What Are the Cut Off Levels for Drug Testing?

Drug testing uses a cut-off level to determine the concentration of drugs and drug metabolites in your urine, blood sample, saliva, and hair. There is a safety risk if the results are equal to or above the recommended cut-off levels. If your sample is below the cut-off level, your test will show a negative result. If it is equal to or above the cut-off, your test result will be positive

What is the significance of cut-off levels?

Cut-offs in drug testing programs are important. It’s because not all positive test results mean a donor uses illicit drugs. For example, he might have taken drugs a few months before detection, and the laboratory used hair samples for testing. In this case, drugs would most likely be present, but the result would be below the cut-off.

Also, cut-offs are essential because it protects donors from false-positives. It makes it clear that while drugs may have been present because of prior exposure, the donor hasn’t used drugs recently.

 How are cut-off levels determined, and what regulatory body determines them?

The U.S. Department of Health and Human Services (HHS) establishes the scientific and technical guidelines for federal and non-federal workplace drug testing programs. An example of a federal agency is the U.S. Department of Transportation (DOT). It requires employees and applicants to undergo drug testing. DOT only permits HHS-certified laboratories to conduct both drug testing and verification to determine the results’ accuracy.

 Are cut-off levels affected by detection times?

There are different detection times for various drugs among individuals. These depend on factors such as body weight, gender, age, or substances the person may have consumed with the drug.

Also, drugs have various windows of detection due to their degree of fat solubility. Highly fat-soluble compounds like Tetrahydrocannabinol (THC) have a long half-life.

Thus, some highly fat-soluble compounds can be detected in urine up to several weeks from last use among heavy users. Benzodiazepines drug test detection time vary among individuals due to their half-life.

Long-acting (up to 10 days), intermediate-acting (up to 5 days), or short-acting (up to 2 days). Other factors such as dosage, administration route, time of the last dosage, and individual differences in the drug’s interaction with other substances will affect the detection of benzodiazepine.

NCBI shows the various detection windows via urine samples for some commonly used substances.


Cut-off levels for drug testing

Drug tests vary, depending on the types of drugs tested and the types of specimens collected. Specimens can be in the form of urine, hair, saliva (oral fluid), or sweat samples.

In federally regulated programs, however, only urine samples are collected.

The five categories of the most commonly tested drugs are:

  • Amphetamines
  • Cocaine
  • Marijuana
  • Opiates
  • Phencyclidine (PCP)

Additional categories may include barbiturates, benzodiazepines, ethanol (alcohol), hydrocodone, MDMA, methadone, methaqualone, or propoxyphene.

For the evaluator, knowing the cut-off levels for drug testing can help them provide a more accurate interpretation of results.

To learn more about drug testing, visit the Ovus Medical Blog. We have a wealth of information you’ll find beneficial.


MRO for Drug Testing: What Does He Do?

When an employee undergoes drug testing, a medical review officer reviews the results. But what exactly does an MRO do? Read on to find out what an MRO is and the part he or she plays in the drug testing process.

What is an MRO for drug testing?

A Medical Review Officer is a licensed physician holding either a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree. MROs are different from medical examiners. They are the ones who analyze the laboratory results of a drug test.

MROs are familiar with both prescribed and illegal drugs. They also know anti-drug laws and guidelines very well. MROs must also pass a nationally recognized board exam and maintain their certifications by retaking the same exam every five years.

Work Process of a Medical Review Officer

So what exactly does an MRO do when it comes to drug testing measures? Here is a step-by-step process.

Step 1: Reviewing Laboratory Results Generated

When an employee of the company has provided a sample to the drug testing lab, the lab tests it immediately. The lab then sends its findings to the MRO.

Step 1.1: If Test Result is Negative

If the test is negative, the MRO will verify the result, then send it to the employer.

Step 1.2: If Test Result is Non-Negative

If the result comes back as non-negative, the MRO will first double-check to see if it correct. If it is, the MRO has 72 hours to contact the employee.

Step 2: Interviewing the Employee

The MRO will have to talk to the employee to check if they are on any treatments or have any other medical explanations for non-negative or positive results.

Step 2.1: If the Employee Fails to Respond

The MRO will try three times to contact the employee and wait for 72 hours for him or her to respond. If there is no response, the MRO will ask the employer to tell the employee to contact the MRO. The MRO will not give the employer any specifics about the result.

Step 2.2: When the Employee Responds

The MRO will ask the employee for any medical explanations for the non-negative result, like a prescription drug. If there is a valid explanation, the MRO will classify the test as negative. If the employee doesn’t have a good reason, the MRO will report the test as positive.

Having an MRO review test results protects individuals from being wrongly accused of using illegal drugs and the employer from being sued by any employee fired for failing a drug test.

Are MROs required in all drug tests?

MROs are mandatory for drug tests for employees who have safety-related functions regulated by the Department of Transportation, as outlined in 49 CFR Part 40. MRO services are optional for those who do not fall under these regulations, though it is ideal for employers to use them.

To summarize, the MRO ensures the accuracy and integrity of drug test results and helps to confirm if the tested employee has a legitimate medical explanation if he or she has a positive drug test result. That way, employees won’t face wrongful termination, and employers won’t have to worry about facing any legal battles.


Want to know more about drug testing? Read other blog articles here at Ovus Medical.

Onsite Drug Testing in the Workplace

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According to US Legal, onsite drug testing is a drug test to which an employee is subjected to by an employer. It may be required as part of its drug testing policy, using products approved by the Food and Drug Administration (FDA). It should be conducted by a test administrator from a state-certified laboratory.

Although a controversial matter in the US, drug testing in the workplace is still being implemented in government and private industries where customer safety is of prime concern, evidence after evidence shows how illegal drugs affect employee productivity, attendance, social behavior, and so on.

This post will discuss the different types of onsite drug testing, the most common drug tests, and how it should be performed in the workplace. This post also includes a chart that features the different laws that govern drug testing in various states.

5 Types of Onsite Drug Testing

1. Pre-employment drug test

Pre-employment is the most common type of drug testing. It is required by most companies prior to hiring a candidate.

2. Random drug screening

Random drug testing, as the name suggests, is unplanned. It can be performed on any employee anytime. Some states are required to provide a notice to employees, but not for most.  It is an attempt to prevent employees from using illegal substances.

3. Post-accident drug screening

When an employee is involved in an accident, whether the results are detrimental to him and others, a post-accident drug test is performed to find out if the employee is under the influence. If the employee is found guilty, he may be suspended, sent to a rehabilitation facility, or, in worst-case scenarios, terminated from his job.

4. Reasonable suspicion drug testing

This type of drug test is administered to people who are suspected of using illegal substances due to behaviors related to a drug-induced state –violent behavior,  suicidal thoughts, and tendencies – that may harm not only the concerned employee but others as well.

5. Return to duty/ follow up drug screening

If an employee who was caught and suspended or sent to rehab for violating the company’s policies on illegal drug use, he will be subjected to a return to duty drug examination. If the test proves that the employee is still using drugs, he or she can be terminated.

Types of Drug Tests

Below are the three basic types of drug tests.

1. Urine Testing

This is the most basic and non-invasive type of drug test. A drug testing cup is used to collect about 30 ml of urine. Then, a strip is inserted, depending on what drugs are to be checked. A 6 panel urine drug test, for example, is used to detect frequently abused substances like opiates and cocaine. 10 panel cups, on the other hand, is for detecting amphetamine, ecstasy, marijuana, among others. A 12 panel drug test is used to detect barbiturates, oxycodone, and tricyclic antidepressants in the metabolite.

Be aware, however, that this test is easy to manipulate. Clients can dilute their urine with water or substitute it with drug-free urine. They might also try to take detoxifiers or drink plenty of water to pass the test.

2. Hair Testing

Of all drug tests, this is the most difficult, if not impossible, to cheat. It’s because it can detect drugs three months after use. Drug residues cannot be washed off with shampoo, conditioner, or vinegar because they are not in the hair itself but embedded in the follicles. And even if a client cuts his hair or shaves his head, testers can collect hair from other areas of the body – the eyebrows, armpit, and so on.

3. Blood Testing

This is the least used type of drug testing because it’s the most expensive and the most invasive. It is performed by collecting a blood sample from an individual suspected of using illegal substances.

How to Perform an Onsite Urine Drug Testing

  1. Prior to testing, a standardized form is given to the employee. He or she must fill this up.
  2. An area in the workplace will be set up specifically for the procedure.
  3. A site collection person will be assigned to ensure the integrity of samples.
  4. The collection of urine samples should be done in private. The employee will be given a CLIA-approved urine drug testing cup. In case of supervised testing or if a non-medical person is assigned, only the same gender as the client is allowed to assist. Then, 30 ml to 45 ml of urine will be collected.
  5. The urine sample will be analyzed.


State-by-state Workplace Drug Testing Laws

Drug testing laws may vary from state to state. For more details, check out the chart below.

State-by-State Workplace Drug Testing Laws

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