As a result of the above-mentioned issues of cost and immediacy, drug courts have experimented with most of the testing methodologies in an effort to discover the most efficient means to achieve their testing agenda. Based upon the high concentration of drug metabolites present in urine, the basic ease of urine sample collection, the accuracy of urine testing, and the relatively low cost of testing a urine sample, urinalysis has become the primary choice of most drug courts. Drug courts have experimented with other matrices, such as hair, saliva, sweat, breath, and ocular scans. All of these methodologies have specific, limited value within a typical drug court. Because courts test multiple times per week and are concerned about new use, long-term methods such as sweat patches and hair testing have only minimal relevance in specific situations. Untimeliness of results, lack of long-term validity studies, and high cost have minimized the acceptance of saliva tests. Ocular scans have only recently become available to the general public consumer, so logistic and cost concerns have yet to allow this technology to enter the mainstream of drug court testing protocols. Breathalyzers are utilized by most drug courts for the testing of alcohol consumption. Ease of administration, immediacy of results, and the low cost per screen have made this a very valuable tool for drug court practitioners. As non-urine testing technologies become more efficient and cost-effective, they will undoubtedly gain greater acceptance and utilization within the drug-court environment.
It is established that the matrix of choice for most drug courts is urine. How the urine sample is tested varies from court to court. Cost factors into the decision to utilize lower-cost immunoassay screens over higher-cost chromatography tests like gas chromatography (GC)-mass spectrometry (MS). Courts that contract with an outside laboratory to conduct their testing usually include GC-MS confirmations of samples that test positive on the immunoassay screen. Courts that do their own screening using either noninstrumented or instrumented testing provide a confirmation option for participants who wish to challenge a positive test result. Because GC-MS confirmation screens can cost upward of $150, the participant is usually required to pay this extra cost unless the confirmation overturns the previous immunoassay results. Drug-court testing results are considered presumptive, and thus most drug courts do not confirm positive results unless the participant requests the confirmation test. The long-term duration of drug-court participation, the frequency of testing, and the graduated sanctions for positive test results all support this position of limited confirmation testing. Many drug-court participants will be tested more than 120 times during their drug-court experience. This fact does not minimize the need for accuracy, however, because testing is simply a part of a bigger picture. Drug testing is used to monitor participant progress in recovery, not to catch a participant using for the purpose of punishment. Drug courts realize that recovery and relapse are all a part of the process toward a lifetime of sobriety and socially appropriate behavior.
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