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The Standard - Urine Testing
Urine drug testing has long been the accepted standard in virtually all courts and business as the most efficient, least invasive, and most reliable means of detecting the illegal use and abuse of drugs. Most companies have adopted the Department of Transportation (DOT) drug cut-off levels to eliminate the objection of "passive inhalation," "second hand smoke," "poppy seeds," and other causes for testing positive other than abuse.
Once a drug test is ordered, the following process must be conducted:
- Properly identify the individual to be tested.
This is usually done by asking the donor for a photo ID such as a driver's license or other valid form of identification that includes a photo of the donor. If the donor has no photo ID, a supervisor who knows the donor may identify the donor. The supervisor must be present (this cannot be handled over the phone) and the collector must make a notation in the remarks section of the collection form stating, "No photo ID. Supervisor John Doe has identified the donor." If the donor has no photo ID and a supervisor is not present, the test should not be conducted. It is imperative that positive ID is obtained in the event that it is necessary to use the test results information in court or arbitration.
- Complete the test information section of the collection form.
Since all federal collection forms and most other collection forms are universal in appearance, the information is essentially the same. The collector prints the employer's name and address; the medical review officer's name and address go in the first section (this area is usually pre-printed by the laboratory). Next, the collector must print either the donor's social security number or identification number. The reason for the test must be indicated by the collector. The choices are: pre-employment, random, reasonable suspicion/cause, post-accident, return to duty, follow up, or periodic. The last part of this section deals with the selection of the actual tests that are to be performed. The most common (and mandatory for DOT employees) is the SAMHSA 5 panel, which includes THC, cocaine, PCP, opiates and amphetamines.
- Preparing for the collection.
Several steps must be taken in order to assure that a valid specimen is obtained.
- The collector must ask the donor to remove any exterior garments (coat, cap, hat, scarf, etc.) and remove all items from his/her pockets. This is to avoid the use of any contaminants, dilutants, or substitutions by the donor while providing the specimen.
- The collector must ask the donor to wash his/her hands, primarily to remove any possible contaminants from the hands of the donor.
- The collector must secure the restroom prior to the collection by: removing any substances that could be placed by the donor into the collection container (contaminating the specimen); turning off and/or "taping off" any water supply (to avoid dilution of the specimen); placing a bluing agent into any standing water, such as the toilet bowl and tank (to detect an attempt to use such water as a dilutant); and posting signs to remind donor not to attempt to flush the toilet or turn on the water.
- Collecting the urine specimen.
The collector should ask the donor to select a drug test kit from several that are available and inspect the container to make sure that it is not open or contaminated. Then the collector will instruct the donor to open the container and remove only the collection cup. The two bottles used for sealing the specimen for shipment are secured in a separate, sealed bag to avoid any possible tampering while the donor is providing the specimen. The collector instructs the donor to take the cup into the restroom and provide at least 45 milliliters of urine (indicated on the side of the cup by graduated lines). It is advisable to remind the donor at this time not to turn on any water or flush the toilet. The collector should stand outside the door so he/she can hear any attempt to interfere with the testing process. Prior to accepting the specimen from the donor the collector should use latex (or similar) protective gloves. Once the donor provides the specimen to the collector, the temperature strip on the cup must be immediately read. When there is a valid temperature ranging from 90? to 100?F, the collector must check the "yes" box, stating that the temperature is within range. If the temperature is not within this range, the specimen may be considered invalid and a new collection may be necessary.
- Splitting the specimen and sealing the bottles.
The collector should instruct the donor to inspect the bottle container and then open it. The collector should explain this process as it is being completed by stating: "Your company policy says that you are to provide a single specimen collection and that it is then to be divided into two containers in your presence and sealed." (This is done so that the donor understands that the same specimen is in both containers.) "The first bottle is to have a minimum of 30 milliliters. This is the bottle that will be screened initially at the laboratory. If any of the drugs tested for should screen "positive," then this very same bottle will be tested again using a very elaborate confirmation method called GC/MS. The second bottle is to have a minimum of 15 milliliters. It will be tested only if your first bottle confirms positive and you request a second test at a different laboratory through your medical review officer." The collector must place the first seal (labeled "A" and attached to the collection form) over the cap of the first bottle and down both sides. Once it's secured, the collector must instruct the donor to place his/her initials and date on the seal where indicated. The second seal (labeled "B split") is placed on the bottle containing the 15 milliliters of urine in the same manner. Upon dating and initialing the bottles the collector should instruct the donor to place both bottles into the shipping container.
- Donor completes information.
The collector will turn to the donor information page and ask the donor to print his name, day and evening telephone numbers, current date and date of birth. Before signing the form the donor should read or the collector should read to the donor the certification statement. "I certify that I provided my urine specimen to the collector; that I have not adulterated it in any manner; that each specimen bottle used was sealed with a tamper-evident seal in my presence; and that the information provided on this form and on the label affixed to each specimen bottle is correct."
- Collector completes the collection site information.
The most important item in this section is the box where the collector indicates that the specimen is split. The balance of this section identifies the collection facility, collector, address, telephone number, date and time and the collector's certification with signature.
- Collector completes the chain-of-custody section.
After the specimen is released by the donor to the collector, the chain-of-custody section of the form is completed (indicating each person who handles the specimen and why). The donor releases it to the collector; the collector signs the chain-of-custody section; the courier shipping the specimen receives the specimen from the collector and is listed on the chain-of-custody form; the laboratory accessioning department receives the specimen from the courier and signs the chain-of-custody form, and so on. Any break in the chain-of-custody may cause the specimen to be declared invalid for testing.
- Collector distributes copies.
The collector can now place pages 1,2 and 3 of the collection form into the specimen container. The container must be sealed. The collector must give copy 5 ("donor copy") to the donor and state that: "In the event of a positive result, a physician known as a medical review officer will call, using one of the numbers given by you. The physician will want to know about any medications that you are taking as well as any over-the-counter medications that may legitimately explain the positive test result. The physician will also give you the opportunity to have the split specimen tested if you do not agree with the positive results. On your copy of the form, below your certification statement, is a notice that you may want to list any medications that you are currently taking on the back of your copy of form to serve as a memory jogger should the medical review officer call you for such information." At this point the donor may be excused; collection is complete. The collector must now send the medical review officer (MRO) copy to the MRO, the employer copy to the employer and retain the collector copy.
- Courier receives specimen for shipment to the laboratory.
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