Objective Testing
Open accessAbstract
Drug testing, when carefully collected and thoughtfully interpreted, offers a critical adjunct to clinical care and substance use treatment. However, because test results can be misleading if not interpreted in the correct clinical context, clinicians should always conduct a careful interview with adolescent patients to understand what testing is likely to show and then use testing to validate or refute their expectations. Because of the ease with which samples can be tampered, providers should also carefully reflect on their own collection protocols and sample validation procedures to ensure optimal accuracy."
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“Relatedly, recent substance use was assessed using a urine drug screen, which typically detects drug metabolites up to 2 - 30 days after use, depending on the substance of use[40] – which is more accurate than self-report.”
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“Significant insights are provided by drug evaluations in bodily fluids, including medication effectiveness, therapeutic ratio, bioavailability, metabolic processes, pharmacokinetics, pharmacodynamics, interactions between drugs, and drug safety [66–68] .”
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“Urine and blood tests have been widely used to trace drug abuse [46, 47], and PSI has been shown to easily and quickly analyze dried blood spots [17, 18, 23].”
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“is recognized by setting up the sample with water.([43]) SurfaceEnhanced Raman Spectroscopy is useful for determining the presence of drugs of abuse and their metabolites in saliva as well as quantifying them.”
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“Furthermore, it is important to note that urine drug screens can be misleading if interpreted out of clinical context because they do not reflect real-time exposure.(17) Urine toxicology screening can be positive for up to 7 days with acute ingestion and up to 30 days with chronic (daily) use.”
BackgroundRuglass, L. M., Shevorykin, A., Zhao, Y., Killeen, T. K., Bauer, A. G., Morgan‐López, A. A., Back, S. E., Fitzpatrick, S., López‐Castro, T., Norman, S. B., et al. (2023) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2023.109769 · Cited by 12 · see citing works
Bikinesi, L., Spinelli, M. A., Nyoni, N., Mouton, D. P., Mengistu, A. T., Kamangu, J. W. N., Konstantinus, I. N., Kalimugogo, P., Mutandi, G., Negussie, F., et al. (2024) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2024.107328 · Cited by 12 · see citing works
Madde kullanan ergenlerde psikiyatrik eş tanı, bağımlılık profili ve tedavi isteği: ÇEMATEM verileri
Karcı, C. K., Gürbüz, A. A., Özdemir, F., Varmış, D. A., & Tahiroğlu, A. Y. (2021) · Journal of Dependence · doi:10.51982/bagimli.956300 · Cited by 12 · see citing works
Bridging Disciplines: Applications of Forensic Science and Industrial Hemp
Finley, S. J., Javan, G. T., & Green, R. L. (2022) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.760374 · Cited by 12 · see citing works
A tiered strategy for investigating status epilepticus
Craig, D. P., Mitchell, T. N., & Thomas, R. H. (2019) · Seizure · doi:10.1016/j.seizure.2019.10.004 · Cited by 12 · see citing works
Pascual‐Caro, S., Borrull, F., Aguilar, C., & Calull, M. (2020) · Separations · doi:10.3390/separations7040053 · Cited by 12 · see citing works
McNeill, L., Megson, D., Linton, P. E., Norrey, J., Bradley, L., Sutcliffe, O. B., & Shaw, K. J. (2021) · Forensic Chemistry · doi:10.1016/j.forc.2021.100370 · Cited by 12 · see citing works
Wiedmann, M., Kuitunen-Paul, S., Basedow, L., Wolff, M., Donato, N. D., Franzen, J., Wagner, W., Roessner, V., & Golub, Y. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02025-6 · Cited by 8 · see citing works
Pillar[n]MaxQ sensing ensemble: Application to world anti-doping agency banned substances
King, D., Deng, C., & Isaacs, L. (2023) · Tetrahedron · doi:10.1016/j.tet.2023.133607 · Cited by 11 · see citing works
Urine point-of-care tenofovir test demonstrates strong predictive clinical and research utility
Mustanski, B. S., Ryan, D. T., Spinelli, M. A., Gandhi, M., & Newcomb, M. E. (2023) · AIDS · doi:10.1097/qad.0000000000003710 · Cited by 11 · see citing works
“In our experience, urine sample collection is also more acceptable to participants as it does not require a needle stick, which can be painful for up to several days [31,32] and is easier to self-collect .”
BackgroundTaylor, L. (2020) · PubMed · Cited by 11 · see citing works
Çocuk ve ergenlerde madde kullanımı ve adli toksikolojik analizler
Aslan, R., Aktaş, A., & Akgür, S. A. (2023) · Journal of Dependence · doi:10.51982/bagimli.1071269 · Cited by 10 · see citing works
Electromembrane extraction of drugs of abuse and prescription drugs from micropulverized hair
Schüller, M., Bergh, M. S., Pedersen‐Bjergaard, S., & Øiestad, E. L. (2024) · Journal of Analytical Toxicology · doi:10.1093/jat/bkae051 · Cited by 10 · see citing works
Hegde, C., Shekhar, R., Paul, P. M., & Pathak, C. (2024) · Forensic Science International · doi:10.1016/j.forsciint.2024.112343 · Cited by 9 · see citing works
Cannabis self-administration in the human laboratory: a scoping review of ad libitum studies
Xiao, K. B., Grennell, E., Ngoy, A., George, T. P., Foll, B. L., Hendershot, C. S., & Sloan, M. E. (2023) · Psychopharmacology · doi:10.1007/s00213-023-06360-4 · Cited by 9 · see citing works
“The use of cannabis in adults age 65 and older has been gradually increasing from 0.4% in 2006 (Han et al., 2017) to about 2.9% by 2016 (Han & Palamar, 2018).”
BackgroundInfluentialEvaluation of Latent Fingerprints for Drug Screening in a Social Care Setting
Pollard, C., Sievers, C., Royall, P. G., & Wolff, K. (2020) · Journal of Analytical Toxicology · doi:10.1093/jat/bkaa183 · Cited by 9 · see citing works
Concordance between Self-Reported Drug Use and Urinalysis in a Sample of Black American Women
McLouth, C. J., Oser, C. B., & Stevens-Watkins, D. J. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2021.2019778 · Cited by 9 · see citing works
“Conversely, the window for cocaine detection is much smaller, lasting only 1–3 days (Hadland & Levy, 2016).”
BackgroundSubstance Use in Adolescents Presenting to the Emergency Department
Onigu-Otite, E., Kurtzweil, M., Tucci, V. T., & Moukaddam, N. J. (2018) · Adolescent Psychiatry · doi:10.2174/2210676608666181015114220 · Cited by 9 · see citing works
“…also little guidance on how to use this process effectively to inform treatment in the ED and the immediate cost-benefit ratio has been cited as a drawback (Levy, Harris, Sherritt, Angulo & Knight, 2006; Hadland & Levy, 2016; Donofrio, Santillanes, McCammack, Lam, Menchine, Kaji & Claudius, 2014).”
BackgroundSullivan, M. C., Strainge, L., Blackmon, J. E., Cruess, S. E., Wheeler, D., & Cruess, D. G. (2020) · Journal of Addictions Nursing · doi:10.1097/jan.0000000000000318 · Cited by 8 · see citing works
“For instance, toxicology tests are typically unable to detect cocaine or methamphetamine use beyond a latency of 3 days (Hadland & Levy, 2016).”
BackgroundAndersen, A. M., Gerrard, M., Gibbons, F. X., Beach, S. R. H., & Philibert, R. A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.688384 · Cited by 8 · see citing works
“While these concerns should be balanced against the public health impact of smoking, the largest preventable cause of mortality in the US, it is important to note that laboratory testing, whether conventional or epigenetic, is generally not supported as a standalone screening or assessment for substance use (78), and…”
BackgroundOsmotic Processor for Enabling Sensitive and Rapid Biomarker Detection via Lateral Flow Assays
Chen, S., Wu, A. Y., Lunde, R., & Lai, J. J. (2022) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2022.884271 · Cited by 8 · see citing works
“Urine is one of the most used biospecimens next to blood that can be easily collected in large quantities with noninvasive procedures (Hadland and Levy, 2016).”
BackgroundClinical implications of opioid parent-metabolite ratios
Liao, H.-C., Phipps, W. S., Keebaugh, M. W., Hoofnagle, A. N., & Baird, G. S. (2024) · Clinica Chimica Acta · doi:10.1016/j.cca.2024.119995 · Cited by 7 · see citing works
McQuaid, G. A., Darcey, V. L., Patterson, A. E., Rose, E. J., VanMeter, J. W., & Fishbein, D. H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1025259 · Cited by 8 · see citing works
Brathwaite, R., Mutumba, M., Nannono, S., Ssewamala, F. M., Filiatreau, L. M., & Namatovu, P. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04339-6 · Cited by 7 · see citing works
“In our study, we try to mitigate this risk by also using biological (urine) measures but these tests are not without limitations due to the limited windows for detecting drug use [109].”
Aber, H., Nuwaha, F., Kisaakye, E., Engebretsen, I. M. S., & Babirye, J. N. (2023) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-023-00570-x · Cited by 6 · see citing works
“However, it is important to note that blood tests are generally more precise, capable of determining the exact amount of alcohol or other substances, and can detect alcohol and drug compounds themselves rather than just their metabolites [39].”
BackgroundBogdan, R., Leverett, S. D., Constantino-Pettit, A. M., Lashley-Simms, N., Liss, D. B., Johnson, E. C., Lenze, S. N., Lean, R. E., Smyser, T. A., Carter, E. B., et al. (2024) · Neurotoxicology and Teratology · doi:10.1016/j.ntt.2024.107351 · Cited by 6 · see citing works
Gersch, H. G., Shah, D., Chroust, A. J., & Bailey, B. A. (2023) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2023.2211706 · Cited by 6 · see citing works
“Although there are many benefits to using maternal urine for biological drug testing such as ease of sample collection and cost, a major limitation is that the window of detection for opioids is only 2–5 days, approximately [12,13].”
BackgroundRudy, L., & Lacroix, E. (2024) · Palliative & Supportive Care · doi:10.1017/s1478951523001402 · Cited by 6 · see citing works
Bond, B. W., Duric, B., Spinazzola, E., Trotta, G., Chesney, E., Li, Z., Quattrone, D., Tripoli, G., Gayer-Anderson, C. E., Rodríguez, V., et al. (2025) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241290187 · Cited by 6 · see citing works
Lau, G., Gabbe, B. J., Mitra, B., Dietze, P., Reeder, S. C., Cameron, P. A., Read, D. J., Symons, E., & Beck, B. (2023) · Emergency Medicine Journal · doi:10.1136/emermed-2023-213186 · Cited by 6 · see citing works
Complexity of Translating Analytics to Recent Cannabis Use and Impairment
DeGregorio, M. W., Kao, C.-J., & Wurz, G. T. (2024) · Journal of AOAC International · doi:10.1093/jaoacint/qsae015 · Cited by 6 · see citing works
Wang, T., Lee, Y., Chen, H., Ko, C., Hong, C., Wen, J.-W., Yen, T., & Cheng, C. (2020) · Diagnostics · doi:10.3390/diagnostics11010006 · Cited by 6 · see citing works
“For example, the detection times for amphetamine are 2–4 days and 12 h in urine and plasma, respectively [22].”
BackgroundCreatinine normalization approach to diluted urine samples screened by LC-MS/MS method
Karakükçü, Ç. (2024) · International journal of medical biochemistry/International journal of medical biochemistry : · doi:10.14744/ijmb.2024.57441 · Cited by 5 · see citing works
“It has some advantages such as easy sampling, availability of sufficient samples, a higher concentration of substances or metabolites than blood, a wider detection window (average 2–3 days), and availability of validated analysis methods [1, 2].”
BackgroundMethodDifferentiation of Therapeutic and Illicit Drug Use via Metabolite Profiling
Stoeva, S., Hvarchanova, N., Gancheva, S., Eftimov, M., Georgiev, K., & Radeva-Ilieva, M. P. (2025) · Metabolites · doi:10.3390/metabo15110745 · Cited by 4 · see citing works
Therapeutic and Toxic Concentrations of Drugs in Biological Matrices
Amponsah, S. K., & Pathak, Y. V. (2022) · Springer eBooks · doi:10.1007/978-3-031-12398-6_1 · Cited by 4 · see citing works
Evaluation of Antipsychotic Drugs’ Stability in Oral Fluid Samples
Gameiro, C., Gonçalves, J., Soares, S., Rosado, T., Araújo, A. R. T. S., Passarinha, L. A., Barroso, M., & Gallardo, E. (2023) · Molecules · doi:10.3390/molecules28052030 · Cited by 4 · see citing works
“However, the blood collection method is considered invasive, and urine can be easily adulterated; in addition, some substances, such as highly lipophilic compounds, may be difficult to detect [5,6].”
BackgroundRamey, O. L., Bonny, A. E., Almodóvar, A. S., & Nahata, M. C. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.02.013 · Cited by 4 · see citing works
Prevalence of alcohol and other drug detections in non‐transport injury events
Lau, G., Mitra, B., Gabbe, B. J., Dietze, P., Reeder, S. C., Cameron, P. A., Smit, D. V., Schneider, H. G., Symons, E., Koolstra, C., et al. (2023) · Emergency Medicine Australasia · doi:10.1111/1742-6723.14312 · Cited by 4 · see citing works
Jang, W., Lee, S., & Jeong, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1302994 · Cited by 4 · see citing works
“Therefore, questionnaires must often be combined with quantitative analyses of drugs or metabolites in peripheral biospecimens, such as urine drug tests, as a supplementary tool to confirm recent MA use and strengthen conclusions about drug addiction (25).”
BackgroundCannabis use among hospitalised adolescents before and after decriminalisation in South Africa
Swartz, M. C., Dannatt, L., & Lachman, A. (2024) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v30i0.2244 · Cited by 4 · see citing works
“35 There was a gender difference in our study pre-and post-ruling, with 67.6 % of participants being male pre-ruling and 57.7 % being female post-ruling.”
InfluentialEvaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study
Mohammed, S. A., Abdelhamed, A., & Elsayed, R. M. (2020) · Sexual Medicine · doi:10.1016/j.esxm.2020.08.008 · Cited by 4 · see citing works
“However, these rapid urine tests lack specificity and should be confirmed by specific antibodies.(27) In the present study, smoking was significantly higher in positive drug abuse in both patients with PE and control.”
BackgroundProtocol Design and Implementation for Monitoring Parental Substance Use in Child Custody Litigation
Weiss, C. J. (2021) · Family Court Review · doi:10.1111/fcre.12544 · Cited by 2 · see citing works
‘Supervising children to be good people’: Parents and children's views of child supervision in Laos
Ruiz‐Casares, M., Phommavong, S., Park, S., & Douangphachanh, M. (2024) · Child & Family Social Work · doi:10.1111/cfs.13140 · Cited by 4 · see citing works
Polysubstance use patterns among individuals applying for opioid-use disorder treatment in the U.S.
Lee-Easton, M. J., Magura, S., Abu-Obaid, R. N., Reed, P., Allgaier, B., Fish, E., Maletta, A., Amaratunga, P., Lemberg, B. L., Levitas, M. P., et al. (2024) · Journal of Substance Use · doi:10.1080/14659891.2024.2372093 · Cited by 3 · see citing works
“● Shorter detection window than for urine (1 to 2 days for most classes of drugs) (Hadland & Levy, 2016).”
Clinical Drug Testing Supporting Patients with Substance Use Disorder: A Review
Saitman, A. (2025) · The Journal of Applied Laboratory Medicine · doi:10.1093/jalm/jfaf069 · Cited by 3 · see citing works
Reported associations between kratom and seizures: a systematic review
Turla, T. M., Abele, G., Hua, M., & Paustenbach, D. J. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1632835 · Cited by 4 · see citing works
Abdelhakim, A. K., Bio-Sya, A., Damien, G. B., Klikpo, E. T. E., Gansou, G. M., & Allabi, A. C. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04394-0 · Cited by 3 · see citing works
False-positive drug test results in patients taking psychotropic drugs. A literature review
Masternak, S., Padała, O., & Karakuła‐Juchnowicz, H. (2021) · Psychiatria Polska · doi:10.12740/pp/113173 · Cited by 3 · see citing works
“Screening for drugs of abuse is now uncomplicated and quick due to the broad use of urine tests [1].”
BackgroundBonner, C. P., Browne, F. A., Carney, T., Shangase, N., Ndirangu, J., MYERS, B. J., & Wechsberg, W. M. (2022) · South African Medical Journal · doi:10.7196/samj.2022.v112i5.15971 · Cited by 3 · see citing works
“[35] We did not conduct a comprehensive assessment of the second-hand exposure to cannabis smoke and consequently could not address this risk.”
BackgroundLau, G., Gabbe, B. J., Mitra, B., Dietze, P., Reeder, S. C., Cameron, P. A., Read, D. J., & Beck, B. (2024) · Injury · doi:10.1016/j.injury.2024.111782 · Cited by 3 · see citing works
“While these results can be measured using either a blood or breath test, only the results of blood tests were examined in this study for consistency as different biological tests have different windows of detection for alcohol [28].”
Changes in cannabis use post decriminalisation in mental health care users in South Africa
Moshori, R., Galvin, L., & Paruk, L. (2025) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v31i0.2305 · Cited by 3 · see citing works
Halpern, S., Walls, D. O., Gupta, A., Lustig, A., Weinrieb, R. M., Levine, M. H., & Abt, P. L. (2019) · American Journal of Transplantation · doi:10.1111/ajt.15548 · Cited by 3 · see citing works
Use of Ketamine as a Date Drug: a Systematic Scoping Review
(2021) · International Journal of Psychological Research and Reviews · doi:10.28933/ijprr-2021-07-1505 · Cited by 2 · see citing works
Predictors of future overdose among people who inject drugs in Baltimore, Maryland
Ramirez, M. P., Lucas, G. M., Page, K. R., Zook, K. J. C., Landry, M., Rosecrans, A. M., Harris, R., Grieb, S. M. D., Falade-Nwulia, O. O., Clarke, W., et al. (2024) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2024.100286 · Cited by 2 · see citing works
“As Baltimore and the nearby geographical areas experience an increase in overdose rates attributed to fentanyl with each passing year, the availability of harm reduction resources, such as naloxone and fentanyl testing strips, for safer drug consumption become ever more essential to help reduce the risk of overdose mo…”
BackgroundInfluentialReflexive Drug Testing Strategies for Efficient Utilization of Resources and Better Interpretation
Pape, A., Hoofnagle, A. N., & Liao, H.-C. (2025) · Clinics in Laboratory Medicine · doi:10.1016/j.cll.2025.01.008 · Cited by 2 · see citing works
A Challenge Is Brewing: False-Positive Urine Alcohol in an Elderly Diabetic Male
Borgan, S., Sourial, K., Robalino, E., Macias, K. C., & Ho, M. Q. (2019) · The American Journal of Medicine · doi:10.1016/j.amjmed.2019.04.029 · Cited by 2 · see citing works
- Authors
- Hadland, S. E., & Levy, S.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Hadland, Scott E.
- Venue
- Child and Adolescent Psychiatric Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2016-07
- Volume
- 25
- Issue
- 3
- Pages
- 549-565
- ISSN
- 1056-4993 (ISSN-L)
- PMC
- PMC4920965
- OpenAlex
- W2404995590
- Cited by
- 183
- References
- 35
- Citations by year
- 2026: 22 · 2025: 21 · 2024: 26 · 2023: 23 · 2022: 21 · 2021: 20 · 2020: 30 · 2019: 11 · 2018: 3 · 2017: 6
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Child and Adolescent Psychiatric Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5t32hd075727-02, 5r01aa021913-03)
- National Institute on Alcohol Abuse and Alcoholism (R01-AA021913)
- National Institute on Drug Abuse (R03DA037770)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32-HD075727)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- drug testing, addiction treatment, adolescents, clinical interview, test result interpretation, sample validation, objective testing
- MeSH terms
- Adolescent, Adolescent Behavior, Humans, Substance Abuse Detection, Urinalysis, Substance-Related Disorders
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