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Drug test
To minimize opportunities for tampering, a direct line of sight between the observer and the specimen bottle must be maintained during collection of a urine sample.
MeSH	D015813

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A drug test is a technical analysis of a biological specimen – for example urine, hair, blood, sweat, or oral fluid / saliva – to determine the presence or absence of specified parent drugs or their metabolites. Major uses of drug testing are to detect the presence of performance enhancing steroids in sport or for drugs prohibited by laws, such as cannabis, cocaine and heroin.

A "10-panel urine screen" consists of the following: 1. Amphetamines (including Methamphetamine) 2. Barbiturates 3. Benzodiazepines 4. Cannabinoids (THC) 5. Cocaine 6. Methadone 7. Methaqualone 8. Opiates (Codeine,Morphine, Heroin,Oxycodone, Vicodin, etc.) 9. Phencyclidine (PCP) 10. Propoxyphene

Detection periods

The following chart from LabCorp gives approximate detection periods for each substance by test type.

The detection windows depend upon multiple factors—drug class, amount and frequency of use, metabolic rate, body mass, age, overall health, and urine pH. For ease of use, the detection times of metabolites have been incorporated into each parent drug. For example, heroin and cocaine can only be detected for a few hours after use, but their metabolites can be detected for several days in urine. In this type of situation, we will report the (longer) detection times of the metabolites.

Oral fluid or saliva testing results for the most part mimic that of blood. The only exceptions are THC (tetrahyrocannabinol) and benzodiazepines. Oral fluid will likely detect THC from ingestion up to a maximum period of 6–12 hours. This continues to cause difficulty in oral fluid detection of THC and benzodiazepines.

Rapid oral fluid products are not approved for use in workplace drug testing programs and are not FDA cleared. Using rapid oral fluid drug tests in the workplace is a violation of many state and federal laws.

Types

Urine drug screen

Drug Screens are reported as PASS, or FAIL with urine reported invalid or adulterated.

When an employer requests a drug test from an employee, or a physician requests a drug test from a patient, the employee or patient is typically instructed to go to a collection site or their home. The urine sample goes through a specified 'chain of custody' to ensure that it is not tampered with or invalidated through lab or employee error. The patient or employee’s urine is collected at a remote location in a specially designed secure cup, sealed with tamper-resistant tape, and sent to a testing laboratory to be screened for drugs (typically the SAMHSA 5 panel). The first step at the testing site is to split the urine into two aliquots. One aliquot is first screened for drugs using an analyzer that performs immunoassay as the initial screen. If the urine screen is positive then another aliquot of the sample is used to confirm the findings by gas chromatography – mass spectrometry (GC-MS) methodology. If requested by the physician or employer, certain drugs are screened for individually; these are generally drugs part of a chemical class that are, for one of many reasons, considered more abuse-prone or of concern. For instance, oxycodone and diamorphine may be tested, both sedative analgesics. If such a test is not requested specifically, the more general test (in the preceding case, the test for opiates) will detect the drugs, but the employer or patient will not have the benefit of the identity of the drug.

Employment-related test results are relayed to an MRO (Medical Review Office) where a medical physician reviews the results. If the result of the screen is negative, the MRO informs the employer that the employee has no detectable drug in the urine. However, if the test result of the immunoassay and GC-MS are non-negative and show a concentration level of parent drug or metabolite above the established limit, the MRO contacts the employee to determine if there is any legitimate reason—such as a medical treatment or prescription .

On-site instant drug testing is a more cost-efficient method of effectively detecting drug abuse amongst employees, as well as in rehabilitation programs to monitor patient progress. These instant tests can be used for both urine and saliva testing. Although the accuracy of such tests varies with the manufacturer, some kits boast extremely high rates of accuracy, correlating closely with laboratory test results.

Hair testing

Hair analysis to detect drugs of abuse has been used by court systems in the United States, United Kingdom, Canada, and other countries worldwide. In the United States, hair testing has been accepted in court cases as forensic evidence following the Frye Rule, the Federal Rules of Evidence, and the Daubert Rule. As such, hair testing results are legally and scientifically recognized as admissible evidence. Most hair tests screen and confirm for the main drugs of abuse (Cocaine, Amphetamines, Methamphetamines,Opiates, PCP, and Marijuana).

Hair testing for alcohol markers is now recognised in both the UK and US judicial systems. There are guidelines for hair testing that have been published by the Society of Hair Testing that specify the markers to be tested for and the cutoff concentrations that need to be tested. There are only a few UKAS ISO17025 accredited laboratories in the UK including Tricho Tech based in Cardiff and Alpha Biolaboratories based in Warrington, UK. Drugs of abuse that can be detected include Cannabis, Cocaine, Amphetamines and drugs new to the UK such as Mephedrone.

Alcohol

In contrast to other drugs consumed, alcohol is not deposited directly in the hair. For this reason the investigation procedure looks for direct products of ethanol metabolism. The main part of alcohol is oxidized in the human body. This means it is released as water and carbon dioxide. One part of the alcohol reacts with fatty acids to produce esters. The sum of the concentrations of four of these fatty acid ethyl esters (FAEEs: ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate) are used as indicators of the alcohol consumption. The amounts found in hair are measured in nanograms (one nanogram equals only one billionth of a gram), however with the benefit of modern technology, it is possible to detect such small amounts. In the detection of ethyl glucuronide, or EtG, testing can detect amounts in picograms (one picogram equals 0.001 nanograms).

However there is one major difference between most drugs and alcohol metabolites in the way in which they enter into the hair: on the one hand like other drugs FAEEs enter into the hair via the keratinocytes, the cells responsible for hair growth. These cells form the hair in the root and then grow through the skin surface taking any substances with them. On the other hand the sebaceous glands produce FAEEs in the scalp and these migrate together with the sebum along the hair shaft (Auwärter et al., 2001, Pragst et al., 2004). So these glands lubricate not only the part of the hair that is just growing at 0.3 mm per day on the skin surface, but also the more mature hair growth, providing it with a protective layer of fat.

FAEEs (nanogram = one billionth of a gram) appear in hair in almost one order of magnitude lower than (the relevant order of magnitude of) EtG (picogram = one trillionth of a gram). It has been technically possible to measure FAEEs since 1993, and the first study reporting the detection of EtG in hair was done by Sachs in 1993.

In practice, most hair which is sent for analysis has been cosmetically treated in some way (bleached, permed etc.). It has been proven that FAEEs are not significantly affected by such treatments (Hartwig et al., 2003a). FAEE concentrations in hair from other body sites can be interpreted in a similar fashion as scalp hair (Hartwig et al., 2003b).

Hair Alcohol Testing was first commercialised in the UK by Trimega Laboratories.

Saliva drug screen / Oral fluid-based drug screen

Saliva / oral fluid-based drug tests can generally detect use during the previous few hours to 1–2 days. THC may only be detectable for less than 12.0 hours in most cases. On site drug tests are allowed per the Department of Labor.

Detection in saliva tests begins almost immediately upon use of the following substances, and lasts for approximately the following times:

• Alcohol: 6–24 h

Sweat drug screen

Sweat patches are attached to the skin to collect sweat over a long period of time (up to 14 days). These are used by child protective services, parole departments, and other government institutions concerned with drug use over long periods, when urine testing is not practical. There are also surface drug tests that test for the metabolite of parent drug groups in the residue of drugs left in sweat.

Blood

Drug-testing a blood sample measures whether or not a drug or a metabolite is in the body at a particular time. These types of tests are considered to be the most accurate way of telling if a person is intoxicated. Blood drug tests are not used very often because they need specialized equipment and medically trained administrators.

Depending on how much marijuana was consumed, it can usually be detected in blood tests within six hours of consumption. After six hours has passed, the concentration of marijuana in the blood decreases significantly. It generally disappears completely within 30 days.

Anabolic steroids

Anabolic steroids are used to enhance performance in sport and as they are prohibited in most high-level competitions drug testing is used extensively in order to enforce this prohibition. This particularly so in individual (rather than team) sports such as athletics and cycling.

Random drug testing

Can occur at anytime, usually when the investigator has reason to believe that a substance is possibly being abused by the subject by behavior or immediately after an employee-related accident occurs during work hours.

Diagnostic screening

In the case of life-threatening symptoms, unconsciousness, or bizarre behavior in an emergency situation, screening for common drugs and toxins may help find the cause, called a toxicology test or tox screen to denote the broader area of possible substances than self-administered drugs. The test is usually done within 96 h (4 days) after the estimated time of intoxication. Both a urine sample and a blood sample may be tested. A blood sample is routinely used to detect ethanol/methanol and ASA/paracetamol intoxication. Various panels are used for screening urine samples for common substances, e.g. triage 8 that detects amphetamines, benzodiazepines, cocaine, methadone, opiates, cannabis, barbiturates and tricyclic antidepressants. Results are given in 10–15 min.

Similar screenings may be used to evaluate the possible use of date rape drugs. This is usually done on a urine sample.

Methodologies

Before testing samples, the tamper-evident seal is checked for integrity. If it appears to have been tampered with or damaged, the laboratory rejects the sample and does not test it.

Next, the sample must be made testable. Urine and oral fluid can be used "as is" for some tests, but other tests require the drugs to be extracted from urine. Strands of hair, patches, and blood must be prepared before testing. Hair is washed in order to eliminate second-hand sources of drugs on the surface of the hair, then the keratin is broken down using enzymes. Blood plasma may need to be separated by centrifuge from blood cells prior to testing. Sweat patches are opened and the sweat collection component is removed and soaked in a solvent to dissolve any drugs present.

Laboratory-based drug testing is done in two steps. The first step is the screening test, which is applied to all samples. The second step, known as the confirmation test, is only applied to samples that test positive during the screening test. Screening tests are usually done by immunoassay (EMIT, ELISA, and RIA are the most common). A "dipstick" drug testing method which could provide screening test capabilities to field investigators has been developed at the University of Illinois.

After a suspected positive sample is detected during screening, the sample is tested using a confirmation test. Samples that are negative on the screening test are discarded and reported as negative. The confirmation test in most laboratories (and all SAMHSA certified labs) is performed using mass spectrometry, and is precise but expensive. False positive samples from the screening test will almost always be negative on the confirmation test. Samples testing positive during both screening and confirmation tests are reported as positive to the entity that ordered the test. Most laboratories save positive samples for some period of months or years in the event of a disputed result or lawsuit. For workplace drug testing, a positive result is generally not confirmed without a review by a Medical Review Officer who will normally interview the subject of the drug test.

Urine drug testing

Urine drug test kits are available as on-site tests, or laboratory analysis. Urinalysis is the most common test type and used by federally mandated drug testing programs and is considered the Gold Standard of drug testing. Urine based tests have been upheld in most courts for more than 30 years, however, urinalysis conducted by the Department of Defense has been challenged for reliability of testing the metabolite of cocaine. There are two associated metabolites of cocaine, benzoylecgonine (BZ) and ecgonine methyl ester (EME), the first (BZ) is created by the presence of cocaine in an aqeous solution with a pH greater than 7.0, while the second (EME) results from the actual human metabolic process. The presence of EME confirms actual ingestion of cocaine by a human being, while the presence of BZ is indicative only. BZ without EME is evidence of sample contamination, however, the US Department of Defense has chosen not to test for EME in its urinalysis program.

A disadvantage of saliva based drug testing is that it is not approved by FDA or SAMHSA for use with DOT / Federal Mandated Drug Testing. Oral fluid is not considered a bio-hazard unless there is visible blood; however, it should be treated with care.

Spray drug testing

Spray (sweat) drug test kits are non-invasive. It is a simple process to collect the required specimen, no bathroom is needed, no laboratory is required for analysis, and the tests themselves are difficult to manipulate and relatively tamper-resistant. The detection window is long and can detect recent drug use within several hours.

There are also some disadvantages to spray or sweat testing. There is not much variety in these drug tests, only a limited number of drugs can be detected, prices tend to be higher, and inconclusive results can be produced by variations in sweat production rates in donors. They also have a relatively long specimen collection period and are more vulnerable to contamination than other common forms of testing.

Hair drug testing

Hair drug testing is a method that can detect drug use over a much longer period of time, and is often used for highly safety-critical positions where there is zero tolerance of illegal drug use. Standard hair follicle screen covers a period of 30 to 90 days. The growth of hair is usually at the rate of 0.5 inches per month. The hair sample is cut close to the scalp and 80 to 120 strands of hair are needed for the test. In the absence of hair on the head, body hair can be used as an acceptable substitute. Even if the person being tested has a shaved head, hair can also be taken from almost any other area of the body. This includes facial hair, the underarms, arms, and legs or even pubic hair. Because body hair grows at a different rate than head hair, the timeframe changes, with scientists estimating that drug use can be detected in body hair for up to 12 months. Currently, most entities that use hair testing have prescribed consequences for individuals removing hair to avoid a hair drug test.

The claim that a hair test cannot be tampered with has been shown to be debatable. One study has shown that THC does not readily deposit inside epithelial cells so it is possible for cosmetic and other forms of adulteration to reduce the amount of testable cannabinoids within a hair sample.

Legality, ethics and politics

The results of federally mandating drug testing were similar to the effects of simply extending to the trucking industry the right to perform drug tests, and it has been argued that the latter approach would have been as effective at lower cost.

United Kingdom

A study in 2004 by the Independent Inquiry into Drug Testing at Work found that attempts by employers to force employees to take drug tests could potentially be challenged as a violation of privacy under the Human Rights Act 1998 and Article 8 of the European Convention of Human Rights. However, this does not apply to industries where drug testing is a matter of personal and public safety or security rather than productivity.

United States

In consultation with his drug czar, Dr. Carlton Turner, President Ronald Reagan issued Executive Order 12564. In doing so, he instituted mandatory drug-testing for all safety-sensitive executive-level and civil-service Federal employees. This was challenged in the courts by the National Treasury Employees Union. In 1988, this challenge was considered by the US Supreme Court. A similar challenge resulted in the Court extending the drug-free workplace concept to the private sector. These decisions were then incorporated into the White House Drug Control Strategy directive issued by President George H.W. Bush in 1989. All defendants serving on federal probation or federal supervised release are required to submit to at least three drug tests. Failing a drug test can be construed as possession of a controlled substance, resulting in mandatory revocation and imprisonment.

There have been inconsistent evaluation results as to whether continued pretrial drug testing has beneficial effects.

Testing positive can lead to bail not being granted, or if bail has already been granted, to bail revocation or other sanctions. Arizona also adopted a law in 1987 authorizing mandatory drug testing of felony arrestees for the purpose of informing the pretrial release decision, and the District of Columbia has had a similar law since the 1970s. It has been argued that one of the problems with such testing is that there is often not enough time between the arrest and the bail decision to confirm positive results using GC/MS technology. It has also been argued that such testing potentially implicates the Fifth Amendment privilege against self-incrimination, the right to due process (including the prohibition against gathering evidence in a manner that shocks the conscience or constitutes outrageous government conduct), and the prohibition against unreasonable searches and seizures contained in the Fourth Amendment.

According to Henriksson, the anti-drug appeals of the Reagan administration "created an environment in which many employers felt compelled to implement drug testing programs because failure to do so might be perceived as condoning drug use. This fear was easily exploited by aggressive marketing and sales forces, who often overstated the value of testing and painted a bleak picture of the consequences of failing to use the drug testing product or service being offered." On March 10, 1986, the Commission on Organized Crime asked all U.S. companies to test employees for drug use. By 1987, nearly 25% of the Fortune 500 companies used drug tests.

According to co-study done by DATIA and Society for Human Resource Management in 2012 (sample of 6,000 randomly selected human resource professionals), human resource professionals reported the following results after implementing a drug testing program: 19% of companies experienced an increase in employee productivity, 15% reported decrease in absenteeism, 56% reported improvement of workers' compensation incidence rates and 16% employee turnover decreased.

According to US Chamber of Commerce 70% of all illicit drug users are employed. Some industries have high rates of employee drug use such as construction (12.8%), repair (11.1%), and hospitality (7.9-16.3%).

Canada

According to the Canadian Human Rights Act, random and pre-employment alcohol and drug tests are not allowed in Canada. The one exception to the ban on random drug tests in Canada is alcohol testing including breathalysers in situations where the safety of employees could be at risk if alcohol is consumed at work.

Urban legends, myths, and misconceptions

The increasingly common practice of drug testing has led to an increase in the number of drug users looking for ways to beat the tests, and has spawned a number of myths and urban legends as a result. However, this does not stop users from getting creative in their attempts to somehow shorten the detection times and/or mask the contents of their fluid specimens, with varying degrees of success or lack thereof.

Drinking vinegar will help you pass

This legend is one of the oldest ones in the history of drug testing, and is only partly true. Consumption of diluted vinegar will lower the pH of the blood and urine, and drugs that contain amine groups (such as amphetamines) will be cleared out somewhat faster as their water solubility increases due to protonation. Also, the reduced pH can potentially throw off the pH-sensitive enzymes in a particular type of bioassay (EMIT) often (but not always) used as the initial screening test, even for non-amine-containing drugs such as THC. Also, the effects of urine acidification on detection times (for any substance) are modest at best, often practically insignificant, and drinking vinegar is thus not very reliable as a stand alone measure for beating a drug test. Also some people believe that drinking Certo brand liquid fruit pectin mixed with a fruit juice or sports drink such as Gatorade as a diluent continuously the day before, night before and morning of the drug test will help soluablize the drug chemicals from fat storage and help eliminate traces of drug metabolites by clear urination of the drug in your system. However this method is ineffective if being sent to a lab for testing. A B vitamin is sometimes taken to give the urine more of a natural yellow color. This is still debated as to whether it is effective or not. Drinking club soda (which has sodium bicarbonate) also may fool the analysis into a positive by alkalizing the ph of the urine and temporarily masking the drug. Cayenne pepper is believed by some to also alter the drug's effects in the metabolism.

Bleaching your hair will alter the test result

There is no peer-reviewed scientific study that indicates that bleaching your hair or using any type of cosmetic hair treatment will alter the test result. It is argued that, at first, treatments do lower the level of drug detectable in the hair, but subsequently leave the hair more porous allowing the hair to accumulate higher than normal levels of the drug through continued use.

High doses of niacin will help you pass

This legend has been around for at least a decade. Niacin, also known as Vitamin B3, is speciously claimed by some to "burn it out" of one's system when taken at high doses (250–500 mg per day). While some Internet (and other) sources often claim that it works wonders, there is no scientific evidence that it has any effect. Very high doses can also cause adverse side effects.

This legend may have been (inadvertently) inspired by Narconon, a Scientology-based drug rehabilitation program that uses exercise, saunas, and high doses of niacin (and other vitamins) to detox. It is also part of L. Ron Hubbard's general Purification Rundown, which Scientology purports to remove pollutants as well as drug residues. However, there are currently no peer-reviewed scientific studies to back these methods up.

Drinking urine will help you pass

Various (mostly internet) sources claim that human urine contains enzymes which, when ingested, can speed the breakdown of THC in the body. While Cytochrome P450 enzymes, which are partially responsible for breaking down THC (and other drugs), are found in trace amounts in urine, there is no scientific evidence to suggest that they can be made biologically available through ingestion. It is possible that this myth is based on some cultures' beliefs that ingested urine contains strong healing and detoxification properties.

Secondhand exposure will cause you to fail

This legend is technically true but highly misleading. According to a U.S. Army study, the amount of secondhand cannabis smoke needed to cause a false positive result (failure) is quite large indeed, and would require being sealed in an unventilated car or small room filled with marijuana smokers for several hours. Hair testing, however, is a different matter, particularly with passive exposure to crack/cocaine, which can deposit onto hair and be readily incorporated into it. Though for cannabis, typically only metabolites (produced by the body and thus not found in smoke) are tested rather than THC, so failure is unlikely to result from non-extreme passive exposure.

Ibuprofen causes false positives for THC

While this was true in the past, newer versions of the EMIT bioassay are much less sensitive to ibuprofen (Advil, Motrin, etc.), and this has become relatively uncommon as of 1998, at least in the United States. However, abnormally high doses of ibuprofen can still potentially cause a false positive in some cases. Nonetheless, this no longer works as an alibi for THC since GC/MS can now distinguish between the two.

Poppy seeds cause false positives for opiates

Poppy seeds do contain trace amounts of morphine, but it would require about 100 poppy seed bagels to reach enough to cause a positive (failed) test result. Poppy seed-filled pastries (such as hamantashen), on the other hand, do in fact contain enough to potentially cause a false positive. A 1996 episode of the highly popular sitcom Seinfeld may have helped perpetuate this urban legend.

An episode of MythBusters tested this legend, and found that as little as three poppy-seed bagels was enough to cause a positive result for the remainder of the day they were eaten (though participants tested clean the following day). But the results of this experiment are inconclusive, because the test used had a low opiate cutoff level of 300 ng/mL instead of the current SAMHSA recommended cutoff level used in the NIDA 5 test. In 1998, the cutoff level was raised from 300 ng/mL to 2,000 ng/mL in order to avoid false positives from poppy seeds.

One thing poppy seeds cannot do is serve as an alibi for heroin: a unique metabolite (6-monoacetylmorphine) is produced from heroin use that is never produced from consuming any other substance. But in order to find it, diamorphine must be tested for specifically, and most tests do not test for heroin. Rather, they test for opiates and opioids as a group. Should anyone try to claim they received a false positive due to poppy seeds and have not used heroin, modern testing can readily find the truth.

Cannabis remains detectable in urine for 30 days or more

While this is technically true in some cases, more recent studies have shown that detection times of 30+ days are actually quite exceptional, even for chronic users subjected to tests with lower than normal cutoffs. Under the typical 50 ng/mL cutoff for THC in the United States, an occasional or on-off user would be very unlikely to test positive beyond 3–4 days since the last use, and a chronic user would be unlikely to test positive much beyond 7 days. Using a more sensitive cutoff of 20 ng/mL (less common but still used by some labs), the most likely maximum times are 7 days and 21 days, respectively. However, one must remember that every individual is different, and detection times can vary due to metabolism or other factors.

Refusal

There have been many high-profile instances in which individuals or groups have refused to take drug tests. In 2009, a Belgian bodybuilding championship was canceled after doping officials showed up and the competitors fled. Likewise, in 2010, Iranian super heavyweight class weightlifters refused to submit to a drug test authorized by the Iran Weightlifting League. In 2000, an Australian Mining Company South Blackwater Coal Ltd with 400 employees, imposed drug-testing procedures, and the trade unions advised their members to refuse to take the tests, partly because a positive result does not necessarily indicate present impairment; the workers were stood-down by the company without pay for a week. In 2006, Levy County, Florida volunteer librarians resigned en masse rather than take drug tests. In 2003, sixteen members of the Chicago White Sox considered refusing to take a drug test, in hopes of making steroid testing mandatory. In the United States federal criminal system, refusing to take a drug test triggers an automatic revocation of probation or supervised release.

See also

• Drug-Free Workplace Act of 1988
• Equine drug testing
• Forensic toxicology
• Presumptive and confirmatory tests
• School district drug policies
• Cannabis drug tests
• Urinalysis

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47. ^ http://opiumpoppies.org/faq/legal-issues/can-eating-a-poppy-seed-bagel-cause-you-to-fail-a-drug-test/ The Opium Poppy FAQ
48. Erowid Opiates Vault : Drug Testing. Erowid.org. Retrieved on August 7, 2011.
49. http://www.ndci.org/sites/default/files/ndci/THC_Detection_Window_0.pdf THE MARIJUANA DETECTION WINDOW: DETERMINING THE LENGTH OF TIME CANNABINOIDS WILL REMAIN DETECTABLE IN URINE FOLLOWING SMOKING A CRITICAL REVIEW OF RELEVANT RESEARCH AND CANNABINOID DETECTION GUIDANCE FOR DRUG COURTS By Paul L. Cary, M.S., National Drug Court Institute
50. "Bodybuilders flee drug testers; event canceled" (Document). May 18, 2009Template:Inconsistent citations {{cite document}}: Cite document requires |publisher= (help); Unknown parameter |agency= ignored (help); Unknown parameter |url= ignored (help)CS1 maint: postscript (link)
51. "Iranian weightlifters refuse drug testing". February 16, 2010Template:Inconsistent citations{{cite web}}: CS1 maint: postscript (link)
52. Holland, Peter. "Case-Study. Drug Testing in the Australian Mining Industry" (PDF). Surveillance and Society: 204–9.
53. Voyles, Karen (October 6, 2006). "Library volunteers just say no to drug testing". Gainesville Sun.
54. "White Sox Players Almost Refused Drug Test". Los Angeles Times. Associated Press. March 12, 2003.
55. 18 U.S.C. § 3565(b)(5)
56. 18 U.S.C. § 3583(g)(3)

External links

• US National Institute on Drug Abuse (NIDA) Website
• Humphreys K, Rappaport J (1993). "From the community mental health movement to the war on drugs. A study in the definition of social problems". Am Psychol. 48 (8): 892–901. doi:10.1037/0003-066X.48.8.892. PMID 8379597. {{cite journal}}: Unknown parameter |month= ignored (help) A Political History of White House Drug Policy
• US Substance Abuse and Mental Health Services Administration (SAMHSA) Website
• European Workplace Drug Testing Society
• The Drug and Alcohol Testing Industry Association
• National Institute on Drug Abuse

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• Doping in sport
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