Drug Testing Services

Pain Management Testing


Pain management testing incorporates many different purposes into one testing panel. Its primary focus is to verify that pain management patients are taking their medications appropriately.

In this context, “appropriate use” means not using too little or too much of the medication. Low levels of drug present or no drug present may indicate very little drug use or no use at all. This may be because the patient is having difficulty with the medication or that the patient is subverting or selling the medication to others.

High levels of drug identified during testing may indicate that the medication is not helping the patient and the patient is taking more than prescribed. The patient also could be getting the medication from more than one physician.

Another focus of pain management testing is to verify that the patient is not taking other medication that may interfere with the prescribed medicine. Sometimes a patient may not provide a complete list of medications they take to their pain physician. Other medications can interfere with the way prescription pain medications work. Therefore, a complete pain management testing protocol includes other commonly used medications whose presence may interfere with a successful pain management plan.

A third focus of pain management testing involves looking for illicit or illegal medication. Illegal drug use may indicate addictive behavior and can exclude the patient from the pain management program. Illicit use of a prescription medication, or using a medication without proper physician oversight, may indicate addictive behavior, or at the very least non-compliance with the rules of a pain management program.

Because pain management testing evaluates a patient over time, multiple drug tests are required. Creatinine normalization (See more about the “creatinine normalization”) can eliminate urine concentration as a factor in fluctuating test results.

Criminal Justice Testing

Criminal justice testing includes drug testing for probation and parole, court services, family services, and other local, state, and federal agencies whose role is to ensure that the people under their supervision do not use illicit or illegal drugs.

Onsite testing is common in criminal justice settings. The donor can be confronted immediately with the results of testing. This immediate confrontation can be an effective tool in addressing adverse behavior. We at STL provide services to confirm the results of the onsite testing when a donor denies use. The focus of laboratory drug testing in this type of criminal justice situation can be limited in scope, depending on which drug or drugs are specifically requested from our client.

Some criminal justice agencies prefer to have a laboratory perform all drug testing on their specimens. STL provides two options:

First, an agency can elect to have STL perform just an initial presumptive screen test and report those results. STL will hold the urine sample to give the agency time to contact the donor and confront him or her with any presumptively positive result. The agency can then have follow-up confirmatory testing if the donor denies use.

And secondly, a client that prefers to have a laboratory perform all testing can opt for an initial screen test, with automatic confirmation of all positives prior to reporting. STL can tailor your testing protocol to your specific needs.

Criminal justice testing may involve evaluation of known drug users over time. Often the question is not “did the donor use drugs” but “when did the donor use drugs”. Evaluation of continued drug use, or abstinence from drug use is critical in criminal justice monitoring. In these cases, multiple drug tests are performed throughout the period of supervision. Creatinine normalization (see creatinine normalization) is a calculation that can be performed to eliminate urine concentration as a factor in evaluating drug result fluctuations over time.

Some criminal justice donors can be remarkably resourceful at tampering with drug specimens. (see specimen validity testing). Dilution is most commonly used to mask ongoing drug use. If requested by your agency, STL can perform Limit of Quantitation (LOQ) testing. That means we can report the presence of a drug down to our lowest ability to accurately identify and quantitate a drug, even if that level drops below standard industry cutoffs. This testing protocol often identifies the presence of a drug in specimens despite attempts at dilution.

Workplace Drug Testing

Workplace drug testing can be an effective deterrent to drug use and abuse in the workplace and by its workers. The goal is workplace safety, as well as employee health and well-being. The four main categories of workplace drug testing are:

  • Pre-employment -- Employers may require a prospective employee to pass a drug test before hiring.
  • Random -- Employers also may test their employees randomly to deter illicit or illegal drug use.
  • Post accident -- After an on-the-job accident, an employer may require a drug test to ensure that drug use did not contribute to the accident.
  • For cause. Also, if an employee acts in an inappropriate way at work, the employer may choose to perform a drug test to ensure that drug use is not the reason for the abnormal and potentially unsafe behavior.

The results, of course, mean that employees or prospective employees testing positive may not get the job they want, may lose their job, or may be directed to a drug treatment program. Workplace drug testing utilizes presumptive screening followed by confirmatory testing and utilizes industry standard cutoffs. Specimen validity testing is often included in a comprehensive workplace drug testing program.

Presumptive screening

This is the first step in the drug testing process. The reason the test is presumptive, is that it indicates the likely presence of drug. It may not target a drug specifically and absolutely to the exclusion of all others. At STL, the presumptive screening is performed on an automated chemistry analyzer, interfaced with the laboratory computer system. Presumptive screening is rapid and fairly inexpensive, but its purpose is to eliminate the negative specimens and narrow down the scope of more costly confirmatory testing.

Confirmatory testing

True confirmatory testing uses a testing protocol that identifies a drug to the exclusion of all others. At STL, confirmatory testing is performed using liquid chromatography coupled with tandem mass spectrometry (LC/MS/MS). In any urine drug testing program, identifying a drug with this methodology establishes absolutely that the donor of the specimen used the drug identified to the exclusion of all others.

This testing is quantitative. The resultant value is then used to address any quantitative drug issues, i.e. active use verses passive exposure, new verses residual use (see explanations for each of these here [another hyperlink]).

Creatinine normalization

When evaluating specimens testing positive over time, the concentration of the urine itself may complicate the interpretation. To eliminate urine concentration as a factor, a calculation called creatinine normalization is performed. Creatinine is a substance produced in the body and excreted in the urine. The presence of creatinine indicates that the specimen is urine, and the level of creatinine is an indicator of the concentration of the urine. The higher the creatinine value, the more concentrated the urine specimen is. The lower the creatinine value, the more dilute the urine specimen is.

The creatinine level fluctuates based on fluid intake. The creatinine normalization calculation corrects or normalizes the creatinine level of the specimen to that of an industry standard and then applies that correction or normalization factor to the drug result. This calculation corrects for fluctuation of the urine concentration and presents a clearer picture of the drug level in the sample and simplifies interpretation of drug levels in drug tests over time.

Limit of Quantitation testing

The limit of quantitation (LOQ) is the lowest level at which a laboratory can identify and accurately quantitate a drug of interest. This level is determined by linearity studies performed either annually, or as procedural changes occur. STL has the option of reporting results utilizing LOQ testing. That means we can report the presence of a drug down to our lowest ability to accurately identify and quantitate a drug, even if that level drops below standard industry cutoffs.