Drug screen left out for 4 days

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I thought this forum might suit the topic a little better, maybe someone may have a better understanding than I do. If there are any lab specialists out there that would be great lol! Forgive me for the lengthy post, in advance.

The purpose of this thread is mostly to ask the question: Can a urine drug screen be accurate after sitting in room temp x 4 days? Ive googled and most of the info i have found is that chain of custody states it should be frozen/refrigerated asap and sent out at least within 24 hours.

If youd like to know more info heres some background: I was pulled for a random at my hospital due to a pharmacy report red flagging me. I was pulled aside by house supervisor immediately arriving to the floor before starting my shift. This is night shift so it was only her and i reporting to employee health, she had to call someone in to conduct the test, on a holiday btw. (On a side note the nurse called in brought a family member or friend with her, which surprised me because I feel like that should be a violation of my privacy, any thoughts on that?) Anyway, she conducted the test, we did all as usual, she set the test with the paperwork on the counter, shut the lights off and we all walked out, she locked the door. And i asked "So its ok to just sit there on the desk?" & her reponse was "Yea its good, the doors will be locked and itll be shipped out on monday via fedex" (holiday weekend so that means 4 days later when the main person comes back to work). I was in so much shock at the time that i didnt think much else about it until later. The house supervisor (along with the pre-written hospital policy) states it takes 5-7 days to get results back & ill be notified by my manager. I just feel like this is very strange and assume I may have to retest if it comes back unreadable or whatever, which hopefully theyll give me the chance and i dont have to fight with them about it. Thanks for reading!

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sounds totally suspicious to me, but I have never been involved in this sort of thing. I would be more afraid of it being purposefully adulterated then the break down.

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It could ferment and test positive for a lot of alcohol.

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Specializes in Psych, Addictions, SOL (Student of Life).

Fermentation is a non issue unless there is a substantial glucose content in the urine which would mean you need a more through medical work-up. When in monitoring your urine is collected at a site then packaged for overnight shipment to a lab for testing. So it is conceivable that it has not been refrigerated for 24 to 36 hours. I never had a problem with that regard. What I would be more concerned about is what Morte mentioned, a lack of proper chain of custody. After it was collected the urine should have been immediately packaged for shipment in your presence. All kinds of things can happen to that sample just sitting on a counter for three to four days. I would be prepared to have a hair or nail test at your own expense if necessary and it wouldn't hurt to consult with a license defense attorney.

Hppy

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Yeast can cause a false positive also if left out too long, along with glucose.

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For what it's worth, they likely aren't testing for urine alcohol for a work screening, which is where prolonged sitting may come into play (say if you are spilling glucose in your urine which could cause fermentation for a ethyl test). Also, even if they were testing urine ETG, ETG actually degrades over time in non-refrigerated urine, so if they are testing for ETG (unlikely), having it sit at room temp may actually be beneficial.

A coworker of mine was pulled because someone reported her for smelling of alcohol, and she had to pee in a cup for the drug screen and also breathalize (she was negative on both). Work screens don't test for urine alcohol because it's not forbidden to drink as a non-monitored nurse, just you can't have a BAL at work. So I seriously would doubt that they would be checking for remote alcohol use in urine, because a BAL or a breathalyzer is what they would need to check for that.

Now, my routine testing lab told me that general drug panel samples can sit at room temp for a week, unless the test specifies that it must be frozen or refrigerated, for what that's worth. Urine samples can get pretty warm sitting on the back of a hot shipping truck. If there is a temp requirement on the sample, the lab will reject it if it doesn't meet it...I have a urine test I frequently get that has to arrive frozen, and those samples have been repeatedly rejected before for being too warm, for me at least.

As for the chain of custody, was the sample sealed up before they left it on the counter? Or was it left just sitting in an unsealed cup on the counter?

But regardless, when I was reported, my urine drug screen was from the hospital as a patient, and it was not a forensic test, so it went through zero chain of custody. The Board still accepted it. And my current place of work at a hospital reports nurses/medical folks with mental health issues and substance issues and submits the drug screens we use that are just basic non-forensic samples...and the Board acts on those too.

The thing with temp is, aside from a situation like alcohol (which they likely wouldn't be testing for in urine in your case), sitting out won't make urine produce a metabolite for say a benzo or an opiate. It could degrade a metabolite and make the metabolite reduce (which is why some samples are refrigerated or frozen), but it won't make a cocaine or THC metabolite or the like pop out of nowhere or multiply. So the Board would likely accept a positive screen regardless of any temp concerns. Warm urine (aside from alcohol) can create a false negative, but not a false positive.

So, even if it wasn't best practice (which it may be fine), the Board likely wouldn't throw out a positive sample because they are the Board and they don't practice innocent until proven guilty...they accept hearsay and opinions and all sorts of non-facts and use them as evidence. People have been reported and punished for far less than an imperfect drug screen, such as the claim of an ex spouse or a weak coworker accusation even with a negative screen, and other things a criminal court will not accept...because they operate under administrative law and get away with punishing with suspicions over facts.

If you are clean, I wouldn't worry about the temp. Temp won't make a drug metabolite come from nowhere. As for tampering if the sample wasn't sealed, most tests check the metabolite of the drug in question, so if you took a drug, they would be looking for the metabolite the body makes from that drug, so people would have a hard time, say dunking a benzo in your urine and hoping it would test positive.

You may be able to kick a fuss if they didn't follow chain of custody, but I guess I'm saying that it may not be a successful argument because the Board often doesn't give a hoot anyway. When I complained about my screen not having chain of custody, my Board investigator literally said "It doesn't matter. We don't need chain of custody or a forensic sample...a suspicion is more than enough." I wish I was joking.

And for employment purposes, in at-will employment states, they can fire you for no reason, regardless. Before I ever used drugs, I was pulled for a random because reasons I still don't understand (nothing patient care or pyxis related). The test was negative, and they still fired me. And they could, because my state is at will employment.

Now I'm rambling. I wish I could say if you could prove that they didn't follow protocol, that it would nullify that drug screen for you. But I guess I'm saying is I've seen the Board accept non-forensic screens or shoddy screens...or even accusations with no screens. It certainly could be a rabbit hole worth going down, but I'm not sure it will change the outcome for you.

Best wishes and welcome.

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From experience that is only with the Ethanol, bacteria does not effect ETG it degrades it so the test is invalid, they do an ECT to show that alcohol is negative and other test to determine bacteria oxidation is from normal causes. I know this because it happened to me and had this explained by the MRO.

Also they are not necessarily continuously refrigerated. If you use Quest, samples are sent to a northeast state for drug testing and when that is complete the sample is shipped to another lab across the country for the alcohol testing. I doubt refrigeration is maintained.

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Thank you so much for all your replies! Gives me a lot to think about. I was just curious. Im just hopingit doesnt get rejected & then i dont know what theyll decide from there, retest or not? And if they do retest theres another week of waiting. But it is what it is. Thanks guys, youve given me some great info here!

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Oh and btw to specify the specimen was sealed and put in the bag with the label, so i dont believe thats an issue with chain of custody, just the fact that it sat for awhile, which i now feel like it should be fine thanks to your responses. I dont really want to raise any fuss about that aspect i just wast sure if the specimen would still be good. But any thoughts on the fact that the lady who conducted the test (she was called in off hours) brought someone else there that doesnt work there. Do i have any ground to stand on with the fact that that is a violation of my privacy? I intend to return to work with no issues regarding the test (as long as the sitting didnt cause it to be rejected). But i was thinking about filing a complaint with them regarding the possible Hippaa Violation.

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Specializes in Psych, Addictions, SOL (Student of Life).
Yeast can cause a false positive also if left out too long, along with glucose.

From a chemistry standpoint and having made bread and other fermented foods for years - I have found from experience that in order for yeast to cause fermentation it must have glucose to act on. I'm not sure how small the amount of glucose has to be but yeah if there is yeast and glucose in the sample and it's left at room temp - your gonna get fermentation which releases sugar alcohols . So conceivably one could get a positive from that. Still it would not hit on Etg. Just presence of alcohol which could be explained as incidental exposure.

Hppy

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Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.

I was accused of being under the influence at work and had to do a probable cause at the end of my shift. Like you, I planned on returning to work and having no issues with the test. I was terminated 5 days after the probable cause collection, they said I was positive for methadone and benzos. The test was done as an EIA ( enzyme immunoassay) and apparently the confirmation was an EIA as well (still trying to figure out how that works?) It took me 14 months of hell and fighting to clear my name.

When did you have to submit this sample? I would suggest getting your own drug test completed, so you have proof that you are in fact negative. I had a hair test complete red that was negative and the BON didn't care about that one bit and still made me enroll into monitoring for a year. Once I had proof that I was negative ( the original sample retested with GC/MS cane back negative) I dropped out of EEP, had my case kicked back to the BON and closed.

I'm not trying to scare you, just making you aware. I hope everything turns out ok for you.

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Specializes in Psychiatric and emergency nursing.

While the nurse did break chain of custody by leaving the sample on a desk until Monday, if the tape surrounding the sample was left intact, there's no chance of tampering. The only thing that would possibly show from the sample being left out is EtOH, and only if there was yeast and glucose already present. There's nothing about what happened with the sample that would cause a false positive of any other drug metabolites. Please excuse me if I'm wrong, but it sounds like the OP is just looking for a potential reason the sample would pop positive besides drug use.

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