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Frequently Asked Questions

Frequently Asked Questions

Hair Umbilical Cord Tissue ChildGuard® PEth 

*Click the green and white plus sign beside each question to view the answer.

Can a second test of a different specimen type be used to prove that a previously taken test was inaccurate?

No. The results of any second collected specimen have absolutely no bearing on the validity of the results of the first collected specimen. Furthermore, each matrix has its own advantages, disadvantages and limits of interpretation.

Can a nail test be used to prove that a previously taken hair test was inaccurate?

No, the result of any second collected specimen has absolutely no bearing on the validity of the result of any first collected specimen because you have no idea what the donor did between time A and time B.

Can drugs administered to the mother during labor or delivery be detected in the newborn’s meconium or umbilical cord tissue specimen?

Yes. Drugs such as fentanyl or morphine only take a few minutes to reach the meconium and umbilical cord tissue. Although we do not see it every time, we routinely pick up morphine administered to the mother during labor and delivery. The appropriate question is whether there is a prescription or medical record that can provide a reasonable explanation for the specimen to test positive.

Can I use the reported value (the number) from a hair, nail, meconium, umbilical cord tissue, or urine test to determine how much or how often someone is using a drug (either prescription of illicit)?

No. These specimen types act as reservoir, where drugs and their metabolites may accumulate and/or degrade over time. When testing any reservoir matrix, it is impractical to back-track to determine time, dosage, or frequency. There are too many variables involved. The reported values (the numbers) have no therapeutic or clinical value. You cannot use the number to estimate how much the donor used or to what extent the donor was exposed.

Can someone test positive in fingernail because of passive or environmental exposure?

Yes, environmental exposure versus ingestion must be resolved when interpreting drug tests using fingernails.

Can the drug test from a maternal specimen (such as maternal hair, nail or urine) differ from the result from a neonatal specimen such as neonatal urine, meconium or umbilical cord tissue?

Yes, the results can be different. Each specimen type has its own advantages, disadvantages, threshold to positivity, and detection time window. One test does not refute the other. The test results are cumulative. For instance, if the maternal urine is positive for cocaine and newborn meconium is positive for methamphetamine, the results do not rule each other out. The appropriate interpretation is that the mother consumed both cocaine and methamphetamine.

Can the reported quantitation of drug or metabolite in hair, nail, meconium, umbilical cord, or urine be used to determine the timing of the drug use, how often the donor uses the drug, or the extent of the donor’s drug use?

No, when testing a reservoir specimen type, a specimen type where analytes tend to accumulate, you may not backtrack to determine time, dosage, or frequency. The result is positive or negative for the appropriate detection window associated with the specimen type.

Can the use of any isopropanol (rubbing alcohol) containing product explain a positive ethyl glucoronide (EtG) or fatty acid ethyl esters (FAEE) result?

No. The use of any product that contains isopropanol, such as isopropyl rubbing alcohol will not explain the present of a direct ethyl alcohol biomarker such as EtG or FAEE. Isopropanol forms its own glucoronide, isopropyl glucoronide and does not interfere with the detection of EtG or FAEE.

What is the detection window for drugs of abuse in meconium and umbilical cord and why?

The detection windows for meconium and umbilical cord have been established over time through experience as opposed to experimentation. Dose-response experiments using harmful addictive drugs with pregnant women would be highly unethical.

The detection window for most drugs of abuse in meconium and umbilical cord testing is up to approximately 20 weeks (some drugs such as methamphetamine may be less). Meconium begins to accumulate in the fetal gut near mid-term of the pregnancy; therefore prior to this time frame there is no meconium for the drug to become trapped in. The umbilical cord cutoffs were selected to emulate the positivity rate of meconium through side-by-side studies inferring a similar detection window.

Does the sample need to be frozen?

No, the sample may be shipped ambient.

Can the use of any isopropanol (rubbing alcohol) containing product explain an ethyl glucuronide (EtG) result?

No, the use of any product that contains isopropanol will NOT explain the presence of EtG. Isopropanol forms its own glucuronide, isopropyl glucuronide and does not interfere with the LC-MS/MS detection of ethyl glucuronide (EtG).

Does the use of lidocaine explain a positive cocaine or cocaine metabolite in any specimen type?

No, lidocaine will not explain a GCMS or LC-MS/MS confirmed positive cocaine or cocaine metabolite in any specimen type. The compounds are structurally very different and breakdown into different metabolites.

Can I use the reported value (the number) from a hair, nail, meconium, umbilical cord, or urine test to determine how much or how often someone is using a drug (either prescription or illicit)?

No. These specimen types act as a reservoir, where drugs and their metabolites may accumulate and/or degrade over time. When testing any reservoir matrix, it is impractical to back-track to determine time, dosage or frequency. There are too many variables involved. The reported values (the numbers) have no therapeutic or clinical value. You cannot use the number to estimate how much the donor used or to what extent the donor was exposed.

Does the use of Xylocaine® (lidocaine) explain a positive cocaine or cocaine metabolite in any specimen type?

No, Lidocaine will NOT explain a GCMS or LCMSMS confirmed positive cocaine or cocaine metabolite in any specimen type (blood, urine, hair, nails, meconium, umbilical cord segment, etc…). The compounds are very structurally different and breakdown into very different metabolites.

Can the drug test result from a maternal specimen (such as maternal hair, nail or urine) differ from the result from a neonatal specimen such as neonatal urine, meconium or umbilical cord tissue segment?

Yes, the results can be different. Each specimen type has its own advantages, disadvantages, threshold to positivity, and detection time window. One test does not refute the other. The test results are cumulative. For instance, if the maternal urine is positive for cocaine and newborn meconium is positive for methamphetamine, the results do not rule each other out. The appropriate interpretation is that the mother consumed both cocaine and methamphetamine.

Have results been used in court cases?

Yes, the analysis of a number of tissue types for the presence of drugs of abuse has been used in every state for decades. Specifically, our umbilical cord testing has been used to provide evidence of drug use by the mother in numerous states. Additionally, the detection of drug in umbilical cord was used as evidence of maternal drug consumption in a murder case in South Carolina and that interpretation was upheld on appeal to the SC Supreme Court.

Can morphine administered to the mother during labor or delivery be detected in the newborn’s meconium or umbilical cord specimen?

Yes, drugs such as morphine only take a few minutes to reach the meconium and umbilical cord. Although we do not see it every time, we routinely pick up morphine administered to the mother during labor and delivery.

Have USDTL’s newborn test results been used in court cases?

Yes. Testing results are forensically defensible when they are “confirmed results” or results that went through confirmation testing. Forensic testing is performed through two separate, validated laboratory procedures based on different scientific principles. The first procedure screens the specimen using one scientific method, and the second procedure confirms the results using a different scientific method. As an accredited forensic laboratory, we confirm all positive screening test results and our procedures follow strict guidelines laid out and overseen by our accrediting bodies. Our test results have been upheld in court because we follow strict internationally accepted forensic protocols.

If a mother was prescribed a particular drug during her pregnancy will it produce a positive result in the newborn’s meconium or umbilical cord test?

Maybe. There is no guarantee that the drug is in the meconium or umbilical cord tissue at or above the threshold to positivity cutoff level. There are numerous factors that may affect the outcome such as dose, metabolism, medication taking compliance, and recall bias. The appropriate question to ask is IF the specimen is positive is there a prescription or medical record that provides a reasonable explanation. Just because a specimen is negative, does not prove that the donor was abstinent.

How are newborn drug testing results reported to the hospital?

Results are reported through USDTL’s client access web portal or, for an additional cost, can be distributed via an approved Health Level Seven International (HL7) method. Under no circumstances are results given via telephone.

Is there a test that can differentiate between fetal exposure to heroin and fetal exposure to morphine during the birthing process?

Yes. The umbilical cord tissue or meconium from a baby whose mother was administered morphine during delivery will only be positive for morphine. The umbilical cord of a baby that is positive for Meconin and/or Monoacetylemorphine (6-MAM) in addition to morphine is indicative of heroin exposure. 

What is Meconin and why is it important in newborn toxicology?

Morphine is the predominant metabolite of heroin, but morphine is also a stand-alone drug and a metabolite of codeine. Some mothers are provided morphine during delivery. Historically, there have been instances where heroin-using moms could not be distinguished from moms given morphine during delivery. Meconin is a contaminating constituent from the poppy that is present in heroin. Therefore, like Monoacetylmorphine – a metabolite of heroin, the presence of Meconin indicates the use of heroin and when found in newborn specimens, indicates fetal exposure to heroin.

How do drugs get into nails?

Drugs are distributed via the blood supply to the nail cells and the nail bed. Nails grow not only in length but in thickness as well. As the nail grows in thickness, it creates layers of drug history.

How long do I have to dispute a result?

USDTL saves negative specimens for seven days after initial accessioning. Seven days is longer than the customary three days that most labs retain negatives. This duration should allow clients a reasonable time to decide if dispute resolution is needed, to contact customer service and initiate the process. Positive specimens are stored frozen for one year following accessioning. Our Client Services Representatives will provide you with the necessary paperwork for you to sign and return to initiate the re-test process. Once the paperwork is in order, Client Services will return a re-test result to you in one to two working days. If you have any questions after receiving the results, please contact Client Services and they will either assist you or direct you to one of our forensic toxicologists to discuss the case with you.

What can our organization do if we strongly suspect that an individual was drug-exposed, but the specimen results came back negative?

All of USDTL’s clients can “dispute” a negative result and request a “re-test” for one or more specific drug classes that are suspected of being present. The re-test is a concept routinely used in workplace urine testing, where a subject disputes a positive result and requests a re-test, which is a re-confirmation of the specimen with a cutoff at 40 percent of the original confirmation cutoff. For non-workplace cases, clinical professionals may believe that drug exposure occurred and dispute the negative finding, which results in a re-confirmation of the disputed drug class at 40 percent of the confirmation cutoff. This re-test then becomes the result of record for the case.

To order a re-test, fax or email USDTL Client Services a re-test request on your letterhead and state the test(s) requested, the subject’s demographic information, the USDTL lab number and your contact information. You can also call Client Services with the case information. Our representative will provide you with the necessary paperwork for you to sign and return to initiate the re-test process. Once the paperwork is in order, Client Services will return a re-test result to you in one to two working days. If you have any questions after receiving the results, please contact Client Services and they will either assist you or direct you to one of our forensic toxicologists to discuss the case with you.

How does using a forensic drug test help the child later in life?

There are several reasons why testing a newborn for potential substances is important. Early detection provides many more options than detection at a later stage in the child’s life including:

  • Early detection of alcohol biomarkers allows newborns to be identified and enrolled into early intervention and community programs. New programs are showing dramatic improvements in children identified earlier in life.
  • Detection of an exposed child can allow help, intervention and treatment to be offered to the mother, so that exposure during future pregnancies may be prevented.
  • The forensic identification of fetal alcohol exposure allows future corroboration of alcohol related disorders in childhood.

How long can drugs be detected in body hair?

Body hair has a different growth cycle compared to head hair. Body hair may go dormant and remain in place up to one year. A positive result reflects exposure up to 12 months.

How long does the laboratory keep remaining specimens?

Generally, negative specimens are kept for 7 days, and confirmed positive specimens are kept for 1 year.

How much breast milk is needed?

Requested sample volume is 10 milliliters collected in a sterile container.

How much fingernail needs to be collected?

The optimum amount of nail clippings needed is 100 milligrams. If trimming all 10 fingernails, each clipping must be at least 2 millimeters to 3 millimeters long.

How much is needed for an adequate urine sample?

Requested sample volume is 10 milliliters.

How much meconium is needed for the test?

A minimum of 3 grams of meconium (about a teaspoon) is normally required. However, for best results, we recommend collection of the entire passage of meconium until the milk stool appears.

If a mother was prescribed a particular drug during her pregnancy will it produce a positive result in the newborn’s meconium or umbilical cord tissue test?

Maybe. There is no guarantee that the drug is in the meconium or umbilical cord tissue at or above the threshold to positivity cutoff level. There are numerous factors that may affect the outcome, such as dose, metabolism, medication compliance, and recall bias. The appropriate question is whether there is a prescription or medical record that can provide a reasonable explanation for the specimen to test positive. A negative specimen does not prove that the donor was abstinent.

If the quantity of drug or alcohol metabolite detected is high, could that be an indication that the donor (1) was consuming a large amount, (2) was using recently, or (3) was using frequently?

There are too many variables for anyone to know time of use, dosage, or frequency from the result(s) of a drug test. Reservoir matrices such as hair, fingernail, umbilical cord, and meconium continuously collect drug and alcohol biomarkers. This makes it difficult to determine specific details of use. Because the biomarker is collected over a period of time, the results represent total accumulation that cannot be pin-pointed to specific times/dates/dosages, etc.

Is there a time frame in which meconium must be collected for testing?

Only with regard to being able to test for fatty acid ethyl esters (FAEE), the ethyl alcohol biomarker in meconium. To be able to test for FAEE, the meconium specimens must be collected within 18 hours after birth. All other drug testing can be done on meconium regardless of when the meconium is passed as long as it is meconium that is being collected and not milk stool.

May the reported quantitation of drug or metabolite in hair, nail, meconium, umbilical cord, or urine be used to determine the timing of the drug use, how often the donor uses the drug, or the extent of the donor’s drug use?

No. When testing a reservoir specimen type, a specimen type where analytes tend to accumulate, you may not backtrack to determine time, dosage, or frequency. The result is positive or negative for the appropriate detection window associated with the specimen type.

Why are both ethyl sulfate (EtS) and ethyl glucuronide (EtG) included in urine testing for alcohol use, but only EtG in fingernail or hair testing?

A: For urine testing, it is standard practice in the field of toxicology to include both EtS and EtG, because EtG is subject to bacterial production and degradation if a urine sample is contaminated (e.g. when the donor has a urinary tract infection). EtS is not subject to bacterial production or degradation, and provides a second, more reliable alcohol biomarker in these urine contamination scenarios. Other specimens types, such as fingernails and hair, do not have this issue, so only EtG is measured in those sample types.

What are the meconium specimen storage requirements?

Drugs and metabolites are stable in meconium for up to 2 weeks at room temperature. Storage in a refrigerator or freezer is preferred. Alcohol biomarkers specifically fatty acid ethyl esters (FAEE), are sensitive to heat and light; therefore, the preferred shipping method is frozen on dry ice. Since shipping via this method is both difficult and expensive, most institutions send specimens at room temperature and realize that the FAEE concentrations may be reduced. USDTL accept specimens that are shipped at room temperature.

What is meta-hydroxybenzoylecgonine (m-OH-BZE)?

Meta-hydroxybenzoylecgonine (m-OH-BZE) is a metabolite of cocaine which is often present in the meconium of neonates born to cocaine-using mothers. It is a minor metabolite in adults, but it has been identified as the only cocaine metabolite present in 23 percent of meconium specimen screening positively for cocaine.*

*Reference: Lewis D, Moore C, Becker J, Leikin J. Prevalence of meta-hydroxybenzoylecgonine (m-OH-BZE) in meconium samples. Bulletin of the lnt.Ass.Forens Toxicol 1995;25(3):33-36

What is the detection window for urine?

A sample of urine provides a drug history from the last two to three days for most drugs, and an even longer period for marijuana.

What is the turnaround time for testing results?

Generally, the standard turnaround time for reporting negative screening test results is the next business day, with an additional 1-2 business days for specimens that require confirmatory testing. Turnaround time begins from receipt of the valid specimen -accompanied by a properly documented valid order- into the laboratory. Some tests require additional time to process and will fall outside the standard turnaround time window.

What is the window of drug exposure for drugs of abuse in meconium and umbilical cord tissue and why?

The detection window for most drugs of abuse in meconium and umbilical cord tissue testing is up to approximately 20 weeks prior to birth. Meconium begins to accumulate in the fetal gut near mid-term of the pregnancy. Prior to this time frame there is no meconium to trap the drug or drug metabolites. The umbilical cord tissue cutoffs were selected to emulate the positivity rate of meconium through side-by-side studies inferring a similar detection window.

What newborn alcohol tests are available at USDTL?

USDTL offers three different tests that can be used for detecting direct ethyl alcohol biomarkers in newborns.

  • Ethyl glucoronide (EtG) can be detected in umbilical cord tissue with a window of detection up to approximately 20 weeks prior to birth. EtG can be tested in umbilical cord tissue as a stand-alone test or it can be added to any umbilical cord tissue panel.
  • Fatty acid ethyl esters (FAEE) can be detected in meconium with a window of detection up to approximately 20 weeks prior to brith. FAEE can be tested in meconium with a window of detection up to approximately 20 weeks prior to birth. FAEE can be tested in meconium as a stand-alone test or it can be added to any meconium panel. Collection must occur within the first 18 hours after birth to be viable for FAEE testing. See the meconium collection instructions for details.
  • Phosphatidylethanol (PEth) can be detected in blood. Collection is done via heel stick on a dried blood spot card anytime during routine newborn screenings. It has a unique window of detection in blood up to approximately 2-4 weeks prior to collection.

When will I receive breast milk results?

Results will be provided in two to three days after the sample is received in the laboratory.

Why was one matrix positive and another negative on the same donor?

There are several explanations for this.

  1. Different sample matrices have different detection time frames. The result of any second collected specimen has no bearing on the validity of a first collected specimen. For example, a hair sample with a 3-month detection window might test positive for a particular substance, while a urine sample from the same donor, with a 2-3 day detection window, might test negative. In this case, the donor has used that substance within the past 3-months, but may not have used it within the most recent 3-days.
  2. The result of any second collected specimen has no bearing on the validity of a first collected specimen. Therefore, a negative result observed for the umbilical cord does not refute a positive result observed on the maternal urine specimen and the reverse is true as well. There are many legitimate reasons for discrepant urine and umbilical cord results.
  3. The urine specimen was a screen-only result and was not confirmed using an appropriate mass spectrometric method. The screen-only urine result is a clinically valid result, however, without an appropriate mass spectrometric confirmation, the urine result has no value in a forensic proceeding.
  4. Lastly, some placentas can prevent some compounds from reaching the fetus. There are documented cases of maternal ingestion without in utero exposure.

Will a UTI affect the result of drug and/or alcohol testing?

Certain bacteria may interfere with drug detection but will not generate a false positive. Fermenting bacteria in the presence of excess glucose may produce ethanol in the bladder and in the specimen cup.

Will drugs administered or taken by the mother affect the newborn drug test result?

Any drugs administer or taken during pregnancy, labor, or delivery have a possibility of being detected. The appropriate questions is whether there is a prescription or medical record that can provide a reasonable explanation for the specimen to test positive.

Will one-time drug use be detected in Fingernail Testing? How many times would they have to use drugs for it to be detected in nails?

Single doses do not guarantee a positive result. The number of doses required to generate a positive result is highly variable between donors.

Contact USDTL

1.800.235.2367