What time period can one cover with hair drug testing ?

Hair drug testing covers up to 12 months depending on the type and length of hair of the donor. For one month of results requires approximately 1.3 cm of hair length.

How fast does hair grow ?

Studies indicate that head hair grows on the average approximately 1.3 cm (or 1/2 inch) per month. This growth rate varies slightly (estimated at ± .2 cm per month), consequently there is some (± 1 week) time variation possible.

How does hair testing compare to urinalysis?

The primary differences are that hair testing provide a wider window of detection and the inability to tamper with the test. Cocaine, methamphetamine, opiates and PCP are rapidly excreted and usually undetectable in urine 72 hours after use. The detection period for hair is limited only by the length of the hair sample and is approximately 90 days for a standard screen. Additional advantages include non-intrusive collection procedures; virtual elimination of test evasion; and greater accuracy through test repetition capability. The combination of an increased window of detection and resistance to evasion makes hair testing far more effective than urinalysis in correctly identifying drug users.

How soon after use can a drug be detected in hair?

It takes approximately 4-5 days from the time of drug use for the affected hair to grow above the scalp. Body hair growth rates are generally slower and cannot be utilised to determine a timeframe of drug use.

What is the shortest time period that can be accurately evaluated?

The minimum time period is approximately one month (1/2 inch). Body hair can be used if head hair is too short for a test. If body hair is used the timeframe represented by the test is approximately one year, due to the different growth pattern in hair below the neck.

Can tests be run on people with little or no hair?

Hair can be collected from several head locations and combined to obtain the required amount of hair. In addition, body hair may be used as a substitute to head hair. In the rare case where no hair is collectable, complete urine/adulteration testing may be utilised.

Does body hair give the same type of results as head hair?

Body hair can be used to test for all drug classes. Body hair growth patterns are different than head hair though most body hair is replaced within approximately one year. This means a test done with body hair will be reported as drug usage during approximately a one-year timeframe.

Can hair collected from a brush be used for testing?

No. Trimega Laboratories requires a hair sample to be collected using proper chain-of-custody protocols that will withstand a legal challenge. The sample must be submitted using Trimega's hair collection kit. The donor must provide sufficient identification and initial the sample collection pouch to certify the authenticity of the sample at the time of collection.

How does Trimega Laboratories establish its cut-off levels?

Trimega follows the cut-off levels generally accepted industry-wide. These levels are based in part by minimum detection levels for GC/MS confirmation.

What is GC/MS and what does it mean?

Gas chromatography / mass spectrometry is a confirmation test which is applied to any hair samples that produce positive results in the screening process. It is considered by the Forensice Science Services as the 'gold standard' in hair testing.

Can over-the-counter medications produce positive results in a hair test?

Enzymes-immunoassay antibodies (EIA), similar to those used to test urine, are used for the initial screening test for drugs of abuse in hair; therefore the potential for substances such as over-the-counter medications to cause a false positive screening result does exist. To eliminate the possibility of reporting a false-positive due to cross-reactivity, Trimega Laboratories confirms all positive results by GC/MS for methamphetamine, opiates, PCP, cocaine and cannabis.

Would external contaminants, such as bleaches or cannabis smoke, affect the hair test results?

Bleaches, shampoos and external contaminants (i.e. marijuana smoke) have no known impact on test results. Drug residues remain permanently entrapped in the hair.

Is there anything that can affect the quantity of drug that has been detected?

The quantity detected is affected by many factors such as frequency of use, quantity consumed, quality of the drug, method of consumption, smoking efficiency if smoked, and variations in metabolism due to other factors such as diet and bodyweight.

Where can I learn and read more about Drugs and Alcohol?

Trimega Laboratories have researched a number of leading books that could act as a way to help our clients understand the impact of drugs and alcohol on their patients/donors or internal clients. Please visit our Drug & Alcohol Literature section for more information.

What situations would I consider using hair alcohol testing?

There are many applications where you would want to determine whether someone had an alcohol problem, or indeed prove they didn't have a problem.
These include:
- Child custody cases
- Probation service for alcohol offences
- Safety critical employment
- Suspicions that a corporate / colleague has an alcohol problem
- Proof of responsibility, eg eaders, armed forces etc.
- Alcohol treatment programmes
- Screening people in clinical trials
- Suitability for surgery

What are the limitations?

Obviously, we need hair. Occasionally drug screening companies encounter someone who has shaved from head to toe, with not a single hair on their body, but that does raise suspicions.

Can you tell whether someone is totally abstinent from alcohol?

No, the Hair Alcohol Testing methods have not been developed for that purpose.

What methods are available to me?

EtG and FAEE testing are now two methods available for use, to detect consumption of alcohol over a longer period ranging from one month and up to six months. No other method can do this.

What is EtG and FAEE?

"EtG" stands for ethyl glucuronide and "FAEE" stands for fatty acid ethyl esters. Both are direct and very specific alcohol markers, which are metabolites of alcohol produced in the body when alcohol is consumed. These markers cannot originate from other pathological reasons.

What kinds of samples are used for both tests?

Both tests require hair samples whereby both markers are deposited in hair during chronically high alcohol consumption.

What is the difference between EtG and FAEE?

The EtG marker is formed almost exclusively in the liver and is deposited into hair mainly from sweat. The FAEE marker is formed in blood and all tissues and gets into hair mainly by diffusion from the external sebum layer. Unlike the detection of drug metabolites in a hair test, environmental contamination (for example, being exposed to a drinking environment at a pub) can result in the detection of traces of ethanol. However, such traces as these do not correlate to the consumption of alcohol.

Why would I choose to use one test over another?

It is all case-dependant as to which test to use. If you wish to provide an average result up to six months, the FAEE test would allow this.

Do you recommend against using either test-technology in isolation?

The Society of Hair Testing, represented by 23 countries, recently met in Rome (June 2009) and the consensus states that either FAEE or EtG methods can be used independently for chronic excessive alcohol consumption assessment. However, they continue to state that for mutual confirmation and for exclusion of false positive or false negative results, the determination of both parameters can be useful.

Test results should be used as corroborative evidence only. In line with the consensus, we recommend the combination of EtG and FAEE testing together, or the combination of hair and blood tests; including the consideration of medical and case contextual information.

Some companies offer only EtG testing. What are the disadvantages of this?

It is recommended that EtG testing is performed on the most recent 1-3 months of hair growth (approximately 1 - 3cm from the scalp). That is due to the fact that using the EtG test in isolation carries the risk of the 'wash-out' effect whereby the frequent washing and intense shampooing of a donor's hair slowly removes the EtG marker that has been deposited onto the hair. As a result, this marker is sensitive to false-negative results. Trimega Laboratories therefore, recommends the combined use of EtG and FAEE testing at all times.

If there is a 'wash-out' effect when testing EtG with the potential risk of false-negative results, is this test still useful?

Yes, the test is still very useful because it does what testing blood cannot do -- that is to test for alcohol abuse for periods of one month and longer. In line with the recent consensus of the Society of Hair Testing (June 2009), EtG testing should only be recommended on head hair samples of no longer than 0-3cm or on body hair samples.

Does the 'wash-out' effect apply to FAEE testing?

No. FAEE markers are relatively stable in hair. A study showed that the effect of hair care and hair cosmetics on FAEE concentrations, and 20-times the usual shampooing of hair samples of heavy drinkers did not significantly decrease the concentration.

Is the combination of both tests therefore better and more accurate?

Yes. The combined EtG and FAEE tests certainly increase considerably the accuracy of the interpretation. Agreeing positive or negative results enable an almost unambiguous interpretation. The members of the Society of Hair Testing met in June 2009 and agreed that the testing of both parameters is useful for mutual confirmation and for the exclusion of false positive or false negative results.

My client uses an array of hair products including hot oils, shampoos and hair sprays with high alcohol content and washes her hair on a more than regular basis. Does my client need to disclose this information at the time the samples are being collected?

Yes. Information such as this would benefit Trimega Laboratories' analysis of the results as best possible. The more information is provided, the more interpretative the results will be to explaining any abnormalities. Trimega Laboratories request that this information is provided at the time of the sample collection and provided on the chain of custody documentation.

Is there the possibility of disagreeing results if both tests are carried out?

Yes, this is possible. In the case of a negative result with a positive, the absolute value of the concentration of the positive marker is of particular importance.

Does the EtG and FAEE concentration found in my client's test results equate to the quantity my client has consumed?

No. We cannot quantify the exact amount of units your client has been drinking, as Trimega Laboratories does not measure the alcohol itself, but rather identifies and quantifies metabolites produced by the body once alcohol has been ingested. Results cannot be quantified into consumption levels due to differences in alcohol metabolism and physiology in hair growth; including the differences in hair care (for example, frequency of shampooing). As with all medically-based tests, results are not subject to the lineal laws of basic mathematics.

If you cannot determine the quantity of alcohol consumed from the test results, what do these tests determine?

Trimega Laboratories determine whether the donor falls above or below the cutoff level that we have set, which is 60 grams of pure ethanol per day over a protracted period.

What is meant by a "positive" result?

A positive result is reported when the total concentration of FAEE and/or EtG values exceeds the Cut-Off level which correlates to 60 grams plus on a daily basis (see previous question/answer).

Is it possible to determine whether a positive test result is due to binge drinking or high regular consumption?

No. Unlike other drugs which are deposited through the root alone, FAEEs are deposited through both the root and the sebum produced by the sebaceous glands in the scalp. This means it is possible for sections of hair to have lost or gained concentrations of FAEEs through the migration of sebum along the follicle which could distort any timeline analysis. It is therefore only possible to provide an average level of consumption for the period of time being tested for.

Similarly, the fact that most peoples' hair does not stick up out of the scalp, but lies against the scalp surface for several centimetres as it grows down, means that more mature sections of hair are being bathed in the EtG-laden sweat which is produced by the sweat glands, thus making it scientifically unsound to offer segmented results on a month-by-month basis from which to establish a chronological pattern of consumption.

It is therefore only possible to provide an average level of consumption for the period of time being tested for.

Is it possible to provide a chronological analysis of a subject's drinking history?

Not with a single test (see above). However with a series of tests conducted at regular intervals, a very accurate picture of a subject's level of consumption can be obtained. By comparing two or more results we can tell whether a subject's consumption has increased, decreased or remained constant and if it has varied, by approximately how much.

Is it possible for a couple with similar drinking habits to return different test results?

Yes. Physiological differences such as weight and metabolism mean everyone's ability to process alcohol is different. Weight is particularly influential and taken into account when interpreting borderline cases.

How is it possible for someone who only drinks over the weekend (Fri - Sun) to test positive?

If consumption over the weekend or other limited periods is high enough to produce an average daily value above the cut-off level, the result will be positive.

If a subject's test result is, say, 8 times over the cut-off level does this mean they are consuming an average of 8 x 60 (480) grams per day (60 units of alcohol)?

No. Although there is a significant correlation between alcohol intake and the concentrations of marker in the hair there is not a lineal relationship between the two.

Can a subject who returns a negative result one month after returning a positive result be said to have abstained completely in the intervening weeks?

No, but if the difference in the results is significant enough we could conclude that this could only have been achieved through virtual abstention or levels of consumption consistent with very moderate drinkers.

Can I test for both EtG and FAEE at the same time without having to work with two separate companies?

As the first provider in the world to commercially offer FAEE-testing, Trimega Laboratories now offers the combined test (EtG and FAEE), also known as the "Trimega Gold Standard of Hair Alcohol Tests" to ensure that accuracy of your results can be achieved. This will also minimise the hassle and inconvenience of having to use two companies. Working with a company who prides itself on service and testing excellence, you can be assured that the tests are carried out with utmost accuracy and speed.

Trimega Laboratories can provide expert opinion on results from other laboratories but will not run FAEE from its laboratory, and analyse EtG results carried out by another company. Both tests must be run at Trimega Laboratories for optimal result output and analysis using similar analytical methods.

My client does not have any head hair, can body hair be used for both tests?

Yes. Pubic, axillary, beard and other body hair can be analysed if head hair is not available.

What information will the report show?

It will include the identity details for the sample that has been sent to us, and then a result for the alcohol level that has been detected. A 'negative' or 'positive' result is provided dependant on whether the result falls below or above the cutoff level set by our laboratory. Results can also be provided in a standard Section 9 legal statement where requested.

Can you determine how much alcohol a person has had monthly?

No. Although we will give a value in our report, we can only say that the value exceeds our interpretation of the cutoff level we have set, which is 60 grams of alcohol per day over a protracted period. We cannot interpret how much alcohol was actually consumed. To do so would be scientifically unsound because alcohol is metabolised in slightly different ways by different people.

How much alcohol is "60 grams"? How many glasses of wine or pints of beer does this equate to?

It has been widely considered in Britain that a level of 60 grams of alcohol and above consumed daily represents alcohol misuse. In the UK, alcohol is based on units to allow drinkers to establish their alcohol consumption. One unit is 8 grams (10 millilitres) of pure alcohol. However, the amount of drink that equates to 60 grams depends on how strong the drink is. On average, one pub measure of wine, one half of average strength beer, and one 'short' of spirit are all one unit. So seven of these units provides 7 x 8 = 56 grams of alcohol. A 750ml bottle of wine with 13% alcohol by volume would contain 9.75 units. See the Bupa alcohol calculator in our Resource Section to see how many units has been consumed.

For an individual who is strictly abstinent, would I expect a 'zero' result?

Alcohol is not as easily detectable in hair as other drugs. Ethanol is present in all hair including those of teetotallers, however these traces are products of the environment. Simply being in a pub or laboratory is enough for traces of ethanol to find their way into the hair. A case study on a group of individuals who were strictly abstinent were found to have small traces of ethanol in their hair samples. However, these traces of ethanol do not correlate to alcohol which has been consumed.

Where does the process originate from?

It has been developed by a combination of German and English laboratory collaboration using leading experts in this field and the latest analytical technologies.

Can we tell if an excessive drinker really has stopped drinking?

Trimega Laboratories can see after 1-2 months if an excessive alcohol drinker has ceased drinking (i.e. if he is abstinent). In some cases the FAEE values sink after only one month of abstinence to below the cut off level, however at most after two months. Following three months of abstinence, the values will increasingly liken to those of social drinkers and teetotaIers. Please note: For this test we also require, where possible, 6 cm of head hair (standard conditions).

Can a reformed alcoholic be monitored?

Yes, Trimega Laboratories can monitor a reformed alcoholic using its new technological advances. According to a study, in cases where a relapse follows a period of abstinence of more than one year, binge drinking lasting several weeks is sufficient to give a positive finding over the whole length of hair. This corresponds to our experience: a relapse can be detected after two to four weeks. Please note: For this test we also require, where possible, 6 cm of head hair (standard conditions).

Is hair testing for alcohol an imprecise science?

No, because it is subjected to the same rigours and decisions that apply to other branches of testing such as blood alcohol in drivers, for example. However, it does require a certain amount of specialised interpretation. The cutoff level of 60 grams of alcohol per day has been related to the quantities of hair alcohol markers detected in a very large number of trial subjects. The decision as to what constitutes an alcoholic is not ours, and some people who become classified as alcohol dependent by our test will no doubt consider they are not dependent, in the same way that many drivers caught with an excess of alcohol in their blood will argue it improves their driving.

Is there a risk of false positives?

Mitigating circumstances could include a serious abnormality in the metabolism of the donor or abnormal hair growth conditions such as hirsutism, or indeed recent donor hair transplanting. Trimega Laboratories have introduced a medical review document for donors that should be completed and supplied with the sample, for optimum accuracy that will identify such conditions. While we would offer constructive advice on such occasions, they are not encountered or required very frequently. Trimega Laboratories has led the field in this work and is the only organisation worldwide to offer this service coupled with a thorough and considered medical review, and as such is committed to offering as much information and advice as possible to clients.

Can hair treatments affect results?

We have not found any influence on FAEE results from cosmetics and shampoo but there may be occasions when this should be considered (example: hair modelling where the hair is constantly being styled). Recent alcohol application to the scalp for head lice will also not affect the results. As noted above, intense shampooing could cause a 'wash-out' effect to EtG markers, removing the markers already deposited onto the hair, increasing the risk of false-negative results. Our experience in this field would allow us to offer constructive advice on such occasions.

Where can I learn and read more about Drugs and Alcohol?

Trimega Laboratories have researched a number of leading books that could act as a way to help our clients understand the impact of drugs and alcohol on their patients/donors or internal clients. Please visit our Drug & Alcohol Literature section for more information.

What is the window of detection for both CDT and LFT tests?

Both tests provide a window of detection covering 2-4 weeks.

What is the difference between CDT and LFT testing?

The Liver Function Test assesses a number of liver produced enzymes within a blood sample, which indirectly can tell you how the liver is working. Carbohydrate Deficient Transferrin (CDT) looks at a specific marker which will be present / elevated when an individual has consumed excessive alcohol.

Does my client / employee need to undergo both tests to obtain an accurate result?

We recommend that both tests are taken together.

For example in a CDT test, false results may occur in individuals suffering from chronic hepatitis, cirrhosis and other related conditions, however these conditions would cause corresponding anomalies in the LFT results. For these reasons, combining LFT tests with a CDT test increases the level of confidence in results than simply utilising one test technology in isolation.

Would abstention from drinking for one week result in a negative test?

No. CDT markers have a mean half-life value of 14-17 days. This means that for most people who are alcohol dependent, their elevated CDT level will be detected even if they have abstained for a short period before the test.

What is the difference between hair alcohol and blood alcohol testing?

Other than looking for different markers, blood alcohol testing requires blood as opposed to hair samples and provides results covering a timeframe period more immediate than that of hair testing. For example, this can allow for those who are undergoing regular testing for rehabilitation purposes to monitor progress.

What is the difference between oral alcohol testing and blood alcohol testing?

Oral testing provides a shorter window of detection and covers timeframes of no longer than 72 hours. Detecting alcohol consumption seven days ago is not possible with oral testing.

Why should I use Trimega Laboratories rather than a GP for a blood test?

Trimega Laboratories provide trained nurses to collect the samples and complete the necessary paperwork for chain of custody purposes. Collections may be carried out on your premises, allowing you (as the carer, solicitor, social worker, employer) to ensure that the samples are promptly taken and not having to rely on the individual making the appointment with their GP. Appointments via the NHS usually provide lengthy waiting times resulting in delay. Trimega Laboratories also provide user-friendly reports with all results.

What are steroids?

Anabolic (muscle building) steroids are synthetic versions of testosterone, which can be injected or taken orally in tablet form. Anabolic steroids are illegal substances.

What are steroids used for?

Steroids are often used to promote growth of muscle and bones because of their ability to increase cell growth and division but can also increase growth in other bodily tissues as well.

If steroids are illegal substances, what is the cutoff level and how is this established?

There is no accepted threshold or cutoff level below which a result can be deemed "negative". The cutoff level is the detection level.

Is testosterone a controlled steroid substance?

As the most important androgen, testosterone is a steroid hormone that stimulates the development of male secondary sexual characteristics, produced mainly in the testes. In males, 95% is secreted by the testicles, with a small amount (5%) also coming from the adrenal glands. A mature male secretes between 4 and 10 mg of testosterone per day. In females, small amounts of testosterone are also secreted by the adrenal glands and ovaries.

Other than having natural levels of testosterone, synthetic testosterone may be ingested to enhance performance and are often used by bodybuilders, athletes and other sports people.

If testosterone is produced naturally, then would this be detected on the test results? If so, is this deemed a "positive" result?

If testosterone concentration is less than 15 pg/mg, then this has not been abused and is deemed "negative". This level is provided to allow for natural testosterone. If testosterone concentration is found at higher than 15 pg/mg, we recommend a further test to check if esters are present. These esters are the active ingredients in synthetic testosterone. If an ester is detected, the donor has abused testosterone.

Can you segment the hair in order to provide a pattern of abuse?

Yes we can. This is achieved using head hair.

My client does not have any head hair. Can body hair be used?

Yes. The window of detection provided by body hair is longer than that of head hair and depends on the body area in which hair has been obtained. Chest hair will provide a window of detection of up to 12 months.

My client is a body builder and does not have any hair on his head or anywhere on his body. How else can we detect steroids?

We can test steroids using urine samples however the window of detection is not as great. Urine provides a window of detection of no more than 72 hours of use whereas hair provides detection of up to 12 months if required. To achieve a longer window of detection, we suggest that your client allows for hair growth.

My client has been accused of using steroids and disputes these claims. Is there a list of steroids that he should be testing for to prove his innocence?

We suggest that the client is tested for the following list of anabolic steroids, which cover 98% of the most commonly used steroids.

DHEA
Epitestosterone
Nandrolone
Norandrostenediol
Norandrostenedione
Mesterolone
Metandienone
Testosterone
Boldenone
Trenbolone
Metenolone
Stanozolol

Is there a risk of a "false-positive" result?

Anabolic steroids can be used in medicine to treat anaemia, burns, rickets and muscle weakness after surgery. Donors would hold a prescription for these and provided that this is information is disclosed at the time of providing the sample and on the chain of custody documentation, this would minimise the risk of any "false-positive" results.

My client is a severe asthmatic and has been prescribed steroids to help it. Would this affect a test for anabolic steroids?

Corticosteroids are another type of steroids used to treat other medical conditions, such as asthma, eczema and skin inflammations. These should not be confused with anabolic steroids. Ingestion of corticosteroids as prescribed by a physician should not affect a test for anabolic steroids.