A compliance management organization model for drug screen delivery


Drug screening for the courts, like drug screening for employment has been with now us for nearly thirty years, and many statistics have been garnered over that period of time Currently, something like one to five percent of employment-related screens will produce confirmed positive results for one or more substances. Conversely, our population–the court ordered screens–tend to confirm positive from twenty-five to thirty percent of the time. One statistic we don’t have is the number of active substance abusers who successfully pass a drug test. As the saying goes, their name is legion.

Here are a few of the ways cheaters attempt to game the system:

On urine screens:

  1. Adding water or other fluids (bleach, vinegar, artificial urine or someone else’s urine) to the specimen at the time of collection
  2. Purchasing and attempting to use various products (powders, pills) to mask the presence of drugs or to interfere with assay process
  3. Purchasing and using artificial genitalia designed to deliver artificial urine or someone else’s urine, while still having the appearance of normal human genitalia
  4. Inserting a balloon or condom filled with artificial urine or someone else’s urine vaginally, then breaking the container, allowing the urine to seep out
  5. Water loading–that is drinking large amounts of fluid within an hour of the time of collection in order to dilute the urine, thus diluting the presence of drugs
  6. Sending another person in to screen with false ID


On oral fluid screens:


  1. Rinsing the mouth immediately before the collection
  2. Purchasing and attempting to use various products (fluids, capsules) designed to mask or dilute the oral fluid in order to tamper with detection
  3. Hiding an ice chip in the mouth in order to dilute the oral fluid
  4. Holding the swab in the teeth rather than collecting fluid near the gum line
  5. Avoiding collection until the last possible minute
  6. Sending another person in to screen with false ID


On hair screens:


  1. Purchasing and attempting to use various products (mostly shampoos) designed to interfere with the identification of drugs in the hair shaft
  2. Shaving off all body hair
  3. Sending another person in to screen with false ID



So what can be done to stop them?


Urine screens:


Most items designed and sold to help an individual cheat on drug screens simply don’t work. Many of them are products you mix with water and consume prior to the collection. The only thing they do to prevent detection of drugs is dilute the urine. Labs measure that and report those screens as dilute.


The few substances that might successfully mask positives (chemical oxidants such as nitrites, for example may mask Marijuana), are identified when the laboratories run their adulteration panel or conduct validity testing. This information is then transferred to the referring agency who can take appropriate action with the client.

Observed collection prevents the addition of other substances to the client’s specimen and also prevents the use of artificial genitalia. A client attempting to open a urine-filled condom by inserting her finger and pricking open the condom would be reported for her unusual behavior.


Finally, the laboratory measures both Createnine (a substance created as the body breaks down protein) and Specific Gravity. When the urine specimen falls below the normal range of both, it is labeled “dilute.” Though not all dilute specimens indicate an attempt by the client to water load, repeated dilutes without a medical explanation are more than highly suspect.


The two major ways of preventing cheating on urine screens are 1). having a solid random management program, and, 2). employing observed collections by trained collectors. Nothing beats experience, and when trained collectors oversee the process, few attempts at gaming the system get through unnoticed. But even if they do, a regular, well-managed program of randomly managed screens combined with compliance and non-compliance data is almost impossible to compromise.


Oral Fluid Screens:

Like the adulterants sold to mask the presence of drugs in urine, those products sold to mask the presence of drugs in oral fluid seldom have any effect, if the collectors follow appropriate collection procedures. Specifically, the collector must wait a minimum of fifteen minutes before introducing the swab to the donor’s mouth. And before the swab is introduced, the collector must examine the donor’s mouth to make sure it is free from potential adulterants. Like a urine screen, the oral fluids screen must be observed as well. The collector must make sure the swab meets the gum line and is not held in the donor’s teeth. Good collection techniques assure a quality specimen. If caseworkers are involved with the collection process, it is essential that they receive training from their provider in order to avoid common mistakes and insure the integrity of the specimens.

The only potential problem a collection site cannot control for is that of the client who puts off collection until the last possible minute. Oral fluid screens typically have a shorter window of detection than do urine screens. This is particularly true with Marijuana. Conceivably, a client could partake of Marijuana at 5:00 PM Monday evening, call the following morning to find out that he needs to screen, then avoid going into the clinic until 5:00 PM on Tuesday evening. Twenty-four hours would have expired and the Marijuana would most likely be undetectable. As with urine screens, a solid random management program will help, but because of the shorter detection windows, the number of screens per week or month would have to be increased by approximately one third to achieve the same level of detection. Likewise it would be essential to carefully examine the difference between the call-in time and the collection time to see if there were any unusual patterns. Alternately, it may be essential to reduce the allowable time between call-in and collection or select a different type of drug screen to run (urine or hair).

Hair Screens:

Like those products purchased to block drug detection for urine and oral tests, the shampoos sold to block positive results on hair tests simply don’t work. Laboratories continue to be vigilant, and continue to examine new cheating products as they are marketed.

The best way to prevent an individual from shaving all his or her body hair is to ask the judge to make that part of the court order. If an individual is ordered to avoid haircuts and shaving, then does it anyhow, he or she is out of compliance with the court order and it’s not too hard to figure out why it was done.

False ID

Frankly, false IDs are not that difficult to obtain as any college Freshman could tell you. And even though our collection sites check ID carefully, if it’s fake, it could go through. That’s why we encourage caseworkers to retain a copy of their client’s signature on file. When you have serious doubts about a reported negative screen, you need to contact your provider for a copy of the Chain-of-Custody form. On that form you’ll find a copy of the signature of the specimen donor. Compare it to the signature of your client that you have on file. You don’t necessarily have to be a handwriting analyst to see that in many instances the signatures don’t match and that the donor is not your client.

The Future

To further combat false IDs and cases in which, say, a sister who resembles your client submits the specimen rather than your client, Span has been investigating the use of fingerprint technology at the point of collection. Further, we’re also close to partnering with a specialty laboratory that is able to analyze fingernails and hair for up to seventeen drugs. This testing can also be used on children to detect passive exposure to certain substances. The current hair test is only able to detect five classes of drugs so this would represent a huge step forward, as well as helping to reduce the risk of cheating.

There’s more on the horizon. There’s always more on the horizon. And you may be sure we’ll be keeping up with it.