DRUG TEST CUT OFF LEVELS

Are There Standard Cut Off Levels In Drug Screens?

How to pass drug test is a question many have to deal with in today's world.  Drug cutoff levels are the minimum concentrations of drugs or metabolites that must be present in specimens, before labs will report the drug testing results as positive. How much of a drug labs can detect depends on drug detection times, frequency of use, type of specimen, drug testing method, metabolism, and other factors.

Labs that follow the Mandatory Guidelines for Federal Workplace Drug Testing Programs published by the Substance Abuse and Mental Health Services Administration (SAMHSA), first conduct one or more initial screens followed by confirmatory tests. The approved methods for urine analysis are one or more types of immunoassay (IA) screens, confirmed by gas chromatography and mass spectrometry (GC/MS). If you test below the drug cutoff levels on the initial screens, the lab cannot report it as positive or continue with the confirmatory tests. If you test above them on the initial screens, but below them on the confirmatory test, the lab still cannot report it as positive.

On-site drug testing devices (OTD's or field test kits) are increasingly used by clinics, law enforcement organizations and other agencies because of the immediacy of results.

We can show you how to pass a drug test for:

• Urine Drug Test

• Blood Drug Test

• Saliva Drug Test

• Hair Drug Test

OTD's use immunoassay technology impregnated on cellulose strips. When saturated with urine, a positive result is typically indicated by the absence of the colored band and a negative result is indicated by the presence of a colored band, regardless of the intensity. Most OTD's use drug cut-off levels established by the Substance Abuse and Mental Health Services Administration (SAMHSA) for the initial screen test.

Independent studies have been published comparing the accuracy of OTD's to laboratory based testing. In one such study1 devices from five manufacturers were evaluated. The OTD's from all five manufactures were checked first with authentic donor specimens that had been previously analyzed in a laboratory by enzyme-immunoassay and GC/MS. They were then used on manufactured specimens fortified with known drug concentrations at 25% above the cutoff (supra-threshold specimens) and at 25% below the cutoff (sub-threshold specimens). The findings showed that:

• 53% of the sub-threshold, manufactured specimens were false positives.

• 29% of the supra-threshold, manufactured specimens were false negatives.

• 45% of the negative authentic donor specimens were false positive for amphetamine, yet only 1% were false positive for THC.

• 1% of the positive authentic donor specimens were false negatives.

Comparison to Laboratory Testing

In the laboratory, control samples with drug concentrations 25% above and 25% below the cutoffs are frequently run to check the ability of the testing instrument to reliably measure above and below the cutoff level. The findings show that:

• Laboratory instruments are more reliable than OTD's when the specimen drug level is close to the cutoff.

• Laboratory tests are more resistant to interfering compounds.

Limitations of OTD's

Specimen dilution is not detected with OTD's. In the laboratory, excess water consumption "flushing" is detected by the routine measurement of the creatinine level. Specimen adulteration is more easily detected in the laboratory. The OTD's test for methamphetamine is subject to false positive results caused by interfering over-the-counter drugs. This necessitates a GCMS confirmation test for positive methamphetamine results.

The propensity for OTD's to read positive with "less than cutoff" levels is probably not desirable even for those agencies that have a "zero tolerance" policy. The increased false positive rate can reduce the defensibility in court and increase the GC/MS confirmation costs.

• OTD’s evaluated were not accurate close to the cut-off and tended to overcall the number of positives compared to laboratory based testing

• OTD’s were more susceptible to false positives from other cross-reacting compounds

• Substituted and diluted specimens are not as easily identified

• GC/MS confirmation should be mandatory for all positives

Basic testing typically screens for the following, commonly-abused drugs.

• Amphetamines (speed, meth, crank, ecstasy)

• Cannabinoids (marijuana, hash)

• Cocaine (coke, crack)

• Opiates (heroin, morphine, opium, codeine)

• Phencyclidine (PCP)

Extended testing might also screen for some or all of the following, but basic testing is the most common.

• Barbituates (phenobarbital, butabital, secobarbitol)

• Benzodiazepines (tranquilizers like Valium, Librium, Xanax)

• Ethanol (ethyl alcohol, booze)

• Hallucinogens (LSD, mushrooms, mescaline, peyote)

• Inhalants (paint, glue, hairspray)

• Anabolic Steroids (synthesized, muscle-building hormones)

The tables below are compiled from public-domain information in the Mandatory Guidelines for Federal Workplace Drug Testing Programs. (See Notes below.) They are for urine drug test analysis of the commonly-abused types of drugs known as the "SAMHSA Five." Hair drug test criteria are completely different.

As of September 3, 2001, SAMHSA last revised these cutoff levels in 1998 and considers them sound. For the full text of the guidelines and tips about searching for revisions.

Other government entities might have their own specifications that differ from those above.

See > Mandatory Federal Guidelines < for more information and links.

If you've never or rarely abused drugs, but happen to get some into your system close to the time you submit your specimen, like at a party where pot smoke fills the air, you'll come in at only about 5 ng/ml for marijuana metabolites. That's well below the cutoff level of 50 ng/ml, so you're safe. The tests are only for illegal drug use, too. If you're on legit prescription medications and have normal levels for such, you have nothing to fear. But if you're royally screwing up on the job because of your medication or the condition you're medicating, you might have to take medical or disability leave.

6-acetylmorphine (6-AM) is a heroin metabolite and also called 6-monoacetylmorphine (6-MAM). 6-AM is rapidly metabolized to morphine, so will not likely be detected in most urine specimens. But of course, morphine will likely be detected after recent heroin use. Because codeine is a naturally-occurring alkaloid in the opium poppy juice that is the source of morphine and heroin, it too might be in the urine of heroin users.

Codeine is rapidly metabolized and excreted in urine as codeine, morphine, or both. Morphine is a metabolite of codeine, but not the other way around, so ingestion of morphine will not account for the presence of codeine.

The chemical names for the most-common forms of amphetamines are d-amphetamine and d-methamphetamine.

MDMA, MDA and MDEA are methylene-dioxy derivatives of amphetamine and methamphetamine. They are the so-called "designer drugs" commonly known as Ecstasy, X, XTC, etc.

An analyte is the substance for which the lab is testing (analyzing).