Hair Analysis for the Detection of Abused Drugs and Medications

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This analysis is a retrospective method, which uses a gas chromatograph with a mass-specific detector. DIN EN 45001 as well as the 93/42/EWG and 90/385/EWG guidelines should accredit the lab (Table V-9). To complete drug analysis service offerings, hair analysis alongside drug quick tests and confirmation analysis are available. Why is hair analysis a suitable method for long-term detection of abuse? Hair has the advantage of being able to detect the ingestion of drugs and medication over a specific time period. Drugs and medications are stored in the hair follicles and grow along with the hair. Since hair grows approximately 10-15 mm per month, past drug abuse can be determined by examining the respective segment of hair. For the examination, one requires a pen-sized tuft of hair, which was cut directly at the scalp. Individual hairs are not sufficient to run an analysis.

Table V-9. Excess of any of the values below is considered a positive result in hair analysis

Drug Cut-off value (ng/mg hair)

Amphetamine/Methamphetamine/Ecstasy 1.10

Methadone 1.00

Opiate 1.00

THC (Cannabis) 0.20

Benzoylecgonine (Cocaine) 0.50

Sweat collection using a sweat patch provides a noninvasive, cumulative measure of drug use over a period of days to weeks, which is most appropriate for monitoring drug use in addiction treatment or probation programs [21, 80]. Disadvantages include varying sweat production and risk of accidentally removing or contaminating the collection device [80].

There is reduced possibility that patients can influence test results with blood samples and more accurate determination of drug concentrations could possibly be obtained by a quantitative analysis of drugs in blood [66]. However, blood samples are not amenable to rapid screening procedures (Table V-10), have low drug concentrations, and require invasive collection [21, 66]. Therefore, blood is not recommended for routine testing [21].

The relative detection times of drugs in these biologic specimens are shown in the next figure. Blood and saliva maintain detectable levels of drugs for hours, urine for days, and sweat for weeks with a cumulative device, and hair and nails for several years (Figure V-16).

To summarize, one orders a UDT, takes a detailed history of the medications a patient uses, including prescribed, over-the-counter (OTC), and herbal drugs, with dose and time of last use, and his or her drug misuse/addiction history. And let the laboratory know what you are looking for; i.e., an illicit substance, prescription drug misuse, or presence of a prescribed medication.

Accurate interpretation of UDT results in clinical practice requires information. You should know how the specimen is collected; what prescription, over-the-counter

Table V-10. Summary of pros and cons for using sweat and/or blood for drug testing

Sweat Blood

Table V-10. Summary of pros and cons for using sweat and/or blood for drug testing

Sweat Blood



• Noninvasive, cumulative measure over days

• Reduced chance of patients influencing test

to weeks




• Varying sweat production

• Not amenable to rapid screening

• Risk of accidentally removing/contaminating

• Low concentration

collection device

• Invasive collection

Figure V-16. Differences in detection times of abused drugs in various body fluids Adapted from [83]

(OTC), or herbal drugs the patient is taking; retention times of drugs in urine; alternative medical explanations; metabolism of drugs; scams; and laws, regulations, and guidelines concerning controlled substances. The UDT is an important tool at healthcare professionals' disposal to evaluate patients. Testing cannot, however, substitute for diagnostic skills or an ongoing therapeutic alliance with a patient [62]. It may not be required in every patient, and is insufficient alone in any patient.

The clinical value of a UDT depends on the interactions between the healthcare professional and testing laboratory or manufacturer of a point-of-care test so that the healthcare professional understands the limits of the UDT in terms of what it can and cannot detect, so that appropriate tests are ordered [60]. Healthcare professionals should establish a relationship with the director or certifying scientist from the testing laboratory and consider a medical review officer consult. Medical review officers are licensed physicians who are responsible for receiving laboratory results generated from forensic testing and who have appropriate medical training to interpret and evaluate test results together with medical history and any other relevant biomedical information [62]. In conclusion,

• All clinicians can improve the detection of addiction disorders while prescribing drug medication.

• Good pain care with the use of opioids requires attention to the assessment of emerging addiction.

• There are reasons for aberrant drug-related behaviors other than addiction.

• Documentation of initial and ongoing findings accompanying continued patient assessment & decision-making process is critical.

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