In 30 minutes or less, learn from industry expert Joe Reilly about drug testing panels currently available and being sold that are beyond the traditional five panel drug test. This will include panels for urine testing, hair testing, oral fluid testing, blood testing and instant testing with urine. Expanded healthcare panels will also be discussed. Click on the video to the right to view.
Okay, so we’re ready to go. This is Joe Riley, with National Drug Screening. Today’s topic is beyond the five panel, where we will be talking about drug testing and the panels that are available. We are going to go through this pretty quickly. I know everybody has busy schedules so this should take only 30 minutes, but I will stay on the line as long as possible in order to answer any questions that anybody has. So feel free to stay on if you have more questions.
So, to get started we’re going to talk about the different drug testing panels that are available for urine testing, hair testing or fluid testing, blood testing and a little bit about instant testing. And for the most part other than the instant testing we are talking about specimens that go to the laboratory. And at the laboratory, they get screened using an immunoassay test. And if they’re non-negative they go to confirmation testing.
If you send an instant test to the lab because it tested as non-negative, typically that goes straight to confirmation testing at the lab. But our main focus today is on panels, drug testing panels and a couple of precursors to just make sure that you’re aware. Not all labs have the same panels or the same cut-off levels. So, if your panel requirement and cut off level requirements are very specific, you will want to ask if the panel matches what Labcorp, Quest, or what Alere may be offering.
Just a little bit about those labs. Labcorp and Quest have a patient service center network, which means they have facilities around the country where you can get a specimen collected at a very reasonable price. Quest also has a PPN or a preferred provider network, for a couple of dollars more. You can get a specimen collected going to Quest’s PPN facilities at that price. Those are privately owned facilities, not owned by Quest, but they do have a relationship with Quest. Alere has a collection site network using the proprietary network that belongs to eScreen. Those also are private collection facilities. They have an agreement with eScreen to provide specimen collections for eScreen customers and in turn also for Alere customers.
Any other labs that you may be using or if you’re doing breath alcohol testing it is important that you make arrangements with the collection site for payment, because if you send somebody into a third-party facility for a collection of breath alcohol test, they’re going to want to know who’s paying for it. So you should make those arrangements in advance.
Okay, we’re going to start with the five panel. This is beyond the five panel but we got to get the basics down, okay? So, if you call a lab and say “I’d like a five-panel drug test,” you’re going to get Marijuana, Cocaine, Opiates and Amphetamines. So, I would never call a lab or your drug testing provider, whoever you’re dealing with and say, “I need a five-panel drug test, period.” You want to order it as a five panel DOT like.
Now that was developed in 2008, when DOT came out with new regulations and said that within the five panel we want you to expand the Opiates to now include Heroin where previously it only included Opiates of Codeine and Morphine. We now want you to include Heroin which is what they’re testing 6-Acetylmorphine or 6AM for short, which is the metabolite apparel. DOT also said within the Amphetamine panel we want you to test for Methamphetamine as well as the metabolites MDMA, MDA, MDEA which are picking up Ecstasy and Molly. The prior five panel only tested for Amphetamine.
In addition what’s important is that the five panel DOT like which is what you should always be ordering or DOT test or a non-DOT test, DOT like is it includes specimen validity testing. They’re testing the Creatinine, they’re testing the PH levels, they’re testing the specific gravity, and if anything is off they’re testing for more adulterants, so that they can determine if the specimen is adulterated or substituted.
One other thing you want to be aware of this with Methamphetamine testing is that there’s two types of Methamphetamine, there’s a good kind and there’s a bad kind. And the good kind is present in certain over-the-counter medications. One of them specifically is the Vicks inhaler. So if a donor says to the MRO after a positive Methamphetamine I’ve used the Vicks inhaler. The MRO is going to be required to request what’s called D&L Isomer testing at the laboratory which determines if that claim of the Vicks inhaler was true or not.
That D&L Isomer testing costs extra money at the lab and there’s a bill back for that. It’s going to be difficult for you to bill your clients for that. It happens once in a while, and you’ve got to amateurish it over the cost of all your testing costs of doing business. So that’s the five panel.
Now we go to the ten panel. We still want to start with the basic five panel DOT look alike, so that we get the five with the expand Heroin metabolites under the Opiates, the Methamphetamine and Ecstasy metabolites under Amphetamine. And then the other five drugs are Barbiturates, Benzodiazepines, Methadone, Propoxyphene and Methaqualone. Because we’re choosing a DOT like panel, it includes that specimen validity testing which is valuable to you. So your clients are getting more bang for the buck.
Now some labs are starting to eliminate Methaqualone. So a ten panel really becomes a nine panel. But some companies may choose to call Methamphetamine the tenth panel, so although they call it a ten panel it may not be comparable to a standard ten panel. So, in all reality, beyond the five panel it is what you want it to be. You have to say what are the drug metabolites that you want to test for. But typically a nine panel is the elimination of the Methaqualone. Now some labs still might call that a ten panel. They might call the Methamphetamine the tenth panel. It’s just the way the labs or the specific lab interprets it.
Now with the five panel or the ten panel which are overwhelmingly the most commonly ordered drug test panels, there are other add-ons. And so, a client may say to you, “I need a 12 panel.” Or a client may say to you, “I need a 14 panel.” We really need to know what that means. What drugs are they asking to test for, because it could be Fentanyl, Meperidine, Tramadol, it could be Ketamine, it could be Ambien. Maybe they’re interpreting 12 panel to be a ten panel that now includes Hydrocodone and Oxycodone. So we don’t know unless we ask.
So, there’s a lot of different add-ons. You can add alcohol which is a test for Ethanol in the urine. I don’t recommend it ever for workplace drug testing. It is not measuring current impairment. So maybe they had a glass of wine or two with dinner the night before they were not working. Did they violate a company policy? No, so that test is dangerous. But beyond the ten panel could be your expanded Opiates, your Hydrocodone, your Hydromorphone, your Oxycodone, your Oxymorphone, picking up OxyContin which is widely abused, picking up Percocet and Dilaudid and those type of things.
If you’re getting into the health care industry it might include even more expanded Opiates – Fentanyl, Meperidine, and Tramadol. In the treatment world we might be testing for Buprenorphine which is what’s in Suboxone which is what people take to wean themselves off of OxyContin. And then it could be other expanded drugs – Ketamine which is a horse tranquilizer, it could be a specialized test for Ambien, it could be testing for Antidepressants, it could be testing for Antihistamines. We really need to know what they’re asking for.
So when we talk about expanded panels there’s a lot that can be included. And if you’re dealing with the health care industry that’s where you see that the most, so if you’re setting up a program for a hospital system, they might want to test for something that’s very expanded. And we provided a handout that Quest Diagnostics also provides with the different profiles and the levels of those expanded health care panels.
Now those panels don’t have to be is just for health care, but typically that’s where we see them being used. And they typically start with the ten panel plus expanded Opiates and then they go into the other drugs you see listed and potentially into the Antidepressants, the Antihistamines, and the Stimulants.
Now we have EtG. EtG is not typically done for workplace drug testing. It’s done more in the treatment world, personal testing, court order testing, divorce case child custody case, okay? Not all labs will do an EtG test for you. Labcorp actually requires a physician’s order. Quest and Labcorp are TPA, so we can order EtG testing with urine. And it gives us an 80-hour look back for any consumption of alcohol. So if someone went out and got drunk on Friday night, we test them on Monday we can determine that they consumed alcohol. In workplace is that a violation of policy, probably not. But in a treatment program or some type of zero tolerance program it would be a violation of that program.
The EtG urine test can be combined with the typical five or ten panel DOT look alike panels and the expanded Opiate panels. You can test for EtG, a 100-nanogram cut off, a 250 nanogram cut off, and a 500 nanogram cut off. We recommend the 500. The others are very sensitive. They could pick up consumption of alcohol that was potentially in a food product or potentially in a cough medicine or something of that nature. So you want to be very careful about EtG testing.
Other testing with alcohol, you can do an Ethanol only which is your alcohol test. Again I don’t recommend it for workplace. There’s testing for synthetic THC, what they call Spice, K2. Those tests are expensive. They’re not done on a routine basis. You can test for designer stimulants which are what you see out there as bath salts which are compounds that are made to mirror Opiates, so we call them synthetic designer stimulants.
And you can test for Steroids, so that may be a law enforcement program, a high school sports program, a college sports program. Steroids is typically tested with urine. You typically need as much urine as possible, more than the normal amount that you get for your urine drug test. By the way, we do have a chat box also if you wanted to type in any questions, I will answer those as we go. And I’ll pause at the end to answer any other questions and I’ll stay as long as possible to answer all your questions.
Going to switch over now to hair testing. So the basic hair test is the five panel which is tested like a DOT like, your Marijuana, your Cocaine, your PCP Opiates including the 6AM, the metabolite of Heroin.
Also, in the amphetamine the methamphetamine and the MDMA metabolites picking up ecstasy and what’s known as Molly. Most of the labs have the ability to add the expanded opiates to their five panel. Hair testing is available with Quest, Labcorp, Omega laboratories and Psychometrics laboratories. The Omega lab and the Psychometrics lab are primarily hair testing labs. But you do need third-party collection facilities to get those collected. So then needs to be manual arrangements made with a collection facility to collect if you’re using Omega or Psychometrics. With the Quest or Labcorp you can use a patient service center and with Quest you can also use their PPN or preferred provider network.
Labcorp and US drug testing labs also offer expanded hair testing panels. These get to be very expensive. We are talking about a several hundred dollars for these types going up over $300 for the [14 panel]. So beyond the five panel they can add barbiturates, benzodiazepines, methadone, propoxyphene, meperidine, tramadol, fentanyl and sufentanil. So these are what we see in court ordered situations, child custody cases and divorce cases. Those type of things where they are looking to test for anything and everything when money is not a whole big object.
We can also test for EtG in the hair. This is available for ExperTox which is a specialty testing lab, psychometrics and US drug testing laboratories. This is a 90 day look back for alcohol consumption. Again it is not recommended for workplace drug testing unless there in some zero tolerance program. If you are using these labs then you need to make arrangements for the specimen collection. Oral fluid panels. Right here I’m talking about lab-based oral fluid. So it is basically what I call having a sponge on a stick. It goes into the mouth. It collects oral fluid or saliva. Then it is send out through FedEx or by carrier out to the lab. The basics are the five panel that is structured like the DOT like. Depending upon the laboratory and not the case for all labs. They going to add expanded opiates. Labcorp can add alcohol. Omega has OxyContin, methadone, benzodiazepines and barbiturates. They also have the synthetic marijuana, the bath salts and cotinine which is a metabolite of nicotine. So it is testing for people who are smoking.
Your oral fluid test that is available today is fairly expanded to most of our major drugs and there is a specialty test for the synthetic marijuana, bath salts and cotinine. You need to check what the lab has available. The prices differ from lab to the lab on these. You are typically buying these collection devices. They do cost money but not like specialty collection cups that are given out free. Are you sending to present to a collection site which is risky because most collection sites are stocking these devices. Many times employers are doing the collections themselves on this type of test because it is a fairly easy collection.
Some labs, such as Omega lab, US drug testing lab and ExperTox, do not pay for shipping. So, when you’re shipping specimens, you’re going to have to consider shipping charges from that lab. The RFO collection is an easy process as you can see in the graphic. And it is very appropriate for post-accident and reasonable suspicion drug testing because it is picking up very recent use of drugs.
If they say he used drugs that morning or the night before and had an accident or there is reasonable suspicion that morning, then it is a very appropriate test. So it may work well for post-accident reasonable suspicion testing where the company does these themselves. Now if you are collection site or collector then it takes you out of the equation on that part of the drug test. So that might affect your revenue and it is something to think about.
Blood testing for drugs? It’s available but is not used very often. It’s expensive and it’s invasive. Not all labs do it. A lot of times they are collection errors on the drawing of the blood and getting it back to the lab the right way labelled correctly. There is a longer turnaround time. It is usually 5 to 7 days and it is not any more reliable than a urine test or an oral fluid test. If you talk about look back period which is how long the drugs stay in the system. Well, oral fluid is going to give you the quickest look back period than blood, urine or hair. Sometimes blood is required because of a court order or something of that nature. Labcorp has the most expanded blood test panels. They’ve got the five panel including the expanded opiates. They’ve got a seven-panel adding barbiturates and benzodiazepines. They have a nine-panel adding methadone and propoxyphene. You can also add the ethyl alcohol. Medtox is another lab which is actually owned by Labcorp. It also provides blood drug panels.
The question is will the cost of synthetics lower with the rise in use? Well, it is not necessarily the rise in use that will lower the cost it is how many specimens that are sent to the lab. So today it is not a lot. The process of the lab is more of a manual process. It is not as automated. They’re not running as many specimens as with a traditional urine test. So the cost per specimen that they’re running is higher. If they start getting more specimens that is when the costs can potentially come down. They make it more as a use goes up so that is potentially true.
Instant urine drug testing. So the biggest question with instant urine blood trusting is who is collecting the specimen, running the test and reading the result? How are they reporting out the result? How are they storing that result? If you send somebody to a third-party facility for instant drug test, well number one, do they have the instant drug test sitting there to run it? Who is going to run it? How are they going to report the results? How are they going to store the results? That can all be a challenge. Now there are automated systems and you can get instant urine drug testing done at Labcorp and at Quest with automated systems. At both Labcorp and Quest you would order that test electronically. The person will go in with an order form or a donor pass. They will stock the test that they offer and they would enter the result into the system. Depending on how they are set up with your MRO the test will come back through your result reporting and storage system. If you do your own collections at your own facility we have a product called NextScreen that is connected to our software system. You can do with an instant test. You can do an electronic custody and control form which automate out the reporting of the result. It still is result on a web-based system and also provides for a one-page custody and control that will go to the laboratory with the specimen in the event of a nonnegative test result. So we provide that NextScreen instant testing solution.
Now with Labcorp and Quest they have slightly different variations of their panels. With Quest you can get a six panel and a 10 panel that is going to include OxyContin. With Labcorp you can get a six panel and basically, they call the Heroin the 6th panel. Then they’re adding barbiturates, benzodiazepines, methadone and propoxyphene. So, if you doing instant drug testing at Quest or Labcorp, it is important to understand what you’re getting in those panels.
Instant urine drug testing is available with our NextScreen solution. It contains self-collection electronic custody and control, instant auto-email of negative results for reporting out to your client. Also there is lab confirmation and we market to panels which are the six panel and the 10 panel which includes the expanded opiates such as oxycodone. There are other instant testing drug testing products that you can buy that have up to 14 panel configurations. There is also the E screen system that many folks have with the E reader that is reading the results and reporting it up through the system. They are formatted into a five panel. With all the other instant drug testing products that are out there the question is who is collecting it? Who is reporting the result? How are they reporting the result? How is the result being stored? How is the product and stored? Who is buying the product? Who is storing the product? All of that has to be worked out with a procedure for these various instant drug testing products there are hundreds of them. There are many different configurations but if you want to do a 14 panel instant drug test at a facility in Burbank California. The question is do they have that 14 panel instant drug test sitting there. Typically the answer is no.
So with that I promised that this would be a 30 minute presentation. I know that everybody has a busy schedule, but I’m happy to answer any questions. You can speak up on the phone or you can type questions into the chat box.
Question: My question to you regards PCP. In the 11 years of doing this, I think we had one positive. Do you see DOT ever taking PCP off and potentially adding a bigger expanded opiate?
Joe: You know, that is a great question. It is actually a two-part question. So the expanded opiates for DOT is currently a proposed rule that is in a comment period through March 25th. During that time comments are evaluated and it will become a final rule. More than likely that will take place before the end of the year. So, that means we will be seeing expanded opiates on the DOT panel. That also means the price is going to go up at the lab, so the price to your customer is going to go up as well.
Joe: As for as PCP goes, the DOT is still seeing PCP positives. They’re not going to take it off until they don’t see any positives for two years in a row.