Why are they done?
Medical Screening
Medical drug abuse screening is primarily focused on determining what drugs or combinations of drugs a patient may have taken so that they can receive the proper treatment. In many cases, drugs have been combined and/or taken with ethanol (alcohol). The overall effect on a particular person depends on the response of their body to the drugs, on the quantity and combination they have taken, and when each was taken. For instance, MDMA is initially a stimulant with associated psychedelic effects, but it also causes central nervous system (CNS) depression as it is metabolized and cleared from the body. If patients drink ethanol during this time period, they will have two CNS depressants in their system, a potentially dangerous combination.
Those who may be tested for drug abuse include:
someone in the emergency room who is having acute health problems, such as unconsciousness, nausea, delirium, panic, paranoia, increased temperature, chest pain, respiratory failure, seizures, or headaches, that the doctor thinks may be drug-related.
someone in the emergency room who has been in an accident, when the doctor suspects that drugs and/or alcohol may have been involved.
a child or adult that the doctor suspects may be using drugs.
those who are being monitored for known drug use. This may include both legal and illegal drug use. It may be general testing or specific for the substance that has been abused.
pregnant women thought to be at risk for drug abuse or neonates exhibiting certain characteristic behaviors.
Legal or Forensic Testing
Drug testing for legal purposes is primarily concerned with the detection of illegal or banned drug use in a variety of situations. Sample collection procedures for this type of testing are strictly controlled and documented to maintain a legal “chain-of-custody.” The donor provides a sample (usually urine) that is sealed and secured with a tamperproof seal in his or her presence. Specific chain-of-custody paperwork then accompanies the sample throughout the testing process; each person who handles and/or tests the sample provides their signature and the reason for the sample transfer. This creates a permanent record of each step of the process. Examples of legal drug abuse screening follow.
Employment drug testing done prior to employment, on a random basis, following an accident, or if the employer has a reasonable suspicion that their employee is using illegal drugs. Only the major drugs of abuse are tested, and any positives are confirmed by another method. Employment drug testing has become very common. It is required in some industries (those that involve the U.S. Department of Transportation), for federal employees, and has become an accepted practice in many others.
Court-mandated drug testing usually involves the random monitoring of someone who has been convicted of illegal drug use. Testing may also be ordered in custody cases to rule out drug use by one or both parents.
Government child protective services may sometimes require extended monitoring of a parent with a known drug problem to ensure that they have not returned to drug use.
Law enforcement drug testing may be done when someone has an accident that is suspected to be alcohol- or drug-related.
Forensic testing utilizes a variety of body fluids and tissues that may be tested for numerous drug metabolites during a crime investigation. The goal may be to determine whether drugs were a contributing factor to an accident or crime (such as a DUI or rape). Testing may also be done to determine whether someone died of a drug overdose or drug-related condition.
Insurance companies may perform limited drug screening on their insurance applicants. This may include a test for cocaine and a test for nicotine (even though nicotine is a legal substance).
Schools may have programs that incorporate random drug testing. This may include illegal drugs of abuse and, with competitive sports, may include testing for performance-enhancing substances.
Sports/Athletic Screening
While conventional drug testing is performed on competitive athletes, the primary focus is on doping - drugs and/or supplements that are taken to promote muscle growth and/or to improve strength and endurance. On a local level, sports testing may be limited, but on a national and international level it has become highly organized.
The World Anti-Doping Agency (WADA), U.S. Anti-Doping Agency (USADA), and the International Association of Athletics Federations (IAAF) work together to monitor athlete drug use on a national, international, and Olympic level. WADA has a written code, which establishes uniform drug testing rules and sanctions for all sports and countries, and a substantial list of prohibited substances. Athletes are responsible for any banned substances that are found in their body during testing. Most of the compounds tested are considered positive if they are detected in any quantity while others, such as caffeine, are only prohibited when they are present in large amounts. Some of the substances, such as anabolic steroids (testosterone) and peptide hormones (such as erythropoietin, growth hormone, and IGF-1) are banned but are difficult to measure as they are produced by the body. Testing methods must be able to distinguish between endogenous (that produced by the athlete’s body) and supplemented compounds.
Screening programs randomly perform out-of-competition drug tests on athletes during the training season to look for anabolic steroids (such as testosterone) that promote increased muscle growth. During competitions, testing is frequently done both randomly and on all winners and includes categories such as: stimulants, narcotics, cannabinoids, anabolic agents, and peptide hormones. Sports such as archery, gymnastics, and shooting add additional testing for substances like beta blockers, which are prohibited in these sports because they decrease blood pressure and heart rate.
While professional sports organizations, such as the NFL (National Football League), NHL (National Hockey League), and NBA (National Basketball Association), are not covered by the WADA code, they have programs in place to test their athletes for panels of drugs that combine aspects of sports and employment testing. Those professional athletes that also take part in the Olympics, however, are subject to the same out-of-competition (pre-game) and in-competition testing as other competing athletes.
