Editing Drug test (section)

==Types==

===Urine drug screen===
[[File:Urine_drug_screen.jpg|thumb|Example of a device used to screen urine for drugs. There is no line present at the [[benzodiazepine]] area, indicating a positive screen for this class of drugs. Other drugs, and the negative control (labelled "C"), are negative.]]
Urine analysis is primarily used because of its low cost. Urine drug testing is one of the most common testing methods used. The enzyme-multiplied immune test is the most frequently used urinalysis. Complaints have been made about the relatively high rates of false positives using this test.<ref>{{Cite book|title = Drug use and abuse: A comprehensive introduction|last = Abadinsky|first = H.|publisher = Wadsworth Cengage Learning|year = 2014|isbn = 9781285070278|location = Belmont|pages = 163–165}}</ref>

Urine drug tests screen the urine for the presence of a parent drug or its metabolites. The level of drug or its metabolites is not predictive of when the drug was taken or how much the patient used.<ref>{{Citation |last1=Verstraete |first1=Alain G. |title=Clinical Drug Testing |year=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK557523/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491455 |access-date=2022-10-21 |last2=Mukhdomi |first2=Taif |archive-date=July 5, 2024 |archive-url=https://web.archive.org/web/20240705030054/https://www.ncbi.nlm.nih.gov/books/NBK557523/ |url-status=live }}</ref>

Urine drug testing is an [[immunoassay]] based on the principle of competitive binding. Drugs which may be present in the urine specimen compete against their respective drug conjugate for binding sites on their specific antibody. During testing, a urine specimen migrates upward by capillary action. A drug, if present in the urine specimen below its cut-off concentration, will not saturate the binding sites of its specific antibody. The antibody will then react with the drug-protein conjugate and a visible colored line will show up in the test line region of the specific drug strip.<ref>{{Cite book |last1=Garrels |first1=Marti |url=https://books.google.com/books?id=LM9sBQAAQBAJ&dq=Urine+drug+testing+is+an+immunoassay+based+on+the+principle+of+competitive+binding.+Drugs+which+may+be+present+in+the+urine+specimen+compete+against+their+respective+drug+conjugate+for+binding+sites+on+their+specific+antibody.+During+testing%2C+a+urine+specimen+migrates+upward+by+capillary+action.&pg=PA289 |title=Laboratory and Diagnostic Testing in Ambulatory Care - E-Book: A Guide for Health Care Professionals |last2=Oatis |first2=Carol S. |date=2014-08-20 |publisher=Elsevier Health Sciences |isbn=978-0-323-29236-8 |language=en}}</ref>

A common misconception is that a drug test that is testing for a class of drugs, for example, [[opioids]], will detect all drugs of that class.  However, most opioid tests will not reliably detect [[oxycodone]], [[oxymorphone]], [[meperidine]], or [[fentanyl]].<ref>{{Cite journal|last1=Pesce|first1=Amadeo|last2=West|first2=Cameron|last3=Egan-City|first3=Kathy|last4=Strickland|first4=Jennifer|date=July 2012|title=Interpretation of Urine Drug Testing in Pain Patients|journal=Pain Medicine|language=en|volume=13|issue=7|pages=868–885|doi=10.1111/j.1526-4637.2012.01350.x|pmid=22494459|issn=1526-2375|doi-access=free}}</ref> Likewise, most [[benzodiazepine]] drug tests will not reliably detect [[lorazepam]].<ref>{{cite book |last1=Shaw |first1=Leslie M. |title=The Clinical Toxicology Laboratory: Contemporary Practice of Poisoning Evaluation |date=2001 |publisher=Amer. Assoc. for Clinical Chemistry |isbn=9781890883539 |page=216 |url=https://books.google.com/books?id=pXvFGqz44pYC&pg=PA216 |language=en}}</ref><ref>{{cite book |last1=Ries |first1=Richard K. |last2=Miller |first2=Shannon C. |last3=Fiellin |first3=David A. |title=Principles of Addiction Medicine |date=2009 |publisher=Lippincott Williams & Wilkins |isbn=9780781774772 |page=301 |url=https://books.google.com/books?id=j6GGBud8DXcC&pg=PA301 |language=en |access-date=May 27, 2020 |archive-date=January 12, 2023 |archive-url=https://web.archive.org/web/20230112235030/https://books.google.com/books?id=j6GGBud8DXcC&pg=PA301 |url-status=live }}</ref>  However, urine drug screens that test for a specific drug, rather than an entire class, are often available.

When an employer requests a drug test from an employee, or a physician requests a drug test from a patient, the employee or patient is typically instructed to go to a collection site or their home. The urine sample goes through a specified 'chain of custody' to ensure that it is not tampered with or invalidated through lab or employee error. The patient or employee's urine is collected at a remote location in a specially designed secure cup, sealed with tamper-resistant tape, and sent to a testing laboratory to be screened for drugs (typically the [[Substance Abuse and Mental Health Services Administration]] 5 panel). The first step at the testing site is to split the urine into two [[wikt:aliquot|aliquots]]. One aliquot is first screened for drugs using an analyzer that performs immunoassay as the initial screen. To ensure the specimen integrity and to detect possible adulterants, additional parameters are tested for.<ref>{{Cite web|url=https://sobercheck.co.nz/how-adulteration-works/|title=How adulteration works|date=October 11, 2021|access-date=October 22, 2021|archive-date=October 22, 2021|archive-url=https://web.archive.org/web/20211022034938/https://sobercheck.co.nz/how-adulteration-works/|url-status=live}}</ref> Some test the properties of normal urine, such as, [[Creatinine|urine creatinine]], pH, and [[specific gravity]]. Others are intended to catch substances added to the urine to alter the test result, such as, oxidants (including bleach),<ref>{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/32924786/|pmid = 32924786|year = 2021|last1 = Aydoğdu|first1 = M.|last2 = Akgür|first2 = S. A.|title = Urine drug-testing tampering approaches: Turkish probationers|journal = Medicine, Science, and the Law|volume = 61|issue = 1|pages = 6–13|doi = 10.1177/0025802420956453|issn=0025-8024|s2cid = 221720183}}</ref> nitrites,<ref>{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/30408836/|pmid = 30408836|year = 2019|last1 = Steuer|first1 = A. E.|last2 = Kamber|first2 = D.|last3 = Kraemer|first3 = T.|title = Evaluation of endogenous urinary biomarkers for indirect detection of urine adulteration attempts by five different chemical adulterants in mass spectrometry methods|journal = Drug Testing and Analysis|volume = 11|issue = 5|pages = 638–648|doi = 10.1002/dta.2539|s2cid = 53241111|access-date = October 22, 2021|archive-date = October 22, 2021|archive-url=https://web.archive.org/web/20211022033450/https://pubmed.ncbi.nlm.nih.gov/30408836/|url-status = live}}</ref> and gluteraldehyde.<ref>{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/27645818/|pmid = 27645818|year = 2016|last1 = Fu|first1 = S.|title = Adulterants in Urine Drug Testing|journal = Advances in Clinical Chemistry|volume = 76|pages = 123–163|doi = 10.1016/bs.acc.2016.05.003|isbn = 9780128046876|access-date = October 22, 2021|archive-date = October 22, 2021|archive-url=https://web.archive.org/web/20211022033448/https://pubmed.ncbi.nlm.nih.gov/27645818/|url-status = live}}</ref> If the urine screen is positive then another aliquot of the sample is used to confirm the findings by [[gas chromatography]]—[[mass spectrometry]] (GC-MS) or [[LC/MS|liquid chromatography - mass spectrometry]] methodology. If requested by the physician or employer, certain drugs are screened for individually; these are generally drugs part of a chemical class that are, for one of many reasons, considered more habit-forming or of concern. For instance, [[oxycodone]] and [[diamorphine]] may be tested, both [[sedative]] [[analgesics]]. If such a test is not requested specifically, the more general test (in the preceding case, the test for opioids) will detect most of the drugs of a class, but the employer or physician will not have the benefit of the identity of the drug.

Employment-related test results are relayed to a medical review office (MRO) where a medical physician reviews the results. If the result of the screen is negative, the MRO informs the employer that the employee has no detectable drug in the urine, typically within 24 hours. However, if the test result of the immunoassay and GC-MS are non-negative and show a concentration level of parent drug or metabolite above the established limit, the MRO contacts the employee to determine if there is any legitimate reason—such as a medical treatment or prescription.<ref>{{cite web|title=Medical Review Officer Manual|url=http://workplace.samhsa.gov/DrugTesting/pdf/MRO_Manual_2010_100908.pdf|publisher=SAMSHA Gov|url-status=dead|archive-url=https://web.archive.org/web/20130215084325/http://workplace.samhsa.gov/DrugTesting/pdf/MRO_Manual_2010_100908.pdf|archive-date=February 15, 2013|df=mdy-all}}</ref>

On-site instant drug testing is a more cost-efficient method of effectively detecting substance use amongst employees, as well as in rehabilitation programs to monitor patient progress.<ref>{{Cite book |last=Treatment |first=Center for Substance Abuse |url=https://www.ncbi.nlm.nih.gov/books/NBK64092/ |title=Appendix B. Urine Collection and Testing Procedures and Alternative Methods for Monitoring Drug Use |date=2006 |publisher=Substance Abuse and Mental Health Services Administration (US) |language=en |access-date=October 21, 2022 |archive-date=October 22, 2022 |archive-url=https://web.archive.org/web/20221022212713/https://www.ncbi.nlm.nih.gov/books/NBK64092/ |url-status=live }}</ref> These instant tests can be used for both urine and saliva testing. Although the accuracy of such tests varies with the manufacturer, some kits have rates of accuracy correlating closely with laboratory test results.<ref>{{Cite web |url=https://www.confirmbiosciences.com/knowledge/blog/everything-need-know-instant-drug-tests/ |title=Article in ''Confirm Biosciences'' |access-date=September 2, 2017 |archive-date=January 25, 2021 |archive-url=https://web.archive.org/web/20210125035217/https://www.confirmbiosciences.com/knowledge/blog/everything-need-know-instant-drug-tests/ |url-status=dead }}</ref>

===Breath test===
{{main article|Breathalyzer}}
[[File:Breathalyzer on citizen.jpg|thumb|204x204px|Breath test being used on a volunteer.]]
Breath test is a widespread method for quickly determining alcohol intoxication. A breath test measures the alcohol concentration in the body by a deep-lung breath. There are different instruments used for measuring the alcohol content of an individual though their breath. [[Breathalyzer]] is a widely known instrument which was developed in 1954 and contained chemicals unlike other breath-testing instruments.<ref>{{Cite book|title = Forensic science: From the crime scene to the crime lab.|last = Saferstein|first = R.|publisher = Pearson Education Inc.|year = 2013|isbn = 978-0131391871|location = Upper Saddle River|pages = 295–300}}</ref> More modernly used instruments are the infrared [[Spectrophotometry|light-absorption devices]] and [[fuel cell]] detectors, these two testers are microprocessor controlled meaning the operator only has to press the start button.

To get accurate readings on a breath-testing device the individual must blow for approximately 6 seconds and need to contain roughly 1.1 to 1.5 liters of breath. For a breath-test to result accurately and truly an operator must take steps such as avoiding measuring "mouth alcohol" which is a result from regurgitation, belching, or recent intake of an alcoholic beverage.<ref>{{Cite book|title = Forensic science: From the crime scene to the crime lab.|last = Saferstein|first = R.|publisher = Pearson Education|year = 2013|isbn = 978-0131391871|location = Upper Saddle River|pages = 295–303}}</ref> To avoid measuring "mouth alcohol" the operator must not allow the individual that's taking the test to consume any materials for at least fifteen minutes before the breath test. When pulled over for a driving violation if an individual in the United States refuses to take a breath test that individual's driver's license can be suspended for a 6 to 12 months time period.

===Hair testing===
{{main article|Hair analysis}}
Hair analysis to detect addictive substances has been used by court systems in the United States, United Kingdom, Canada, and other countries worldwide. In the United States, hair testing has been accepted in court cases as forensic evidence following the Frye Rule, the Federal Rules of Evidence, and the Daubert Rule. As such, hair testing results are legally and scientifically recognized as admissible evidence.<ref>{{Cite journal |last=Huestis |first=M. A. |year=1996 |title=Judicial acceptance of hair tests for substances of abuse in the United States courts: scientific, forensic, and ethical aspects |url=https://pubmed.ncbi.nlm.nih.gov/8857568/ |journal=Therapeutic Drug Monitoring |volume=18 |issue=4 |pages=456–459 |doi=10.1097/00007691-199608000-00025 |issn=0163-4356 |pmid=8857568 |access-date=October 21, 2022 |archive-date=October 21, 2022 |archive-url=https://web.archive.org/web/20221021172711/https://pubmed.ncbi.nlm.nih.gov/8857568/ |url-status=live }}</ref> Hair testing is commonly used in the USA as pre-employment drug test. The detection time for this test is roughly 3 months, which is the time, that takes head hair to grow ca. 1.5 inches, that are collected as a specimen. Longer detection times are possible with longer hair samples.

A 2014 collaborative US study of 359 adults with moderate-risk drug use found, that a large number of participants, who reported drug use in the last 3 months,  had negative hair tests. The tests were done using an [[immunoassay]] followed by a confirmatory [[GC-MS]].
For marijuana, only about half of self-disclosed users had a positive hair test. Under-identification of drug use by hair testing (or over-reporting) was also widespread for cocaine, amphetamines, and opioids. Because such under-identification was more common among participants, who self-reported an infrequent use, the authors suggested, that the immunoassay did not have the sensitivity required for such infrequent uses.<ref name="z300">{{cite journal | last1=Gryczynski | first1=Jan | last2=Schwartz | first2=Robert P. | last3=Mitchell | first3=Shannon Gwin | last4=O’Grady | first4=Kevin E. | last5=Ondersma | first5=Steven J. | title=Hair drug testing results and self-reported drug use among primary care patients with moderate-risk illicit drug use | journal=Drug and Alcohol Dependence | volume=141 | date=2014 | pmid=24932945 | pmc=4080811 | doi=10.1016/j.drugalcdep.2014.05.001 | pages=44–50}}</ref> It is worth noting, that most earlier studies reported, that hair tests found ca. 50-fold higher prevalence of illicit drug use, than self reports.<ref name="j960">{{cite journal | last1=Delaney-Black | first1=Virginia | last2=Chiodo | first2=Lisa M. | last3=Hannigan | first3=John H. | last4=Greenwald | first4=Mark K. | last5=Janisse | first5=James | last6=Patterson | first6=Grace | last7=Huestis | first7=Marilyn A. | last8=Ager | first8=Joel | last9=Sokol | first9=Robert J. | title=Just Say "I Don't": Lack of Concordance Between Teen Report and Biological Measures of Drug Use | journal=Pediatrics | volume=126 | issue=5 | date=2010-11-01 | issn=0031-4005 | pmid=20974792 | pmc=3508771 | doi=10.1542/peds.2009-3059 | pages=887–893}}</ref>

In late 2022 the US [[Federal Motor Carrier Safety Administration]] denied a petition to recognize hair samples as an alternative (to the currently used urine samples) drug-testing method for truckers. The agency did not comment on the test validity, but rather stated, that it lacks the statutory authority to adopt new analytical methods.<ref>{{Cite web |title=FMCSA denies petition for federal recognition of hair-sample drug testing {{!}} Safety+Health |url=https://www.safetyandhealthmagazine.com/articles/23411-fmcsa-denies-petition-for-federal-recognition-of-hair-sample-drug-testing |access-date=2023-11-16 |website=www.safetyandhealthmagazine.com |language=en |archive-date=October 30, 2023 |archive-url=https://web.archive.org/web/20231030144425/https://www.safetyandhealthmagazine.com/articles/23411-fmcsa-denies-petition-for-federal-recognition-of-hair-sample-drug-testing |url-status=live }}</ref>

Although some lower courts may have accepted hair test evidence, there is no controlling judicial ruling in either the federal or any state system declaring any type of hair test as reliable.

Hair testing is now recognized in both the UK and US judicial systems. There are guidelines for hair testing that have been published by the Society of Hair Testing (a private company in France) that specify the markers to be tested for and the cutoff concentrations that need to be tested. Addictive substances that can be detected include Cannabis, Cocaine, Amphetamines and drugs new to the UK such as Mephedrone.

====Alcohol====
In contrast to other drugs consumed, alcohol is deposited directly in the hair. For this reason the investigation procedure looks for direct products of ethanol metabolism. The main part of alcohol is oxidized in the human body. This means it is released as water and carbon dioxide. One part of the alcohol reacts with fatty acids to produce esters. The sum of the concentrations of four of these fatty acid ethyl esters (FAEEs: ethyl [[myristate]], [[ethyl palmitate]], [[ethyl oleate]] and ethyl [[stearate]]) are used as indicators of the alcohol consumption. The amounts found in hair are measured in nanograms (one nanogram equals only one billionth of a gram), however with the benefit of modern technology, it is possible to detect such small amounts. In the detection of [[ethyl glucuronide]], or EtG, testing can detect amounts in picograms (one picogram equals 0.001 nanograms).

However, there is one major difference between most drugs and alcohol metabolites in the way in which they enter into the hair: on the one hand like other drugs FAEEs enter into the hair via the [[keratinocytes]], the cells responsible for hair growth. These cells form the hair in the root and then grow through the skin surface taking any substances with them. On the other hand, the [[sebaceous glands]] produce FAEEs in the scalp and these migrate together with the sebum along the hair shaft (Auwärter et al., 2001, Pragst et al., 2004). So these glands lubricate not only the part of the hair that is just growing at 0.3&nbsp;mm per day on the skin surface, but also the more mature hair growth, providing it with a protective layer of fat.

FAEEs (nanogram = one billionth of a gram) appear in hair in almost one order of magnitude lower than (the relevant order of magnitude of) EtG (picogram = one trillionth of a gram). It has been technically possible to measure FAEEs since 1993, and the first study reporting the detection of EtG in hair was done by Sachs in 1993.<ref name="Kintz">{{cite book |author=Pascal Kintz |title=Analytical and practical aspects of drug testing in hair |url=https://books.google.com/books?id=IBBq180lUEAC&pg=PA305 |date=August 30, 2006 |publisher=CRC Press |isbn=978-0-8493-6450-1 |pages=305–}}</ref>

In practice, most hair which is sent for analysis has been cosmetically treated in some way (bleached, permed etc.). It has been proven that FAEEs are not significantly affected by such treatments (Hartwig et al., 2003a). FAEE concentrations in hair from other body sites can be interpreted in a similar fashion as scalp hair (Hartwig et al., 2003b).

===Presumptive substance testing===
Presumptive substance tests attempt to identify a suspicious substance, material or surface where traces of drugs are thought to be, instead of testing individuals through biological methods such as urine or hair testing. The test involves mixing the suspicious material with a chemical in order to trigger a color change to indicate if a drug is present. Most are now available over-the-counter for consumer use, and do not require a lab to read results.
[[File:Duquenois Reagent.jpg|thumb|174x174px|Duquenois reagent]]
Benefits to this method include that the person who is suspected of drug use does not need to be confronted or aware of testing.  Only a very small amount of material is needed to obtain results, and can be used to test powder, pills, capsules, crystals, or organic material. There is also the ability to detect illicit material when mixed with other non-illicit materials. The tests are used for general screening purposes, offering a generic result for the presence of a wide range of drugs, including Heroin, Cocaine, Methamphetamine, Amphetamine, Ecstasy/MDMA, Methadone, Ketamine, PCP, PMA, DMT, MDPV, and may detect rapidly evolving synthetic designer drugs. Separate tests for Marijuana/Hashish are also available.<ref>{{Cite web |title=Global Synthetic Drugs Assessment |url=https://www.unodc.org/documents/scientific/2014_Global_Synthetic_Drugs_Assessment_web.pdf |access-date=October 21, 2022 |archive-date=October 21, 2022 |archive-url=https://web.archive.org/web/20221021172713/https://www.unodc.org/documents/scientific/2014_Global_Synthetic_Drugs_Assessment_web.pdf |url-status=live }}</ref>

There are five primary color-tests reagents used for general screening purposes. The [[Marquis reagent]] turns into a variety of colors when in the presence of different substances. [[Dille–Koppanyi reagent|Dille-Koppanyi reagent]] uses two chemical solutions which turns a violet-blue color in the presence of barbiturates. [[Duquenois–Levine reagent|Duquenois-Levine reagent]] is a series of chemical solutions that turn to the color of purple when the vegetation of marijuana is added. [[Ehrlich's reagent|Van Urk reagent]] turns blue-purple when in the presence of LSD. [[Scott test]]'s chemical solution shows up as a faint blue for cocaine base.<ref>{{Cite book|title = Forensic science:From the crime scene to the crime lab|last = Saferstein|first = Richard|publisher = Pearson Education Inc|year = 2013|isbn = 978-0131391871|location = Upper Saddle River|pages = 271}}</ref>

In recent years, the use of presumptive test kits in the criminal justice system has come under great scrutiny due to the lack to forensic studies, questioned reliability, rendering of false positives with legal substances, and wrongful arrests.<ref>{{Cite web|url=https://www.nytimes.com/2016/07/10/magazine/how-a-2-roadside-drug-test-sends-innocent-people-to-jail.html|title=How a $2 Roadside Drug Test Sends Innocent People to Jail|last1=Gabrielson|first1=Ryan|last2=Sanders|first2=Topher|date=16 December 2016|website=The New York Times Magazine|archive-url=https://web.archive.org/web/20161206102939/http://www.nytimes.com/2016/07/10/magazine/how-a-2-roadside-drug-test-sends-innocent-people-to-jail.html|archive-date=6 December 2016}}</ref><ref>{{Cite web|url=https://www.propublica.org/article/common-roadside-drug-test-routinely-produces-false-positives|title=Tens of thousands of people every year are sent to jail based on the results of a $2 roadside drug test.|last1=Gabrielson|first1=Ryan|last2=Sanders|first2=Topher|date=7 July 2016|website=ProPublica.org|archive-url=https://web.archive.org/web/20190316153405/https://www.propublica.org/article/common-roadside-drug-test-routinely-produces-false-positives|archive-date=16 March 2019|access-date=16 March 2019}}</ref><ref>{{Cite web|url=https://www.cacj.org/documents/sf_crime_lab/studies__misc_materials/falsepositives.pdf|title=False Positives Equal False Justice|last=Kelly|first=John|year=2008|website=California Attorney General|archive-url=https://web.archive.org/web/20190316152146/https://www.cacj.org/documents/sf_crime_lab/studies__misc_materials/falsepositives.pdf|archive-date=16 March 2019|access-date=16 March 2019}}</ref>

===Saliva drug screen / Oral fluid-based drug screen===
[[Saliva]] / oral fluid-based drug tests can generally detect use during the previous few days. It is better at detecting very recent use of a substance. THC may only be detectable for 2–24 hours in most cases. On site drug tests are allowed per the Department of Labor.<ref>{{Cite journal |last1=Macdonald |first1=Scott |last2=Cherpitel |first2=Cheryl J. |last3=Stockwell |first3=Tim |last4=Martin |first4=Gina |last5=Ishiguro |first5=Sonya |last6=Vallance |first6=Kate |last7=Brubacher |first7=Jeff |date=2013-05-06 |title=Concordance of self-reported drug use and saliva drug tests in a sample of emergency department patients |url=http://dx.doi.org/10.3109/14659891.2012.760010 |journal=Journal of Substance Use |volume=19 |issue=1–2 |pages=147–151 |doi=10.3109/14659891.2012.760010 |pmid=25104914 |pmc=4120967 |issn=1465-9891}}</ref>

Detection in saliva tests begins almost immediately upon use of the following substances, and lasts for approximately the following times:

* [[Alcohol (drug)|Alcohol]]: 6-12 h<ref name="ReferenceC">{{Cite web|url=https://www.erowid.org/psychoactives/testing/testing_info1.shtml|archiveurl=https://web.archive.org/web/20100217023841/http://www.erowid.org/psychoactives/testing/testing_info1.shtml|url-status=dead|title=Erowid Drug Testing Vaults : The Basics|archivedate=February 17, 2010|website=www.erowid.org}}</ref>
* [[Marijuana]]: 1-24h

A disadvantage of saliva based drug testing is that it is not approved by FDA or SAMHSA for use with DOT / Federal Mandated Drug Testing.<ref>{{Cite web |title=Drug Testing Resources |url=https://www.samhsa.gov/workplace/drug-testing-resources |access-date=2022-10-21 |website=samhsa.gov |date=April 16, 2014 |language=en |archive-date=October 21, 2022 |archive-url=https://web.archive.org/web/20221021172713/https://www.samhsa.gov/workplace/drug-testing-resources |url-status=live }}</ref> Oral fluid is not considered a bio-hazard unless there is visible blood; however, it should be treated with care.

===Sweat drug screen===
Sweat patches are attached to the skin to collect sweat over a long period of time (up to 14 days).<ref name="Drug Test">{{cite web|url=http://aboutdrugtesting.org/drug_test.htm|title=Drug Test|year=2007|archive-url=https://web.archive.org/web/20071011043028/http://aboutdrugtesting.org/drug_test.htm|archive-date=2007-10-11|website=aboutdrugtesting.org}}</ref> These are used by child protective services, parole departments, and other government institutions concerned with drug use over long periods, when urine testing is not practical.<ref>{{cite web|url=http://stopthedrugwar.org/chronicle-old/167/thepatch.shtml|title=Federal Court Drug-Testing Device Under Fire, PharmChem Sweat Patch May Be "Too Good"|date=January 5, 2001|access-date=January 18, 2008|archive-date=May 3, 2008|archive-url=https://web.archive.org/web/20080503094811/http://stopthedrugwar.org/chronicle-old/167/thepatch.shtml|url-status=live}}</ref>

There are also surface drug tests that test for the metabolite of parent drug groups in the residue of drugs left in sweat. An example of a rapid, non-invasive, sweat-based drug test is fingerprint drug screening.<ref>{{Cite web|title=Clearing The Haze: Intelligent Fingerprinting Drug Screening with Dr. Paul Yates _049 on Apple Podcasts|url=https://podcasts.apple.com/us/podcast/intelligent-fingerprinting-drug-screening-dr-paul-yates/id1479292049?i=1000493620251|access-date=2021-04-14|website=Apple Podcasts|language=en-us|archive-date=April 14, 2021|archive-url=https://web.archive.org/web/20210414123505/https://podcasts.apple.com/us/podcast/intelligent-fingerprinting-drug-screening-dr-paul-yates/id1479292049?i=1000493620251|url-status=live}}</ref> This 10 minute fingerprint test<ref>{{Cite news|first=Oliver|last=Moody|title=New device can sniff out the weekend drug-takers|newspaper=[[The Times]]|language=en|url=https://www.thetimes.com/uk/society/article/new-reader-1000-device-can-sniff-out-the-weekend-drug-takers-intelligent-fingerprinting-sheffield-medico-legal-centre-rzwzq27gf|access-date=2021-04-14|issn=0140-0460|archive-date=April 14, 2021|archive-url=https://web.archive.org/web/20210414123506/https://www.thetimes.co.uk/article/new-reader-1000-device-can-sniff-out-the-weekend-drug-takers-intelligent-fingerprinting-sheffield-medico-legal-centre-rzwzq27gf|url-status=live}}</ref> is in use by a variety of organisations in the UK and beyond, including within workplaces,<ref>{{Cite web|date=2021-02-25|title=Keepmoat Homes deploys fingerprint drug testing for plant operator Health & Safety|url=https://www.bdcmagazine.com/2021/02/health-safety-environmental/occupational-hs/keepmoat-homes-deploys-fingerprint-drug-testing-for-plant-operator-health-safety/|access-date=2021-04-14|website=BDC Magazine|language=en-GB|archive-date=February 25, 2021|archive-url=https://web.archive.org/web/20210225203357/https://www.bdcmagazine.com/2021/02/health-safety-environmental/occupational-hs/keepmoat-homes-deploys-fingerprint-drug-testing-for-plant-operator-health-safety/|url-status=live}}</ref><ref>{{Cite web|title=Vantec Europe introduces Intelligent Fingerprinting drug tests|url=https://www.commercialfleet.org/news/latest-news/2021/03/18/vantec-europe-introduces-intelligent-fingerprinting-drug-tests|access-date=2021-04-14|website=commercialfleet.org|language=en|archive-date=April 14, 2021|archive-url=https://web.archive.org/web/20210414123507/https://www.commercialfleet.org/news/latest-news/2021/03/18/vantec-europe-introduces-intelligent-fingerprinting-drug-tests|url-status=live}}</ref> drug treatment and family safeguarding services<ref>{{Cite web|title=Introducing intelligent fingerprinting – better, safer drug testing {{!}} Change Grow Live|url=https://www.changegrowlive.org/about-us/news-views/intelligent-fingerprint-testing|access-date=2021-04-14|website=www.changegrowlive.org|language=en|archive-date=April 14, 2021|archive-url=https://web.archive.org/web/20210414123506/https://www.changegrowlive.org/about-us/news-views/intelligent-fingerprint-testing|url-status=live}}</ref><ref>{{Cite web|last=Attias|first=Julia|date=2019-09-03|title='Revolutionary' drug test can tell if you're intoxicated from just a fingerprint|url=https://www.mirror.co.uk/science/revolutionary-drug-test-can-tell-19321447|access-date=2021-04-14|website=mirror|language=en}}</ref> at airport border control (to detect drug mules)<ref>{{Cite web|title=Fingerprint-based drug test accelerates identification of drug mules|url=https://www.internationalairportreview.com/news/96347/fingerprint-drug-testing/|access-date=2021-04-14|website=International Airport Review|language=en|archive-date=April 14, 2021|archive-url=https://web.archive.org/web/20210414123506/https://www.internationalairportreview.com/news/96347/fingerprint-drug-testing/|url-status=live}}</ref> and in mortuaries to assist in investigations into cause of death.<ref>{{Cite web|last=SelectScience|title=Revolutionary Fingertip Drug Test Aids Forensic Toxicology {{!}} SelectScience|url=http://www.selectscience.net/product-news/revolutionary-fingertip-drug-test-aids-forensic-toxicology/?artID=44551|access-date=2021-04-14|website=www.selectscience.net}}</ref>

===Blood===
Drug-testing a blood sample measures whether or not a drug or a metabolite is in the body at a particular time. These types of tests are considered to be the most accurate way of telling if a person is intoxicated. Blood drug tests are not used very often because they need specialized equipment and medically trained administrators.

Depending on how much marijuana was consumed, it can usually be detected in blood tests within six hours of consumption. After six hours has passed, the concentration of marijuana in the blood decreases significantly. It generally disappears completely within 30 days.

===Random drug testing===
Can occur at any time, usually when the investigator has reason to believe that a substance is possibly being used by the subject by behavior or immediately after an employee-related incident occurs during work hours. Testing protocol typically conforms to the national medical standard, candidates are given up to 120 minutes to reasonably produce a urine sample from the time of commencement (in some instances this time frame may be extended at the examiner's discretion).

===Diagnostic screening===
In the case of life-threatening symptoms, unconsciousness, or bizarre behavior in an emergency situation, screening for common drugs and toxins may help find the cause, called a ''toxicology test'' or ''tox screen'' to denote the broader area of possible substances beyond just self-administered drugs. These tests can also be done post-mortem during an autopsy in cases where a death was not expected. The test is usually done within 96 hours (4 days) after the desire for the test is realized. Both a urine sample and a blood sample may be tested.<ref name=webmd>[http://firstaid.webmd.com/toxicology-tests WebMD --> Toxicology Tests] {{Webarchive|url=https://web.archive.org/web/20120115101950/http://firstaid.webmd.com/toxicology-tests |date=January 15, 2012 }} </ref> A blood sample is routinely used to detect [[ethanol]]/[[methanol]] and [[Acetylsalicylic acid|ASA]]/[[paracetamol]] intoxication. Various panels are used for screening urine samples for common substances, e.g. ''triage 8'' that detects [[amphetamines]], [[benzodiazepine]]s, [[cocaine]], [[methadone]], [[opiates]], cannabis, [[barbiturates]] and [[tricyclic antidepressants]].<ref>{{Cite web|url=http://www.surrey.ac.uk/MDA/Pages/GuildfordEvaluations/PreviousReports/Reports/Drugs%20of%20abuse%20report.htm|archiveurl=https://web.archive.org/web/20110811080853/http://www.surrey.ac.uk/MDA/Pages/GuildfordEvaluations/PreviousReports/Reports/Drugs%20of%20abuse%20report.htm
|url-status=dead|title=Sixteen devices for the detection of drugs of abuse in urine|archivedate=August 11, 2011}}</ref> Results are given in 10–15 min.

Similar screenings may be used to evaluate the possible use of [[date rape drug]]s. This is usually done on a urine sample.<ref name=webmd/>

===Optional harm reduction scheme===
[[Drug checking|Drug checks/tests]] (also known as pill testing) are provided at some events such as concerts and music festivals. Attendees can voluntarily hand over a sample of any drug or drugs in their possession to be tested to check what the drug is and its purity. The scheme is used as a [[harm reduction]] technique so people are more aware of what they are taking and the potential risks.<ref>{{cite news |last= Moodie |first= Kim |date= 18 December 2019 |title= Govt to back research on drug-checking programmes at music festivals |url=https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12295114 |work= The New Zealand Herald |access-date= 23 December 2019 |archive-date= December 23, 2019 |archive-url=https://web.archive.org/web/20191223225112/https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12295114 |url-status= live }}</ref><ref>{{cite news |date= 22 May 2017 |title= Six UK music festivals are to allow drug testing including Reading and Leeds |url=http://www.bbc.co.uk/newsbeat/article/39996522/six-uk-music-festivals-are-to-allow-drug-testing-including-reading-and-leeds |work= BBC Newsbeat |access-date= 23 December 2019 |archive-date= December 24, 2019 |archive-url=https://web.archive.org/web/20191224011313/http://www.bbc.co.uk/newsbeat/article/39996522/six-uk-music-festivals-are-to-allow-drug-testing-including-reading-and-leeds |url-status= live }}</ref><ref>{{cite news |date= 3 September 2018 |title= Thousands of people use drug-testing facilities at UK music festivals |url=https://www.bbc.co.uk/news/uk-england-45367810 |work= BBC News |access-date= 23 December 2019 |archive-date= December 24, 2019 |archive-url=https://web.archive.org/web/20191224011308/https://www.bbc.co.uk/news/uk-england-45367810 |url-status= live }}</ref>

===Occupational harm reduction strategies===
Drug and alcohol impairment while at work increases the risk of work-place accidents and decreases productivity. Employers such as the commercial driving and airline industry may conduct random drug tests on employees with the goal of deterring use to improve safety.<ref>{{Cite journal|last1=Akanbi|first1=Maxwell O.|last2=Iroz|first2=Cassandra B.|last3=O'Dwyer|first3=Linda C.|last4=Rivera|first4=Adovich S.|last5=McHugh|first5=Megan Colleen|date=January 2020|title=A systematic review of the effectiveness of employer-led interventions for drug misuse|journal=Journal of Occupational Health|volume=62|issue=1|pages=e12133|doi=10.1002/1348-9585.12133|issn=1348-9585|pmc=7293184|pmid=32533807}}</ref> There is some evidence that increasing the use of random drug testing in the airline industry reduces the percentage of people who test positive, however, it is unclear if this decrease is associated with a corresponding decrease in fatal or non-fatal injuries, other accidents, number of days absent from work.<ref name=":0">{{Cite journal|last1=Els|first1=Charl|last2=Jackson|first2=Tanya D.|last3=Milen|first3=Mathew T.|last4=Kunyk|first4=Diane|last5=Wyatt|first5=Graeme|last6=Sowah|first6=Daniel|last7=Hagtvedt|first7=Reidar|last8=Deibert|first8=Danika|last9=Straube|first9=Sebastian|date=2020-12-27|title=Random drug and alcohol testing for preventing injury in workers|journal=The Cochrane Database of Systematic Reviews|volume=2020|issue=12|pages=CD012921|doi=10.1002/14651858.CD012921.pub2|issn=1469-493X|pmc=8130990|pmid=33368213}}</ref> It is also not clear if there are other unwanted side effects that may result from random drug and alcohol testing in the workplace.<ref name=":0" />