What an instant test is
An instant test is a urine screen read at the collection site, on the day of collection, from a single-use testing device. The donor provides a specimen under the same chain-of-custody procedure as a laboratory test; the collector seals it, and a built-in device reads it there and then. There is no laboratory step for a negative screen, which is why the answer comes back in hours rather than days.
The collection sites TrueTest uses for instant testing are Quest Diagnostics patient service centers. Quest reads the device and issues a written point-of-collection report. TrueTest reports from that document and attaches it to the notice; nothing is reported from a phone call or a verbal reading.
The panel is set by the test ordered. A five-panel instant screens for amphetamines, cocaine, marijuana, opiates and PCP. A ten-panel adds barbiturates, benzodiazepines, methadone, methamphetamine and propoxyphene. Instant tests do not screen for alcohol.
A negative screen
If every panel on the device reads negative, the screen is the final result for that order. The specimen is not sent to a laboratory, no confirmation test is run, and there is no Medical Review Officer step, because there is nothing for an MRO to review. The result notice goes out once Quest’s written point-of-collection report is in hand — usually within a few hours of the collection.
The notice is built from the report itself: one line per panel, each reading negative, and the report attached. It does not carry a laboratory certification, because no laboratory analyzed the specimen.
A non-negative screen
If any panel on the device reads non-negative, the on-site screen is not the result. The sealed specimen is forwarded to Quest Diagnostics’ laboratory for confirmation testing by mass spectrometry, and a confirmed positive is then reviewed by a Medical Review Officer before anything is reported. The parties are told that the specimen has been sent for confirmation; they are not told which panel read non-negative, and the screen is never reported as a positive.
A screen that requires confirmation is not a result. An instant device can read non-negative on a specimen that the laboratory then confirms negative, which is the reason the confirmation step exists. The result the parties receive is the laboratory’s confirmed result after MRO review, and it reads like any other laboratory result.
Confirmation testing typically takes three to six business days from the day the specimen is forwarded.
Reading the report
The point-of-collection report lists each panel the device screened and the reading for each: negative, or non-negative. Each panel has a screening cutoff, printed on the report, below which the device reads negative. A negative instant screen carries no number — the device does not measure a concentration; it reads whether the drug is present at or above the cutoff.
The report also records the collection date, the collection site and the specimen identifier, which match the chain-of-custody form the donor signed.
An instant device does not run the laboratory validity testing — creatinine and specific gravity — described on the lab report page. The collector checks the specimen’s temperature at collection, as on every urine collection.
What a negative does and does not show
A negative instant screen establishes that none of the drugs on the panel was present in the specimen at or above the device’s screening cutoff on the day of collection. The same detection-window limits apply as to any urine test: most drugs clear urine within a few days, so a negative speaks to the days before collection, not to the weeks before.
- It does not say the donor has never used the drug, or did not use it earlier than the detection window.
- It does not cover drugs that are not on the panel. A five-panel instant says nothing about benzodiazepines, and no instant panel says anything about alcohol.
- It is a screen, not a laboratory confirmation. A negative screen is final for the order because nothing was found to confirm; it is not a laboratory-confirmed negative, and the notice does not describe it as one.
- It is read at a screening cutoff. A concentration below that cutoff reads negative, as it would on a laboratory screen.
The general limits of any test result — what a report does not say — apply here in full.
Instant or laboratory
An instant test answers one question quickly: is any drug on the panel present today at or above the screening cutoff. A negative is final the same day, and a non-negative goes to the laboratory and the MRO exactly as a laboratory test would. That makes an instant test suited to monitoring where a same-day answer matters and the panel is standard.
A laboratory test is the choice when the order calls for a quantitative result on every specimen, for drugs or cutoffs an instant panel does not offer, for alcohol markers, or for a specimen other than urine. A laboratory test is also what any non-negative instant screen becomes.
What the order has to say
An order for instant testing should name the test and its panel — five-panel or ten-panel instant urine — rather than a category, and should say what the parties already receive under TrueTest’s procedure: that a negative screen is reported as the result, and that a non-negative screen is confirmed by a laboratory and reviewed by an MRO before any positive is reported. Naming that in the order removes the argument later.
The model order names specific tests rather than categories in its panel selections.