Laboratories for Drug Testing

>> Drug testing in the United States is big business.  Many do not know that the actual laboratory drug testing is performed at major laboratories such as:

  • Quest Diagnostics
  • Labcorp
  • MedTox (owned by LabCorp)
  • Abbott (formerly Alere Toxicology)
  • Clinical Reference Laboratory (CRL)
  • Phamatech, Inc.,

The drug testing laboratories listed above all have one very important thing in common.  That is that they are all certified by the DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) specifically by the DHHS agency – Substance Abuse and Mental Health Services Administration (SAMHSA).  This is important to have confidence that the laboratory has the highest standards possible and will provide the most accurate legally defensible drug test results. These labs employ certified experts and utilize state of the art technologies.

In fact, the use of SAMHSA certified labs is required for testing of Federal employees and for DOT testing.  Many State laws for workplace drug testing also require the use of the SAMHSA certified labs.  How do you know of your lab is SAMHSA certified? This is very easy as SAMHSA maintains a web listing of certified labs and updates the list every 30 days – SAMHSA Certified Lab List.

It is an expensive process to become a SAMHSA certified lab and these labs undergo rigorous inspections.  Quarterly proficiency testing and compliance audits every six months are required. 

Laboratory Process

Specimens for drug testing are collected in all areas of the United States.  These specimens are shipped to the major labs listed above for testing. Laboratory testing of specimens for drug testing is not performed at the facility where the specimen is collected.  Once the specimen gets to the lab, it goes through a screening process immunoassay (EMIT) and if necessary, a second, confirmation test (by gas chromatography/mass spectrometry or GC/MS).  The GC/MS is considered the gold standard and is highly accurate and provides specificity to help rule out any false positives from the initial screen.  The GC/MS is considered the confirmation test.

Specimens testing negative during the initial screening or immunoassay (EMIT) process are reported to the Medical Review Officer (MRO) 

Officer (MRO) as negative.  For specimens that go to confirmation testing, the result of negative or positive are reported to the Medical Review Officer (MRO). Review and verification of all drug test results is provided by the Medical Review Officer (MRO) who also takes into consideration any legally prescribed medications.

Paper or Electronic Custody & Control     

Traditionally labs have utilized a 5-part custody and control form for the custody and control of a specimen from collection to lab.  The form records the demographic information of the employer and the person to be tested (Donor).

In recent years and in effect today (Oct of 2020); electronic custody and control or eCCF is the preferred method of processing a specimen with custody and control.  An electronic order is placed by the employer and the collection site fulfills the order on a collection APP which eliminates the paper process.  This also eliminates a lot of mistakes in the process and is much more efficient and less costly.  FormFox is the APP mostly used to process a collection with eCCF.   

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