepatic, renal, endocrine, and other pathologies may extend the detection window."
"Drugs are present in urine from within minutes of use to several days after, depending on the substance; quantity ingested; the degree to which the bladder was filled with drug-free urine at the start of drug use; the patient’s hepatic, cardiac, and renal function; the patient’s state of hydration; and drug type. Drugs that are smoked or injected are detectable in urine samples almost immediately. Detection rates for drugs taken orally are slower, taking up to several hours and peaking at about 6 hours (Dolan et al., 2004).
"The window-of-detection estimates used in this chapter are from several sources: Cone (1997), Dasgupta (2008), Verstraete (2004), Warner (2003), White and Black (2007), Wolff et al. (1999), and Wong and Tse (2005).
"Many urine drug tests detect the drug metabolite, rather than the drug itself. As a general rule, drug metabolites remain in the body for a longer period than does the parent drug, allowing for a longer detection period. For example, when the test is for cocaine using urine, the target compound is usually the metabolite, benzoylecgonine, rather than the parent cocaine molecule."

"DrugTest 5000 screening results were evaluated against Quantisal confirmation data to determine TP [True Positive], TN [True Negative], FP [False Positive], FN [False Negative], diagnostic sensitivity and specificity, and efficiency at various cutoffs (Tables 1 and 2). When compared to THC alone, the diagnostic sensitivity and specificity and efficiency were 86.2%–90.7%, 75.0%–77.8%, and 84.8%– 87.9% at the 5-μg/L cutoff and 75.9%–92.7%, 76.0%–100.0%, and 78.8%– 86.4% at the 10-μg/L DrugTest 5000 cutoffs. Overall, the DrugTest 5000 performed better with the 5-μg/L screening cutoff, with diagnostic sensitivity and efficiency above the DRUID-recommended 80%. There were few FP and FN tests, and when they occurred, concentrations were at or near the confirmation cut-off. A limitation of this study was the inclusion of a small number of TN samples, only 6 –12 with the 5-μg/L DrugTest 5000 and 1- and 2-μg/L confirmation cutoffs, to adequately evaluate diagnostic specificity. On the basis of previous reports, more TN samples were expected over the 22-h collection period. Detection rates were highest and windows of detection were longest when we confirmed for THC alone (Fig. 1 and 2). However, the recent report of THC concentrations in OF following 3 h of passive exposure to cannabis smoke advocate for the inclusion of THCCOOH in confirmation criteria, because this analyte is not present in cannabis smoke and was not found in any OF [Oral Fluid] samples following passive exposure (18)."

"Additional controversies exist about whether biophysical attributes affect hair analysis. Studies have shown that concentrations of drugs in hair can be affected by variations in hair structure, growth rate, melanin content, hygiene, and cosmetic hair treatments, such as bleaching (Dasgupta, 2008). Although there have been a limited number of human clinical controlled studies, data show that higher concentrations of some drugs (e.g., codeine, cocaine, amphetamine) are found in dark hair compared with concentrations found in blond or red hair (SAMHSA, 2004). Cone and Joseph (1996) reviewed several articles and found that hair testing may be biased toward some hair types. Drugs of abuse bind more readily to Africoid and Mongoloid types of hair compared with Caucasoid hair. Cosmetic hair treatments also affect the binding of drugs to hair. For example, bleaching of the hair can reduce drug content, but it also can damage the hair to the extent that bleaching may increase binding of the drug to the hair (Skopp, Pötsch, & Moeller, 1997). Some drugs (i.e., THC) do not differentially distribute into hair based on melanin content (Smeal, 2007). Therefore, hair testing may not be the most equitable drug testing matrix. Hair rinses, bleaches, and shampoos that claim to interfere with drug tests are advertised on the Internet and in magazines."

"Disadvantages for testing for drugs in hair are the high costs and the longer time needed to obtain results, compared with the time required by other matrices. Analysis of the hair specimen is a complex process that involves breaking down the hair to free the drugs trapped in it. This chemical process requires a longer time of analyses than other matrixes. It can be done only in a laboratory; no POCTs [Point Of Care Tests] are available for testing hair samples."

"It is disturbing that the sensitivities of the cannabis and cocaine tests were all quite low, although further testing of the cocaine tests is desirable due to the low prevalences and the low concentrations encountered in this study. There are several countries in Central and Southern Europe for which these two substance classes are of special interest. On the other hand, it seems the sensitivities of the devices are generally better for amphetamines, a frequently encountered drug class among the DUI drivers in the Nordic countries. The suitability of the device for the intended national DUI population should also be considered, for example, PCP is rarely, if ever, found in Europe, therefore at the current time utilising a PCP test is unnecessary. Since the on-site tests are relatively expensive the suitability of all the individual substance tests incorporated in the device should be considered.
"The evaluation showed that none of the evaluated tests is on a desirable level (>80% for sensitivity, specificity and accuracy) for all of the separate tests that they comprised. However, there were tests that performed already on a promising level for one or more substance classes. The DrugTest 5000 had the best overall results. The next best device was Rapid STAT, which performed at a similar level, except for the cocaine test which was somewhat less sensitive. Clearly the best device in terms of sensitivity for amphetamines was the DrugWipe 5+."

"The body metabolizes alcohol rapidly, but alcohol will be detectable in breath as long as it is present in blood. The detection period for ethyl alcohol itself is hours (not days) after the last alcohol use. The metabolism of alcohol varies considerably by the person’s gender, age, physical condition (especially the condition of the liver), and weight.
"Easily administered breath alcohol tests are available to confirm alcohol ingestion within the past several hours. When a breath alcohol analyzer test is conducted properly, it gives an accurate measurement of breath alcohol content (BrAC). The BrAC gives an estimate of blood alcohol level (BAL) (Watson et al., 2006). Body temperature and breathing patterns can affect breath alcohol test results. Compared with blood and urine tests, breath tests are less precise. Some evidence suggests that breath tests may underestimate BALs by approximately 8.5 percent (Garriott, 2008).
"The breath alcohol analyzer (such as the best-known version, Breathalyzer) is a device that gives an accurate BrAC."

"Several collection devices have been manufactured for collecting sweat specimens. The two most common are the patch and the swipe; however, the sweat patch is the only device approved by the U.S. Food and Drug Administration (FDA). The quantity of sweat collected is determined by the length of time the patch is worn and the physiology of the person wearing the patch. The patch should be worn for at least 3 days, but no longer than 7 days, although most drugs will have been excreted within the first 48 hours (Barnes et al., 2009; Huestis et al., 2008; Kacinko et al., 2005; Schwilke et al., 2006). This ensures that a sufficient amount of sweat is collected for testing. The sweat collected with the patch detects drug use that occurred shortly before the patch was applied and while the device remains on the skin."

"There is no psychological test that can reliably screen for substance abuse. The MAC-R Index on the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) detects only addiction potential, not current use. If someone has been addicted in the past but is currently living a sober lifestyle, that person is still likely to test positive for addiction potential as this is more a personality style instead of a measure of current status (Friedman, Lewak, Nichols, & Webb, 2001). The idea behind the Substance Abuse Subtle Screening Inventory (SASSI) (Miller, 1994) is a good one. Essentially, it is an attempt to identify substance abuse through a self-report of symptoms that are associated with substance abuse without directly asking the central question. The Michigan Alcohol Screening Test (MAST) (Selzer, 197 1) is considerably less subtle, asking questions more directly. NCS also has an Alcohol Use Inventory (Horn, Wanberg, & Foster, 1987) that it markets."

"Collecting information about the performance of impairment testing proved extremely difficult because the field is so small. Only a handful of companies have ever marketed impairment testing systems and there is no list of their names. However, the Institute conducted an extensive networking program based on our contacts in the field that identified what we believe to be every company that has ever marketed impairment tests. There are only 10 such companies. Of these, only 6 manufactured systems for employers. Three of these 6 are now out of business. This means that there are only 3 companies currently in business that provide impairment testing systems for employers.
"By contacting these employers, we were able to identify 18 employers who had used impairment testing. Of these, 14 employers participated in our study. One employer that had used impairment testing is now out of business. The remaining 3 employers declined to participate."

"Based on the case law analyzed above, state or federal laws that require drug tests as a condition of receiving governmental benefits without regard to an individualized suspicion of illicit drug use may be susceptible to constitutional challenge. Drug tests historically have been considered searches for the purposes of the Fourth Amendment. The reasonableness of searches generally requires individualized suspicion, unless the government can show a special need warranting a deviation from the norm. However, governmental benefit programs like TANF, SNAP, unemployment compensation, and housing assistance do not naturally evoke the special needs that the Supreme Court has recognized in the past.
"The implementation of governmental assistance programs and the receipt of their benefits do not raise similar public safety concerns as those at issue in Skinner and Von Raab. In implementing these programs, the government also does not clearly act as tutor or guardian for minors, as the Court considered important in Earls and Vernonia. Finally, the evidence, at least thus far, in Lebron has failed to show a pervasive drug problem in the subset of the population subjected to suspicionless testing that strengthened the government’s interests in Earls and Vernonia. Thus, if lawmakers wish to pursue the objective of reducing the likelihood of taxpayer funds going to individuals who abuse drugs through drug testing, legislation that only requires individuals to submit to a drug test based on an individualized suspicion of drug use is less likely to run afoul of the Fourth Amendment.⁹⁴"

"Although most laws concerning drug testing are at the state level, federal law must be considered when employers do test for ethanol (i.e., alcohol). The Americans with Disabilities Act (ADA) (Pub. L. No. 101-336) protects individuals with disabilities from discrimination in the workplace. Individuals with current alcohol-induced impairments and past alcohol problems are covered under the ADA. Thus, applicants cannot be tested or questioned about alcohol-use disorders until after a job offer has been made, and, even then, the law restricts when and under what conditions employees can be tested for alcohol use and other alcohol-use disorders. Moreover, employment decisions, particularly negative ones, cannot be based on these test results unless the employer can establish impairment caused by alcohol use (Hartwell, Steele, and Rodman, 1998). On the other hand, use of illegal drugs and of prescribed drugs used illegally and the drug-use disorders associated with such use are not covered under the ADA."

"Ferguson v. City of Charleston (2001) is an important case in the family law domain because MUSC’s [Medical University of South Carolina] policy of testing pregnant women for illegal drugs raises issues at the intersection of public health and constitutional law. The public-health aspects concern the very real and significant risks to maternal, fetal, and societal well-being of drug use during pregnancy; in addition, the policy raises constitutional questions about what constitutes a reasonable search and seizure and women’ s privacy right to reproductive autonomy. Ultimately, the case addresses how best to strike the sometimes competing interests between mothers and their unborn children.
"Although the policy was discontinued before the Supreme Court’s ruling and the Court held the policy to be unconstitutional, all the components of the decision—majority, concurring, and dissenting opinions—point to ways in which a similar policy could be designed so as to avoid the constitutional pitfalls encountered by the policy in Ferguson (2001). The petitioners won, but their victory is likely to be short lived. Recent developments in a number of states, combined with ongoing public concern about drug abuse, especially by pregnant women, suggest that despite Ferguson’s outcome, pregnant women should not feel too secure from state intervention when receiving prenatal care. Such interventions are likely to have significant consequences for pregnant women’s legal rights, as well as for their health, their fetuses’ health, and their behavior during pregnancy."

In a study of high tech industries, researchers found that "drug testing programs do not succeed in improving productivity. Surprisingly, companies adopting drug testing programs are found to exhibit lower levels of productivity than their counterparts that do not. The regression coefficients representing potential effects of drug testing programs on productivity are both negative and significant. Both pre-employment and random testing of workers are found to be associated with lower levels of productivity."

Click here for the complete datatable of Recommended Cut-Offs, Metabolites, and Cross-Reactors in Urine Drug Tests