Data-Driven Drug Testing: Should You Reevaluate Your Screening?
Learn how to balance compliance, safety, and cost-effectiveness in the evolving landscape of your drug free workplace program; including antiquated drugs, potential add-ons, and how to leverage POCT testing.
Employers across industries are reconsidering which drugs to include or exclude in their screening programs. Whether it’s changes in state and federal regulations, shifting societal norms, or the need for more efficient workforce management, organizations are being prompted to take a fresh look at what's necessary.
Drug Testing Panels and Add-ons
The use of the standard 5,7,9, and 10 panel testing is common. However, the evolution of drug testing panels continues with past analytics and emerging substances of abuse. Same goes for testing specimens, with urine being the most common. Some alternate, but also common, specimens can be hair or oral fluid. Both can be used to test for amphetamines, cocaine, delta-9 THC, opiates, and extended opioids.
Methaqualone and Propoxyphene are considered antiquated drugs that persist on standard panels. Methaqualone is a sedative-hypnotic drug with pharmacological effects that was discontinued in 1984. There have been no lab positives for years. In fact, Quest Diagnostics removed it from its standard panels. Propoxyphene is an opioid that was banned for medical purposes by the FDA in 2010 and has had a lab positive rate of 0.000% over the last 5 years.
As for potential add-on analytes, consider fentanyl and synthetic cannabinoids. In July 2025, HHS added fentanyl and its metabolite, norfentanyl, to the federal drug testing panel. As of now, the addition of fentanyl is solely for U.S. government employees, not including the DOT. Synthetic cannabinoids are not one drug, but instead hundreds of different synthetic cannabinoid chemicals that act on the same brain cell receptors as tetrahydrocannabinol (THC). The US federal government has classified many as Schedule 1 substances.
Urine-specific add-ons can include extended opioids, MDMA/MDA, psychedelics, and kratom. Oral fluid-specific add-ons can include benzodiazepines. This means that employment drug screening can be customized and altered to match your business’s specific needs and help keep your screening up to date with the evolving landscape around testing.
Point of Collection Testing (POCT) Testing
There’s also a rise in popularity of POCT testing. POCT is simply moving the initial immunoassay test from the laboratory and having it done at the time of testing, either in a clinic or onsite. The initial screening process does not measure the specific amount of drugs present in the sample, instead just providing either a negative or a presumptive positive result.
Immunoassay tests are highly sensitive, but they are not as highly specific. This means that due to cross reactivity, there are specimens that are presumptively positive that do not have the drug present. False positive results are a known issue with POCT. However, confirmation testing helps address this.
Confirmation testing at an accredited lab utilizing chromatographic/mass spectrometry helps eliminate the false positive issue. Typical best practice, as well as many state statutes, require confirmation testing on an immunoassay presumptive positive result. Both urine and oral fluid are specimens supported by POCT, with multiple test panels available for each.
Regulatory Considerations
While revisiting your drug screening program, it's critical to keep legal and regulatory considerations in mind. This goes for panel selection, specimen selection, and the reason for the test. For example, some states restrict testing for delta-9 THC, apart from reasonable suspicion. Knowing what’s universally allowed and accepted in terms of drug screening and understanding your state and federal laws and regulations is important when reevaluating your screening program.
Also consider state-level regulations for point of collection testing. There are unique cases where POCT is allowed with special certifications, eReaders, or restricted to only pre-employment use.
Drug Screening Best Practices Based on Business Goals
Identifying your business’ goals can also be a factor in reevaluating your screening program. As part of informed decision making, consider ranking priorities around the speed-to-hire, cost, return on investment (ROI), and ease of administration. If increasing your speed-to-hire is a high priority, consider POCT for quicker results, and limit your panel for routine testing. If cost is a considerable factor, consider self-collection.
If you are looking to yield a higher ROI, consider alternate specimens or adding suggested add-ons for post-accident and reasonable suspicion testing; where permitted by law in your geographic area. As for ease of administration, clinic collected urine is typically easiest.
The landscape around drug screening will continue to change and making the decision to adjust your screening program along with it can be beneficial. Whether it's alternate testing panels, add-ons, changes in specimen selection, or utilizing POCT, considering regulations and your unique business goals can help direct you and your program forward.
Watch our on-demand webinar, hosted by Dr.Simo, where all this plus more is discussed.
Release Date: October 7, 2025
Dr. Todd Simo
Dr. Todd Simo currently serves as the Chief Medical Officer and Managing Director of Transportation at HireRight. He came to HireRight with a decade of experience in the medical consulting arena. Prior to HireRight, he was the Medical Director of an occupational health clinic in Virginia and owned a consulting firm providing medical director service to multiple companies located throughout the country. In that capacity, he established multiple customer specific health and drug screening services. In his current position, he oversees HireRight's medical department.