Workshop - Drug Testing: Best Practices

Workshop - Drug Testing:
Best Practices
Greg Skipper, MD
Michael Kaufmann, MD
At the end of today’s workshop:
• We will have a shared understanding of the
concept of a “Best Practices” in PHP drug
testing document;
• We will have blueprint suggestions for the
categorical content of the document;
• We will have suggestions for specific content for
the document;
• We will have good ideas regarding the format
and stewardship of such a document;
• We will have direction for next steps in the
production of this document.
• Elements of a “best practices” document
must include:
– Elements that ought to be included
– Elements that don’t need to be included
– Where further information or research is
required before a decision regarding inclusion
can be made
– Content not discussed today that you think
ought to be included
Drug Test Panels
• Components –
• Fixed vs Variable Panels?
– Based on DOC?
– How and when to vary?
• Naltrexone – Other therapeutic meds, (Psych
• Alternative substrates
– Hair, nails – for security? How often? Saliva?
• Dipsticks? Use in the “field” or office?
• Cutoffs – arbitrary, as low as possible?
Observed? To what degree?
DOT protocol? (empty pockets, remove
jacket and outer clothing, have no access to
water in bathroom, etc..)
• Enforced and if so how?
• QA?
Frequency & Duration of Testing
• What type of random testing? Define
• When to suspend? Vacation? Evidence?
• Should the pattern change after relapse and
if so how?
• Duration of testing?
• Who should decide frequency, duration,
change after relapse? PHP, Evaluator, Tx
• Is having the TPA provide the PHP
management software a good idea?
• Is it a conflict of interest for programs to
mark-up the price for a drug test and take
• Registry for TPAs
• FSPHP authorized? Accredited?
Ethanol Monitoring
 EtG,EtS, pEth – (i.e. cutoffs, EtG
immunoassay, normalization to creatinine
100, warning regarding products to avoid,
confirmation of drinking with PEth,
 Protocol for use with EtG that “proves
• SCRAM/TAD – transcutaneous monitors
• Home/work photo/voice recognition
Interpretation Issues
Dilute urine
Missed check-in
Missed tests
False positives and negatives
Second hand exposure
Out of range: temp, pH
Invalid test
Consequences for each?
Best Practices “Document”
• What should this document be called?
– Best Practices, guidelines, other?
• What will be the format for this “document”?
Published paper
Some form of Wiki document
How will this document be produced?
How will this document be maintained?
How will this document be distributed?
Who will oversee validity?
Participants on Prescribed Drugs
How to designate test (positive, negative,
other) when on legitimate prescription
How to certify legitimacy
Valid prescription from any licensed MD
Require evaluation by PHP authorized MD
Never allow

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