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  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. 


Fentanyl – The Opioid Crisis

Fentanyl is a synthetic pharmaceutical prescribed for severe pain-relief. It is usually only prescribed for intense and severe pain that is physically debilitating. Fentanyl is routinely prescribed for relief from pain associated with advanced cancer diagnoses.

You may realize that morphine is a pain-reliever which can cause severe addiction. With that in mind, understand that fentanyl is 50 to 100 times more potent than morphine, so you can see how easy it would be to abuse this drug for feelings of euphoria, and pain-relief.

Fentanyl is usually prescribed as a lozenge that can be taken orally, or as a transdermal patch which is applied to the skin. Sometimes injections are prescribed. The drug is becoming in such high demand that it is being produced in overseas drug laboratories and smuggled into the US from China and other less regulated countries. The smuggled drug is often sold as a regulated dose of fentanyl. These illegal, street fentanyl products can create incredible addiction, and are responsible for overdoses and death.




The next level of addiction

If you hear someone speaking of China Girl, Jackpot, TNT, Dance Fever or Tango and Cash in a setting where those terms don’t seem to apply, what you may be hearing common street names for illicit fentanyl.

Like hydrocodone and OxyContin, fentanyl is considered an opioid and narcotic. The brand names for fentanyl-based pain relievers include Duragesic and Sublimaze, among others. A rush of dopamine, a “feel good” chemical, is delivered when fentanyl is taken, and this is one of the reasons this prescription or street-level opioid is so addictive.

Fentanyl has also been found to be cut or added into heroin being sold on the streets to provide users with a more intense experience.  First time or newer heroin users typically overdose almost instantly if they unknowingly use heroin cut with fentanyl.

What is hydrocodone?

Hydrocodone is an opioid used to treat severe pain of a prolonged duration, if other measures are not sufficient. It is also used as a cough suppressant in adults.  A mixture of hydrocodone and other chemicals work to suppress coughing. The narcotics in this cough treatment slow down and depress the reflex in your brain that makes you cough. Hydrocodone is usually present in a combination with different chemicals, and is often used to treat moderate to severe levels of pain. Hydrocodone is one of the class of medications considered an opioid or narcotic, and it relieves pain by blocking the ability of your brain and nervous system to sense pain.

You may be prescribed a pain-reliever or cough suppressant in a capsule, liquid or pill, or possibly a tablet. As a pain-reliever, doctors will usually tell you to take as needed to treat pain, but never more than every 4 to 6 hours. Since it is an opioid, this product can be highly addictive. Your doctor will tell you that if you take hydrocodone in combination with some other medications, you dramatically raise your risk of experiencing serious breathing problem issues, and could possibly lapse into a coma.


how it works

The way hydrocodone works when it “talks” to your brain and nervous system can create a powerful addiction in some people. Because it is a narcotic, it can deliver short-term euphoria which an addicted individual wants to replicate frequently. This can lead to physical dependence and addiction if hydrocodone and other opioid painkillers are taken long-term.

Also, the withdrawal symptoms after an abrupt cessation of this drug are so powerfully negative, some users will do just about anything to get their hands on some more hydrocodone, or a similar opioid or opiate such as Oxycontin, Heroin or Fentanyl.


urine, saliva or hair…oh my!

When it comes to drug testing choices, the most common specimen types are urine, saliva or hair follicle testing.  The differences in costs,  the ability to cheat the test as well as the window of detection of various drugs vary depending on the specimen type tested.  Depending on the reason for the drug testing, it is important to understand these differences when choosing a drug test for your particular needs.

urine specimens

The most popular, cost effective and widely available drug test is the urine drug screen. Urine specimen testing can be completed via rapid testing or laboratory testing. Urine testing allows for the largest number of drugs to be tested. When choosing a rapid test, it is imperative to have any presumptive positive results confirmed by a laboratory before taking any kind of action.  Laboratory testing is the gold standard when it comes to drug testing and provides the most accurate and scientifically valid results, period. 


Drug detection times for urine specimens are fairly short – most drugs only being detectable for 2-3 days. THC, the metabolite found in marijuana can be detected for a longer period (up to 30+ days) depending on the frequency of use of the substance.


The ability to adulterate or cheat a urine drug test is moderate in comparison to other options. Given the short window of detection, a user may be able to refrain from use for a few days prior to an anticipated drug test like a pre-employment drug test. As a result, they may be able to pass the test giving the appearance of a drug free lifestyle.  Where most urine collections are conducted in private and not observed, the opportunity to adulterate or substitute the specimen is always a possibility.

saliva specimens

Saliva drug testing is often a little more expensive than urine testing in that it is not as widely used at this time. It is, however, growing in popularity as an option for testing. Saliva testing can be completed using rapid tests or laboratory testing. Unlike urine rapid tests, saliva rapid testing is not as effective or accurate in drug detection or use. WE DO NOT RECOMMEND RAPID TESTING FOR SALIVA SPECIMENS. Laboratory testing of saliva specimens is far more accurate and scientifically valid in terms of results.


Drug detection times for saliva are actually shorter than urine testing for all drugs, including THC. Saliva is the only specimen type that can detect from immediate usage up to 3 days, depending on the drug.


The ability to cheat or adulterate a saliva specimen is very difficult as the entire collection process is observed by the collector. This eliminates the opportunity for the donor of the specimen to provide someone else’s specimen or to try and adulterate the specimen in other ways.


Hair follicle testing is more expensive than urine testing or saliva testing – and for good reason. Hair follicle testing can only be completed via laboratory testing and provides many benefits above and beyond urine or saliva.  Some companies and attorneys prefer hair follicle testing by itself or in combination with urine or saliva testing.


The detection window for hair testing is much larger than urine or saliva, however detection of drug use can only be detected approximately two weeks after the last usage. For this reason, hair follicle testing in not a good option if looking to detect recent usage of drugs.  Detection of drug use can be detected up to 90 days or more depending on the length of hair being tested.


The ability to cheat or adulterate a hair follicle test is very difficult as the collection is an observed collection by a collector. This eliminates the ability to use someone else’s specimen or to adulterate the specimen in other ways.  The use of bleach or harsh chemicals may affect or mask the drug test results for some types of drugs, but not all.


When deciding on which drug test to use, consider the potential drug use time frame you are concerned with (recent or long term) as well as the ability for the donor to be able to cheat or adulterate the specimen.  Consideration for the specific drug(s) of concern may also play a factor. Not all specimen types can test for all drugs. 

Urine testing provides  the most affordable option as well as the widest availability of drugs that can be tested. To combat concerns of cheating a urine test, an observed collection may be an option. 

If privacy concerns are a factor, saliva and hair follicle specimens provide observed collections by default and offer more accurate results for the short and long term.

The most important consideration is to have a certified collector performing specimen collections and use an approved and certified laboratory to test  all specimens.





 or H

Opioid Drug Crisis – Oxycontin

Any discussion of an opioid drug crisis has to include OxyContin. From 2010 to 2017 in the United States, opioid addiction rates have exploded, up nearly 500% in that 7-year span. Right at the top of the prescription addiction list is OxyContin, a drug which has an addiction more powerful than that of morphine. The United States is far from the only country to suffer from addictions to prescribed medications, with most modern countries recognizing this is a serious public health issue.

Opioid-related deaths have risen by 300% since the turn of the century in the US, and OxyContin is one of the most addictive pain-relievers often prescribed by doctors. Because it is frequently in the news, OxyContin is routinely turned down when offered by a physician for treating pain. The potential relief it can deliver is outweighed by the possible addiction in the mind of the patient.



pathway to addiction

Ever since the late 1990s, OxyContin has been used to treat postoperative pain for a number of operations and procedures. When the pain is extremely high, this drug is sometimes prescribed because of the oxycodone it contains. One dose of OxyContin contains between 10 and 80 mg of oxycodone, which delivers a time-released relief from pain for up to 12 hours.

Whether obtained through a legal prescription or by other means, OxyContin can be crushed and then snorted or swallowed, or diluted in water and injected. This removes the time-release mechanism and gives a ‘high’ or feeling of euphoria comparable to that of heroin. This sometimes leads to criminal behavior in an effort to get more of this addictive drug than a prescription allows. Street prices for Oxycontin have risen leading people who are addicted to the drug and can no longer get the pill to seek out alternative drugs in its place including heroin which is widely available and more affordable.