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NCBI Bookshelf. Center for Substance Abuse Treatment.
Urine testing is the best developed and most commonly used monitoring technique in substance abuse treatment programs. This appendix describes procedures for implementing this service and other methods for detecting clients' substance use.
Each intensive outpatient treatment IOT program should consider establishing a schedule for urine testing that takes into Federal and State requirements e. Clients generally need more frequent monitoring during the initial stages of treatment when they are trying to achieve abstinence but still may be using substances.
Routine specimen collection after admission should take place in conjunction with regular clinic visits. Under ideal conditions, the consensus panel believes that collection should occur not less than once a week or more frequently than every 3 days in the first weeks of treatment. It is important that the scheduled frequency of urine collection match the usual detection window for the primary drug. Too long an interval between urine Pass a drug test for heroin can lead to unreliable because most of the target drug and its metabolites will have been excreted.
On the other hand, if the interval between tests is too short, a single incidence of drug use may be detected twice in separate urine samples. Multiple positive urine test produced by a single ingestion carryover positives can be discouraging for the client and misleading for the clinician Preston et al.
Once clients are stabilized in treatment, they require less intensive monitoring of abstinence. At this point, most programs reduce the frequency of scheduled tests Pass a drug test for heroin randomize the collection times. Even with a decreased and randomized testing schedule, specimen collection should be scheduled on clinic days following weekends, holidays, or paychecks—the times when clients are most tempted to use.
Urine sample collection procedures need to strike a balance between trusting clients and ensuring that specimens are not contaminated or falsified. Some programs insist that a staff member of the same sex accompany a client into the bathroom to observe urine collection. Others find that monitoring through an open door and having clients leave packages and coats outside are sufficient.
A sink that is separate from the toilet area also discourages attempts to dilute samples Bureau of Justice Assistance Many programs use temperature strips to make certain that urine specimens are produced on site and are body temperature. Tests of creatinine or specific gravity can determine whether a sample has been diluted with water or the client is consuming excessive fluids to lower the concentration of drugs below detectable levels Preston et al.
Information about how to beat the drug testing system is widely available. Web sites advertise inexpensive products that can be added to urine specimens to absorb toxins as well as herbal remedies for consumption for a few hours before testing to cleanse the urine.
A variety of low-cost, self-testing kits also are available to preview likely from more formal testing procedures. As part of their orientation to the IOT program, clients need to be informed about the urine collection and testing procedures. Clients also Pass a drug test for heroin be advised that informed consent is necessary for release of toxicology to anyone other than staff.
Most IOT programs do not comply with workplace standards for testing or maintain an adequate chain-of-custody for specimens that would meet court challenges. If employers, representatives of the criminal justice system, or children's protection agencies feel that such reporting is necessary, they can be advised to conduct their own testing or to accept other clinical evidence of client progress in treatment.
Clients should report any substance use to their counselor before a urine sample is submitted so that the substance use can be addressed therapeutically. It may be helpful to remind clients that the clinic conducts drug monitoring to support their recovery. Because there may be some likelihood of cross-reactivity and false positive on screening tests, clients need to keep counselors informed about any prescribed medications or over-the-counter OTC drugs they have used.
Appropriate attention needs to be given to handling and storing collected specimens. Collection bottles that are sent to an offsite laboratory should be clean and tamper proof. Waterproof labels attached to the bottles should note either the client's name or identification and be checked for accuracy by the client and the counselor or technician. Collected specimens need to be kept cool—or refrigerated—until transmitted to the laboratory and should be stored in a protected or locked room for security.
Clients and staff members who touch the urine collection bottles need to be reminded to wash their hands thoroughly. Rubber gloves should be worn by technicians who perform onsite analyses. Programs need to test for a standard battery of drugs, which may include such drug groups as amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, methaqualone, opioids, phencyclidine PCPpropoxphene, or euphorics Ecstasy. In programs where the majority of clients use only a few types of substances, the standard battery can be small, and only selected individual clients need be tested for other specified substances.
Programs should add substances to the routine battery, temporarily or permanently, if patterns of substance use change in the target population or in the community. It is helpful to stay up to date about local drug use patterns identified by the nearest Community Epidemiology Work Group www.
F come and go for abuse of a wide variety of substances e. The length of time during which different licit and illicit substances or their metabolites can be detected in urine samples depends on many interacting factors, including. Most substances of abuse can be detected for approximately 2 to 4 days see exhibit B However, the higher the dose taken and the more frequently the substance has been used over an extended time, the more likely that it will be detected.
Although substances are excreted at various rates, they accumulate in the body with continued use. Whereas a single use of cocaine may be detectable in urine for only a day or less, continued daily use is likely to be detectable for 2 to 3 days following its discontinuation Preston et al. Chronic use of such drugs as marijuana, PCP, and benzodiazepines may be detectable for up to 30 days, whereas alcohol remains in the system for 24 hours or less. Realistically, it may be difficult to detect illicit substances in most clients who stop all use for several days before a drug screen.
An accurate profile of a client's substance use over more than a few days requires both urine test and a good retrospective history. View in own window. Adapted with permission. No further reproduction or distribution is permitted without the written permission of the American Pass a drug test for heroin Association Preston et al. A program should consider a variety of factors in selecting a method and source for drug testing. Turnaround time in receiving is another important determinant.
Pass a drug test for heroin onsite methods can provide in a matter of minutes, more accurate and expensive commercial laboratory analyses may take several days or longer. Reliability is a major consideration. However, substance abuse treatment programs that are using for clinical purposes do not require the same accuracy i.
Some cities and States have assumed responsibility for selecting a single vendor for providers under their jurisdiction to use and choosing a standard battery of drugs to be tested. Providers may wish to create a buying collective to negotiate the best discounts from a local drug-testing laboratory. Urine test can be inaccurate. Counselors should keep this fact in mind when discussing findings with a client. Asking the client whether are accurate and, if so, when and how much of a particular substance was used can be the beginning of a therapeutic discussion that includes the circumstances surrounding substance use and the client's triggers.
Most screening tests are immunoassays that take advantage of antigen-antibody interactions—using enzymes, radioisotopes, or fluorescent compounds—and compare the specimen with a calibrated quantity of the substance being tested Bureau of Justice Assistance Several other body products are gaining prominence in Pass a drug test for heroin search for simpler, less expensive, noninvasive, and more accurate techniques for detecting the recent and current use of substances.
Exhibit B-2 compares the effectiveness of urine, breath, saliva, sweat, blood, and hair testing methodologies for detecting drugs. Because alcohol is metabolized rapidly at an average rate of 15 to 25 milligrams per hour—and the detection period is hours, not days—drinking usually is not monitored by urine or blood tests. Instead, clinicians frequently rely on other observations of current use e. Blood alcohol concentrations—measured in milligrams mg of alcohol per deciliter dl of blood—usually are expressed as a percentage i. One drink increases the breath alcohol level BAL by approximately 0.
For most men, some impairment is observable at 0. A woman weighing pounds would reach a BAL of 0. BALs between 0. In addition to Breathalyzer tests, several other simple-to-use but accurate techniques now exist for determining either a client's BAL or his or her approximate blood alcohol concentration. One is a relatively inexpensive, portable, and disposable unit the size of a cigarette containing crystals that turn a particular color—from yellow to blue—to ify a blood alcohol concentration of 0. For alcohol, saliva is correlated closely with blood concentrations 2 hours after consumption.
However, routes of drug administration that contaminate the oral cavity can change the pH levels of saliva. These changes can distort correlations of other drugs found in saliva with blood plasma levels Magerl and Schulz ; Preston et al. One advantage of saliva testing is the ready availability of saliva specimens and the packaging for onsite testing. However, the short time window for detecting substances limits the effectiveness of this method to ascertaining only recent drug use e. Most substances disappear from both blood and saliva within 12 to 24 hours of use; cannabinoids may be detectable for only 4 to 10 hours after marijuana is smoked.
The U. Although a of licit and illicit substances can be detected in perspiration probably diffused from bloodperspiration is difficult to collect for monitoring purposes. It has been used successfully to detect amphetamines, cocaine, ethanol, methadone, methamphetamine, morphine, nicotine, and PCP.
The drugs are absorbed gradually into the pad, which must be applied carefully on clean skin and removed carefully for analysis. Although no rapid methods for analysis are available, and the p must be mailed to laboratories, the FDA has approved their Pass a drug test for heroin for detecting cocaine, amphetamines, and opioids. The p are used primarily to monitor offenders on parole or probation. Hair analysis can be used for detecting illicit substance use in the workplace and for drug treatment screening. The exact mechanism by which drug metabolites are absorbed into hair follicles remains unclear.
Trace amounts of metabolites in the bloodstream enter hair follicles; these metabolites then are trapped in the core of each hair strand. It seems to take about a week after substance use for hair follicles to absorb drug residues. Certain objections to this technique have not been resolved. Few laboratories conduct the analyses.Pass a drug test for heroin
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