Dr Altman shares the pros and cons of the available drug testing products.
Christopher D. Altman, PharmD: There are 2 types of kits out there: the urine test and the hair test. Urine tests are quicker. You’ll get results relatively quickly—the same day. They only test about 3 to 6 days back, depending upon what we’re checking for, and it’s just a small urine collection, so patients can do it at home. An individual would fill the urine cup, get the results, and then send them off for validation. The hair test would require sampling multiple spots of hair on the individual. The good thing about the hair test that’s different than the urine test is, it is going to give you a much longer duration, so you can look further back in time to know if there was historic use. It also gives you an idea of how much use occurred. It will give you feedback as far as quantity of use, so the person receiving the results would know if it was a 1-time thing or continuous, and how much they are using. It does give a fuller picture, but there is that lag time in getting the results back.
We carry the urine drug testing products. They’re available right in the front of the pharmacy. We carry a range of them that test single entities up to multiple entities.
From a pros and cons perspective, the biggest thing about a urine test, from both a patient’s perspective and pharmacist’s recommendation perspective, is that you will get those tests back quickly. The con is that you’re only testing back for a smaller duration, so you may not get an accurate picture if someone had used and then stopped using, or is a less frequent user. They are typically less expensive, so they tend to be a little bit easier for patients to get. The pro of the hair test is that you get a really good picture of what that individual is doing for a longer duration. The con there is you’ve got to wait for the results to come back in, and cost becomes a factor for patients, too.
I don’t think pharmacists have a good understanding of the different types. I would say pharmacists in a pharmacy setting know what they carry, but they may not know what else is available for patients. I think that’s an opportunity to get a better level of education and get those resources available to them to say, “This might be what you have. This is what’s also available if you wanted to order, or that could be accessible to a patient.” The one thing we see oftentimes is, as community pharmacists, patients come in from everywhere. That patient may have been down the street at a hospital, received a hair follicle test, and come to us with the questions on how to do it, or they may have received it online. They could have had it shipped to the house. They come in to us with questions because we’re so easy to access, but if we don’t carry the product, oftentimes we’re not familiar with it. We’re quickly doing our research on the back end to know what the test is, how it works, and what’s it for. There is an opportunity there to broaden the education so the pharmacist knows what the test is, how it works, and what’s available that they don’t carry so that they can answer all those questions.
I don’t have a particular preference. Knowing what the patients are seeing when they’re coming into the store, I think the urine test makes the most sense for them. They are generally seeking an immediate result, and they also are seeking something that is a little bit more cost-effective for them. For most patients in that situation, they’re probably going to lean toward a urine test. We do have those individuals who want to see a better picture or want to know what the hair test is and how it works, but generally, we’re going to be recommending the urine test.
When it comes down to it, I wouldn’t recommend this to patients who don’t have a good understanding of what they’re doing or don’t have the buy-in from the person who’s going to be doing the test, because there is the potential for cheating. There is a potential that the individual might not do the test at all. The patient may not be ready to have that conversation, or the person administering the test doesn’t have that comfort level, so they’re going to purchase a test that they might not be able to execute or that’s going to be taken fraudulently.
In that conversation, figuring out if the caregiver is ready to administer the test is important. If they’re not, I may not recommend they go down that road. It’s probably a different kind of conversation. If there is an immediate crisis moment, and they want to do a drug test but the patient is at a position where we know the results are probably going to be positive—if the patient is really in crisis, I would not suggest doing those tests, but trying to urge them to get treatment first, let that take its course, and see where that leads. Having the test results for the sake of test results isn’t beneficial if the patient is in that moment where they absolutely need help.
The urine tests are done in-home. They’re readily available at most pharmacies. It’s a small collection of urine, about an ounce and a half, so it’s not a massive amount of urine we’re collecting. It tests back 3 to 7 days. The results come in quickly, and then they get sent off for validation.
The urine test does give you a quick positive or a negative. It’s going to tell you, “Yes, there are trace amounts of whatever drug you’re testing,” or “No, there are not.” It doesn’t give you an idea of how much is there; it’s just going to say, “Yes, there was use,” or “No, there was not use.”
With a urine test, there is a potential for cheating. Individuals may use someone else’s urine, or they may use something that’s not urine. There is a possibility when they go in the bathroom with the cup, that what they bring out in the cup may not be what you thought they were going to collect.
For the hair tests, the individual would take hair from the patient. It’s generally collected from several different locations. Doing that really minimizes the potential for cheating, because you’re taking the hair physically from the individual and you know that’s the person you’re testing. That’s collected and then sent to the laboratory. It will test back about 90 days. You will have to wait for the results to come in, but what’s different is, it’s not just a positive/negative. It will tell you that there were amounts of medication, and it gives you an idea of how much of the medication was used. You’ll get that full picture of what medications were being used, as well as how much they were used. You do get a fuller picture of what the patient was doing.
For urine tests, I think the big benefit is, it’s quick, easy to administer, and you’re going to get those results the same day. The benefits of the hair test are that it’s cheat-proof, so you know the hair comes from the individual you’re testing, and it gives you a full picture of what they’ve done over a longer period of time, as well as that quantitative aspect to know how much was being used. Really thinking about how those 2 pieces fit for a patient allows me to decide which one to recommend.