Testimony submitted by Jill F Captain, MD, MPH
Representative of Drug and Alcohol Testing Industry Association (DATIA)
Regarding: Devices and products used to subvert drug test results
DATIA supports a federal solution to ending the manufacture, sale and distribution of products meant to thwart a drug test.
The piecemeal approach of individual states attempts to punish the sellers and users of products is inadequate. E-commerce has perpetuated the distribution of these products and further impaired the ability of law enforcement agencies to track down violators.
These products pose a public safety risk and impose a serious financial burden on American businesses.
More than 12 million employees are subject to mandatory drug testing under the Department of Transportation (DOT) guidelines. These employees are in safety-sensitive positions including truck drivers, airline pilots, bus drivers, mass transit operators, railroad engineers, pipeline workers, mariners and related personnel in safety sensitive positions. Each drug user who successfully evades testing using these products poses a serious safety risk to the public.
The burden to American businesses to detect the use of these products is substantial in terms of tardiness, absenteeism, workers’ compensation benefits, health benefit utilization and employee turnover. Companies implement drug free workplace programs that include drug testing to help keep these costs down and keep their employees safe.
As new products meant to evade drug testing flood the market, laboratories must develop and utilize new detection technologies. These costs are passed on to the employer.
The DOT published their guidelines for drug and alcohol testing in 1991. From those guidelines, DATIA has developed industry standards that promote the integrity of the entire drug testing process. From ensuring the privacy of donors, the security of the collection process, chain of custody trails, verification of accurate reports and protecting employees from flawed interpretation of results, DATIA has provided standards and training to ensure a sound testing process.
As a representative of DATIA, I can outline the processes the drug testing industry uses to ensure a safe and legitimate drug testing program, and what steps are included to prevent or detect the use of products meant to subvert the test.
I’m happy to present an overview of a typical urine drug screen collection regulated by the Department of Transportation (this scenario does not include every step but outlines the essential elements):
Securing the collection site
- The bathroom has no water supply available to the donor
- Excess equipment such as trash cans are removed from the room (prevents concealment of products place in the bathroom before the collection takes places)
- The water in the toilet has bluing agent added
Collection process:
- The donor is asked to remove extra outer garments such as jackets, coats or coveralls and heavy boots
- Photo identification is required and checked
- The donor is asked to empty pockets to check for bottles that might contain liquids or containers of substances that might be used to adulterate specimens
- The donor then washes his/her hands
- The collector opens a sealed collection container and hands it to the donor
- The donor is instructed to urinate in the container
- The donor is allowed to enter the bathroom and shut the door, if the donor flushes the toilet, the collection process will start over
- When the donor exits the bathroom, the collection container has a temperature strip and the temperature of the specimen must be within 90 to 100 degrees Fahrenheit (this is to detect the addition of water or other liquid)
- The collector observes the specimen for color and odor (the human check for adulterants)
- The collector then pours the urine into 2 separate containers. Each container is sealed with a label and the donor initials each label. Two containers are used to hold the original specimen. One container is designated bottle A and used for testing. The second container is designated bottle B and reserved if a donor wishes to challenge a result, this challenge is called “split testing”.
Paperwork (aka chain of custody):
- The chain of custody form is a multipart carbonless form. Each page is barcoded and the sealing labels of the urine containers (these labels are part of the top page) have the same barcode
- The donor’s name and identification number is printed. The donor also signs this form. Additionally, the date of birth and contact telephone numbers are printed.
- The form that goes to the laboratory has only the id number and no other donor identifying information.
- Additional info on the chain of custody includes the collector’s name and signature, the date and time of the collection, the company name and contact information and the method of transportation of the specimen to the lab.
- When the paperwork is complete, the specimens and one copy of the form are sealed in a tamper evident bag for shipping.
- The donor is given a copy of the chain of custody.
Laboratory processing (this process can be more properly explained by a representative of a SAMHSA-certified lab):
- When the specimen arrives at the lab, the paperwork and specimen bottles are checked to ensure they match.
- The specimen undergoes validity testing (specific gravity, pH and creatinine) this is to ensure that the specimen is consistent with human urine.
- Adulterant testing is done if requested (not currently required under DOT regulations and costs approximately 10% more).
- If these tests are cleared, then the specimen is subjected to a screening test for 5 drugs: cocaine, opiates, PCP, marijuana, amphetamines.
- If the screening test is positive, the sample undergoes a confirmation test using a different technology that is highly specific. If that test is confirmed, the test is considered positive at the lab level.
Medical Review:
- All test results regulated by DOT must be received in the office of a Medical Review Officer (MRO, who must be a licensed MD with additional certification)
- When a non-negative result is received, the lab result is matched to a copy of the chain of custody to eliminate clerical errors.
- The donor is contacted by the MRO to investigate the possibility of a legitimate medical explanation. For instance, if a donor can a result positive for opiates if he/she took Tylenol with codeine. The donor is required to submit a note from the treating physician documenting the safe and appropriate use of the medication. Our office verifies that the physician has an active license to practice. If all criteria are met, the ultimate result of the test is NEGATIVE. This will be the only result the employer will see.
- If there is no legitimate medical explanation, then the final result is POSITIVE. Under DOT guidelines, donors are offered the process of split testing. With split testing, the second container label bottle B (which is still sealed and labeled) is shipped to a DIFFERENT SAMHSA-certified lab for retesting.
Federal legislation is needed to curtail the use of substances and devices that subvert drug tests. These products pose a safety risk in the transportation industry; they increase employer costs associated with workers compensation, health benefits, impaired productivity; and, they increase employers costs associated with drug testing and the increased need to improve the technology to detect the products.
Thank you for the opportunity to be here. I look forward to answering any questions you may have.
