Types of Collectors
To do collections in Canada one should be a Certified Specimen Collector. This means that the collector will be aware and well versed in all aspects of collecting, processing, and interpreting results from urine, oral fluid and hair specimens. Having gained accreditation as a CSC the collector will also follow appropriate protocols with regard to all collection procedures including chain of custody.
If one is testing for an individual who requires US compliancy, then they will need to be certified as a DOT Specimen Collector. This means that they will be certified under the U.S. Department of Transportation’s rules and regulations regarding workplace drug testing and the testing they do will comply under their federal laws.
For alcohol testing there are two different certifications available, the Screening Test Technician (STT) and Breath Alcohol Technician (BAT). Both give accreditation for all aspects of alcohol screening, breath and oral fluid, but only the BAT gives training for the alcohol confirmation testing procedures.
Types of Tests
Point of Care Tests
Point Of Care Test: The Ontario Ministry of Health and Long-Term Care (MOHLTC) defines point-of-care testing as:
“Testing of samples taken from a patient and performed at or near the bedside (area of care) with the result leading to possible changes in the care of that individual is defined as point-of-care testing (POCT)”
Point-of-care tests use immunoassay technology and give an immediate result. This includes tests such as cassettes, cups, and saliva test. These tests can be given in a set up clinic/office or they can be done remotely, on a work site. Alcohol tests are most commonly given using a breathalyzer either by a BAT or an STT.
Lab Based Test
A lab based test is one that, regardless of where the collection was done (on-site or off), it is sent to the lab for analysis. A lab will do an initial screen with a POCT device, and if there is a non-negative result they will go forward with a full lab test. For a full lab test they use the very informative gas-liquid chromatography which gives a specific, quantitative breakdown of exactly what is in the sample.
Confirmation Testing and the MRO
Confirmation testing is the process undergone when a POCT test is done and a non-negative result is received. You will notice that the terminology here used is non-negative, NOT positive for the results of a test. A non-negative test will need to be confirmed at a lab, using a full gas-liquid chromatography breakdown of the sample, and then reviewed by an MRO to assess the final result. This breakdown will be sent to an MRO (Medical Review Officer), who is a doctor of medicine who is also knowledgeable in the area of drug and alcohol abuse and counseling. The MRO will look over the results of the test, along with the accompanying forms (CCF) and lab results. The MRO will then contact the donor to speak with them, finding out if there are any medications the donor is taking which could explain the presence of whatever drug is in question, having shown up within the sample. If there is no viable explanation as to how the drug could be present in the sample due to prescribed medication (this could include a medicated drug that is in a much larger quantity than appropriate as well) then the result will be released as positive. If, however, there is a reasonable explanation for the presence of the drug, due to medication(s) that the donor is on, the result will be released as negative.