Substance Monitoring

Substance monitoring uses lab tests to check for recent use, ongoing patterns, or abstinence from alcohol, drugs, and nicotine/tobacco. It supports clinical care (addiction treatment, pain management), workplace and safety programs, and legal/compliance needs. A proactive plan starts by matching your goal (now, recent, or long-term pattern) and detection window to the right test and specimen matrix (urine, oral fluid, blood, hair). Rapid immunoassay screens offer fast yes/no results; definitive confirmation by LC-MS/MS or GC-MS identifies the exact drug and metabolite at set cutoffs.

Lab results can confirm abstinence, verify adherence, and identify undisclosed use. They cannot prove impairment, intent, or exact dose/time. Always interpret results with a qualified professional and follow your program or workplace policy.

Signs, Situations & Related Needs

• Treatment & recovery: document abstinence, monitor relapse risk, support medication-assisted treatment (MAT)

• Pain management: verify adherence, detect risky combinations (e.g., opioids with benzodiazepines)

• Workplace/safety: pre-employment, random, post-incident, return-to-duty testing

• Legal/compliance: court or custody orders, probation, monitoring agreements

• Nicotine/tobacco: cotinine testing for cessation programs or pre-op planning

• Urgent care: suspected overdose, severe sedation, chest pain, suicidal ideation—seek immediate medical help
  All testing should be reviewed by a clinician, Medical Review Officer (MRO), or program administrator.

Why These Tests Matter

What monitoring can do

• Verify presence/absence of target substances and confirm specific analytes with metabolites

• Distinguish adherence vs. non-adherence and identify undisclosed use

• Provide objective trends over time to guide visit frequency, counseling, or program steps

What monitoring cannot do

• Prove impairment, exact dose, or time since use

• Replace clinical judgment, chain-of-custody procedures, or program policies

• Explain motive or context without additional information

What These Tests Measure (at a glance)

• Alcohol

  • BAC (blood alcohol concentration): alcohol now (hours window)

  • Urine EtG/EtS: metabolites detect recent use (~1–3 days, longer with heavy use)

  • PEth (whole blood): repeated/heavy use over ~2–4 weeks

  • CDT, GGT/AST/ALT/MCV: supportive liver/pattern markers (not alcohol-specific)

• Drugs of abuse / controlled meds

  • Opioids & semisynthetics: morphine, codeine, 6-MAM (heroin), hydrocodone/hydromorphone, oxycodone/oxymorphone, fentanyl/norfentanyl, methadone/EDDP, buprenorphine/norbuprenorphine

  • Stimulants: amphetamine/methamphetamine (± D/L isomer), MDMA/MDA, methylphenidate metabolites

  • Cocaine: benzoylecgonine, ecgonine methyl ester

  • Cannabinoids: THC-COOH (urine), parent THC (blood/oral fluid)

  • Benzodiazepines: alprazolam/α-hydroxyalprazolam, clonazepam/7-aminoclonazepam, lorazepam, oxazepam, temazepam (many are glucuronidated—best by LC-MS/MS)

  • Other classes as ordered: barbiturates, PCP, synthetic opioids/novel psychoactives

• Nicotine/Tobacco

  • Cotinine (blood/urine/saliva): nicotine exposure (hours–days)

  • Anabasine (optional): helps distinguish tobacco use from nicotine replacement in some protocols

• Specimen validity (urine): creatinine, specific gravity, pH, oxidants—to detect dilution or adulteration

Typical detection windows (vary by dose, frequency, matrix, and cutoff)

• Urine: ~1–3 days for many drugs; THC longer with frequent use

• Oral fluid: hours to ~1–2 days (very recent use)

• Blood: hours to ~1 day (current presence)

• Hair: weeks–months (long-term pattern; not impairment)

How the Testing Process Works

1. Define the goal & window: “now” (blood/oral fluid), “recent” (urine/oral fluid), or “pattern” (hair; PEth for alcohol)

2. Select the matrix & panel: choose urine/oral fluid/blood/hair and drug classes per policy

3. Screen, then confirm: run an immunoassay screen; perform LC/GC-MS confirmation for non-negative or policy-directed classes

4. Add validity (urine): creatinine, specific gravity, pH, oxidants to assess dilution/adulteration

5. Report & review: secure results list analytes, metabolites, levels (and validity metrics when applicable); compare with meds and program rules

6. Trend over time: schedule repeat testing to document abstinence, adherence, or change

Interpreting Results (General Guidance)

• Confirmed positive: analyte(s) at/above cutoff—review metabolite profile (e.g., norfentanyl with fentanyl, 6-MAM for heroin) and medication list

• Negative/below cutoff: not detected or under threshold—does not exclude use outside the detection window

• Alcohol markers: BAC = current alcohol; EtG/EtS = recent exposure; PEth/CDT = repeated/heavy use; liver markers add context but are not specific

• Matrix matters: oral fluid/blood reflect recent use; urine reflects clearance; hair shows long-term patterns
  Always interpret with clinical findings, timing, and program policy.

Choosing Panels vs. Individual Tests

• Abstinence/recovery programs: urine EtG/EtS (alcohol), PEth for patterns; add multi-drug panels with confirmation as needed

• Workplace/safety: standard multi-drug screens with confirmation and chain-of-custody; include specimen validity for urine

• Pain management/MAT: targeted opioid ± benzodiazepine panels including key metabolites (e.g., EDDP, norbuprenorphine)

• Nicotine cessation/pre-op: cotinine (± anabasine) per program protocol

• Long-term patterns: hair panels; pair with periodic urine/oral fluid for near-term checks

FAQs

What’s the difference between screening and confirmation?
Screening is a quick yes/no immunoassay; confirmation uses mass spectrometry to precisely identify and quantify drugs/metabolites.

Does a positive test prove impairment?
No. Results show presence above a cutoff, not impairment or exact timing.

Which specimen should I choose?
Match the window to your goal: blood (now), oral fluid (recent), urine (recent/clearance), hair (weeks–months).

Can prescriptions cause positive screens?
Yes. That’s why confirmation distinguishes cross-reactivity from true positives and verifies metabolite patterns.

How do I monitor 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 for nicotine/tobacco exposure; some programs add anabasine to differentiate from nicotine replacement.

Internal Links & Cross-References

• Drug & Alcohol Tests Hub

• Alcohol

• Drug Monitoring

• Drug Confirmation Test

• Drug Toxicology Monitoring

• Nicotine & Tobacco

• KEY LAB TESTS: EtG/EtS (Urine) • PEth (Blood) • Multi-Drug Screen (Urine/Oral Fluid) • LC-MS/MS Drug Confirmation • Hair Drug Panel • Cotinine (Nicotine) • Specimen Validity Panel

References

1. Substance Abuse and Mental Health Services Administration (SAMHSA). Drug and alcohol testing guidance and cutoffs.

2. U.S. Department of Transportation (DOT). Drug and alcohol testing program regulations.

3. American Society of Addiction Medicine (ASAM). Appropriate use of drug testing in clinical addiction medicine.

4. American Association for Clinical Chemistry (AACC). Definitive toxicology testing best practices (LC/GC-MS).

5. College of American Pathologists (CAP). Toxicology standards and chain-of-custody.

6. Centers for Disease Control and Prevention (CDC). Alcohol and tobacco biomarkers—public health considerations.

7. ARUP Consult/clinical toxicology compendia. Detection windows, metabolite interpretation, and specimen validity.

Available Tests & Panels

Your substance monitoring menu is pre-populated in the Ulta Lab Tests system. Select the matrix and panel that match your goal (abstinence, adherence, recent or long-term pattern), pair screening with LC/GC-MS confirmation when required, and include specimen validity for urine. Review all results with your clinician, MRO, or program administrator.

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