Substance Abuse Testing

We’ve all heard the term “substance abuse”, but what does it really mean? Substance abuse can be defined in many ways, but is most commonly defined as abusing (excessively using) drugs, alcohol and even tobacco. Substance abuse tests are commonly required by employers of potential new hires. Read on to find out more about substance abuse and how it can be tested at Windermere Medical Center.

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Substance abuse can be defined as the harmful use of chemical substances that lead to an inability to control the use of the substance. Substance abuse is the consumption of alcohol, prescription medications, or illicit drugs for mood-altering purposes. At Windermere Medical Center, we offer urine drug and alcohol screenings. Urine drug testing is a test that evaluates the urine to determine if the subject has been using the drug or drugs in question. Drug testing is often done for pre-employment, college or professional athletes, and post-accident (on-the-job accidents).

How Does a Urine Drug and Alcohol Screening Work?

Urine tests use a sample of urine to test for the presence of alcohol, certain illegal drugs and prescriptions medications. Urine tests are painless and only requires a urine sample of the person getting tested. The urine drug test usually screens for alcohol, amphetamines, benzodiazepines, marijuana, cocaine, PCP, and opioids (narcotics).

Urine analysis can test for alcohol use by detecting the presence of Ethyl Glucuronide (EtG), a metabolite found in alcoholic beverages. The test can show ethanol ingestion within the previous 3-4 days.

What To Expect During and After Urine and Alcohol Screening?

For a screening, a patient will be given a cup and escorted to the restroom. The patient will urinate into the cup in private. When finished, they will place the lid on the cup and wash their hands. The cup will either be left in the restroom, or the patient will be directed to bring the cup out of the restroom when they are done. Once the patient has provided the urine sample the test is complete.

The urine is than analyzed and a medical professional at Windermere Medical Center will review the results with the patient and/or employer. Results are usually returned within three to four days.

Drug testing is a prevention and deterrent method that is often part of a comprehensive drug-free workplace program. Any workplace drug-testing program, Federal and non-federal, should comply with applicable local, state, and federal laws.

Access the latest Federal Custody and Control Forms (CCF), HHS Mandatory Guidelines, public comments and information requests.

Laboratory Resources

• Current HHS Certified Laboratory Lists
• Electronic Custody and Control Approved Laboratory List
• Drug Testing Index from Quest Diagnostics
• Authorized Drug Testing Panels – Urine and Oral Fluid
• Suppliers of Blind Quality Control Urine Samples (PDF | 132 KB)
• Anomalous Results for 6-Acetylmorphine (PDF | 33 KB)
• National Laboratory Certification Program (NLCP)
• National Laboratory Certification Program (NLCP) (PDF | 52 KB)
• NLCP Revised Fee Schedule Notice (PDF | 505 KB)
• NLCP Certification Payment Schedule (PDF | 25 KB)

Cannabimimetics Testing: For the current list of HHS-certified laboratories that offer cannabimimetics testing for federal agency specimens, please contact the National Laboratory Certification Program (NLCP) at (919) 541- or .

Specimen Collection Resources

• Oral Fluid Collection Handbook (PDF | 1.7 MB)
• Oral Fluid Collection Site Manual (PDF | 540 KB)
• Oral Fluid Collection Site Checklist (PDF | 290 KB)
• Urine Specimen Collection Handbook (PDF | 2 MB)
• Urine Specimen Collection Site Manual (PDF | 616 KB)
• Urine Specimen Collection Site Checklist (PDF | 272 KB)
• Oral Fluid Collection Handbook (PDF | 1.5 MB)
• Oral Fluid Collection Site Manual (PDF | 496 KB)
• Oral Fluid Collection Site Checklist (PDF | 511 KB)
• Urine Specimen Collection Handbook (PDF | 2 MB)
• Urine Specimen Collection Site Manual (PDF | 532 KB)
• Urine Specimen Collection Site Checklist (PDF | 605 KB)
• Access archived specimen collection resources

Conducting Drug Tests

Testing must be conducted by an HHS-certified test facility. HHS-certified urine laboratories and oral fluid laboratories conduct all tests and report all specimen results. For urine only, instrumented initial test facilities (IITFs) conduct the initial drug and first specimen validity tests for urine specimens and report only the negative and negative-dilute results. IITFs forward specimens requiring further testing to an HHS-certified urine laboratory.

Before beginning drug testing, ask the following questions addressed in your drug-free workplace policy and consider how they will affect your testing program.

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• Who receives testing?
• When are the drug tests given?
• Who conducts the testing?
• What substances are tested for?
• Who pays for the drug testing?
• What steps are taken to ensure the accuracy of the drug tests?
• What are the legal rights of employees who receive a positive test result?

Develop a system to protect the confidentiality of employee drug-testing records. Select a person within your organization who will be responsible for receiving employee drug test results, and make sure that the person is aware of confidentiality protocols. Explain the relationship of the drug testing program to your organization’s employee assistance plan (EAP), if one is offered. Let employees know how drug-testing results can be used to inform their treatment, rehabilitation, and re-integration into the workplace.

Find more information on determining whether to conduct workplace drug testing.

Types of Drug Tests

Drug tests vary, depending on what types of drugs are being tested for and what types of specimens are being collected. Blood (plasma, serum, whole blood), breath, hair, meconium, saliva (oral fluid), sweat, body tissues, and urine are some of the specimen types that can be used for drug testing.

Under the authority of Section 503 of Public Law 100-71, 5 U.S.C. Section , and Executive Order No. , the Department of Health and Human Services (HHS) establishes the scientific and technical guidelines for Federal workplace drug testing programs and established standards for certification of laboratories engaged in drug testing Federal agencies. The Substance Abuse and Mental Health Services Administration (SAMHSA) has published mandatory guidelines for drug testing for urine (UrMG) and for oral fluid (OFMG).

Federal agency drug tests include five categories of drugs, along with required specimen validity tests (for urine) and provisions for analysis of specimen biomarkers. Drug categories and drugs include: amphetamines (amphetamine, methamphetamine, methylenedioxyamphetamine [MDA], methylenedioxymethamphetamine [MDMA]); cocaine; marijuana; opiates/opioids (heroin, codeine, hydrocodone, hydromorphone, morphine, oxycodone, oxymorphone); and phencyclidine (PCP). On a case-by-case basis, specimens may be tested for any of the Schedule I or II drugs of the federal Controlled Substances Act. Urine specimen validity tests are used to determine if a specimen exhibits abnormal physical characteristics, causes reactions or responses characteristic of an adulterant during initial or confirmatory drug tests, or contains an unidentified substance that interferes with the confirmatory analysis. Biomarker tests are used to identify specimens that are not consistent with a human specimen (i.e., based on the absence or abnormal concentration of the biomarker).

Drug testing may be used in the following set times or circumstances:

• Pre-employment: You can make passing a drug test a condition of employment. With this approach, all job candidates will receive drug testing prior to being hired.
• Annual Physical Tests: You can drug test your employees as part of an annual physical examination. Be sure to inform employees that drug testing will be part of the exam. Failure to provide prior notification is a violation of the employee's constitutional rights.
• For-cause and Reasonable Suspicion Tests: You may decide to test employees who show discernible signs of being unfit for duty (for-cause testing), or who have a documented pattern of unsafe work behavior (reasonable suspicion testing.) These kinds of tests help to protect the safety and wellbeing of the employee and other coworkers.
• Post-accident Tests: Testing employees who were involved in a workplace accident or unsafe practices can help determine whether alcohol or other drug use was a contributing factor to the incident.
• Post-treatment Tests: Testing employees who return to work after completing a rehabilitation program can encourage them to remain drug-free.
• Random Tests: Tests using an unpredictable selection process are the most effective for deterring illicit drug use.
• Return-to-duty Tests and Follow-up Tests: Regulated employees that return to duty may be subject to follow-up testing. These kind of tests follow the employee to subsequent employers or through breaks in service.

Test Results

Ensuring the accuracy of drug-testing results is critical. Using an HHS certified laboratory to test the specimens and a Medical Review Officer (MRO) to interpret federally-regulated test results are required and help prevent inaccurate testing. MROs are licensed physicians who receive laboratory results and have knowledge of drug testing, substance use disorders and federal drug testing regulations.

MROs are trained to verify test reports by interpreting and evaluating test results together with the employee’s medical history, employee interview, and other relevant information. A negative test result does not indicate that an employee or job applicant has never used illicit drugs (or alcohol), nor is it a guarantee against future use. Note that a laboratory-confirmed positive test result does not automatically identify an employee or job applicant as having misused drugs, nor does a laboratory biomarker result of invalid, adulterated, or substituted automatically identify a person as having tampered with a specimen.

Federal agency specimen collections are split into containers A and B. Container A is tested by the HHS-certified laboratory. Container B is retained for additional testing (if needed). Federal employees or employees in safety and security-sensitive industries that receive a MRO-verified positive drug test report have the right to have the split specimen (container B) tested by a second HHS-certified laboratory. Although a second test is not required, all employers should include this right in their employee drug-testing programs.

Depending on the federal agency, the workplace, and the circumstances, employees who drug test positive may be referred to Employee Assistance Programs (EAPs), into treatment, or for disciplinary action.

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Medical Review Officer (MRO) Resources