No, local anesthetics used in dentistry are synthetic. They do not have the same chemical structure as cocaine or crack cocaine and will not be detected by our EMIT screening test or by an LC-MS/MS confirmation
When a sample is confirmed by LC-MS/MS, there are no drugs other than morphine that can cause a positive morphine test.
The opiates screen by EMIT will result as positive for codeine, morphine, 6-monoacetlymorphine (heroin metabolite), hydrocodone and hydromorphone above the cutoff and to very high levels of oxycodone and/or oxymorphone.
The quinolone antibiotic drug class has been known to cause positive screening results with some opiate screening technologies.
No, our tests are drug and drug-metabolite specific. Because these commonly ingested substances are chemically and structurally different from the drugs being tested for, they will not interfere with or compromise test results that are confirmed by LC-MS/MS.
Yes, it is possible for a drug test to be positive for alcohol because of diabetes. In the case of an uncontrolled diabetic, excess glucose can accumulate in the urine. In the presence of yeast or bacteria, urinary glucose can be converted to alcohol by fermentation. Thus, people with diabetes and who have a urinary tract infection might have alcohol in their urine even without any alcohol consumption.
The laboratory can test each sample that is positive for ethanol to look for glucose. If glucose is detected, it is possible that the alcohol is a result of urinary glucose fermentation and not of consumption. It is possible (although unusual) that the glucose is completely consumed by fermentation. This usually results in an extremely high urine alcohol level (>1%), pressurization of the specimen container and the smell of yeast. Urine specimens that exhibit an alcohol level of greater than 0.5% should be checked for evidence of fermentation.
No. Some over-the-counter medications may cause a positive test result on our EMIT screening test, which is the first test performed on a sample to determine if a drug is present. Samples that test positive on the screening test are called “presumptive positives” and are immediately scheduled for a second test, called a confirmation test. The confirmation test will determine definitively if the drug present is an over-the-counter medication or a drug of abuse.
No. A sample that is confirmed by LC-MS/MS will never result in a false positive test result. Some prescribed medications may cause a false positive screening result by EMIT technology. Whether the drug was legitimately prescribed or not, the confirmation test will determine definitively if it the drug was present.
Yes, one class of antibiotics may cross-react with the opiate screen. The class of antibiotics known as quinolones (levofloxacin, ciprofloxacin, ofloxacin and others) can cause a positive screen; however, confirmation by methods such as GC-MS or LC-MS/MS will be negative.
Dextromethorphan is the primary active ingredient in over-the-counter cough medicines like Robitussin® DM. Dextromethorphan can cause a positive PCP screening result, but the confirmation test will be negative for PCP. All PCP screening results should be considered presumptive and a confirmation by LC-MS/MS performed.
Yes, but we advise testing an unrefrigerated specimen within seven days of collection. It is known that the concentrations of some drugs and their metabolites decrease gradually in room temperature urine. Refrigeration can slow this process somewhat, and freezing will preserve a sample indefinitely. Usually the decrease is not dramatic, but in the worst-case scenario, a borderline positive level might drop below the detection threshold.
Note that an unrefrigerated specimen would never cause a false positive, with one important exception: Alcohol may form in unrefrigerated urine due to fermentation if the urine sugar (glucose) is elevated, such as if the donor has diabetes. We recommend that alcohol screens be shipped promptly, and we check for the presence of glucose in all alcohol positives.
All samples are carefully labeled at the collection site and contain a tamper-evident seal that is placed over the specimen cup. Additionally, the specimen cup is placed in a tamper-evident bag, along with any chain-of-custody forms. Upon arrival at the laboratory, every sample is examined to ensure that the tamper-evident seals are still intact and that the identification numbers on the sample and the chain of custody forms match. This procedure follows the legal standard for chain of custody, the purpose of which is to ensure that samples are undisturbed.
One of the most precise procedures for detection of drugs of abuse in urine is a combination of liquid chromatography (LC) and tandem mass spectrometry (MS-MS), abbreviated LC-MS/MS. This analytical method identifies the exact substances in a sample. Compounds in a sample are separated from each other as they travel through the LC column and are then introduced, one at a time, into a mass spectrometer. As the sample constituents enter the mass spectrometer, they are bombarded by electrons, which cause each compound to break up into molecular fragments. The fragmentation pattern is reproducible and characteristic and is considered the “molecular fingerprint” of that specific compound. No two drugs or metabolites have the same molecular fingerprint. LC-MS/MS is considered to be the most definitive method for confirming the presence of a drug in urine.
The guidelines from the American Probation and Parole Association (APPA) suggest two methods for using positive test results for the purpose of revoking probation.
First, if the donor tests positive by immunoassay screen and admits to using the drug, then no further testing is required. The admission is all that the court needs to revoke probation.
If the donor denies using the drug, then a confirmation test is required. The universally accepted confirmation techniques are Liquid chromatography– tandem mass spectrometry (LC-M/SMS) or gas chromatography–mass spectrometry (GC-MS).
All commercial screening techniques, including both point of care instant devices and lab-based screening are prone to a small percentage of potential false positives and false negatives. Certain drug classes and drugs are more common in these scenarios. For example, lorazepam is not detected well unless present at very high levels. Conversely, the amphetamines drug class is well known for false positive screens from Sudafed along with other sympathomimetic amines. Therefore, all presumptive positive screening results should be confirmed by LC-MS/MS in the absence of an admission of use. Presumptive negative results for expected prescribed medications should also be confirmed.
Not necessarily. While both laboratory testing and instant-testing devices are designed to identify drugs in a specimen, each has advantages and disadvantages that could lead to a different result. While instant test kits have the advantage of providing a result on the spot, the testing tends to be more limited in terms of identifying adulterants/substitution or cross-reacting substances. Also test kits usually provide a subjective result (because they require some interpretation by the person reading the result). Laboratory testing provides an unbiased result, read by unbiased laboratory instrumentation.
A laboratory has the option to perform additional testing on a specimen should a specimen be suspected of adulteration or when there is a suspicious instrument reading. In the case of PCP, a laboratory can perform an additional test to rule out a positive caused by dextromethorphan, a component of numerous cough medicines. Also, only laboratory testing provides the caseworker or probation officer with creatinine and THC levels, the THC/creatinine ratio, or glucose testing on positive alcohol specimens. Testing for THC and alcohol using instant-testing devices vs. laboratory testing could lead to quite different results or different interpretations of results, which are driven by the technical characteristics of each methodology. While both methodologies have their place, a specimen that is tested in a CAP-FDT– or SAMHSA-certified laboratory provides the highest level of testing and information.
Not exactly. While urine and oral fluid drug testing are both scientifically valid test methodologies, both just as accurate and sensitive, they have some biologic differences that can provide different results. Oral fluid is a direct filtrate of the blood, so drugs are typically present in their parent form and as a result have shorter detection windows and lower levels than urine, particularly THC. Urine is considered a reservoir matrix and as a result drugs are typically present as both parent and metabolites in urine and have a slightly longer detection window over oral fluid. Consequently, a urine sample and an oral fluid sample taken at the same time from the same donor may not correlate, which means one could be positive and one negative.
Yes. Determining the best matrix for drug testing comes down to the information you are trying to obtain. Hair testing has a detection window of the last 90 days so gives the requesting party an idea of the individual’s lifestyle choices. Hair as a matrix could provide very useful baseline information during an intake process. Individuals may not know, remember or may intentionally omit drug use upon intake to a program. Hair testing provides an accurate representation of a person’s true lifestyle choices. This matrix also does not require special facilities or same sex collections and is an observed collection every time so is almost impossible to adulterate. Finally, hair is considered a very stable specimen and can be stored for long periods of time. The drugs and metabolites do not degrade and the matrix itself will not degrade, allowing for future additional testing if needed.
The table below indicates the standardized threshold concentration levels for immunoassay tests established by regulating authorities. These levels are reviewed and updated periodically to conform to new data on drug development, technology and testing statistics. Concentrations are expressed in nanograms per milliliter of fluid.
No. A second screen just provides the same answer twice, but it does not eliminate any substances that could have caused a false positive, such as over-the-counter medications. A result is only considered confirmed if it is attained through a definitive testing methodology, such as GC-MS or LC-MS/MS (methods such as RIA and TLC are considered screening methods). This is why CAP-FDT certification requires the use of two different techniques to confirm a result.
The THC in marijuana is broken down into at least five different metabolites that are excreted in the urine. The THC quantitative test is performed by immunoassay and is sensitive to these five marijuana metabolites, whereas the LC-MS/MS test is specific for only the most abundant metabolite, THCC. The rule of thumb is that the level measured by LC-MS/MS should be about one-third of the level measured by the immunoassay (THC quant) test.
No. New marijuana use should only be evaluated by comparing the THC/Creatinine ratio. The concentration of all drugs and metabolites in urine is highly dependent upon the hydration status of the individual which can vary significantly between samples. The THC/Creatinine ratio accounts for this variability by “normalizing” for the individual’s hydration status.
Generally, no. Hemp can only be considered and sold as such based on the absence of the psychoactive THC product. If the product is a legitimate Hemp product it will not contain THC to result in a level at all high enough for a positive result.
Yes. EtG can detect alcohol consumption and/or exposure of up to 80 hours. However, laboratories must use a testing method like LC-MS/MS and a cutoff level that is able to distinguish between consumption of alcohol and passive contact with products containing alcohol. Commonly used cutoff levels range from 100 ng/mL to 1,000 ng/mL. Evidence is mounting that 100 ng/mL indicates passive alcohol exposure from frequent use of products such as mouthwash or hand sanitizers and the 1000 ng/mL cutoff may be too high and miss real positives. Cordant Health Solutions uses a 500 ng/mL cutoff for both the LC-MS/MS screen and confirmation tests. This robust method detects alcohol consumption while minimizing “passive contact” positives.
No alcohol except for ethyl alcohol (ethanol) will cause a positive result on an EtG test. These other alcohols are chemically very different from ethyl alcohol and break down into metabolites that will not be detected during this test.
In addition, Cordant’s cutoff level for EtG testing is set at 500 ng/mL to virtually eliminate the chance of a positive result from passive contact. See
No. Many synthetic opiates are not detected by an opiate screen and must be tested for as separate drugs.
Not necessarily. Hydromorphone is a direct metabolite of hydrocodone. Consequently, a confirmed positive for both does not always mean the donor has used hydromorphone, which could be positive due to the metabolizing of the hydrocodone.
No. The properties that make methadone an effective treatment for opiate addiction are the same properties that prevent it from testing positive for opiates. Methadone acts on the opioid receptors, just like morphine, heroin or any other opiate, to alleviate withdrawal symptoms, but it is actually a synthetic opioid with a different chemical structure than traditional opiates. Methadone must be tested for separately because of this structural difference.
No. Consuming large quantities (about 1 liter) of any liquid will significantly dilute the specimen within 30 to 60 minutes after consumption. This is the reason that all specimens tested should have a creatinine level determined to evaluate whether the sample is too dilute to provide a valid test result.
No. The times at which drugs become detectable and remain detectable are different between urine and oral fluid. Drugs show up more quickly and are gone more quickly in oral fluid than in urine, with THC showing most significant difference between the two methods. Consequently, depending on the time elapsed since use, one test could be positive and the other negative. Both methodologies are very effective but may have different preferred applications based on the testing timeline and specimen collection issues.
No. A screening test provides numbers that are relative to the cut off determined by the reagent manufacturer based on an antigen-antibody response. These are called qualitative results, meaning the level of drug present is not quantified on the report. The science is based on a competitive binding process, if the targeted drug is present the drug displaces the antigen resulting in a response on the instrument consistent with a presumptive positive. This technique relies on the drug’s molecular composition and spatial orientation, because of that, the test will exclude many substances that are dissimilar but will also bind with those that are structurally similar. When this occurs, we consider it a “false positive screen”.
A confirmation by LC-MS/MS is a physical chemical method distinctly different from the screening method, that is more sensitive and specific compared to screening methods. Cordant uses liquid chromatographic/tandem mass spectrometric (LC-MS/MS) methods to perform legally defensible confirmation tests. LC-MS/MS is considered the “platinum standard” in the drug testing community. This instrumentation allows us to better distinguish the analyte in question from interfering substances such as adulterants or a similar drug, while also allowing measurement of the concentration of the drug.
There are two technologies applied with LC-MS/MS: (1) the liquid chromatography, which utilizes the chemistry of the drug against the chemistry of a separation column to differentiate the compound of interest, and (2) the tandem mass spectrometer that bombards the molecules themselves to calculate what we call the mass fragmentation ratio. Each drug, whether illicit or prescribed, has its own distinct mass fragmentation ratio that is often called it’s “chemical fingerprint”. No two drugs have this same fingerprint, allowing for the definitive confirmation and quantitation of each drug separately.
Some drugs and their metabolites degrade over time, and some quicker than others. Drugs particularly susceptible are drugs that are sensitive to light, such as LSD and mushroom-based drugs. When testing for these drugs, it is important to wrap the specimen in foil so that light exposure is minimized or prevented. We recommend you keep samples in a cool dry place and deliver to the lab for testing within seven days of collection. Refrigeration and/or freezing specimens for storage also minimizes drug degradation.
The nanograms/milliliter (also called “parts per billion”) level corresponds to the amount of the specific metabolite detected. While detection of this metabolite above the cutoff level generally indicates usage, the amount of the metabolite detected cannot be definitively correlated to the amount of the drug used. A variety of factors affect a person’s metabolism and therefore the amount of the drug measured in the specimen, such as when and how much of the drug was consumed, its half–life, a person’s history of drug use, age, sex, weight, health, or even the properties of the specific drug itself. In other words, two people with the same ng/mL level may have consumed vastly different quantities of the drug detected.
Both amphetamine and methamphetamine are potent sympathomimetic agents, meaning that they mimic sympathetic activation of the heart and circulation and therefore stimulate the heart and constrict blood vessels. Both are considered to be highly addictive. Amphetamine is typically prescribed for attention deficit hyperactivity disorder (ADHD), narcolepsy and obesity. Amphetamine is excreted from the body as parent drug Amphetamine. Methamphetamine can also be prescribed for ADHD or weight less but due to its highly addictive nature, less so prescribed than amphetamine. Methamphetamine is typically abused as an illicit street drug prepared by clandestine chemists. Methamphetamine is metabolized to amphetamine and excreted as both parent drug methamphetamine and amphetamine. These two drugs can be distinctly separated during confirmation by LC-MS/MS.
All three of these drugs are derived from opium poppy plant or the opium chemical structure and are in the opiate class of drugs. All three have a very high potential for addiction and dependence. The difference is primarily in the manner in which opium is refined or synthetically manufactured and the form and method of delivery. Heroin is an illicit recreational drug commonly used for its euphoric effects. The heroin and heroin metabolite have a very small window of detection as it converts rapidly to morphine to be excreted finally as morphine. Morphine can also be abused for its euphoric affects as well as prescribed for extreme pain. Finally, codeine, is typically prescribed for pain and/or as a cough suppressant. Codeine can be found in toxicology testing as parent codeine and morphine. All three of these drugs, whether legitimately prescribed or abused, will metabolize into morphine so the presence of morphine in the urine could indicate end point heroin, morphine and/or codeine use.
Not in every situation. The regulatory scope of SAMHSA is strictly limited to mandatory federal workplace drug testing and pertains to a limited number of testing drug classes (i.e. amphetamines, cocaine, opiates, PCP and THC). While SAMHSA requirements improve the quality of testing over CLIA requirements (for example, SAMHSA requires that 10% of all samples run in a batch must be quality control samples), the College of American Pathologists–Forensic Drug Testing (CAP-FDT) certification is equally rigorous in its quality control requirements and offers greater flexibility in the types of drugs tested and in positive cutoff levels.
No. College of American Pathologists–Forensic Drug Testing (CAP-FDT) accreditation requires an annual inspection process and dictates laboratory quality practices, which must be utilized for all testing to ensure a forensic and legally defensible result. Laboratories that participate in the CAP proficiency testing program, alone, are not necessarily complying with any of the strict requirements of accreditation. Participants in the CAP proficiency testing program receive unknown specimens for testing three times per year. The participants analyze the specimens and return the results to the CAP for evaluation. The proficiency program, alone, does not dictate how specimens are to be tested or the quality control measures that are required to ensure the day-to-day quality of testing and to ensure that results will be legally defensible.
No. According to the DEA, abuse of prescription drugs such as OxyContin and Vicodin far outstrips that of “street” drugs like heroin and opium. To ensure that these abuses don’t go undetected, Cordant has developed an expanded opiate confirmation panel that includes morphine, codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone, and dihydrocodeine.
A medical review officer (MRO) is a licensed medical doctor who has special training in the area of substance abuse. An MRO is typically required in review of workplace drug testing result interpretation. In this type of testing, all positive test results will be sent to the MRO, who will then review the results, confirm that the chain-of-custody procedures were followed, and contact the donor to make sure there are no medical or undisclosed reasons for the positive result. It is only after this review that the test result will be sent to the employer.