Here at Confirm BioSciences, we understand that drug testing information and terminology can often be confusing and difficult to learn. HairConfirm’s Knowledge Center contains the most commonly used definitions to offer insight of our products and services, plus what to expect from a hair follicle drug test.


Deliberate tampering of a sample, known as adulteration, is often attempted by those in jeopardy of failing a drug test. Hair follicle drug tests are virtually impervious to adulteration tactics, since the collector is responsible for directly obtaining a sample.

Chain of Custody Form (CCF)

Before collection, a Chain of Custody form acknowledges the integrity, accuracy and confidentiality of a scheduled drug test. A federal CCF requires multiple signatures:

      • Laboratory Testing Facility
      • Medical Review Officer (MRO)
      • Collector
      • Employer
      • Donor

Since Chain of Custody Forms are adopted in pre-employment, treatment and trial settings, they must be filled out completely and accurately to comply with regulatory bodies, e.g. the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Transportation (DOT) and the Department of Justice (DOJ).

CLIA Waived

The Clinical Laboratory Improvement Amendments of 1988 is the regulatory agency overseeing all laboratory testing facilities in charge of human diagnostics, disease treatment, illness prevention and health assessment in the United States.

CLIA waived drug tests are devices approved for a waiver in abidance with CLIA’s 7-point criteria. Waived tests usually also have FDA clearance for home use, and must have a low-risk of defect as listed in the CLIA regulations. At this time, hair follicle drug testing is not CLIA Waived; however, all samples are strictly processed and analyzed within CLIA certified laboratories. Many regulatory bodies, including the Department of Transportation, are petitioning for hair drug tests to be mandated as a pre-employment screening tool.

Department of Transportation (DOT) Drug Testing

Drug tests specifically performed to meet criteria under the Department of Transportation are referred to as DOT drug tests. These tests must be passed without exception to be considered for hire as a Commercial Motor Vehicle operator, and positions associated with signalling or maintaining methods of transport.

Drug Metabolites

Drug metabolism refers to the chemical alteration of a drug while being processed by the body.  When a drug enters the bloodstream, it becomes altered into substances called drug metabolites. Most drugs that enter the body are metabolized by the liver. When conducting a hair drug test, the drugs themselves are not identified; rather, it is the metabolite byproducts that are identified through drug testing.

Drug Test Cut-Off Level

A drug test cut-off level is the concentration range along which drug metabolites are traceable. Any level under the cut-off yields a negative drug test result, whereas any level above the cut-off yields a positive drug test result. This cut-off level is determined by a setpoint to optimize detection of drug use, and minimize the possibility of a false positive result.

False Positive

There are many factors affecting the outcome of a drug test, including the consumption of certains food and drink, e.g. poppy seeds, creatine, tonic water, or ibuprofen. Sufficient amounts of any of these substances may produce enough metabolites to trigger a positive result on a drug test, despite not having taken illicit drugs.

False Negative

When the concentration of a drug within a person’s system falls short of the minimum cut-off level for detection, a false negative may be obtained. The dilemma that arises with false negatives is that donors who do not meet the minimum cut-off level could have still engaged in illicit substance abuse.


The outer component of a hair cell surrounding individual hair roots. Hair follicles are nutrient-rich epidermal structures that support each strand of hair. Hair follicle drug testing is considered a misnomer because the roots do not need to be supplied to detect drug metabolites. Only the hair grown outside of the follicle (which remains embedded in the scalp) is required to perform a hair follicle drug test.

Gas Chromatography Mass Spectrometry (GC/MS)

Gas Chromatography Mass Spectrometry are techniques that employ powerful, sensitive instruments to detect and study trace amounts of chemicals. These laboratory methods of analysis are used specifically for confirming positive drug test specimens. GC/MS can measure the amount of every single chemical present in a given sample by simply comparing the chemical to a pre-measured standard.

      • Gas Chromatography is a procedure whereupon the specimen is vaporized and the subsequent gas produced streams through a permeable membrane
      • Mass Spectrometry measures the specific gravity and mass of a particular substance, or drug metabolites in the case of hair follicle testing.

Once GC/MS results are obtained, a Medical Review Officer (MRO) is appointed to interpret the findings.

Government Drug Testing

Many sectors of the government need to establish a candidate’s drug abuse history to qualify them for open positions. Since hair drug tests offer a cut-off detection time of 3 months, candidates for federal, judicial, and law enforcement roles will often have to pass a pre-employment hair follicle test.

Hair Detection Cut-off Concentration

Used interchangeably with hair drug test cut-off level, cut-off concentration defines the range where drug metabolites are identifiable within a person’s system upon testing. It is therefore possible for a donor to engage in drug abuse, yet still obtain a false negative test result.

Hair Detection Cut-off Time

Hair specimens can detect metabolites for the most common drugs of abuse up to 3 months after intoxication. 1.5 inches of hair through the root provides proof of 3 months worth of drug abuse.

Medical Review Officer (MRO)

A Medical Review Officer is a licensed physician with a Doctor of Medicine or Doctor of Osteopathy degree. There are a number of requirements for a doctor to be eligible to act as an MRO, based on the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs. These requirements include:

      • Expert knowledge and training in the toxicology and pharmacology of illicit drugs and substances.
      • Professional training in:
        • HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs
        • Procedures in collecting federal agency specimens
        • Chain of custody including reporting and recordkeeping protocols for all specimen types
        • Proper procedures for the review, interpretation and reporting of results
        • Passing of the examination conducted by an HHS-approved agency

Occupational Health and Safety Act (OSHA

The Occupational Health and Safety Act is a regulatory body who ensures employers across every industry abide by the rules set in place to protect the rights of employees in the workplace. Drug testing is mandated and accepted by OSHA as a useful tool to identify the possibility of drug abuse in pre-hire candidates and post-hire employees alike.
Pre-employment Screening

A practice adopted heavily before offering a letter of hire to prospective employees to first assess their drug abuse history and determine whether or not they have a history of substance abuse.

Preliminary Positive

There are two stages of drug testing: screening and confirming. Preliminary positive results indicate drug metabolites in a donor’s system during the screening phase. Any time a preliminary positive is obtained, it is delivered to a laboratory for GC/MS confirmation testing. Results from GC/MS tests are subsequently passed along to a Medical Review Officer for interpretation.


The Substance Abuse and Mental Health Services Administration is the federal agency under the Department of Health and Human Services whose mission it is to decrease mental illness and substance abuse across the nation.

SAMHSA guidelines indicate that businesses or companies that employ individuals working in safety sensitive jobs should have a drug screening system in place. They declare the program must test for five specific drug categories including:

In some instances, other drug panels may be requested, however they are not required as part of SAMHSA regulations.

School Deterrence Program

A strategy to maintain sobriety on school grounds by arbitrarily implementing hair follicle testing on students under the age of consent. Deterrence programs using hair follicle testing yield proven results, including higher test scores, meaningful socialization and fewer disciplinary reports.

Substance Abuse Professional (SAP)

Classically trained and qualified under the DOT, Substance Abuse Professionals are responsible for determining whether or not an employee, who has committed a workplace violation, should return to their duties after suspension. SAP responsibilities are not limited to:

        • Designing programs to ensure sobriety
        • Arranging follow-up drug testing
        • Enforcing substance abuse education

Substance Abuse Professionals contribute to public safety by keeping vehicle operators with a history of substance abuse off the road.

Third-Party Administrator

Sole proprietors and large DOT companies alike may opt for a third-party administrator to responsibly manage each employee’s record of drug testing, including signed Chain of Custody forms and drug test results. A third-party administrator must be well-versed in DOT regulations to avoid incurring liability for mishandled documents.

Still have more questions regarding drug testing terminology, processes and procedures? Please visit our FAQ page, here.