Chapter 46. Testing to Identify Recent Drug Use

Robert L. DuPont, M.D.; Carl M. Selavka, Ph.D.
DOI: 10.1176/appi.books.9781585623440.358399



The diagnosis of substance use disorder, like most other medical diagnoses, is primarily clinical, with the patient's history and the mental status examination playing central roles in the diagnostic process. Nevertheless, laboratory testing to identify recent drug use is increasingly important in clinical settings, ranging from the initial diagnosis to treatment management and from research and epidemiology to health care assessment. Drug testing identifies the recent use of specific abused substances and in some settings can help to differentiate chronic or repetitive ingestions from single or low-frequency uses. Laboratory testing is especially helpful in medical settings as part of the screening process to identify patients for evaluation for substance use disorder.

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TABLE 46–1. Comparisons by race in preemployment testing in police applicants
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TABLE 46–2. Urine, hair, oral fluid, and sweat patch testing for drugs of abuse
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Because drugs of abuse are distributed to virtually every part of the user's body, they can be detected in all fluids and tissues.

Urine is the most commonly used matrix for drug testing, but hair, oral fluid (saliva), and sweat patches are increasingly used. No one matrix is best; they each have their strengths and weaknesses.

Drug tests detect recent drug use. They do not detect dependence, intoxication, impairment, or addiction.

Most drug test results are confirmed by the sample donor's admission of recent drug use. Difficult and disputed cases benefit from additional help in interpretation, including assistance from the laboratory that conducted the test or the kit manufacturer for on-site tests and a certified medical review officer.

Smarter drug testing requires the use of all four common test matrices (urine, hair, oral fluid, and sweat patches) so the donor does not know which matrix will be used. It is desirable to vary the drugs tested for. This approach reduces cheating, improves the deterrent effect of testing, and permits comparison over time of the rates of positive results for the various matrices.


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A test of which of the following specimens is generally least expensive and completed at most clinical laboratories?
A test of which of the following specimens has the shortest window of detection?
A test of which of the following specimens can detect drug use for up to 90 days?
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