Q: Does a positive toxicology screen mean someone was intoxicated?
A: Not necessarily. Depending on the drug, the user (naïve or chronic), and the modality of testing, it may or may not translate into intoxication. See General Guidelines
Q. Can passive smoke exposure to a drug lead to a positive urine drug screen?
A: Depending on the specific drug, passive smoke exposure in most naturally occurring environments usually is not enough of an exposure to lead to a positive standard screening urine drug screen. However, there are circumstances (prolonged high level of exposures in a very small, poorly ventilated space) that may lead to enough inhalational exposure to lead to a positive urine drug screen. As there tend to be many factors which could impact results in these situations, consider seeking a medical specialist to review. See Additional Considerations for Testing Children
Q. Is there one matrix (blood, urine, hair, saliva) of testing that is the universally the best for drug exposure?
A: No, each matrix of testing is unique in what it can test, how well it can test, and for what time frame it can detect drug exposure. See Types of Toxicology Tests
Q: Does a negative standards urine drug screen equal no drug exposure?
A: No. Remember, standard urine drug screens only test for a selective number of drug categories and can have many false positives and negatives. If there are specific concerns, they should be followed with selective confirmatory drug laboratory assays. See General Guidelines
Q. Do all drug tests screen for the same drugs?
A: No. There are many different commercial drug tests available. Also, some hospitals specifically do not screen for some drug categories, such as marijuana, due to the high incidence of public use and positive results. Review the Toxicology Tests & Signs and Symptoms Sections.
Q: Does positive hair follicle testing equate to intoxication?
A: No, it can be difficult to determine intoxication from hair testing. Hair follicle testing can be representative of drug exposure - either environmental exposure or systemic exposure - over the past few months. However, it should not be used to evaluate for acute exposure or intoxication. Given that a hair follicle test will only confirm whether or not exposure occurred over the past few months, but not the details surrounding how it occurred, how many times it occurred, or how much exposure occurred, hair follicle testing of children is not recommended as an effective method of confirming caregiver use. See Types of Toxicology Tests
Q: IS DRUG TESTING FOR ADOLESCENTS DIFFERENT THAN DRUG TESTING CHILDREN?
A: The testing methods do not change for adults, adolescents, or children. With adolescents, drug exposures can still be unintentional, but concerns for recreational use also need to be considered. As opposed to young children, where it is likely malicious or unintentional exposure. See Additional Considerations for Testing Children
Q: WHAT IS THE DIFFERENCE BETWEEN A UA & A UDS?
A: UA stands for urine analysis. It is used to detect urine infections. UDS is urine drug screen. The correct term to refer to a toxicology test is UDS. See General Guidelines
Q: DO DECREASING LEVELS ON URINE DRUG SCREENS MEAN A PERSON HAS DECREASED OR STOPPED THEIR USE OF A SUBSTANCE?
Urine drug concentrations (also known as levels) are rarely useful in determining the amount of use or level of intoxication. Blood drug concentrations can be a better indicator of potential level of intoxication. This can vary based on the the drug itself, as well as chronicity and timeline of use. It can be difficult to conclude abstinence by only following drug concentrations over time as this will depend on the speed of metabolism of the specific drugs and the matrix used for testing. See General Guidelines
Q: If fentanyl is known to be lethal in such small doses, why do people continue to use it?
People use fentanyl for the same variety of reasons that they use other substances, including other opioids. Some users with opioid use disorders have chosen to use it as a cheaper and/or more powerful alternative to other opioids. Others may find that fentanyl has been surreptitiously added to other substances such as methamphetamines or cocaine.
Q: What can be done to help someone with an opioid use disorder who is using fentanyl?
The CDC recommends intervening early with individuals at highest risk for overdose, expanding non-pharmacological and non-opioid therapies, and expanding the distribution and use of naloxone to prevent overdose fatalities.
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