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Drug Testing Methods…Learn the Pros and Cons

February 1, 2006
Urine, saliva, sweat, hair. With distinctly different ways to screen for employee drug use, deciding on the best method is a challenge. Is one better than another for a specific purpose? How intrusive is each method? And is newer necessarily better?

No drug-testing method is foolproof. But understanding the pros and cons of each is an important first step in establishing or enhancing a workplace program. Also, employing the services of a medical review officer (MRO)--a licensed physician who is an expert in drug and alcohol testing and the federal regulations that apply to the process-- ensures the greatest likelihood of a program’s success.

Urine
Urine testing is the most commonly used drug screening method. Collection is relatively easy, but it must be accomplished in an area that precludes specimen tampering. Urine testing detects the presence of metabolites--by-products the body produces as it processes drugs for excretion - rather than the drugs themselves. Alcohol and many illegal drugs, with the exception of marijuana, pass through the body within 24-48 hours, without leaving metabolites. Traditionally, urine drug test results are available in 24-36 hours. (A rapid urine test exists, but has not met with universal acceptance.) The detection period is three to five days. Urine testing is most suitable for pre-employment, random, reasonable suspicion/cause, post-accident, return-to-duty and follow-up testing.

Saliva
Oral fluid (saliva) collection is non invasive and resistant to tampering. Drugs can be detected in saliva within one hour of use. However, the active component of marijuana does not diffuse from the blood stream into saliva. And detecting the parent drug of marijuana in saliva does not distinguish between marijuana use or environmental contamination, e.g. the employee was present in a room where others used the drug. Saliva stimulation, such as from gum chewing or even certain oral fluid collection devices themselves, can lower drug concentrations in oral fluids. Spitting directly into a container, although opposed by some donors, avoids saliva stimulation. Saliva test results are usually available within 10 minutes. The detection period is less than one hour to approximately 24 hours. Saliva testing is best suited to reasonable suspicion/cause and post-accident testing. It is not suitable for random testing when more than a day’s prior notice is given.

Sweat
The mechanism through which drugs appear in sweat isn’t clearly understood. Nonetheless, the Food and Drug Administration (FDA) has approved a sweat patch that makes collection non invasive. Attempts to remove or tamper with the patch are usually visible to trained personnel, yet contamination issues remain a concern. Also, skin sensitivity and rash may preclude wearing the patch for the optimal time period. Unlike other drug detection methods, the sweat patch detection period extends from shortly before the application of the patch to as long as it remains applied to the skin.

The sweat patch is particularly suited for return to duty and follow-up testing. Because it must be worn for three to seven days, it is less useful for pre-employment, random, reasonable suspicion/cause and post accident drug testing.

Hair
In 2004, the Department of Health and Human Services proposed the inclusion of hair testing in the Federal Workplace Drug Testing Program. Obtaining a hair specimen from the head is minimally intrusive. Hair is easily transported and stored, less likely than urine or saliva to transmit bio-organisms and more tamper-proof than urine. However, studies that have looked at the effect of hair color on the amount of drug deposited in the hair have produced conflicting results. Hair testing’s long detection period-weeks to months--makes it most suitable for pre-employment and random testing. The method is not suitable for reasonable suspicion and post-accident testing because drug metabolites take seven to 10 days to appear in hair.

Inova Occupational Health Services works with area employers to implement workplace drug testing programs under the auspices of a medical review officer. For more information, contact Jeffrey Carr at 703-321-2555 or jeffrey.carr@inova.org.

Early Counseling Averts Workplace and Family Crisis
With her elderly mother’s needs diverting her attention, Ms. R found it difficult to focus on her work. And it was just a matter of time before her employer would identify a productivity issue. Recognizing the immediate need to prevent a personal and professional crisis, Ms. R turned to her EAP.

"It is to everyone’s advantage when workers seek counseling services as early as possible," says Lavinia Cohen-Hopkins, LCSW, manager of clinical services, Inova EAP. “Employees and their families get the help they need while employers retain productive workers.”

In Ms. R’s case, her mother’s failing health made it increasingly difficult for her to continue caring for herself. Yet Ms. R’s siblings couldn’t agree on a solution. And because Ms. R was the only adult child living in the area she assumed primary caregiver responsibilities-including visiting several times a week to do housecleaning, laundry, food shopping and meal preparation--in addition to working full-time and tending to the needs of her own household.

The EAP provided short-term supportive counseling and a work life referral for elder care services. Over the course of four weekly sessions, Ms. R learned to deal with the emotional aspects of the caretaker role and to set boundariesincluding not talking to her siblings during the work dayto prevent her family situation from spilling over into the workplace.

Within days, Ms. R had a list of carefully-screened, local assisted living communities that would meet her mother’s specific needs. She also gained valuable insight into involving her siblings in the decision making process and helping Mom adjust to her new environment. Best of all, Ms. R reverted to optimal productivity with minimal impact.

The majority of EAP cases are self and informal referrals. Employers can take simple steps to keep workers aware of their EAP:

• Schedule periodic new employee orientations
• Place posters in common areas
• Send reminders through intranet or pay envelope inserts

Workers covered by Inova EAP automatically receive Healthy Exchange, a quarterly electronic newsletter that offers wellness tips and reminders of the benefits of counseling and work life referrals.

Inova EAP offers work life services that help employees balance the demands of job and home. For information, contact Jeffrey Carr at 703-321-2555 or jeffrey.carr@inova.org.

Inova Executive Health Center Keeps Decision Makers in Top Form

Key employees get to the top by maximizing their time. Taking care of their health is often made difficult due to multiple visits, inconvenient appointments and undue delays.

The Inova Executive Health Center understands how to keep decision makers in top form and respect busy agendas. By offering an unparalleled blend of exceptionally trained medical professionals and advanced technology, the program helps detect illness in its earliest, most treatable stage and prevent chronic conditions from escalating. This finely-tuned process is designed for maximum efficiency.

The Inova Executive Health Center - is located at the Inova Heart and Vascular Institute at Inova Fairfax Hospital. This central location is convenient to I-495, I-66 and major secondary roadways, making it very accessible to offices in Northern Virginia, the District and Maryland. With just a single phone call, the Inova registered nurse medical concierge coordinates every detail of the half-day appointment. (Optional screenings may require an additional visit.)

In a relaxed atmosphere of focused, personalized attention, the Inova Executive Health Center provides customized assessments that encompass all body systems as well as the health education that executives need to optimize their well-being:

• medical and social history review
• cardiac health risk and assessment profile
• treadmill stress testing by a board-certified cardiologist
• comprehensive laboratory testing
• chest X-ray
• fitness evaluation
• pulmonary function testing
• vision and hearing
• nutritional assessment
• colonoscopy (optional)
• CT scan (optional)

Following the comprehensive examination, program physicians provide full documentation and interpretation of the results. And should the need arise, executives also gain complete access to top-rated physicians in every specialty who practice with Inova Health System.

The Inova Executive Health Center is affiliated with Inova Fairfax Hospital, a recognized leader in health care.

US News & World Report consistently ranks Inova Fairfax Hospital among the country’s top 50 hospitals. In October 2005, Washingtonian cited Inova Fairfax Hospital as having the area’s best emergency department, intensive care unit and medical equipment.

The Inova Executive Health Center is under the direction of Craig Cheifetz, MD, FACP, and Madeline Erario, MD.

For more information about the Inova Executive Health Center, we invite you to contact Jeffrey Carr at 703-321-2555 or Jeffrey.carr@inova.org, or visit www.inova.org, and click on “Workplace Health.”

Inova complies with all HIPAA guidelines ensuring patient confidentiality. Confidentiality of all tests, assessments, results, and participant files will be maintained in accordance with established and recognized standards of care.

Articles are written by professional journalists, who strive to present reliable health information. They are not intended to be a substitute for medical care and advice.