Drug Court Best Practices for Urine Sample Testing
This is a 2-part series using the AllRise Adult Drug Court Best Practice Standards, Volume 2 as the source. Part 1 was published in September 2024 and provided guidance for the best practices for urine sample collection from Drug Court participants. Part 2 focuses on the best practices for urine drug testing.
Background1
Drug and alcohol testing provides an accurate, timely, and comprehensive assessment of unauthorized substance use during a participant’s enrollment in a drug court program. The following are recommendations for a successful Drug Court outcome.
Frequency of Testing:
Testing is performed frequently to detect substance use quickly and reliably.
- A participant’s urine drug testing should be performed at least twice per week.
- Frequency can be reduced when the participant is in the last phase of the Drug Court program.
Randomization of Testing:
The testing schedule should be random and unpredictable.
- The probability of being tested on weekends and holidays should be the same as other days.
- Participants should be required to provide a urine sample as soon as possible, and no more than 8 hours, after receiving a notification that testing is scheduled.
Duration of Testing:
Testing continues uninterrupted to determine if relapse occurs as other treatment and/or supervision services are adjusted while the participant is enrolled in the drug court program.
Breadth of Testing:
The test menu should include all unauthorized substances that are suspected to be used by a participant. Specimens should be selected randomly to test for a broader range of substances that may be emerging in the Drug Court population and community.
Rapid Results:
Test results, both screening and confirmation, should be available to the Drug Court within 48 hours of collection.
Participant Contract:
Upon entering a Drug Court program, participants should receive their rights and responsibilities related to testing procedures of the Court.
Specimen Validity Testing1
Specimen validity testing is performed on urine samples to detect adulterated or diluted specimens. An adulterated specimen is a urine specimen containing a substance that is not a normal constituent or containing an endogenous substance at a concentration that is not a normal physiological concentration. Part 1 of this series provided recommendations for how Drug Courts can prevent sample adulteration. However, there are validity tests that can easily be performed on urine samples to detect if adulteration has occurred. The common validity tests are:
Temperature
The temperature of the urine sample should be documented immediately within four minutes upon collection to ensure it is consistent with human body temperature. Urine samples should be between 90º – 100º F. A temperature outside of this range may suggest the sample cooled down due to the addition of cold water – an attempt to adulterate the sample. Temperature is read by the collector using a temperature strip attached to the collection cup.
Creatinine
Creatinine is a normal metabolic product of muscle contraction that is excreted in the urine at a relatively constant rate (unless there is an unusual medical condition). A creatinine level below 20 mg/dL is rare and is a reliable indicator of an attempt to dilute the sample by excessive fluid consumption or by adding fluid to the urine specimen.
Specific Gravity
Specific gravity reflects the amount of solid substances that are dissolved in urine. The greater the specific gravity, the more concentrated the urine; and the lower the specific gravity, the closer its consistency to water. The normal range of specific gravity for urine is 1.003 to 1.030, and a specific gravity of 1.000 is essentially water. A urine specimen with a lower than expected specific gravity probably was diluted with water.
pH2
pH is the measurement of acid-base. Human urine is usually near neutral (pH 7), although some biomedical conditions affect urine pH. HHS set the program cutoffs for pH based on a physiological range of approximately 4.5 to 9. The pH of an adulterated specimen may be outside the physiological range.
Oxidants2
Oxidants are added to urine samples to oxidize drugs or drug metabolites to prevent the detection of the drugs or drug metabolites, or affects the reagents in either the initial or confirmatory drug test. Examples of these agents include, but are not limited to, nitrites, pyridinium chlorochromate, chromium (VI), bleach, iodine, halogens, peroxidase and peroxide.
Creatinine, pH, Oxidants and Specific Gravity are usually determined by instrumented testing processes.
Testing Procedures1
Accurate and reliable testing procedures should be used for the drug test. The following is recognized as a valid testing procedure for urine samples:
Screening Test Options
There are several options available for screening urine samples to detect the presence of drugs.
- Urine Drug Cups: urine drug cups consist of a urine collection cup that contains individual drug test strips that detect the presence of various drugs of abuse. Test results are read optically by drug court personnel.
- Urine Drug Test Strips: a urine test strip is dipped into a urine sample to detect the presence of one or more drugs of abuse. Test results are read optically by drug court personnel.
- Urine Drug Test via Instrumented Testing Processes: urine samples are evaluated using an automated instrument and test reagents to detect the presence of drugs of abuse. Test results are automatically determined by the instrument.
Samples that produce a positive drug screening test result, called a Presumptive Positive, should be sent for Confirmatory Testing.
Confirmatory Testing Options
Samples that produced Presumptive Positive test results should receive further testing defined as Confirmatory Testing. There are several options available:
- Gas Chromatography/Mass Spectrometry (GC/MS)
- Liquid Chromatography/Mass Spectrometry (LC/MS)
- Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)
Confirmatory testing is typically performed by a highly skilled laboratory. Confirmation testing virtually eliminates the odds of a false-positive drug result, assuming the sample was collected and stored properly.
Conclusion
Drug testing is a critical factor in helping a Drug Court achieve success. Drug testing provides an accurate, timely, and comprehensive assessment of unauthorized substance use during a participant’s enrollment in a drug court program. Accurate test results are achievable if the Court adheres to simple recommendations for the sample collection and testing processes.
DTPM Solutions
DTPM’s mission is to help fight drug use and dependency. We offer drug testing solutions, both screening and confirmation testing, to a variety of testing facilities such as drug courts, treatment centers, physician office labs, reference labs and more. Our screening solutions provide flexibility to a testing site by offering simple point-of-care (POC) test cups or more specific instrumented drug immunoassays. DTPM also offers drug confirmation testing for those testing sites that require confirmatory results. General testing supplies such as gloves, lint-free wipes and pipette tips are also available on our online store.
