Understanding the Processes & Timeline for Urine Drug Testing

Urine drug testing is a common procedure used to detect the presence of various substances in a person’s system. It plays a crucial role in many settings, including employment screenings, forensic investigations, and medical assessments. Understanding the process of urine drug testing, from the collection of the specimen to medical review, is essential for individuals undergoing such tests and for professionals administering them.

  1. Collection of Specimen:

The first step in urine drug testing is the collection of the specimen. This is typically done in a controlled environment, such as a healthcare facility or a designated collection site. The person being tested is given a sterile container and instructions on how to provide a urine sample. It’s important to ensure the integrity and authenticity of the specimen to maintain the accuracy and reliability of the test results. This is completed by following strict collection protocols and documentation via chain of custody by all parties involved in the testing process beginning with the specimen collector.

  1. Immunoassay Screen:

Once the urine sample is collected, it undergoes an initial screening known as an immunoassay screen. This screening method uses antibodies to detect the presence of specific drugs or their metabolites in the urine. It is a rapid and cost-effective way to identify potential drug use. However, it does not distinguish between different substances or provide detailed quantitative information. If the immunoassay result is negative, the result is reported as negative without further testing required.

  1. Laboratory Testing Using GC/MS Technology:

If the immunoassay screen yields a non-negative result, the urine sample is sent for confirmation testing and undergoes testing using Gas Chromatography/Mass Spectrometry (GC/MS) technology. This method is highly accurate and specific, capable of identifying individual drugs and their metabolites with precision. GC/MS separates and analyzes the components of the urine sample, providing detailed information about the substances present including the specific drug metabolites present and the levels at which they are present.

  1. Average Timelines for Receiving Results:

The timelines for laboratory testing in urine drug testing can vary depending on various factors such as the testing facility’s workload, the complexity of the analysis, and the type of substances being tested for. On average results are released according to they type of testing completed:

  • Immunoassay screening results are typically available within 1-2 days.
  • Confirmatory testing using GC/MS technology may take an additional 2-3 days for comprehensive analysis and reporting. In rare cases, additional testing may be required taking an additional 2-3 days to confirm results.

It’s important to note that these timelines are approximate and can vary in different situations.

  1. Medical Review:

Once the laboratory testing is complete, the results are reviewed by a qualified medical professional. This review includes interpreting the test results, speaking with the donor of the urine sample, considering any relevant medical history or medications, and making an informed assessment of the individual’s drug use status. The medical review is crucial in providing context to the test results and ensuring accuracy in reporting.  This process can take up to 3-5 days to complete.

In conclusion, urine drug testing involves a multi-step process that begins with specimen collection, proceeds with immunoassay screening, advances to laboratory testing using GC/MS technology, and concludes with a medical review of the results. Understanding this process and its timelines can help individuals and professionals navigate the testing procedure effectively and interpret the results accurately. 

While some drug test results can be received in as little as 20 minutes for instant testing or 1-2 days for lab-based tests, some results could take as long as 7-10 days or more to be released.

DOT Regualtions for owner operators

The Department of Transportation (DOT) regulations for owner-operator drivers are designed to ensure the safety of both drivers and the public on the roads. These regulations set minimum standards for the physical and mental fitness of commercial vehicle drivers, as well as the vehicles they operate.

Under DOT regulations, owner-operator drivers must undergo a physical examination by a licensed medical examiner and receive a valid Medical Examiner’s Certificate (MEC). The MEC must be kept up-to-date and be available for review by DOT officials at any time. The physical examination must include a review of the driver’s medical history, a review of their medications, and an assessment of their vision, hearing, and other physical capabilities. The DOT physical examination is designed to ensure that the driver is physically and mentally fit to operate a commercial vehicle safely.

In addition to the physical examination, DOT regulations also require owner-operator drivers to comply with strict drug and alcohol testing requirements. Drivers must be tested for controlled substances, such as marijuana and cocaine, as well as for alcohol. Positive drug test results can result in disqualification from operating a commercial vehicle, and drivers who refuse to take a drug or alcohol test can also be disqualified.

DOT regulations also set standards for the vehicles operated by owner-operator drivers. Vehicles must be regularly inspected and maintained to ensure that they are in safe operating condition. Owner-operator drivers are responsible for maintaining accurate and up-to-date records of their vehicle inspections and maintenance. These records must be available for review by DOT officials at any time.

Furthermore, owner-operator drivers must comply with strict hours-of-service regulations designed to prevent driver fatigue. These regulations limit the number of hours that drivers can spend behind the wheel and require drivers to take mandatory rest breaks. Drivers who violate hours-of-service regulations can be disqualified from operating a commercial vehicle and face penalties.

In conclusion, DOT regulations for owner-operator drivers are designed to ensure the safety of both drivers and the public on the roads. These regulations set minimum standards for the physical and mental fitness of commercial vehicle drivers, as well as the vehicles they operate. Owner-operator drivers must comply with strict drug and alcohol testing requirements, vehicle maintenance standards, and hours-of-service regulations. Failure to comply with these regulations can result in disqualification from operating a commercial vehicle and penalties.

DOT Regulations for 


the role of the medical review officer

Maintaining the integrity of the drug testing process, the MRO plays a critical role.




The Medical Review Officer (MRO) is an integral part of the drug testing process, who plays a critical role in maintaining the accuracy, fairness, and privacy of the results. The MRO is a licensed physician responsible for reviewing and verifying the results of drug tests conducted in the workplace. They act as impartial third-party experts who ensure that the drug testing process is conducted in compliance with all relevant federal and state laws and regulations.

The primary function of the MRO is to review the results of a positive drug test and determine if the result was caused by legitimate medical use of a prescription drug or if it was due to illegal drug use. If a positive test result is obtained, the MRO contacts the employee and gathers additional information to help make an informed decision. The MRO also has the ability to request additional medical or laboratory information if necessary to help make a determination.

One of the key responsibilities of the MRO is to protect the privacy of employees by ensuring that the drug testing process is conducted in accordance with all relevant privacy laws and regulations. They maintain confidential records of all drug test results and ensure that the information is protected from unauthorized disclosure. This helps to ensure that the results of the drug test remain confidential and are only used for the purpose for which they were intended.

The MRO also serves as a resource for employers and employees. They can provide information on drug testing regulations and guidelines and help employers develop effective drug testing policies and procedures. They can also answer questions and provide guidance on the medical aspects of drug testing, including the effects of different drugs, medical conditions that may affect test results, and the appropriate use of prescription medications.

Another important role of the MRO is to help prevent the abuse of drugs in the workplace. By verifying the accuracy of drug test results and ensuring that they are conducted in compliance with all relevant laws and regulations, the MRO helps to create a safe and drug-free workplace. This helps to maintain the health and safety of employees and the public, and to protect the reputation of the workplace.

In conclusion, the role of a Medical Review Officer in the drug testing process is critical. They serve as impartial experts who help to ensure the accuracy, fairness, and privacy of the results. By verifying the results of drug tests and protecting the privacy of employees, they play a critical role in maintaining a safe and drug-free workplace. The MRO helps to protect the health and safety of employees and the public, and to protect the reputation of the company.

Top 5 reasons to drug test employees

Drug testing has become a common practice in many companies, helping to ensure that employees are drug-free and able to perform their duties safely and effectively. Here are the top five reasons why a company should drug test both employees and prospective employees.

  1. Maintaining a Safe Workplace: Drug testing can help identify employees who are struggling with substance abuse, which can pose a risk to the safety of themselves and their coworkers. This can include impaired judgment, decreased productivity, and even physical danger if the employee is under the influence while operating heavy machinery or performing other dangerous tasks. By testing for drugs, companies can mitigate these risks and ensure a safe working environment for all employees.
  2. Protecting Company Assets: Substance abuse can also lead to decreased productivity, missed work days, and decreased job performance, which can negatively impact a company’s bottom line. Drug testing helps identify and address these issues before they become a problem and can protect the company’s financial assets.
  3. Complying with Legal Requirements: Many industries are regulated and require drug testing as a condition of employment. Failing to comply with these regulations can result in significant legal and financial consequences for the company. For example, transportation companies are required to drug test employees who operate commercial vehicles to ensure that they are not under the influence while on the job.
  4. Promoting a Drug-Free Culture: By testing employees and prospective employees for drugs, a company can send a clear message that drug use is not tolerated in the workplace. This promotes a drug-free culture and encourages employees to maintain a healthy and safe lifestyle.
  5. Attracting Top Talent: Companies that drug test are seen as being committed to the well-being and safety of their employees. This can make the company a more attractive place to work for top talent, who are looking for a workplace that values their health and safety.

In conclusion, drug testing employees and prospective employees can provide a variety of benefits to a company, including maintaining a safe workplace, protecting company assets, complying with legal requirements, promoting a drug-free culture, and attracting top talent. Companies should consider implementing a drug testing program to ensure a safe and productive workplace for all employees. It is important to keep in mind that drug testing should be done in a fair and non-discriminatory manner, and with the privacy of employees in mind.

Top 5 Reasons Companies 

To Test or Not To Test

That is the question…


In our capacity as a drug and alcohol testing professionals,  we have come across many business owners and employers that have outright refused to drug test their employees or applicants because they feel that doing so would cause them to lose half or more of their current employees and significantly reduce their overall applicant pool.  When asked what makes them think that, they answer with complete confidence that the kind of people they employ are frequently found to be users of marijuana, and as a result, would never pass a drug test.  Sadly, we have to agree – they probably wouldn’t pass a typical drug test.

Fact of the matter is, there are some industries that are more likely to employ
users of marijuana. These are typically lower paid jobs or hard labor type jobs such as landscapers, restaurant workers, hospitality workers, construction laborers, etc.   Employers and business owners in these, and similar industries often struggle to find enough help to meet demand and simply make the executive decision to eliminate drug testing altogether.


Then we ask them the only question left to ask – 

“So you trust a crystal meth user, cocaine addict, pill popper or heroin junkie to take care of your customers, drive your company vehicles and represent your company to general public?”  

Without fail, the answer is a quick, “no way, of course not.” Our reply is just as quick… then why aren’t you testing for those drugs? 








With states across the country legalizing marijuana use for medicinal and recreational use, the stigma of marijuana users has decreased dramatically and marijuana use has become more acceptable overall in society.  We are not here to debate whether employers and business owners should be testing for marijuana or not. There are pros and cons on both sides of that question and that decision must ultimately be made by the individual employer.  




The primary goal of Carolina Testing is to serve our clients and meet their specific needs.  The need for a drug screen that tests for drugs of concern for a specific employer has never been greater than it is today.  As a result, we have introduced a custom drug test options that does not test for the marijuana metabolite known as THC.  This test is available as a rapid urine test, providing negative test results to the employer within 15 minutes. 

To learn more about your company’s employee screening options and how Carolina Testing can customize an employee screening program to meet your individual needs, give us a call at 843-972-3287, send us a text message, or shoot us an email today.


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.


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: 


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: 



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. 


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.


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.

chaos on the rails

It was a frigid cold January 4th afternoon in 1987 when Amtrak passenger train (Train 94) left Washington DC heading to Boston. Reaching speeds of over 125 mph the train entered the Chase community in eastern Baltimore County, Maryland at approximately 1:30pm. At the same time, a Conrail locomotive crew failed to stop at the signals placing itself in the direct path of the oncoming Amtrak train. Sixteen people lost their lives in the accident and many, many injuries were reported among the approximately 600 passengers aboard.  It took rescuers over 10 hours in frigid temperatures to extricate passengers from the wreckage. The front cars of the passenger train that sustained most of the impact and damage were not yet occupied. The investigation by the National Transportation Safety Board (NTSB) revealed that had those cars been filled, the death toll would have been significantly higher.


the investigation

The NTSB investigated the accident and determined that had the Conrail locomotives failed to slow down at the signals as required, they would have been able to stop in time to avoid the collision.  Ricky Gates, the engineer for Conrail and his brakeman, Edward Cromwell both tested positive for marijuana following the accident, even though they denied using the substance. Prosecutors later cut a deal with Cromwell offering immunity for testifying against Gates stating that both Cromwell and Gates had been smoking marijuana while on duty.  After four years in prison for manslaughter, Gates admitted in an interview in 1993 that the accident never would have happened if he was not under the influence of marijuana st the time. He also admitted that he had smoked marijuana several times while on duty. 





the result

The Federal Railroad Administration was forced by legislation to strengthen its certification processes for locomotive engineers which went into effect January 1990. These processes require that in addition to engineers being properly trained and certified, they can have no drug or alcohol impairment convictions for the five years prior to certification.  In 1991, Congress required not only the FRA, but all agencies regulated by the Department of Transportation to implement mandatory random drug testing for all safety sensitive duty employees regulated by the agency. 


Each year, the agencies review the results of the random testing completed and determine the levels at which regulated companies must randomly test their employees.  Levels of random drug testing range from 25% to 50% depending on the agency and the number of positive results from a specific agency.  The higher the number of positive test results, the more random testing is ordered. 

Companies in these regulated industries are required to follow the regulations found in 49 CFR Part 40 as well as their agency specific regulations.  To learn more about these regulation and the specifics for each agency, please visit www.carolinatesting.com  For help in getting into compliance with the regulations and maintaining compliance with DOT drug and alcohol testing requirements, please contact the DOT specialists at Carolina Testing today.

Teen Drug Abuse Set To Rise Again

It is that time of year when students begin returning back to school and back to a major source of availability and opportunity to experiment with drugs and alcohol.  Some reports show that In 2016,  99% of doctors prescribed narcotic painkillers in dosages which exceed the federally governed three day limit. This means only 1 out of every 100 doctors was responsibly prescribing powerful painkillers. Drugs that have been shown to drive addiction leading to a dramatic downturn in quality of life, criminal behavior, and even death. 

In the United States as many as 45 people die each and every day from the abuse of opioid painkillers which have been prescribed by a doctor. This is more death than what is caused by the combined overdoses of cocaine and heroin. Unfortunately, many of these deaths include teenagers.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2017 that 4.3 million Americans take prescription painkillers for non-medical reasons each month. More than 50% of those people got their drugs from a relative or friend. Teenagers have wide access to these drugs and could be abusing someone else’s prescription medications without you knowing.


what can you do?

Keep lines of communication open with your teen. Talk to them about the dangers of amphetamines like Ritalin or Adderall.  Discuss the fatal consequences of experimenting with drugs they don’t know anything about. Don’t keep your personal, prescribed medications in the medicine chest. Keep them under lock and key, in a location unknown to your teen. If your child asks for money, make them account for what that money was spent on and follow up with them. When your teen comes home from school, extra curricular activities or from a friend’s house, make it a point to have a conversation with them before they hide in their room. Speak to your child’s educators, and arrange for drug abuse education at the school level.

You should also understand that things like cough medicine can be addictive. There are opiates and narcotics in many cough suppressants which can be abused. Prescription cough medications include the opiate codeine and can become addictive quickly. Keeping these and other more serious medications away from your teen, talking to your teen about drug addiction and arranging a discussion between your family doctor and your teen are some simple steps that could keep addiction from devastating your family.

let us help.


If you ever question whether your child may be experimenting with drugs or alcohol, have them tested by a qualified professional who can work with you to determine the most effective test options for your situation. Call us at 843-972-3287 for more information.


Preventing Prescription Drug Abuse

Any medication that changes the way your brain and nervous system communicate with each other can become addictive. Narcotics, opioids and opiates like morphine, codeine, oxycodone, OxyContin, fentanyl and hydrocodone disrupt how your brain and nervous system respond to pain. They deaden how your body recognizes pain, while simultaneously causing the release of hormones and chemicals which make you feel happy, euphoric and “high”.

The first step to preventing addiction from these and any other over-the-counter or prescribed drugs is to understand that what looks like a harmless little pill can cause massive changes in how your internal systems work. Opiates, narcotics and other types of drugs and medications are so good at masking pain and making you feel great that even short-term use can become highly addictive.



protect yourself from abuse

These types of medications should be kept under lock and key – especially with children of any age in the home. If you are prescribed some type of opiate or other possibly addictive medication, this information should be kept by the fewest number of people possible. Addictive drugs like OxyContin are so good at delivering an extreme high and painful withdrawal that some criminals and addicts will stop at nothing to get your pills once they know you have them – including breaking into your home.

You should also talk to your doctor about pain-relief alternatives. Monitor your usage, and keep a journal where you honestly record every time you take one of these types of medications and the amount taken. Check in with your doctor regularly, and ask for a reduction in dosage as your pain starts to wane. Finally, never let someone other than the prescription holder take an opiate, narcotic or opioid. Your intentions may be good, but a single dosage could create an unhealthy addiction.


OxyContin vs. Oxycodone

OxyContin and oxycodone can both be deadly when abused. These powerful opioid pain-relievers can do incredible good when taken properly and prescribed and monitored by a physician that understands the possible addiction both of these opioids can create. They are often prescribed for relief from extreme pain, and are usually administered in some type of time-release formula.

Oxycodone is the active ingredient, and is usually combined with other medications, chemicals, powders or liquids. Just because it is mixed with other substances, it doesn’t mean it can’t still be incredibly addictive, dangerous and even deadly when abused. You may find Tylenol, Ibuprofen or some other low-level pain reliever combined with oxycodone. Brand-name precription pain relievers such as Percodan, OxyContin and Percocet all include some level of oxycodone.


Spark Better Business

OxyContin, however, has only one ingredient … oxycodone. Since the level of addictive, pain-relieving oxycodone is much higher in OxyContin than in some product which combines oxycodone with other chemicals, OxyContin should be considered highly addictive and taken responsibly and under close physician supervision.

OxyContin does contain time-release restrictions when obtained in a legal, prescribed form. However, abusers and addicts have found that crushing the tablet or mixing it in water removes the time-release restriction, and the rush of euphoria is immediate. Withdrawals after taking OxyContin irresponsibly are severe, and this is what makes OxyContin so much more addictive than medications which combine oxycodone with other chemicals and medicines.

OxyContin abuse has been found to be one of the leading causes to the current opioid epidemic causing widespread heroin use nationwide. Opioid abuse leads to addiction so quickly because the user is always seeking the high they received when they first abused the drug. The build up a tolerance to the drug over time leading to more frequent use as well as stronger drugs such as fentanyl and carfentanil.