Understanding drug test levels

One of the most misunderstood and confusing aspects of drug testing – especially when it comes to drug test results – surrounds the term “levels.”  Understanding what levels mean in the drug testing process requires an understanding of how drug testing is performed to begin with and what final results really mean.  There are three types of “levels” found on a typical drug test result report. They are:  screen cutoff level, confirm cutoff level and actual level (also known as test level). 

All specimens undergo an initial screening process to determine if a specimen may contain a substance of interest. The screening process tests for a number of compounds that fall within a given drug class or panel.  It is important to note that the testing methods in the screening process test an overall drug class known as a drug panel.  The panel may include one or more specific drugs or drug metabolites.  The exact drugs within a drug panel may also vary depending on the laboratory.  For example, an opiate (OPI) panel from Lab A may include codeine, hydrocodone and morphine where as Lab B’s opiate panel may include codeine, hydrocodone, hydromorphone, morphine, oxycodone and fentanyl.  Not all drug panels are the same – especially when dealing with different laboratories.

SCREEN CUTOFF LEVEL

A screen cutoff is a predetermined cutoff level of an overall drug class or panel that is established prior to the initial screening of the specimen.  If the specimen tested goes above this predetermined cutoff level for a drug class or panel, the specimen fails the screening process and moves on to the confirmation or laboratory testing process. 

Screen cutoff levels will vary depending on the specimen type (urine, hair, saliva, nails) as well as the established cutoffs used by the testing laboratory.  Most laboratories follow the cutoff levels recommended by the Substance Abuse and Mental Health Services Administration (SAMSHA), but this does not guarantee that the cutoff levels established and used meet these recommendations.

Sample Urine Drug Test Result: 

CONFIRM CUTOFF LEVEL

The confirm cutoff is a predetermined cutoff level that is established prior to the laboratory testing of a specimen.  This cutoff level may be different (different level number) from the screening cutoff because the testing process at the confirmation level is completely different.  Testing at the confirmation level uses highly specialized and calibrated equipment and processes. Unlike the screening level that screens the overall drug class, laboratory confirmation testing analyzes specific drugs and drug metabolites within a specimen and delivers a positive or negative result for each individual drug and/or metabolite being tested.  A positive result for a specific drug or metabolite will demonstrate at a certain level called the test level or actual level.

Sample Hair Follicle Drug Test Result: 

ACTUAL (TEST) LEVEL

This level simply provides a numeric level of detection of a specific drug or metabolite.  This number is also the most misunderstood and misused number in the whole result reporting process of drug testing.  The only thing this number reflects is that there is an amount of drug or drug metabolite that was found in the specimen being tested at the time of the specimen collection.  This number can and will vary day to day, person to person, test by test and report by report.  By itself, the level found on a positive drug test result means absolutely nothing.   

“By itself, the level found on a positive drug test result means absolutely nothing.”

A common mistake people make is to compare the actual drug test levels to the confirm cutoff number thinking this will give them some degree of severity of use of a substance. This is not true. A drug test result that reports as a positive test is a positive test.  Levels that are close to (but above) the confirm cutoff level are not considered “almost negative” – they indicate a positive drug test.

The numeric drug test level DOES NOT indicate a severity of use of the drug or metabolite detected, it merely provides a quantitative (numeric) value to the level of substance found at the time of testing.  Every person’s body reacts and metabolizes drugs at different speeds and quantities making it impossible to compare one drug user to another using a single test to see who is the heavier drug user.  Therefore, one cannot assume that the actual level number in comparison to the confirm cutoff level indicates anything other than the specimen tested positive for the presence of the drug indicated. 

IS THERE A BENEFIT TO drug test LEVELS?

If an actual level reported by itself has no meaning, then what is the point of showing levels on a drug test result?  That’s a great question – and the answer is an important one – especially when it comes to substance abuse tracking, investigative and legal purposes. 

In cases of legal investigations or tracking substance abuse in an individual, levels are a valuable tool to determining if a drug user has abstained from further use or has continued using a specific drug.  In order to determine this, an initial drug test must be performed to obtain the “starting point” or “initial level.”  For tracking purposes, hair follicle testing is most beneficial specimen to test because it detects substance use over a period of 90 days.  Once an initial level has been obtained from the first drug test, subsequent testing using the same specimen type and laboratory will show comparative levels against the initial level.  If the number of the level on a subsequent test is lower, it indicates that the user has not engaged in additional drug use since the last test that was conducted. A higher level would indicate continued use.

It is important to remember that you cannot compare levels from different specimen types or from different laboratories.   For example, you can’t compare a hair follicle test result level to a urine test result level. You also cannot compare a hair follicle test done at Quest Diagnostics to a hair follicle test done at American Toxicology.  For a proper and valid comparison, the testing specimen and laboratory must remain constant throughout the tracking process.

CONCLUSION

In summary, the purpose of levels reported on a drug test result are to assist in determining ongoing drug use or absence of use only.    For initial testing purposes, levels displayed on an initial drug test only provide a starting point or benchmark from which to compare future testing.  A single drug test level as a stand alone number provides no evidence of the severity of use or abuse of a drug. Comparing actual levels to the screen or confirm cutoff levels does not provide an accurate or estimated measure of severity of drug use and should not be practiced.