Urine Drug Tests
- Also Known As:
- Urine Drug Screen
- Drugs of Abuse Test
Test Quick Guide
Urine drug testing detects evidence of recent drug use or misuse in a sample of urine. Testing can detect illegal or prohibited drug use, prescription medications, over-the-counter medicines, and legal substances such as alcohol and tobacco.
Although drug testing can be performed on several types of samples, including samples of blood, saliva, and hair, urine is the most commonly used sample for drug testing. Urine drug tests can be used in a wide variety of situations in which testing for drug use or misuse is required.
About the Test
Purpose of the test
Urine drug testing can detect evidence of recent drug use or misuse. Drug use refers to using an illegal drug, like heroin or cocaine, while drug misuse refers to the use of medication in a manner that is unhealthy or differs from what is prescribed by a doctor.
The most common role of urine drug testing is to screen for drug use or misuse in the workplace. A urine drug test may be requested by an employer when screening job applicants, for periodic or random drug testing of employees, and when drug use is suspected based on symptoms or workplace accidents.
For patients taking prescription drugs that have the potential for misuse, a doctor may order a urine drug test to confirm that the patient is taking medication as prescribed. Some of the most commonly misused prescription drugs include opioids, central nervous system depressants used to treat anxiety and sleep issues, and stimulants used to treat attention-deficit hyperactivity disorder (ADHD).
Other circumstances in which a urine drug test may be performed include:
- Forensic testing: Urine drug tests may be ordered to provide evidence of a crime during an investigation or court case. Periodic or random testing may also be performed as a term of probation.
- Medical testing: Although testing hospitalized patients for drug use or misuse is often unnecessary, a urine drug test may be used in certain circumstances, such as prior to an organ transplant or in cases of a suspected overdose.
- Treatment adherence: A urine drug test may be used to confirm adherence to a substance abuse treatment program.
- Athletic testing: Urine drug testing is often used to screen professional athletes
- Military testing: Members of the military may be required to undergo periodic or random drug tests.
for drugs and other substances that may be performance-enhancing.
What does the test measure?
Urine drug tests may detect the drug itself in the urine, a drug metabolite, or other biomarkers that suggest drug use or misuse. A drug biomarker is any measurable substance that is present after taking a drug. A metabolite is a type of biomarker that remains in the body as a drug is processed and broken down.
Urine drug tests detect evidence of recent or past drug use or misuse but typically cannot diagnose current intoxication or addiction. Drugs can be detected in the urine for a period of days, weeks, or months after use, depending on a variety of factors. These factors include the amount and frequency of drug use, as well as the rate at which the drug is metabolized and eliminated from the body. Drugs that can be detected by a urine drug test include:
|Urine Drug Tests|
|Test Name||Urine Detection Window|
|Alcohol (Ethanol) Testing||Up to 5 days|
|Amphetamines Testing||Up to 4 days|
|Barbiturates Testing||Up to 21 days|
|Benzodiazepines Testing||Up to 30 days|
|Cocaine Testing||Up to 7 days|
|Marijuana (THC) Testing||Up to 6 weeks|
|Nicotine and Cotinine Testing||Up to 7 days|
|Opioids Testing||Up to 10 days|
|Phencyclidine (PCP) Testing||Up to several weeks|
While a urine drug test may only look for evidence of the use or misuse of one drug, tests are often combined into broad screening panels that test for several drugs at once, like a 10-panel drug test. Positive results on an initial drug screening panel are considered presumptive positive should be confirmed by an additional, more specific, confirmatory test.
When should I get a urine drug test?
Urine drug testing may be used in the workplace, the military, and in organized sports. Testing may also be performed to provide evidence of a crime, to check for signs of relapse in a substance use treatment program, or to monitor a patient’s adherence to prescribed medication.
Legal and ethical issues commonly arise when considering urine drug tests. Federal, state, and local laws impact the use of drug testing. Due to the potential implications of drug test results, professional organizations recommend that patients should be given the opportunity to consent to drug testing when possible.
Federal employees may be required to have periodic or random drug testing as part of a drug-free workplace program. Drug-free workplace programs are mandated in several federal industries that involve public safety and national security, such as those in the Department of Transportation and Department of Defense.
Finding a Urine Drug Test
How to get tested
Urine drug tests are performed in a wide variety of settings. Testing can be conducted at hospitals, laboratories, substance use treatment programs, and other medical or legal settings. Samples for urine drug testing can also be obtained at a workplace or other location before being analyzed at a separate laboratory.
A urine drug test may be ordered by a doctor or an administrator of a program that requires drug testing. Urine drug tests can also be purchased over-the-counter without a prescription.
Can I take the test at home?
At-home drug tests conducted using a urine sample are available for a variety of drugs. Individual at-home urine drug tests detect one drug, while at-home urine panel tests detect evidence of multiple drugs in one urine sample.
At-home urine drug testing offers only preliminary results and is not a substitute for laboratory-based testing. If preliminary results are positive, an additional confirmation test is necessary to reduce the risk of an inaccurate test result. Laboratory testing is the most reliable way to confirm a positive drug screening result.
The American Academy of Pediatrics advises against using at-home drug testing in children and adolescents due to the lack of evidence that at-home drug testing reduces drug use in children and adolescents. Additional risks include the potential for misinterpreting test results and the negative effect that testing may have on the relationship between children and parents. Before purchasing an at-home urine drug test, parents may be advised to speak with a doctor or pediatrician.
How much does the test cost?
The cost of urine drug testing depends on many factors, including where the test is conducted and whether the test detects one drug or several drugs in the urine sample. The cost of urine drug testing may include the office visit and a fee for sample collection, in addition to the test itself.
Workplace, military, and athletic drug testing may be paid for by the employer or organization requiring testing. When ordered by a doctor, the costs of testing may be covered by a patient’s health insurance. Patients may still be responsible for copays or deductibles, so it’s important for patients to discuss the cost of testing with their doctor, insurance provider, or the organization requiring testing.
At-home urine drug tests are often available for around $6 depending on the type of drug being tested. The cost of urine drug test panels start around $12.
Taking a Urine Drug Test
Urine drug tests conducted in a laboratory are performed on a clean catch urine sample. Clean catch urine samples require that patients take several steps to reduce the risk of contaminating the urine sample. A clean catch urine sample can be collected in a laboratory, hospital, or other testing site.
In order to prevent tampering with or contaminating a urine sample, patients may be monitored or observed during the process of collecting urine. During urine collection monitoring, a trained staff member checks the restroom before the patient enters to collect their sample. During direct observation, a professional watches the patient while the sample is being collected.
Before the test
Before a urine drug test, tell your doctor or the test administrator about any over-the-counter or prescription medications or supplements that you have recently taken. In some cases, certain medication and supplements can trigger a positive screening result on a drug test.
For a urine drug test taken at a laboratory, additional measures may be taken to prevent tampering with the urine sample. For example, patients are given a plastic container that is sealed in tamper-proof packaging. Additionally, the water supply in the bathroom may be turned off, and the water in the toilet may be tinted with a blue dye.
When preparing to take an at-home urine drug testing, begin by reading all instructions provided in the test kit. Test kits should include instructions, a collection container, and the test itself. At home urine drug tests may be test strips, a test card, or a test cassette.
During the test
The clean catch method of collecting a urine sample begins with patients washing their hands with soap and water to remove any germs. Patients may also be instructed to clean their genitals with a pad or wipe provided by the test administrator.
Once a patient’s hands and genitals are clean, patients begin urinating into the toilet before moving the collection container into the urine stream. Patients urinate into the collection container until it is filled to a pre-marked level. Once filled, the collection container is moved out of the urine stream and the patient finishes urinating into the toilet.
Urine drug testing is painless, although some patients may experience anxiety during the collection process.
Collecting a clean catch sample of urine for an at-home urine drug test is similar to collecting urine for laboratory-based testing. For tests that can be fully completed at home, test kits include a testing device that is either immersed in the urine sample or allows the patient to place a drop of urine into the test cassette. Test devices vary, so it’s important to carefully conduct an at-home urine drug test according to instructions provided in the test kit.
After the test
Once a urine sample is collected for laboratory testing, patients may be instructed to close the sample container and return it to a trained staff member. Laboratory staff may record the temperature of the sample and secure it in tamper-proof packaging before it is sent for testing.
There are no restrictions on activity after a urine drug test.
Urine Drug Test Results
Receiving test results
The results of a urine drug test are generally available within a few business days after the test is taken. Patients may learn about their results from a phone call or email from their doctor, a staff member at the facility conducting the test, or from the organization requiring drug testing. In some cases, urine drug test results may be delivered in the mail.
For at-home test kits that allow for testing in the home, test kit instructions should indicate how long to wait before reading test results. For at-home collection kits that are sent to a laboratory, it may take a few additional days for results to become available. In some cases, patients may access their test report through a smartphone application or the company’s website.
Interpreting test results
Initial drug tests typically provide results within minutes, allowing patients and health care providers to interpret results by looking for the presence or absence of a colored band on the test device or get the results from an automated laboratory analyzer. Test results from an initial drug test, including at-home urine drug tests, provide only preliminary results.
A negative result on an initial drug test indicates that no evidence of drug use or misuse was detected in the urine sample. This may be because the patient hasn’t used the specific drugs tested, because the patient last used the drug outside of its detection window, or because of problems in conducting the drug test.
If initial drug test results are positive, the sample should be sent to a laboratory for a confirmatory test that uses more specific test methods.
The results of a confirmatory drug test conducted in a laboratory may be reported as positive, negative, or invalid. A negative test result on a confirmatory test indicates that no evidence of drug use was detected. Similar to initial test results, a negative confirmatory test indicates that a patient hasn’t used the drugs included in the test or that the patient last used drugs outside of the detection window.
An invalid result indicates that the test was not able to confirm whether drugs were present in a patient’s urine sample due to evidence that the urine sample was adulterated or substituted during the collection process. If a test is found to be invalid, the laboratory will typically report the reason for this result.
A positive test result on a confirmatory test indicates that the drug was detected in the urine sample above the laboratory’s established cutoff value. While the amount of a drug that triggers a positive result can vary between labs, many labs use standards established by the Substance Abuse and Mental Health Services Administration (SAMHSA) for drug-free workplace programs.
SAMHSA has established cutoff values for five drugs or drug classes in the urine that are included in federal drug-free workplace policies: marijuana, cocaine, amphetamines, phencyclidine (PCP), and several types of opioids. The table below includes the SAMHSA cutoff values for both initial and confirmatory urine testing:
|SAMHSA Urine Drug Test Cutoff Values|
|Substance Tested||Initial Test Cutoff||Confirmatory Test Cutoff|
|500 ng/mL||250 ng/mL|
|Benzoylecgonine (Cocaine Metabolite)||150 ng/mL||100 ng/mL|
|THCA (Marijuana metabolite)||50 ng/mL||15 ng/mL|
|Phencyclidine (PCP)||25 ng/mL||25 ng/mL|
|6-Acetylmorphine (heroin metabolite)||10 ng/mL||10 ng/mL|
|Codeine and Morphine||2000 ng/mL||2000 ng/mL|
|Hydrocodone and Hydromorphone||300 ng/mL||100 ng/mL|
|Oxycodone and Oxymorphone||100 ng/mL||100 ng/mL|
Are test results accurate?
Although no drug test is 100% accurate, urine drug testing is the most common method of testing for drug use and misuse. Special precautions may be taken during sample collection, transportation, and testing to improve test accuracy. Inaccurate test results can occur, with several factors impacting test accuracy:
- Varying laboratory methods: There are several laboratory methods that may be used for urine drug testing, each associated with a different level of accuracy. Immunoassays are the most common method of conducting an initial drug screening test. Immunoassays are considered less accurate than gas-chromatography, and liquid-chromatography using mass spectrometry for confirmatory testing. These confirmatory methods are more accurate but also require additional equipment and highly trained staff.
- Risk of false positive results: Certain foods and medicines can lead to a urine drug test providing a false positive screening result, which means that a person tests positive for drug use despite not having used the drug. For example, more false-positives occur for amphetamines than other drugs because many over-the-counter medications and herbal supplements contain chemicals that have a similar chemical structure as amphetamines.
- Risk of false negative results: False negative results, in which a person tests negative for drug use or misuse despite having used the drug are less common but can occur for several reasons. False negative results may be caused by improper sample collection or testing and well as tampering, adulterating, or substituting a urine sample during collection.
Do I need follow-up tests?
After an initial or at-home urine drug test, follow-up testing by the laboratory is necessary to confirm positive test results. Confirmation testing is especially important in cases in which a positive result will negatively affect a person’s employment, legal or forensic case, or medical treatment.
In some cases, a doctor may evaluate a patient for a substance use disorder after a positive result on a urine drug screening test. During an evaluation for a substance use disorder, a patient is asked a series of questions to determine the pattern and effects of drug use or misuse.
Questions may focus on a patient’s ability to control drug use, the effects of drug use on the patient’s ability to meet social obligations, whether the person uses drugs in dangerous situations, and the physical consequences of drug use or misuse. Treatment is available for drug use, misuse, and addiction.
Questions for your doctor about test results
It’s common to have questions about urine drug testing. Patients may find it helpful to talk to their doctor about test results. Questions may include:
- Why am I being tested for drug use or misuse?
- What is the result of my test?
- Is confirmation testing necessary?
- Who will have access to my test result or medical record?
- Will I be retested for drug use or misuse in the future?
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