The Life Cycle of a U.S. Drug Test Part 1
Learn about the chain of events in the drug testing life cycle, including the various processes and potential issues that can impact turnaround times.
The vast majority of people who take a drug test when applying for jobs likely give it little thought after providing their sample until they receive the final report. But there’s a complex process in place designed to provide the results of that test in a fair and accurate manner – a process that anyone requiring or taking a drug test should understand.
To appreciate all that a drug test process entails, we’re presenting an overview of the life cycle of a drug test in the United States, from collection to delivery, to testing, to the end results.
While today’s testing capabilities are impressive, they haven’t evolved to the point where they can identify such granular details about a drug as when it was used or its exact provenance—and the results aren’t immediate. But the analytic product process can identify the specific drug and the quantitative amount within the specimen. On average, a laboratory-positive specimen is identified in four and a half days.
Let’s break down the process and discover what happens during that time.
Drug Testing Collection Process: An Initial Overview
The drug test begins during the initial encounter between the collector, who monitors the collection process and performs the initial specimen validity tests, and the donor (the candidate, driver, employee, or contractor), who provides the specimen. This process kicks off the external chain of custody, which includes documentation affirming that the collector has witnessed the collection process to the extent required and can positively identify the donor. It also includes affirmation from the donor, who attests that the collection process was not subverted, that the specimen was sealed in their presence, and that they consented to this testing.
This may seem simple, but there are numerous steps to the process that help ensure things run smoothly.
Step One: Collection
During the collection process, the first step is confirming the donor’s identity. This is typically done using either a photo ID or with positive identification by a verified employer representative. This assures that the person providing the specimen is the same as the person who is supposed to be tested. As the process is explained to the donor, it’s important that the collector does not ask about the donor’s medications, nor should the donor disclose any medication being taken. This helps ensure the confidentiality of the donor’s privileged medical information. For those concerned that a medication might produce a positive result, that issue will be handled by the Medical Review Officer during their interview with the donor.
With urine collections, the donor is typically asked to remove outer clothing and to leave those pieces, along with such personal items as purses or briefcases, outside the restroom. This reduces the likelihood of the use of concealed items or substances that could be used to tamper with or provide a subverted specimen. Should the donor not comply with this request, it’s generally considered a refusal to test.
Step Two: Collecting the Specimen
As the collector obtains the specimen, they’ll be watching for any unusual behavior on the part of the donor. During hair or oral fluid collection, both parties are in constant contact, which facilitates these observations. The collector will ensure that the quantity gathered is sufficient for each kind of test:
Hair collection will require a hair sample about the size of a large ballpoint pen, ideally taken from an inconspicuous area with hair longer than a half inch.
Oral fluid is collected in devices that have a volume indicator.
Urine samples require 30 cc of a single specimen, unless it’s a Department of Transportation (DOT) test, which then requires a split specimen with 45 cc (30 cc in one vial and 15 cc in another).
Step Three: Examining Potential Signs of Tampering
Since urine collections are obtained out of view of the collector, it’s important for the person administering the test to be aware of the general temperature of the specimen (anything that diverges wildly from 98 F is questionable, as there’s no reasonable explanation for a urine specimen to be below 90 F), and other signs of tampering, such as an unusual color, strange odor, or the presence of foreign objects or material.
If the collector suspects tampering, an immediate recollection will typically be conducted. For federal tests, those tests are performed under the observation of the collector. For non-federal tests, four states disallow observation during a urine sample collection: Connecticut, Maine, Oklahoma, and Rhode Island (note that those regulations don’t apply to federal tests in those states). Both tests are then sent to the lab for examination. If the donor will not provide a second sample, it’s generally considered a refusal to test.
Step Four: Determining A Refusal to Test
There are other actions that a donor can take that will result in a collector determining a refusal to test. These include, but aren’t limited to:
A donor failing to remain at the testing site once the testing process commences until the testing process is complete and the collector allows the donor to leave.
A donor refusing to empty their pockets when directed by the collector.
A donor behaving in a confrontational way that disrupts the collection process.
A donor failing to follow collector instructions.
A donor using a prosthetic or other device that could be used to interfere with the collection process.
Of course, there are valid times when a test must be cut short, and these will be duly noted by the collector. Perhaps the donor receives notice of an urgent family emergency or is instructed to leave by company management. While these situations are also deemed collector-determined refusals to test, the company is the ultimate adjudicator of these collector-determined results.
Another common reason for an incomplete test is known as the “shy bladder.” Sometimes the donor is simply unable to produce the required amount of urine, whether due to a physiological or psychological reason. When this occurs in federal testing, the donor must obtain an evaluation by a licensed physician. A medical explanation for a shy bladder must be an ascertainable physiological condition or a medically documented pre-existing psychological disorder. However, this does not include unsupported assertions of “situational anxiety” or dehydration. In non-federal testing situations, the requesting company should have policies in place for this situation. For example, employers may consider a policy that mimics the federal program or allows testing via an alternate specimen, such as hair.
Step Five: The Drug Testing Specimen in Transit
Once the specimen has been collected and a chain of custody established, the sealed specimen is given to a ground courier (which can be a national or regional courier, or one provided by one of the larger laboratories). The package is typically transferred to an air courier for ultimate delivery to the lab.
From time to time, there will be a delay in transit. Perhaps the collection site sent the specimen to the wrong lab or handed it off to the wrong courier. The specimen may have leaked in transit or been lost. For all specimens, unless the sample is completely lost, a delay is not fatal to the testing process. Oral fluid’s buffer lasts for at least two weeks, and there’s no issue with hair. But for urine samples, the pH will increase as the days between collection and testing increase, particularly when it’s hot. An increased pH can lead to invalid results. Overall, transit delays are responsible for an approximate 0.34% cancellation rate of tests.
In the upcoming second installment of this article, we’ll examine the remaining steps in a drug test, from lab testing to medical review.
For Applicants looking for more information about the status of their background check or need customer service, click here.
Release Date: February 22, 2023
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.