Nail Drug Test

What is Fingernail Testing?

Highly stable, simple to collect, and easy to ship and store, fingernails provide a test sample that is at the cutting edge of drug and alcohol testing. Fingernails are made up of keratin, the same material that hair is made of. As the nail grows, substances can pass from the blood vessels below the nail into the keratin fibers where they become trapped. Fingernails are four times thicker than the typical strand of hair and often capture more of a substance than hair can. Biomarkers become locked in keratin fibers along the entire length of the nail, and can be detected up to 3-6 months after drug or alcohol abuse. Environmental exposure to illicit substances can be detected immediately in nail samples. When drugs or alcohol are ingested, biomarkers can be found in nails as early as 1-2 weeks after. The time period during which drug or alcohol ingestion can be detected depends on the substance used, the amount used, and personal metabolism. Fingernail samples are clipped and collected by the donor in front of a trained collection staff member. A clipping of 2-3 mm long (about the width of a quarter) from all ten fingernails will give about 100 mg of sample, the ideal amount for screening and confirmation. Larger profiles may require more. We recommend weighing the specimen on a jeweler's scale.

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Nail Testing for Drugs, Poisons & Toxins

Drugs of abuse actually have been measured in nails since 1984. However, the need to test for longer detection periods have given fingernail testing a new niche to fill.

Like hair, fingernails and toenails are composed of a hard protein called keratin and are tested with the same process as hair. Drugs are incorporated into nails from the blood stream and remain locked in the nail as it grows. Nails grow in both length and thickness. Drugs enter the nail from the base as the keratin is formed and via the nail bed that extends under the full length of the nail. The method of screening for drug use in a fingernail test is the five panel, Enzyme Multiple Immunoassay Test (EMIT). The fingernail is put in a chemical solution to rid the nail of external contaminants and is then liquefied.

How far does it go back?

Drugs can be identified in nail clippings 2-4 weeks following ingestion and can be detected up to 8 months after last usage. Fingernails grow approximately 3-5 mm per month, toenails grow at a much slower rate of 1 mm per month which means that drugs can possibly appear in toenail clippings over 1 year after ingestion.

Fingernail Drug Test Facts

Five drugs are tested for with the qualitative detection of cocaine, amphetamines / methamphetamines (ecstasy), opiates (heroin, morphine), PCP (angels dust, hog) and tetrahydrocannabinol (marijuana, hashish). The cutoff levels of the test for cocaine (COC) is 300 ng/ml, methamphetamine (METH) is 1000 ng/ml, opium (OPI) is 300 ng/ml, phencyclidine (PCP) is 25 ng/ml and marijuana (THC) is 50 ng/ml.

Results of a fingernail sample will represent drug use that is approximately 4-5 months from the time of ingestion. Fingernails can be clipped, or, if length does not allow, can be shaved in a safe and pain-free collection.

Fingernail Drug Testing

In recent years, new types of drug testing methods have been developed. Urinalysis is the least expensive and most common type of drug test administered, but fingernail drug testing has been used more frequently as of late. However, due to it's high cost, it's the least used out of the available drug testing methods.

To perform this type of test, a trained professional obtains a small sample of scrapings or clippings from your fingernails or toenails. Once the samples are labeled and sealed, the samples are then sent to a laboratory to be processed. As soon as the laboratory receives the samples, the samples are decontaminated. After decontamination the samples are then liquefied and a series of tests is performed. These tests are designed to detect whether or not you have used drugs in the past few months.

Fingernail drug testing is extremely accurate and a positive test can be admitted as evidence in a court proceeding. Depending on your metabolism and the rate at which your nails grow, the test can detect the presence of drugs in your system as far back as eight months.

In many cases, fingernail testing is court ordered. However, this type of testing may be used by employers to determine if you have used drugs at any time during the past few months. But as mentioned before, it's cost prohibitive, so not widely used.

Since urine testing only accurately detects the recent presence of drugs in your system, nail testing may be considered to be the option that offers the best results for longer term drug use. Additionally, this type of testing may offer some subjects a less invasive method than drawing blood or testing urine.

Toxicology and Drug Testing Basics:

What drugs are tested in a five (5) panel drug test?

Marijuana (THC), Methamphetamine, Amphetamine, Cocaine, Opiates and Phencyclidine (PCP)

What drugs are tested in a ten (10) panel drug test?

Marijuana (THC), Methamphetamine, Amphetamine, Cocaine, Opiates, Phencyclidine (PCP), Propoxyphene, Methadone, Barbiturates and Benzodiazepines

What drugs are tested in a basic Date Rape Panel?

GHB, ketamine and various benzodiazepines, including rohypnol. You can view a breakdown of our date rape panels by clicking here.

How long after last use are drugs detectable?

The answer depends on which drug; type of specimen; each person’s own metabolism; drug concentration and/or dosage; how often the drug was used; and the sensitivity of the testing procedure.

Should I bring copies of my prescription medications to my drug test?

No, it is not for the initial drug test.
In situations where a Medical Review Officer (MRO) will be involved, it is better to wait until the MRO's office contacts you so that any personal information, including a copy of your actual prescription, is communicated directly to the MRO.  Copies of your prescriptions will prove you are medically required to take some drugs that can show up as positive in a drug test.  The prescriptions help us to determine whether or not the prescriptions are consistent with the drug test results. 

How long does THC (Marijuana) stay in the body?

This answer depends on your metabolism, the frequency of smoking and concentration of THC.  Even if a person has been clean for a month, they may still test positive on a drug screen because there are still residual amounts of the drug in their body.  If a person was a heavy smoker and had a slow metabolic rate, it is more likely that THC will stay in his/her body longer than someone who smoked less frequently, and had a higher rate of metabolism.

What is the average turnaround time for test results?

The below-listed screen and test result turnaround times are for our most commonly ordered tests.  Note that turnaround time begins upon receipt of the specimen at the laboratory.

What does it mean when the report indicates “non-detected”?

There are no all-inclusive drug tests.  Only specific drugs or drug categories may be addressed by any test or series of tests.  When the toxicology report indicates that no drugs were detected, this merely indicates that none in the specific categories mentioned were found at or above detection limits.  Lower drug concentrations cannot be excluded.  Furthermore, it does not exclude the presence of drugs in categories not tested.

What does it mean when the report indicates “Dilute”?

Creatinine concentration is checked during standard urine drug tests.  High creatinine levels indicate a pure test while low amounts of creatinine in the urine can indicate a possibly manipulated test, either through the addition of water in the sample or by drinking excessive amounts of water.  It should be noted that people who drink excessive amounts of water on a regular basis may also register with a low creatinine level.  Therefore, adulteration should not be automatically assumed, but merely considered.  Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body.  Normal creatinine levels for adults are >20mg/dl.  If creatinine is diluted, the overall test procedure results will be reported as “Dilute”.

What is “Limit of Detection” and do you test this on every drug test?

The standard in toxicology testing is to utilize cut-off levels.  Limit of Detection means reporting any detectable amount of drug.  A test can be performed using Limit of Detection; however, this must be requested in writing on the chain-of-custody form.  There is a $25.00 fee for this service (this fee is not applicable to meconium drug tests or drug-facilitated sexual assault panels).

Drug Testing with Hair Specimens:

How long does it take from time of consumption for drugs to grow out into the hair shaft?

Approximately 10 – 14 days

What are the different timeframes associated with hair testing?

Every one-half inch (1/2”) of head hair is approximately equilavent to a thirty (30) day timeframe.  Body hair yields an aproximate six (6) month timeframe.  A standard hair test is 1 ½”, or 90 days, though longer time periods can be tested, depending on the length of the hair.

Can I find out if a person used drugs on a month-by-month timeframe through hair testing?

Yes, if you request the laboratory to segment the hair sample.  Segmentation of hair must be specified on the chain-of-custody form.  For example, if a client wishes to evaluate the last three (3) months for drug use but wants to evaluate each month separately, the following format should be written in the comments section on the chain-of-custody form:

(0-30), (31-60), (61-90)

The numbers refer to days in the month.  If there is no timeframe specification reflected on the chain-of-custody for hair testing, the standard cut of 1 ½” is tested as a 90 day test.

Is there an extra charge for hair segmentation?

The hair will be cut in the laboratory into thirty (30) day segments.  Each segment will be a separate hair test; therefore, a test fee will be charged for each segment tested.  As an example, if a person submits 1 ½” of hair and requests 30-day segmentation, the hair will be cut into three (3) thirty (30) day segments.  The cost will be the hair test price x 3.

What does “external exposure” mean?

Any hair submitted with “external exposure” indicated is not washed in the laboratory after initial preparation.  The specimen will go directly into incubation in order to preserve as much of the external contaminants present as possible.

What is included in an extended opiates drug test using a hair specimen?  What are the cut-off levels?

Codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, tramadol and meperidine.  The cut-off level is 200 pg/mg.

If I submit hair for a Date Rape Panel, is there any additional information you need when the specimen is submitted?

Yes.  The suspected incident date must be included on the chain-of-custody form.  Make sure that a sufficient length of hair is submitted to coincide with the date of the alleged incident.  There should be at least 7 inches of hair because of the timeframe that will need to be tested. This will ensure there is enough of the sample. As an example, if someone suspects an incident four months ago, a 2” piece of hair must be submitted for testing.

Can hair specimens be adulterated?

It is very difficult to adulterate hair.  Donors attempt to adulterate this type of sample through dyeing or bleaching their hair in an attempt to pull the drugs out of it.  Some even try special shampoos that claim it will rid the drugs from their hair.  These attempts may reduce the level of drugs detected; however, in most cases it does not fully remove the drugs from the hair.

Can I collect a hair sample if the donor’s hair is wet or damp?

If a person’s hair is wet or damp, or smells of bleach, it is important to note this on the chain-of-custody form.  It may be a sign of attempted adulteration.

Do I need to let the laboratory know where the hair specimen was collected from on the body?

Yes, it is important to note the area of origin, since there are completely different timeframes between head hair and body hair.  A note can be as simple as “head hair” or “collected from underarm”.

Nails:

How do you collect a nail specimen?

See ExperTox’s Nail Collection Protocol.  The nails of either all ten (10) fingernails or all ten (10) toenails will be collected.  The collector will also file the surface of the donor’s nails over the aluminum packet contained in the collection kit.  Both the clippings and shavings will be submitted to the laboratory for testing.  Nail clippings and shavings may be submitted together for testing, and this should be noted on the chain-of-custody form.

Blood/Serum:

What are ExperTox’s cut-off levels for serum drug screens?  What is your acceptance/rejection policy for serum drug screens?

The acceptance/rejection policy states that as long as the sample is delivered with the specimen seal intact, we will accept the sample. If, however, the specimen seal arrives broken, ExperTox will reject the sample and inform the appropriate party.

Meconium:

What is meconium?

Meconium is a newborn’s first stool, usually present during labor and delivery.

Is every baby’s meconium tested for drugs?

No.  A newborn’s meconium may be tested if his/her mother is suspected or known to have used drugs during her pregnancy, if the baby is born with low birth weight, if the baby is born premature, or shows symptoms of drug withdrawal.

Is there anything special I need to know about shipping a meconium sample?

Meconium testing is most commonly performed on a STAT basis.  Therefore, the sample must be couriered (if in the Greater Houston Metropolitan Area) or sent via overnight, early morning delivery.  Immediate handling of the specimen is critical to the care of the newborn.  ExperTox takes extra steps when working with meconium samples, immediately faxing the test results to the ordering agency with a follow-up call to ensure the results were received.

What is ExperTox’s cut-off level for meconium drug screens?  What is your acceptance/rejection policy for meconium drug screens?

Meconium drug screens have no cut-off levels.  ExperTox treats meconium samples with Limit of Detection.  This means that any traceable amount of drug(s) found in the meconium samples are reported as positive on a ten (10) panel drug screen.  As long as the sample is delivered with the specimen seal intact, ExperTox will accept all meconium specimens.  If, however, the specimen seal arrives broken, ExperTox will reject the sample and inform the appropriate agency.

Unknown Substances, Poisons and Toxins:

What is an Unknown Substance Scan/Analysis?

An unknown substance scan/analysis is a toxicology test that looks specifically for drugs, usually when someone has found an unknown pill, powder or other substance they suspect is or contains a drug.  ExperTox refers to a number of libraries and databases for an extensive reference and comparison of drugs used during this analysis.  The unknown substance scan includes a 10-panel screen, followed by an unknown drug scan via GC/MS technology.

What is an Unknown Poison and Toxin Analysis?

Following the same methodology outlined within the unknown substance scan/analysis, ExperTox tests for unknown chemicals, poisons and toxins that include but are not limited to pesticides, organic exposure chemicals, painting/cleaning type products, rat poison, volatiles (blood only) and inhalants (blood only).  Note this particular analysis does not screen for drugs or heavy metals.

How do I submit a sample for this type of test?

Due to the complex nature of unknown toxicology testing, it is imperative you first contact ExperTox at 1-877-973-7869 (XPE-RTOX) or customerservice@expertox.com.

Miscellaneous:

Does a Medical Review Officer (MRO) need to review every positive test result?

No, an MRO reviews test results on an as-needed basis.

How can you tell if a person is taking “crystal meth” if he/she has a prescription for Desoxyn?

The “D” in Desoxyn stands for “dextro” which is the Latin word for “right”.  If a person is taking street crystal methamphetamine, the racemic mixture is considered “dirty” and will show up as two peaks in a chromatogram (dextro – right; levo – left), one to the right and one to the left.  If a person is taking Desoxyn, there will only be a peak to the right present on the chromatogram.