Although the addiction treatment field has a dizzying variety of treatment philosophies, centers, disciplines, specialists and options, one simple factor has been ubiquitous in treatment: the urine drug screen. Whether you’re running an inpatient detox with 200 beds or a small outpatient program with 15 clients, it is a given that you understand the importance of accurate and timely drug testing. A second widely accepted facet of drug testing for clinical applications is the role of the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal government’s agency that sets guidelines and oversees the treatment field.
SAMHSA guidelines delineate differing drug metabolite levels and the corresponding cutoffs to determine whether an individual is positive (meaning actively using) a substance, or exhibiting residual or trace amounts of a substance from previous use. The basic scientific premise behind a urine drug screen is that traces of the drug or compounds are left over after the person has ingested the drug, and are present in urine for varying lengths of time. A 12-panel drug testing cup has chemical compounds that bind to each specific drug metabolite and indicate the presence or absence of drug compounds with a color or marker for positive or negative. Each individual’s body metabolizes chemicals and substances differently, but SAMHSA sets out clear thresholds.
Metabolites are measured in nanograms per milliliter (ng/ml), and each testing product should have the ability to indicate the presence of adulterants or diluents. Exploring one specific drug class’s testing levels for a moment, heroin has a SAMHSA threshold of 2,000 ng/ml. This federally mandated threshold works quite well for establishing drug usage in a place of employment. For the addiction treatment field, however, this cutoff might be considered a somewhat lax standard. In a closed and therapeutic clinical setting, a client who shows positive for opiates but comes in below this threshold might be still be using.
Importance of flexibility
The factors that should go into the evaluation of each individual’s drug testing are numerous, considering such variables as previous usage history, individual metabolic rate, and the usage of medical detox drugs. But often SAMHSA guidelines can be too broad. While great for a bare minimum threshold, the guidelines need to be evaluated with a bent toward providing clinical treatment. Using SAMHSA-approved urine testing cups constitutes an excellent initial resource, but these have limitations that can hamper a treatment team’s ability to help patients optimally.
Using urine screening cups will indicate the presence of drug metabolites, and usually UA cups are designed to indicate these SAMHSA thresholds. For more in-depth and accurate results, it is suggested that clinicians use the services of a urinalysis lab or testing facility. The disposable one-time usage urinalysis cups are generally extremely accurate, yet there exists a very slight margin of error. This is compounded when clients are actively taking steps to avoid detection and attempt to alter drug screens through the use of maskers, adulterants and blockers. There is an entire industry around beating drug tests, so finding and obtaining these materials and resources is astoundingly simple.
The best tool for drug testing will always be qualified and certified laboratory analysis. Labs can actively monitor a client’s drug metabolite levels from intake all the way through treatment, and even into aftercare. With more resources available, programs can actively see drug metabolite levels declining (it is hoped) throughout treatment.
To use a simple metaphor, a drug testing cup is a yes-or-no answer. Lab testing is a yes-or-no answer with detailed explanations. The more sophisticated analysis also has close to zero margin for error, and can determine if masking agents or blockers have been introduced into a sample.
Between one-time drug testing products such as urine cups and cheek swabs or more sophisticated methods such as blood or urine analysis, treatment providers have more tools to assist those struggling with addictions. Just as there are many ways to get help and recover from addiction, there are a plethora of approaches to take when considering drug testing. Ensuring accurate results means that addicts and alcoholics will get the treatment and care that they deserve.
The choice is yours
The ultimate determinant as to what drug testing levels or standards you choose to uphold are up to each individual facility. Using SAMHSA guidelines is a fantastic starting resource, but it behooves treatment providers to have a discussion about what they want to consider the cutoff point for specific drug levels. The guidelines are exactly that—guidelines to establish parameters.
Gina Charneco is Vice President of Sales at Ultimate Analysis Cups, a Boca Raton, Fla.-based provider of drug screening devices. She has been with the company since 2012.