A compliance management organization model for drug screen delivery

FAQ

I know my clients were high on marijuana when I took them in for a drug screening. Why are the results Negative?
It can take 6-8 hrs after use to show up in the urine.

What else can make a client positive for cocaine?
Nothing but the use of cocaine.

My clients are cocaine and/or opiate abusers. Why are they always negative?
These drugs have a short detection window, lasting only 24-72 hrs in the system. If you are giving your client too much latitude on when they go for screening, they may be timing for negatives.

My client says he/she has not used marijuana in weeks. He still comes up positive but the quantity is decreasing. Is this proof that he has not re-used?

No – the levels reported are subject to many factors other than ingestion. A person could use marijuana continually can still produce changes in the levels detected.

Does marijuana always stay in the system for 30 days?
It depends on the frequency and longevity of use. A chronic user is more likely to show up positive for 30 days after the last ingestion than an infrequent user.

Can you explain exactly what “Dilute” means? How does it occur?
Dilute means the urine has more fluid in it than normal. It could be caused by adding fluids to the specimen or by drinking copious amounts of fluids before testing. There also may be medical conditions that could affect the urine’s relative dilution.

My client drinks a lot of water because she is on a diet. Is this the reason her results show negative but ‘dilute’?
Unlikely. Your best bet is to advise your client to resume drinking normal amounts of fluid during the testing period.

What about the various things a person can buy on the Internet to clean up their urine. Do they work? Will they show up in the testing Span does?
Some may block certain drug metabolites, but certified laboratories will tag those results as “adulterated.” Other substances that are supposedly intended to block positives, only do so because they are mixed with large quantities of fluid. The labs will report these results out as “dilute.” Even dilute screens may be found positive. Span always tests for adulteration.

My client is an alcoholic and I know he is still drinking. Why are his urine drug screens always negative? How can I prove to the judge that he is not abstaining?
Most urine drug screens will only detect alcohol for 6 to 24 hours after ingestion. An individual can usually time the sample to disguise drinking. A relatively new technology, EtG testing is now available, and it can detect alcohol for up to 72 hours. Placing your client under a random screening program and using the new technology will almost certainly show positive results if he/she is a regular drinker.

Our clients are allowed 24 hrs from the time they call us to go to a collection site. Is this an advantage to them? Can they get clean in 24 hrs? Should some/all clients be given a tighter time schedule?
Such time requirements will generally work with everything except alcohol. That said, if the client knows ahead of time when you will require him to screen–say you always make the decision at your regularly scheduled meeting–he could easily abstain for a short time prior to the meeting. With the additional advantage of 24 hours to present for collection, the client could time his collection to avoid detection. If you suspect such behavior, a hair test or random testing program may be indicated.

What causes a client’s urine to show ‘temp out of range’?
This may indicate the client brought clean urine to the collection site and substituted it for his own. It could also show that the client added fluid to his/her own urine at the time of collection. Or, a client might have a fever, thereby affecting the temperature of his urine. Our collection sites will require a second, observed specimen be provided and report refusal as suspicion of tampering.

My client says she had a fever causing the urine to show ‘temp out of range’. Can this happen?
This is possible. Our recommendation is for a retest as soon as possible. Alternately, an oral fluids or hair test could be taken that same day.

Does eating a poppy seed covered bun cause a client’s specimen to be positive for Opiates?
It is unlikely but possible, although one would have to consume an unusually high amount of poppy seeds to show a positive result. We recommend advising your clients or employees to avoid anything with poppy seeds during their testing period.

Is there any way to tell by looking at the results and the levels if my client is exceeding a therapeutic dosage of his prescribed medication?
No, not unless that evaluation is conducted by a physician with additional training and certification in substance abuse issues. These physicians, Medical Review Officers (MROs), may be able to provide such answers for you.

My client claims he was at a party where a lot of marijuana smoking was going on but did not himself smoke marijuana. Could that explain his positive drug screen for marijuana?
No. Levels of detection are set high enough to avoid triggering a positive from passive inhalation.

My client tested positive for opiates. He has a prescription for Vicodin from his doctor. Is this the reason for his positive?
It may be. Vicodin will trigger a positive for opiates on most drug screens. Vicodin will show a positive for Hydrocodone, and maybe Hydromorphone. A positive for a different Opiate metabolite would not be caused by Vicodin.

If I provide you with a list of the fifteen prescription drugs my client is taking can you tell me what she might be positive for?
The best approach is to wait and see if your client tests positive at all. If she does, then we can take a look at her prescriptions and see if there might be any potential causality.

My client tested positive for alcohol and glucose. Is glucose a controlled substance?
No, it’s not. Our labs test for the presence of glucose every time they have a screen positive for urine alcohol. This is because certain diseases, like diabetes, can cause the body to produce its own alcohol. A positive urine alcohol screen, coupled with a positive glucose would not necessarily lead me to believe that the client had ingested alcohol. On the other hand, an EtG alcohol screen will only detect alcohol that has been ingested. If you know your client is diabetic but suspect alcohol abuse, we recommend testing him for EtG alcohol.

My client says he hasn’t been scheduled for a screen in over two weeks. Why not?
The best way to keep a drug screening program random is by assuring it’s random. That means that instead of scheduling, say, weekly drug screens, we schedule screens four or five times per month. That may result in tests three weeks apart or screens on consecutive days. Were we to schedule screens on a weekly basis, an individual who tested on a Tuesday, for example, would know he wouldn’t be tested again until the following week, and he would be free to use until a few days before that week began.

Why does it take so long for me to get my drug screen results?
The typical turnaround time is 24 to 72 hours. The collection site overnights the specimens to the laboratory. The lab processes, usually the same day they receive the specimen, and reports out negatives that same day. Prospective positive screens undergo yet another kind of testing (GCMS or LCMS Confirmation testing) to assure that any results being reported out as positive are, indeed, positive.

My client is going out of town next week. Will he be able to continue testing?
More than likely we’ll be able to set him up with a collection site. However, it is very important that you give us as much lead time as possible to set it up. We may also need to mail drug screen request forms to you client to take to the new collection site. Drug screen ID cards will only work in collection sites set up to accept them.

I received my drug screen report, but I don’t understand it. What can I do?
Any time something is not clear to you, or any time you have questions about a result, please call the Span office at 734-623-7726 or email Alicia Pollum at Alicia@spancorp.com. Alicia or another staff member will answer your question or find someone else who can.

My client is contesting the accuracy of her drug screen results. Can you provide testimony in court to explain how you determine the results?
Sure. We’re happy to help out via telephone testimony. It is, however, important to understand specifically what kinds of questions you will need testimony to respond to. Questions regarding how the specimen collection was done and how the specimen was handled at the collection site need to be addressed by the collection site. Scientific or technical questions need to be addressed by the laboratory that processed the specimen. For example, those would be questions like, “what process do you use to analyze the specimen,” or “what are the credentials of the individuals performing the test,” or “explain your confirmation test to me.” As an administrator, Span can respond to questions like “how many times did the client call last month,” or “how many positive tests did the client receive in June.” If you’re in doubt as to who you should contact for testimony, give us a call and we’ll help you decide.

My client has been a Heroin abuser. Right now his drug screens are positive for Hydrocodone. Does that mean he’s abusing Heroin again?
No. But he might be abusing Hydrocodone (Vicodin). You’ll want to verify that he has a prescription for that substance. If a client has been abusing Heroin, our drug screens will show him as being positive for Morphine and 6 Acetylmorphine.

I just got my bill and I see you’ve charged me for a collection attempt. The screen was never processed. How can you charge me for that?
We only charge for collection attempts when 1) Kits and forms have been used, 2) Clinic staff have actually begun the collection process. Barring these two things, you would not be charged. Typically a collection attempt happens when the client either provides a specimen whose temperature is out of range, or provides an inadequate volume of specimen. Both of those situations call for a recollection of the specimen. If the client refuses or leaves the building before the recollection can take place, that is considered a collection attempt and a refusal to test. There are no charges for lab services because no lab services have been provided. However the collection site staff have provided their services and supplies have been consumed. They, rightfully, expect to be paid for those services. Thus the small charge.

So, I just got a result that said “Immunoassay Interference.” Does that mean the result was negative, positive, or something else?
Something else. Sometimes our clients will add certain substances to their urine in order to block the detection of drugs. Soap, bleach and vinegar are three such items. These are all likely to “interfere” with the immunoassay or GCMS confirmation testing. Other times, Interference may be completely unintentional. Menstrual blood in the urine can be an unintentional adulterant. And sometimes certain prescriptions may interfere with test results. The best action to take is to order an observed retest as soon as possible. Alternately, a hair test may be ordered. It is virtually impossible to adulterate a hair test.

Are there other kinds of results besides positive, negative and Interference?
Absolutely. We don’t see them often, but you might occasionally notice “Invalid,” when a urine specimen contains an unidentified adulterant or interfering substance, or when the specimen has abnormal characteristics (color, odor, etc.). Also, you may occasionally see a specimen marked “Substituted.” A substituted result is detected by measuring the specific gravity and createnine of the specimen. When those results are too low, they are not consistent with human urine. Of course you’ll also see results labeled “Dilute” or “Temperature out of range.” Usually you will see a positive or negative result with these as well, but those notations should raise a red flag as dilute and temp out of range results may have been tampered with.