A comprehensive drug test is a screening method designed to detect a variety of substances, including prescription and over-the-counter medications and illegal drugs. A comprehensive drug test can identify hundreds of substances, including those that go undetected during routine testing. These tests play a crucial role in employment screening and are useful for identifying and treating addiction.
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In this blog, we look at what comprehensive drug testing entails, the science behind it, how to interpret test results, and more.
A comprehensive drug test is designed to look for hundreds of prescription and non-prescription medications, as well as illicit drugs and even alcohol. These highly sensitive and specific tests can easily identify substances in blood and urine that other tests fail to detect, making them a powerful tool for workplace and overall health screening.
Comprehensive drug panels detect many more substances than other targeted drug tests, which may only discover a certain subset of drugs or medications. Thus, these tests are considered “comprehensive” because they screen for a wide range of substances.
Some of the drugs that comprehensive drug screens detect include:
There are many reasons employers may wish to consider implementing comprehensive drug testing for their workforces. Comprehensive drug tests can reveal whether an employee or prospective employee is using substances that could impact their ability to do their jobs effectively, resulting in greater worker productivity. They can also be an effective tool for maintaining a safe and happier working environment for everyone.
Comprehensive drug screening can also help organizations reduce liability and save money. The National Council on Alcohol and Drug Dependence estimates that substance use disorders cost companies $81 billion annually through lost productivity and absenteeism, turnover and recruitment costs, workplace accidents, healthcare expenses, and more. Testing can identify employees who might be engaging in substance abuse and mitigate these costs.
Most importantly, comprehensive drug tests can lead to employees getting the treatment they need to help them become healthier. Thus, comprehensive drug testing does not just improve a company’s bottom line; it can improve employees’ lives.
There are several types of comprehensive drug tests, each with its own unique processes, benefits, and limitations. Here, we’ll explore the advantages and disadvantages of comprehensive urine and blood tests, as well as a few other lesser-known testing methods.
A urine drug screen is the most commonly used comprehensive drug test method. They are painless, easy, and cost-effective.
With a urine test, a person simply urinates into a plastic container and provides the sample to a technician or doctor. The person collecting the sample then measures the temperature of the sample to ensure it is suitable for testing. If it is, the sample is sealed in a plastic bag and sent to a laboratory for a urinalysis. Results are usually available within a few days or, in some cases, on the same day.
A physician or medical review officer will evaluate the test results and explain their findings to the test subject. In the case of a positive test, the subject may be asked to re-test to ensure that the results are accurate.
Urine tests are not the only type of comprehensive drug screen. Other methods include:
Urine drug screens are usually very accurate, but false positives are possible. In general, immunoassay (IA) urine tests are more prone to false positive results than gas chromatography-mass spectrometry (GC-MS) tests. In fact, GC-MS tests are often used to confirm the results of IA tests. GC-MS tests can also detect more substances, making them the most comprehensive of all urine drug screens.
GC-MS combines gas chromatography and mass spectrometry to identify various substances in a test sample. Gas chromatography separates and analyzes compounds in a mixture; mass spectrometry measures the mass-to-charge ratio of ions. When put together, the two analytical processes can positively identify even very small amounts of substances in a person’s system. This makes the GC-MS test the “gold standard” when it comes to comprehensive drug testing.
However, GC-MS testing is more expensive than an IA test, and the results take longer to retrieve. Therefore, IA tests are more commonly used.
An IA test measures the presence of macromolecules through the use of an antibody or antigen. These antibodies can detect the presence of drugs and other substances. IA testing is usually considered the frontline when it comes to comprehensive drug testing because of its ease, cost-effectiveness, and ability to deliver results quickly.
Interpreting the results of a comprehensive drug test can sometimes be challenging. According to the Mayo Clinic, people who misuse drugs are adept at finding ways to mask their drug use, via methods such as adulteration, urine substitution, and urine dilution. It’s important that physicians and medical review officers know what to look for, including:
Assuming the sample has not been tampered with, the actual interpretation of test results is straightforward. That’s because drug screen results are reported as either positive or negative. Some tests will state the concentration of the drug or metabolite contained in the sample.
There are many factors that can affect the results of a comprehensive drug screen. Some of the most prominent ones include:
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A comprehensive drug test is a test designed to detect hundreds of possible medications and illicit drugs in a person’s system. Comprehensive drug tests look for both prescription and non-prescription medications, illegal substances, and, in some cases, alcohol. They are generally performed through urinalysis, but blood tests, hair follicle tests, and others can also be performed.
The most comprehensive urine drug test is a gas chromatography-mass spectrometry (GC-MS) test, which positively identifies even very small amounts of substances in a person’s system. This makes the GC-MS test the “gold standard” when it comes to comprehensive drug testing.
A 12-panel comprehensive drug test is a urine drug test that tests for 12 different metabolites in a person’s system. It can accurately detect substances—including painkillers, opiates, and stimulants—that may be more difficult to detect on smaller panel drug tests.
Comprehensive drug testing is a critical tool for ensuring a safe and productive workplace. With comprehensive drug testing, employers can proactively tell if employees and prospective employees are using substances that could impact their job performances—and their overall well-being. Proactive drug testing can also help organizations avoid the costs and liability associated with drug use in the workplace, which costs companies billions of dollars every year.
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Employers want a safe and healthy workforce, and so two-thirds of them test workers for drug use, according to recent research—but which method of testing is most effective?
There are currently three primary methods of specimen collection:
The vast majority of employers use urine testing over saliva or hair, primarily because "it's what people have always done," said Matthew Nieman, an attorney in the Washington, D.C., regional office of law firm Jackson Lewis. The typical organization looks to the Department of Transportation (DOT), which tests truck drivers and airplane pilots, and because it still uses urine testing, it's the de facto industry standard, Nieman explained.
The DOT is reportedly on the cusp of adding saliva as the second approved specimen for federal testing, in a rule due sometime this year, according to experts.
Dr. Todd Simo, HireRight's chief medical officer, noted that alternate specimens are gaining interest, especially since urine tests aren't as accurate.
"Both hair and oral fluid testing have had double-digit yearly growth as more companies become aware [of them]. And both hair and oral have substantially higher positive hit rates."
When comparing the number of people who self-report drug use to the National Institute of Drug Addiction and the number of positive test results from Quest Diagnostics nationwide lab, Simo said, urine screens don't detect as many drug users as would be expected.
But he pointed out that urine and hair testing pick up many different drugs, such as prescription medications, which get overturned when reviewed by a medical professional, while oral testing panels are typically screening only for marijuana, cocaine, PCP, amphetamines and opioids. Medical review—which determines whether a legitimate medical explanation can account for positive results reported by the lab—is an important piece of any workplace drug-testing program.
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Urine testing. Urinalysis is currently the only approved drug-testing method for workplaces covered by federal guidelines. It's easy to collect the specimen, which can be screened for many illicit drugs as well as prescription medication, said David Bell, the CEO of USA Mobile Drug Testing, a drug-testing provider in Tampa, Fla.
On the other hand, people have figured out how to cheat on the test, Simo said. "Urine as a specimen is very easily manipulated. There are literally hundreds of websites out there that sell adulterants and synthetic urine for people to buy that can subvert a urine drug testing program."
But cheating may not be that easy. Bell said that while employers typically don't observe workers while the specimen is collected, increasing the risk of tampering, "a urine screen is difficult to cheat as the temperature, pH and creatinine is checked to ensure specimen integrity. Attempts to dilute a urine specimen will only create a specimen that is inconclusive and requires a retest."
Saliva testing. Oral fluid testing can be collected immediately onsite, which makes it more efficient and reduces the amount of time and cost for collection, Bell said. "The test can detect use that has been extremely recent where urine tests require the drugs to have passed through your system to identify."
Saliva testing has a lot of appeal, Nieman agreed, "especially for employers who want to do it themselves. Testers can get FDA-approved onsite swab tests, observe the specimen collection—making it hard to subvert—and send it off to the lab for confirmation. However, some states and localities limit or prohibit onsite testing, so employers need to be aware of the laws that apply to them."
Because of the small detection window—from a few minutes up to about 48 hours—oral tests are likely catching chronic daily users, Simo said. "These are the people you want to deter and keep off your job site because they represent the most imminent risk."
But the limited detection window is also its drawback. "It can only detect drug use that as happened within the past couple of days," Bell said.
Hair testing. Drug-testing hair is a simple and noninvasive way to detect drug use over a greater length of time, most effective when testing for regular use of drugs such as cocaine, methamphetamines and opiates. These drugs can become undetectable in urine after three to four days.
"Hair testing has the highest 'fear factor' as a deterrent," Simo said. "Employers that advertise hair testing deter drug-using applicants that just stay away. It's impossible for regular users to prepare for it."
On the other hand, it typically does not do a good job at detecting sporadic usage, he said.
And "it doesn't really cover the few days right before the test, because it takes time for hair to grow," Nieman said.
Specimen collection is dependent on each organization's drug-testing needs. "The best option is what you're comfortable with," Nieman said. "If you're a small employer and comfortable with being trained on how to conduct onsite saliva testing, go for it. If you are already contracting with a lab for urine testing, you don't have to reinvent the wheel."
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