All Drug and Alcohol Tests

This page brings together all drug and alcohol testing options so you can match the right test window to your testing goal—whether that’s immediate status, recent use, long-term pattern, adherence, or abstinence. A proactive plan uses a screen-then-confirm approach: fast immunoassay screens for broad classes, followed by definitive confirmation with LC-MS/MS or GC-MS when results are non-negative or policy requires it.

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

• Workplace & safety: pre-employment, random, reasonable suspicion, post-incident, return-to-duty

• Clinical care: pain-management adherence, medication-assisted treatment (MAT), unexpected behaviors, potential interactions

• Treatment & recovery: abstinence documentation, relapse monitoring, counseling support

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

• 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

• Verify presence or absence of target substances and confirm specific drugs/metabolites

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

• Provide objective trends to guide frequency of visits, counseling, or program steps

What testing cannot do

• Prove impairment, exact dose, or time since use

• Replace clinical judgment, chain-of-custody, or policy requirements

• Explain motive or context without additional information

What These Tests Measure (at a glance)

Alcohol

• BAC (blood alcohol concentration): alcohol now; hours-long window. Use: fitness/incident assessments. Caveat:declines rapidly—timing is critical.

• Urine Ethanol: very short window (hours). Use: very recent consumption.

• 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.

• PEth (phosphatidylethanol, whole blood): repeated/significant drinking over ~2–4 weeks. Use: pattern/relapse monitoring.

• CDT (carbohydrate-deficient transferrin): supports sustained heavy use (weeks).

• GGT, AST/ALT, MCV: indirect, not specific—clinical context only.

Drugs of Abuse / Controlled Medications

• 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.*

• Stimulants: amphetamine/methamphetamine (± D/L isomer), MDMA/MDA, methylphenidate metabolites.
  Use: clarify screen cross-reactivity; confirm specific stimulant.*

• Cocaine: benzoylecgonine (definitive exposure).

• Cannabinoids: THC-COOH (urine), parent THC (blood/oral fluid).
  Use: matrix determines “recent vs residual” context.*

• Benzodiazepines: alprazolam/α-hydroxyalprazolam, clonazepam/7-aminoclonazepam, lorazepam, oxazepam, temazepam.
  Note: many are glucuronidated—best detected by LC-MS/MS.*

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

Specimen Validity (Urine)

• Creatinine, specific gravity, pH, oxidants/nitrites to detect dilution, substitution, or adulteration.

Typical Detection Windows (approximate; depend on dose, frequency, matrix, and cutoff)

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

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

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

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

How the Testing Process Works

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

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

3. Screen, then confirm: immunoassay screen first; LC-MS/MS or 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). Compare with medication list, timing, and program rules.

6. Trend over time: repeat on a set schedule to document abstinence, adherence, or change.

Interpreting Results (General Guidance)

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

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

• Alcohol markers: BAC = current alcohol; EtG/EtS = recent exposure; PEth/CDT = repeated/heavy use; liver enzymes are supportive, not specific.

• 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

• Abstinence/recovery: EtG/EtS for recent alcohol; PEth (and/or CDT) for patterns; multi-drug panels with confirmation as needed.

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

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

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

• 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

• Drug & Alcohol Tests Hub

• Alcohol

• Drug Monitoring

• Drug Confirmation Test

• Drug Toxicology Monitoring

• Nicotine & Tobacco

• Pain Management

• KEY LAB TESTS: BAC • EtG/EtS • PEth • CDT • Multi-Drug Screen (Urine/Oral Fluid) • LC-MS/MS Drug Confirmation • Hair Drug Panel • Cotinine • 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 considerations.

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

7. World Health Organization (WHO). Screening and laboratory testing principles for alcohol and drug use.

8. 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.