Drug Testing: Is It Keeping Up With Today's Drug Trends?

by Jermaine Galloway

Drug testing is one of the most important tools we have for identifying trends from our streets to our schools. The information gathered through testing helps shape treatment, enforcement, education, and prevention efforts. But accurate or not, why does it feel like, at the Boots on the Ground™ level, drug identification and testing from hospitals to laboratories aren't always keeping up with the rapidly changing drug market? The reality is that drug trends evolve much faster than many people realize, and the systems responsible for detecting those drugs might have to play catch-up. That doesn't mean they're doing a poor job, it simply means the challenge has become much more complicated.

I have the opportunity to communicate with people from nearly every part of the drug-testing world. I regularly speak with professionals in state crime labs, private drug testing companies, probation departments, drug courts, medical examiners, law enforcement, and healthcare. At the same time, I also hear from people working in smoke shops and from individuals who have firsthand knowledge of what's actually being sold and used on the streets. When you listen to all of those perspectives, a common theme begins to emerge. Our drug data is probably lower than the true numbers because there are substances we simply are not detecting. Drug testing is incredibly valuable, not just to courts and law enforcement but to all of us trying to identify the ever evolving trends at the street level. Testing is only as good as the substances we're actually looking for.

A good example is heroin. For those of you who actively conduct or review drug testing, when was the last time someone actually tested positive for heroin? I regularly have attendees in my classes tell me they haven't seen a positive heroin test in over a year. That doesn't necessarily mean heroin has disappeared everywhere, but it does raise an important question. If heroin positives are becoming less common in your community, why are some organizations still routinely testing for it while newer substances are becoming more prevalent? Every community is different, but drug testing panels should evolve along with local drug trends. If we continue testing primarily for yesterday's drugs, there's a greater chance we'll miss today's problems.

One of those newer concerns involves products commonly referred to as "gas station heroin." These products have become increasingly common in many parts of the country, but they present a unique challenge because the legal status varies dramatically from state to state. Some states have banned them outright, some still allow them to be sold legally, and others remain in a legal gray area where regulations continue to change. Because of that, whether these substances are tested, often depends on the agency conducting the testing. A probation department may approach these products differently than a hospital, drug court, or impaired driving investigation. The laws, policies, and priorities of each organization all play a role in determining what gets tested and what does not. That creates inconsistencies in the data, making it more difficult to understand exactly how widespread these substances have become.

Another factor that often gets overlooked is cost. Drug testing is expensive. Laboratories require sophisticated equipment, trained chemists, validation studies, maintenance, and staffing. Many state crime labs and medical examiner offices are already operating with limited budgets while handling increasing caseloads. When funding doesn't keep pace with demand, difficult decisions have to be made. Those decisions may include reducing staff, limiting overtime, or narrowing the number of substances included in routine testing. The end result is fairly simple: if a laboratory isn't testing for a particular drug, it won't show up in the data. That doesn't necessarily mean the drug isn't present, it may simply mean it wasn't part of the testing panel.

One of the most common questions I receive during training is, "Why don't we just test for everything?" It's a fair question, but the answer isn't as simple as most people expect. The first challenge is money, time, and available resources. The second challenge is scientific. There is no such thing as an "everything" drug test. As new synthetic drugs and manufacturers alter chemical formulas to stay ahead of regulations, laboratories must first identify those substances before they can develop reliable testing methods. Once a testing method is created, it must be validated and distributed before it becomes part of routine testing. That entire process takes time, meaning there will almost always be a period when new substances exist in the community before they can be routinely detected in laboratories. On top of that, testing capabilities can vary significantly depending on the laboratory, the company you use, your county, your state, and whether you're located in a rural or urban area. A medical examiner serving a large metropolitan area may encounter a much broader range of drugs than someone serving a rural county, which naturally influences both training and testing priorities.

Hospitals create another source of confusion for many families. I've had countless parents tell me that their child experienced what appeared to be a (non-fatal) overdose, yet the hospital reported that nothing showed up on the drug screen. Many people assume this means the overdose wasn't caused by drugs, but that isn't necessarily the case. Most hospitals use standard toxicology panels designed to quickly identify commonly encountered substances. If the drug responsible isn't included in that panel, the test may come back negative even though a drug was involved. When physicians suspect another substance may be present, some hospitals can send samples to specialized laboratories for additional analysis. However, those advanced tests take more time, cost more money, and aren't always immediately available.

There is also what I call the "test it if you ask for it" challenge. Many laboratories have the capability to test for additional substances when requested, but that creates another obstacle. How do you request testing for a drug you've never heard of? If investigators, medical professionals, probation officers, school officials, or parents don't know a new substance exists, they are unlikely to ask for it to be included in the testing process. This is one of the biggest reasons education remains so important. The better informed we are about emerging drug trends, the better decisions we can make about what substances should be included in testing panels moving forward.

So what does all of this mean? It means drug-testing data should always be viewed with an understanding of its limitations. Education is critical. Organizations should regularly review and rotate their drug testing panels to ensure they reflect current trends rather than historical ones. The laboratory or testing company you partner with matters, and it's important to understand exactly what they do and do not test for. Most importantly, remember that a negative test result does not always mean no drugs were present. Sometimes it simply means the drug wasn't part of the testing panel or did not meet the threshhold. Drug testing remains one of the best tools we have, but like every tool, it works best when we understand both its strengths and its limitations.

If you have questions about drug testing or want to better understand what your organization may or may not be detecting, feel free to reach out. I'm always happy to share what I'm seeing around the country or connect you with colleagues who specialize in drug testing and toxicology. The more we understand today's drug market, the better prepared we'll be for tomorrow's trends.