Choose the specimen matrix that fits your need: blood (now), oral fluid (very recent), urine (recent/clearance), or hair(weeks–months pattern). Alcohol-specific biomarkers (e.g., BAC, EtG/EtS, PEth, CDT) and supportive liver markers add context. Lab results help document use, adherence, and trends; they do not prove impairment, intent, exact dose, or exact timing. Always interpret with a qualified professional and follow your program’s policy.
Signs, Situations & Related Needs
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Workplace & safety: pre-employment, random, reasonable suspicion, post-incident, return-to-duty
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Clinical care: pain-management adherence, medication-assisted treatment (MAT), unexpected behaviors, potential interactions
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Treatment & recovery: abstinence documentation, relapse monitoring, counseling support
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Legal/compliance: court or custody orders, probation requirements, monitoring agreements
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When to seek urgent care: suspected overdose, severe sedation, chest pain, suicidal ideation, or signs of alcohol poisoning (confusion, vomiting, slow/irregular breathing)
All testing should be reviewed by a clinician, Medical Review Officer (MRO), or program administrator.
Why These Tests Matter
What testing can do
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Verify presence or absence of target substances and confirm specific drugs/metabolites
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Distinguish adherence vs. non-adherence and identify undisclosed use
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Provide objective trends to guide frequency of visits, counseling, or program steps
What testing cannot do
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Prove impairment, exact dose, or time since use
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Replace clinical judgment, chain-of-custody, or policy requirements
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Explain motive or context without additional information
What These Tests Measure (at a glance)
Alcohol
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BAC (blood alcohol concentration): alcohol now; hours-long window. Use: fitness/incident assessments. Caveat:declines rapidly—timing is critical.
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Urine Ethanol: very short window (hours). Use: very recent consumption.
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Urine EtG/EtS (ethyl glucuronide/sulfate): detects recent use after alcohol clears (typically 1–3 days, longer with heavy use). Caveat: low positives can follow incidental exposure; labs use cutoffs.
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PEth (phosphatidylethanol, whole blood): repeated/significant drinking over ~2–4 weeks. Use: pattern/relapse monitoring.
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CDT (carbohydrate-deficient transferrin): supports sustained heavy use (weeks).
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GGT, AST/ALT, MCV: indirect, not specific—clinical context only.
Drugs of Abuse / Controlled Medications
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Opioids & semisynthetics: morphine, codeine, 6-MAM (heroin), hydrocodone/hydromorphone, oxycodone/oxymorphone, fentanyl/norfentanyl, methadone/EDDP, buprenorphine/norbuprenorphine.
Use: adherence in pain/MAT; undisclosed opioid exposure; metabolite patterns verify biotransformation.*
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Stimulants: amphetamine/methamphetamine (± D/L isomer), MDMA/MDA, methylphenidate metabolites.
Use: clarify screen cross-reactivity; confirm specific stimulant.*
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Cocaine: benzoylecgonine (definitive exposure).
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Cannabinoids: THC-COOH (urine), parent THC (blood/oral fluid).
Use: matrix determines “recent vs residual” context.*
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Benzodiazepines: alprazolam/α-hydroxyalprazolam, clonazepam/7-aminoclonazepam, lorazepam, oxazepam, temazepam.
Note: many are glucuronidated—best detected by LC-MS/MS.*
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Other classes as ordered: barbiturates, PCP, synthetic opioids/novel psychoactives.
Specimen Validity (Urine)
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Creatinine, specific gravity, pH, oxidants/nitrites to detect dilution, substitution, or adulteration.
Typical Detection Windows (approximate; depend on dose, frequency, matrix, and cutoff)
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Blood: hours to ~1 day (current presence)
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Oral fluid: hours to ~1–2 days (very recent)
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Urine: ~1–3 days for many drugs; longer for THC with frequent use
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Hair: weeks–months (long-term pattern; not impairment)
How the Testing Process Works
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Define goal & window: “now” (blood/oral fluid), “recent” (urine/oral fluid), or “pattern” (hair; PEth for alcohol).
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Select matrix & panel: choose urine/oral fluid/blood/hair and drug classes per policy.
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Screen, then confirm: immunoassay screen first; LC-MS/MS or GC-MS confirmation for non-negative or policy-directed classes.
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Add validity (urine): creatinine, specific gravity, pH, oxidants to assess dilution/adulteration.
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Report & review: secure results list analytes, metabolites, levels (and validity metrics). Compare with medication list, timing, and program rules.
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Trend over time: repeat on a set schedule to document abstinence, adherence, or change.
Interpreting Results (General Guidance)
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Confirmed positive: analyte(s) at/above cutoff—review metabolite profile (e.g., norfentanyl for fentanyl, 6-MAMfor heroin) and prescriptions.
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Negative/below cutoff: not detected or under threshold—does not exclude use outside the window.
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Alcohol markers: BAC = current alcohol; EtG/EtS = recent exposure; PEth/CDT = repeated/heavy use; liver enzymes are supportive, not specific.
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Matrix matters: oral fluid/blood indicate recent use; urine shows clearance; hair shows long-term pattern.
Always interpret with clinical findings, timing, and policy.
Choosing Panels vs. Individual Tests
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Abstinence/recovery: EtG/EtS for recent alcohol; PEth (and/or CDT) for patterns; multi-drug panels with confirmation as needed.
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Workplace/safety programs: standard multi-drug screens with confirmation and chain-of-custody; include urine specimen validity.
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Pain management/MAT: targeted opioid ± benzodiazepine panels with key metabolites (EDDP, norbuprenorphine).
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Long-term pattern review: hair panels; pair with periodic urine/oral fluid for near-term checks.
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Unexpected screen results: expand to definitive LC-MS/MS confirmation; consider isomer testing for amphetamines.
FAQs
What’s the difference between a screen and a confirmation test?
A screen is a quick yes/no immunoassay; confirmation uses mass spectrometry to precisely identify and quantify drugs/metabolites.
Does a positive result prove impairment?
No. It shows presence above a cutoff, not impairment or exact timing.
Which specimen should I choose?
Match the window to the goal: blood (now), oral fluid (recent), urine (recent/clearance), hair (weeks–months).
Can prescriptions cause a positive screen?
Yes. That’s why confirmation distinguishes cross-reactivity from true positives.
How do I check alcohol over weeks, not hours?
Use PEth for repeated/heavy use patterns; EtG/EtS detects recent use after alcohol has cleared.
How do I detect nicotine use?
Cotinine is the primary marker; some programs add anabasine to help distinguish tobacco from nicotine replacement.
Internal Links & Cross-References
References
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Substance Abuse and Mental Health Services Administration (SAMHSA). Drug and alcohol testing guidance and cutoffs.
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U.S. Department of Transportation (DOT). Drug and alcohol testing program regulations.
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American Society of Addiction Medicine (ASAM). Appropriate use of drug testing in clinical addiction medicine.
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American Association for Clinical Chemistry (AACC). Definitive toxicology testing best practices (LC/GC-MS).
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College of American Pathologists (CAP). Toxicology standards and chain-of-custody considerations.
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Centers for Disease Control and Prevention (CDC). Alcohol and tobacco biomarkers—public health considerations.
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World Health Organization (WHO). Screening and laboratory testing principles for alcohol and drug use.
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ARUP Consult/clinical toxicology compendia. Detection windows, metabolite interpretation, and specimen validity.
Available Tests & Panels
Your All Drug & Alcohol Tests menu is pre-populated in the Ulta Lab Tests system. Use filters by goal and window: choose BAC for immediate status, EtG/EtS for recent alcohol use, PEth/CDT for patterns, and multi-drug screens with LC/GC-MS confirmation for definitive results. Include specimen validity for urine when needed, and review all results with your clinician, MRO, or program administrator.
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