Notes from the Field, No. 1

Two tests, one phrase

A father in a custody matter was under a remote alcohol monitoring program. When he missed more tests than the agreement allowed, I recommended a urine EtG in our email correspondence, collected as soon as feasible and no later than the next day. The sooner the test happens relative to the event in question, the more it can tell you.

That phrase covers two different tests. Urine EtG detects a metabolite of alcohol for roughly eighty hours. A urine ethanol test checks for unmetabolized alcohol still in the body — a window of about twenty-four hours. Both are urine alcohol tests. Only one looks back far enough to answer the question the order existed to answer.

He chose ethanol. He waited until hour twenty-three, at the far end of that window, and gave the sample.

He complied with the order exactly as written, using a test that could not detect the drinking the order was written to catch. Nobody did anything improper. The order permitted it.

Where the order gets made matters more than where the sample gets taken

As a service provider for drug and alcohol testing nationwide, this is worth saying plainly: donors do not need to live near our location. We order testing at collection sites near where they live, typically with more than one option.

The collection is standardized. What isn’t is everything else around a court-ordered test. Two donors can walk into the same site on the same day and produce results a court can use very differently — because whether the full laboratory report is released, or only an MRO’s pass/fail determination, is set by how the ordering provider’s account is configured. That decision is made before anyone is collected, by whoever placed the order.

And once results are released: can that provider tell you anything about what they actually say?

Read more: what the laboratory report shows that the MRO report doesn’t →

If you’re drafting an order and want to talk through which test answers your question, call (847) 258-3966.

New on the panel: xylazine

Xylazine is a veterinary sedative, FDA-approved for animal use and not for humans. On the street it goes by “tranq.” It is almost never sought on its own — it shows up as an adulterant in illicit fentanyl. DEA has seized fentanyl-xylazine mixtures in 48 of 50 states, and its laboratory system found xylazine in roughly 23% of fentanyl powder and 7% of fentanyl pills seized in 2022. Because it is not an opioid, naloxone does not reverse its effects, and people who inject mixtures containing it can develop severe wounds, including tissue necrosis.

That is also why it has to be asked for. Xylazine is not an opioid, so it does not appear on a standard opiate panel, or even an expanded one. If opiates are a concern in a matter, adding xylazine to the substances you want tested is worth considering.

We test for it in hair and nail. Detection windows are the ones those matrices always carry — head hair roughly 90 days, body hair up to 12 months, fingernails up to 6 months, toenails up to 12 months. Urine testing is not available at this time.