Drugs of Abuse Screening & Testing

Contents

  1. Overview
  2. Instant Testing
  3. Chain-of-Custody
  4. Immunoassay
  5. Confirmation
  6. Drug Screening Cut-off Levels
  7. Drugs Tested
  8. Headshop Drugs of Abuse
  9. Over the Counter Meds
  10. Opiate-based Drugs
  11. Workplace Random Testing
  12. Costs
  13. Treatment Options
  14. Lab Quality Control
  15. Lab Accreditation
  16. HOW TO BOOK

1. Overview

I carry out Drugs of Abuse Testing at my office in Dublin city centre. This consists of either an observed or unobserved urine sample collection and screening. The observed sample, which meets Chain of Custody conditions and is legally defensible, can then sent to a registered and accredited laboratory in Dublin for immunoassay and confirmation acceptable to employers and the both Irish and UK court systems. There is a 48hr turnabout on lab testing, longer if tested after 12pm on Friday.

Please check out the content above to find more information. If you are considering a test, it’s very important that you read No 9 above.

Here is an overview of the tests I could carry out.

2. Instant Testing

This tests are instant and a result will be given within a few minutes. A signed and stamped paper confirmation document will be issued.

The procedure itself it very straightforward. This is what happens;

  1. We meet in my office and I check your photo ID and take a copy
  2. I explain the procedure to you and give you the consent form, which you sign. I give you a copy.
  3. I accompany you to the urine collection area, usually a WC, where you give the sample. The collection area is prepared to prevent adulteration or tampering.
  4. You hand the sample to me and we return to the office.
  5. I test the sample immediately and in your presence, explaining what I am doing the whole time.
  6. We wait for a few minutes for the kit to work and then examine the results. I interpret this for you.
  7. I give you a form stating what I have dome and the results. I keep a copy.
  8. The whole procedure should take no more than 15 minutes.

These are the Instant Tests:

Unobserved Test.

An unobserved urine collection and screening for drugs of abuse. This would consist of the donor giving a urine sample. This would not be observed and the testing of that sample will result in either a pass or fail. The test kits I use have built-in anti-adulteration properties and tamper-proof procedures would be in place in the collection area, usually a WC.

The advantages of unobserved testing is there is less stress on the donor and the cost is lower than observed test. However, it is open to abuse and certainly does not meet chain-of-custody conditions and is susceptible to legal challenge.

This method is really only suitable for individuals who wish to know their own status.

Observed Test

An observed urine collection and screening. This is the same as above but would consist of the donor giving a urine sample which would be observed. Then the sample would be tested and an immediate result given.

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3. Chain-of-Custody

A Chain-of-Custody test is where the urine sample is not tested on site but instead is sent to an accredited laboratory where the immunoassay test is carried out. This is used when proof of testing is demanded by employers, the Courts or An Garda Siochana/PSNI. Should the sample show a positive for the presence of a substance, then a second Confirmatory Test will be carried out.

Chain-of-Custody of Urine Samples

Starting at the time of collection, a sample’s chain-of-custody must be documented and protected. Chain-of-custody is a legal term that refers to the ability to trace and safeguard the sample, from the time it was donated, through the collection, and analysis, of the sample, to the reporting of the result. Chain-of-custody documentation answers the question: Were the specimen and the reported result correctly matched? Sound procedure requires that the sample be secured in a manner that ensures any tampering or attempted tampering is evident. It further requires that each time the sample changes hands or is moved from one place to another, it is signed for and kept in a secure area to ensure against inadvertent or intentional switching with another sample.

Elements of Chain-of-Custody Procedure

The elements of a good chain-of-custody procedure include the following:

  1. The donor should be supervised either directly or indirectly while delivering the specimen.
  2. The specimen container should be handed directly to the person supervising the collection and labeled and sealed immediately.
  3. The collector and the donor should initial the bottle to indicate that both agree that the bottle contains the donor’s urine specimen.
  4. The name of each person who has access to the specimen should be noted on a form accompanying the specimen. (Access to the specimen should be limited as much as possible.)
  5. The sample should be kept in a secure place, such as a locked room or refrigerator, until it is either tested or sent to the laboratory.
  6. Testing performed on-site should be done in a secure location to avoid the possibility of exchanging samples with a passerby.
  7. If the specimen must be transported to an outside laboratory, it should be mailed in a sealed container and placed in an external carton with an evidence seal. Government mail or licensed and bonded courier services are acceptable means of transporting specimens.
  8. The specimen must be properly labeled so that laboratory personnel will not confuse it with others.
  9. If the specimen is to be offered as evidence in a legal proceeding, it must be in the same condition as it was when taken—unless the change is for a justifiable purpose, such as alteration required for the testing procedure.

An observed urine collection of the sample is then sent to an accredited lab in Dublin and tested. Should the sample give a positive result it will be sent to the second lab in the UK or Germany for confirmation analysis.

Results will be available within 72hrs depending on how busy the lab is, longer during weekend and national holidays. Usually, there is a 48hr turnabout.

The urine sample will be kept for one year in controlled conditions to allow for any possible legal challenge. The collection procedure follows internationally recognised chain-of-custody procedures where every stage of the collection is observed and signed off by an accredited individual.

Note 1: a drugs of abuse screening results in either a pass or fail. This is determined by the level of the cut-off level of the metabolites of the substance in the urine. This cut off levels will be notified and is recognised internationally as a reasonable cut off level. The screening does not measure the amount of the substance or when it was last taken.

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4. Immunoassay

Immunoassay is a qualitative method which indicates only the presence or absence of a drug/drug class in a sample. Each test by immunoassay has a defined cut-off level, above which the test is deemed positive  indicating that the presence of a drug/drug class was detected above the cut-off level. If a test result falls below the cut-off level, the result is deemed negative indicating that the drug/drug class was not detected above the cut-off. Cut- off levels are detailed on every test report

Legally defensible testing is carried out in accordance with European Workplace Drug Testing Society (EWDTS)

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5. Confirmation

In the event of a positive result, a confirmation test is able to definitively detect individual compounds by matching them to a commercially prepared reference standard using one of the following:

  • GC-MS (Gas Chromatography – Mass Spectrometry)
  • GC-MS/MS (Gas Chromatography – Tandem Mass Spectrometry)
  • LC-MS/MS (Liquid Chromatography – Tandem Mass Spectrometry)

Confirmation tests provide qualitative results of drugs and/or drug metabolites present in the sample.

Drugs are rapidly metabolised in the body to aid excretion and detection of the resulting metabolites indicates drug use by the donor. Sometimes it is only the metabolites that are positive in a confirmation test. For example, heroin is rapidly broken down to 6-monoacetylmorphine (6-MAM) and cocaine is rapidly broken down to benzoylecgonine. Detection of these metabolites demonstrates use of heroin and cocaine respectively. Only a confirmation test would allow the laboratory to make the distinction between illicit, prescription medicines or over the counter medication

Confirmation results are expressed as positive or negative and are legally defensible.

NOTE: There might be a delay of several week in getting a result back, especially if sent to Germany. We have no control over this process. This is worth bearing in mind should you need the result for a court case or job interview.

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6. Drug Cut-off & Retention Levels

Cut-off Levels

Standard cut-off levels mean that all laboratories and rapid drug tests should screen at the same level, so wherever a test is conducted, the client will be assessed by the same criteria and results from one region are easily comparable with those of another.

The cut-off levels are set at a point that is sufficiently high to rule out environmental contamination such as passive smoking of Cannabis, etc, and yet low enough to be sure that a client must have abstained from the drug to test negative.

Drug Screening Retention Times

Different drugs are detectable in urine for different lengths of time. Factors including age, height, sex, weight, purity of drug, dose, how often the drug is used, etc, will all play a role in how long drugs remain detectable in a patient’s urine sample. Please use the following figures purely as a guide, as the upper limit can represent extremes:

  • Alcohol (Breath/Saliva)  – 1 hour per unit consumed
  • Alcohol (Urine) EtG – 1 to 7 days
  • Amphetamines – 2 to 6 days – 1000 ng/ml
  • Barbiturates – 3 to 8 days –
  • Benzodiazepines – 2 to 14 days – 300 mg/ml
  • Cannabis (THC) – Typically 14 to 28 days but one-off use can be as little as 3 to 5 days – 50 ng/ml
  • Cocaine – 2 to 5 days – 300 ng/ml
  • K2 (Synthetic Cannabis)  1 to 3 days – 50 ng/ml
  • Ketamine – 2 to 5 days – 1000 ng.ml
  • MDMA (Ecstasy) – 2 to 6 days – 1000 ng/ml
  • Methadone – 2 to 7 days – 300 ng/ml
  • Methamphetamines – 2 to 6 days – 1000 ng/ml
  • Opiates – 2 to 5 days – 300 ng/ml for Morphine, 2000 ng/ml for Opiates/Heroin

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7. Drugs Tested

  1. Alcohol (EtG)
  2. Amphetamines (AMP)
  3. Barbiturates (BAR)
  4. Benzodiazepines (BZD)
  5. Cannabis (THC)
  6. Cocaine (COC)
  7. Ecstasy (MDMA)
  8. Fentanyl (FYL)
  9. Ketamine (KET)
  10. Methadone (MTD & EDDP)
  11. Methamphetamine (MET)
  12. Opiates/Morphine (MOR)
  13. Tramadol (TML)
  14. Tricyclics (TCA)

We routinely screen for all of these substances.

Testing for Alcohol Use

Alcohol is a drug. Ethyl Glucuronide (EtG) is a direct metabolite of ethanol. It can be detected after the elimination of alcohol from the body for several days. This increases the window of detection of alcohol use.

In a study of 117 samples carried out in the HSE laboratory, 33 samples were EtG positive indicating recent alcohol use. Only 7 of these screened positive for ethanol use. The detection rate of recent alcohol use with the ethanol assay was 6%. Using the EtG assay increased the detection rate of recent alcohol use to approximately 28%, an increase of 22%.

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8. Headshop Drugs of Abuse

While these are not routinely screened, you can request to have this done. These are the substances we can arrange to have tested. There will be a seperate charge for these, depending on the substance

2-Aminoindane
2-Fluoromethcathinone
2-Methylamphetamine
2-Phenethylamine
3-Fluoromethcathinone
3-Methiopropamine
3-Methylamphetamine
3-TFMPP
3,4 DMMC
3,4MD-N-benzylcathinone
4-EMC
4-Fluoroamphetamine
4-Fluoromethcathinone
4-MEC
4-Methylamphetamine
4-Methylmethamphetamine
5-APB
5-IAI
5-MeO Dalt
a-PVP
Amphetamine
Arecoline
B-Ethylmethcathinone
Benzedrone
Benzocaine
Benzoylecgonine
Buphedrone
Butylone
BZP
Caffeine
Camfetamine
Cathinone
Cocaine
Desoxypipradol
Dimethocaine
Dimethyl
Ethcathinone
Ethylecgonine
Ethylone
Fluorotropacocaine
Ketamine
Lidocaine
MBDB
mCPP
MDA
MDAI
MDAT
MDEA
MDMA
MDPBP
MDPV
Mephedrone
Methamphetamine
Methcathinone
Methedrone
Methoxetamine
Methylecgonidine
Methylone
MPBP
MPPP
N-Methyl-5 APB
N,N-4-trimethylcathinone
Naphyrone
p-FPP
p-Methoxyamphetamine
p-Methoxymethamphetamine
PCat
Pentedrone
Pentylone
Pseudoephedrine
Sildenafil
Synephrine

Note: Panel of drugs screened will change regularly and as required. If the substance you wish to have tested if not here, please contact us.

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9. Over the Counter Meds

Many over-the-counter and prescription-only medicines may contain compounds or derivatives of them which will lead to a fail. Some of the more common ones are listed below (this list is not exhaustive). If you are taking any medicines not listed here, or have in the past few week, please contact us for further advice. This is important.

  • Aspirin and Codeine Tablets BP
  • Benylin with Codeine
  • Boots Dental Pain Relief
  • Boots Tension Headache Relief
  • Co-codamol
  • Codafen Continus
  • Codeine Sulphate
  • Codis 500
  • Cyclimorph Injection
  • DF118
  • DHC Continus
  • Dihydrocodeine
  • Dimotane Co
  • Diocalm
  • Famel Original Cough Syrup
  • Feminax
  • J Collis Browne’s Mixture
  • J Collis Browne’s Tablets
  • Kapake
  • Migraleve
  • Migraleve Pink
  • Migraleve Yellow
  • MST Continus Suspension
  • MST Tablets
  • MXL Capsules
  • Nurofen Plus
  • Oramorph
  • Panadol Ultra
  • Paracodol
  • Paramol Tablets
  • Propain Tablets
  • Pulmo Bailly
  • Remedeine
  • Remedeine Forte Tablets
  • Robitussin Night-Time
  • Sevredol Oral Solution
  • Solpadeine
  • Solpadeine MAX
  • Solpadeine Oral Solution
  • Solpadol Capsules
  • Solpadol Effervescent
  • Solpadol Caplets
  • Solpaflex tablets
  • Syndol
  • Tylex Capsules
  • Tylex Effervescent
  • Veganin Tablets
  • Zomorph

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10. Opiate-based Drugs

The following substances will produce a positive result on an Opiate-based test and will result in a fail.

  • Codeine
  • Dihydrocodeine
  • Heroin
  • Morphine
  • Opium

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11. Workplace Random Testing

This would consist of visiting your workplace and carrying out random drug testing.

A urine collection area is set up so that anti-tampering procedures are in place. Also, the test kits used have built-in anti-adulteration properties. However, given that the testing will be random and unannounced this is usually not necessary as it takes time to prepare an adulterated or false urine sample.

WP Costs

1 to 10 tests

  • Unobserved: 50€ per test, inclusive
  • Observed: 65€ per test, inclusive
  • Chain-of-Custody: 95€ per test, inclusive

10 or more tests

  • Unobserved: 40€ per test, inclusive
  • Observed: 55€ per test, inclusive
  • Chain-of-Custody: 75€ per test, inclusive

Travel costs

This would be 0.50€ per Kilometer from the centre of Dublin using the shortest route on Google Maps.  Time spent in your premises is included in the cost of the test. There are no travel costs for testing in Dublin City

For example, a business in Kildare wishing to screen 10 employees: 10 tests @ 40€ = 400€,  Travel costs of 260 km (2×130) = 130€.  Total = 530€

(NOTE: this is based on no fails. Should someone test positive, then there would be an extra 95€ for Chain-of-Custody and lab expenses)

All test equipment and administration paperwork is provided by The Next Step. We only need exclusive access to a lockable bathroom or washroom with a WC for the duration of the testing and a lockable desk or office. This is to maintain chain-of-custody conditions.

All biohazard materials will be removed from your premises.

Legally defensible testing is carried out in accordance with European Workplace Drug Testing Society (EWDTS)

Terms

25% deposit and remainder within 7 days of completion of testing.

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12. Costs

Individual Testing

The cost of testing,  including all paperwork and test equipment.

  • Unobserved test: 55€
  • Observed test: 65€
  • Chain-of-Custody: 105€

Workplace or Corporate Testing

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13. Treatment Options

Failing a drug test can have major consequences to a person’s life. It can also be a sign that their lives might be spinning out of control and they need help.

At The Next Step, we are both accredited, qualified and experienced addictions counsellors and also psychotherapists. This means that we can put in place a range of interventions to help those who test positive. This can include a single coaching session, specialist addictions counselling, psychotherapy for what might be driving the substance use, all the way to a spell in rehab and 2 years aftercare.

I work in conjunction with Smarmore Castle, the best treatment centres in Ireland and the UK with decades of experience and a solid research base. Members of the following funds (including insured family members) can access treatment, free of charge:

  • VHI Healthcare
  • St Pauls Garda Medical Aid Society
  • Prison Officers Medical Aid Society
  • ESB Staff Medical Provident Fund

The Health & Safety Executive (HSE) will review applications for Cross Border Funding to Smarmore Castle’s founding hospital, Castle Craig, in the Scottish Borders – we can help you with this process.

Other private health insurance funds may contribute wholly or in part towards the cost of treatment.

NOTE: We do not receive any referral fee from Smarmore Castle. We work with them solely because of the evidence that they have an effective treatment programme.

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14. Laboratory Quality Control

Quality Control and Quality Assurance

To ensure the highest confidence in test results, the HSE laboratory we use adheres to strict quality control (QC) and quality assurance (QA) standards. (Approx. 3% of all samples run are quality controls).

In order to assess performance, the laboratory is involved in two external Quality Assurance schemes, the United Kingdom National External Quality Assessment Scheme (UKNEQAS) and the Irish External Quality Assessment Scheme (IEQAS).

Viewing of quality control data, proficiency testing data, and testing procedures will be accommodated on request by arrangement with the laboratory.

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15. Laboratory Accreditation

The laboratory we use is accredited by the Irish National Accreditation Board (INAB) to ISO/IEC17025. ISO/IEC 17025 is the main standard used by testing and calibration laboratories.The ISO/IEC 17025 standard is a quality system aimed at improving the ability to consistently produce valid results.

The two main aspects of ISO/IEC 17025 Accreditation are Management and Technical Requirements. Management requirements are primarily related to the operation and effectiveness of the quality management system within the laboratory, while technical requirements address the competence of staff, methodology and test/calibration equipment.

In order to maintain this high standard,the laboratory is assessed annually by a team of Irish and international external auditors. In 2012 we successfully applied to extend the scope of their accreditation to include drugs of abuse in oral fluids, Ethyl Glucuronide in urine and Cannabis confirmatory analysis in Urine.

Membership and Representation

To ensure best practice and to keep up to date with the latest developments and trends in drug misuse, laboratory staff have professional membership and attend meeting of various international societies, these include:-

  • ACBI – Association of Clinical Biochemists of Ireland
  • TIAFT – The International Association Forensic Toxicologists
  • SOFT – The Society of Forensic Toxicologists
  • UKIAFT – UK and Ireland Association of Forensic Toxicologist (

The laboratory is also represented at the Early Warning and Emerging Trends (EWET) committee of the National Advisory Committee on Drugs (NACD) LÁRIONAD NÁISIÚNTA CÓIREÁLA

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16. How to Book

Individual Testing

Go to OnLine Booking page where all available dates and times are shown. Then you can choose a suitable test, date and time and make a payment. The system will send an email and Text message confirmation plus a receipt for the test.

Workplace Testing

Please contact me on (01) 901 2678 and we can arrange a testing schedule for your business.

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