Exploring Trends in Drug and Alcohol Testing

Drug testing is a huge global industry, estimated to be worth as much as US$7 billion in 2020. 

With demand for workplace drug and alcohol testing growing in many countries and the increasing liberalization of drug laws across the world, the market is predicted to grow considerably over the next decade. 

While most tests are carried out using samples of urine and oral fluid, hair testing is a growing segment of the market.  

Here we share a Q&A with John Wick, CEO, of Cansford Laboratories. Based in Cardiff, Wales, John and his team pioneered the use of hair testing in the UK around 25 years ago. Cansford is now the fastest drug and alcohol-testing laboratory in the UK, carrying out more than 16,000 tests a year. 

Q: What’s the story behind Cansford Laboratories? 

A: My partner Dr Lolita Tsanaclis and I pioneered the technique for testing human hair for drug use in the early 1990s. Then in 1999 we set up TrichoTech, the first hair testing laboratory in the UK. We sold the rights to the company in 2007, but the new owners didn’t continue to develop the techniques. We knew that with new technologies and laboratory information management systems (LIMS) we could improve the process and make it much more efficient, so we started Cansford Laboratories in 2011. When we left TrichoTech the test turnaround time was around ten days, but now we’ve got that down to two days. 

Q: What are the benefits of hair testing over urine or other samples? 

A: A hair strand drug test is one of the most accurate laboratory tests for drugs and alcohol and is almost impossible to cheat. It can be used to detect virtually all drug and alcohol substances between seven days and six months after their use. Test results can also indicate the month in which a subject took the substance, and can be used to build a picture of substance use over time.  

Q: How are you quicker at returning test results than other labs? 

A: It’s a combination of technology, technique and process. We built our own basic LIMS that monitors and controls everything we do. That has automated a lot of our processes, which in turn has improved efficiency. New instrument technology has improved sensitivity. We concentrated on LC-MS (liquid chromatography–mass spectrometry), which gives us the “gold standard” confirmation of drug use. And we are continually developing and refining our techniques.  

Q: What drugs do you test for, and where does the majority of your business come from? 

A: We started with all the basic drugs of abuse and over the years we’ve added capacity to test for steroids and GHB (gamma-Hydroxybtyric acid – used as an athletic performance enhancer and date rape drug). We carry out around out 1,500 tests every month – around 16,000 a year – for clients including lawyers, government departments, security services, the military, sports bodies, employers and individuals from the UK and abroad. Most of our samples come from social services and family care solicitors – we work with family care solicitors and social service providers across the UK. These are mainly cases where children could be at risk of harm and might need to be placed into care. We do best with the type of client that needs absolute certainty. 

In certain high-risk industries, where there is a safety issue - this includes the security services and the medical profession - it’s imperative to know an employee is drug free. It’s not just a box-ticking exercise, it’s about trust.  

Q: What trends are you seeing in the type of tests you carry out and the customers who are using your service? 

A: Typically, the drugs being abused are the same they have always been – alcohol, cocaine, cannabis and opiates. It’s impossible to predict trends, or what drug will be abused next. We react to trends and design assays to fit. We are seeing an increase in employers using workplace testing, but some are changing their attitude towards it. Workplace drug testing gets a bad name - it’s perceived as trying to trick or trap someone - but the knock-on effect is lack of productivity in the workplace and longer-term health effects for the individual. Some employers are now embracing drug testing as part of a more positive healthcare and wellness approach with their employees, rather than seeing it as a punishment or deterrence. Hair testing would fit in well with this approach. 

Q: How has the COVID-19 pandemic affected your business and the tests you carry out? 

A: What we seem to have seen is an increase in the number of positive tests in the lab during the pandemic. People seem to have been drinking more alcohol and taking more drugs because of lockdown. It’s not specific to any type of drug, it’s across the board. I think people are stressed out and using things to help. 

Q: Cansford Labs recently published a study comparing the use of PEth (phosphatidylethanol), and CDT (carbohydrate-deficient transferrin) blood testing for alcohol consumption. Can you tell us more about the study and the significance of the findings?  

A: CDT is one of the most commonly used biomarkers for monitoring alcohol use. For example, those classed as high-risk offenders by the UK’s Driver and Vehicle Licensing Agency (DVLA) are required to take a medical that involves providing a sample of blood to measure the level of CDT. The newer blood test, PEth, provides the highest sensitivity for the detection of current regular alcohol consumption. It is particularly effective for detecting chronic and heavy drinking where it is critical in settings such as the monitoring of doctors, in child custody cases or in drink driving violations. 

Our study compared the ability of CDT and PEth to detect alcohol use, specifically when hair biomarkers showed no indication of historical alcohol consumption. This is particularly important when interpreting the negative results of hair tests in conjunction with positive blood tests in cases where evidence of abstinence is paramount, for example reissuing a driving licence, proving that a doctor is fit to practice or granting custody of a child. The results provide clear evidence that the PEth test is a better solution for individuals or organisations who need an accurate assessment of alcohol use, misuse or abstinence.  

Q: How does PEth testing compare to testing other samples for alcohol consumption, for example hair? Are there any situations where PEth testing would not be suitable? 

A: Hair and blood testing are often used when assessing harmful or problem drinking or alcohol abuse and the results can be used to support life-changing decisions, such as child custody cases or workplace screening. Ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) are metabolites of alcohol that when detected in hair can provide evidence of a person's drinking behaviour. Hair testing works by measuring biomarkers found in hair when ethanol is consumed.  

The accuracy of these tests is vital, not just to show abuse but to also to prove abstinence. The two types of testing are ideally used in combination to provide an accurate picture of use; blood to show short-term use (narrow window) and hair to show longer-term use (wide window). 

Ethyl glucuronide (EtG) testing in hair samples is commonly used for diagnosis of long-term abstinence and for the differentiation between social and excessive chronic alcohol users. The detection of EtG in hair samples is mainly used in combination with ethyl palmitate (EtPa) when hair cosmetic treatments such as hair colouring and bleaching affect EtG levels. Hair testing, however, does not cover the time period from approximately a week prior to sample collection due to the time it takes for the hair to grow. Therefore, blood tests such as CDT and PEth can be taken to show use during this time period. 

John Wick is CEO of Cansford Laboratories.