Three Types of Drug Testing: What Employers Should Know About Lab Testing, POCT, and Express to Lab Testing

By Suzanne Ball
Published: May 10, 2017 | Last updated: July 17, 2018 11:05:50
Key Takeaways

With drug testing as a standard practice, employers can now utilize several types of methods of screening, depending on the circumstance. Each method is conducted in a different manner and for different reasons

Drug testing in the workplace is not new. Since 1986, when the Reagan administration declared its War on Drugs, employers have been screening both candidates and workers for substances that can decrease job performance, raise the risk of accidents, and increase liability. The 1988 Drug Free Workplace regulations remained in place until 2010.


In 1991, the Omnibus Transportation Employee Testing Act was passed, requiring both drug and alcohol screening for workers holding safety-sensitive positions in aviation, mass transit, pipelines, railroads, and trucking. The Act covers most personnel in all transportation industries and is overseen by the Department of Transportation (DOT). (Learn more in "DOT vs. Non DOT Testing: What's the Difference?")

Private companies began to see the benefits of drug testing, and joined the Drug Free Workplace movement. Currently, about 90% of Fortune 1000 companies use workplace drug testing and have policies in place. Over 60% of all American employers have some type of mandatory drug testing. Some states even offer discounts on workers’ compensation insurance premiums if companies offer state-compliant drug testing programs.


With drug testing as a standard practice, employers can now utilize several types of methods of screening, depending on the circumstance. Each method is conducted in a different manner and for different reasons, as well as pros and cons.

What are the current types of drug testing?

  1. Laboratory Testing: The “gold standard” of drug screening, samples (blood, urine, oral fluid, or hair) are sent to a certified laboratory for testing. (Learn more in "Hair Follicle Drug Testing 101".) Urine and blood lab-based testing also complies with state standards and federally-mandated DOT requirements. Because laboratory testing is the most reliable, it can be used for all screening purposes. (Learn more in "Everything You Need to Know about Oral Fluid Drug Testing".)
  2. Point-of-Collection Testing (POCT): POCT, also called rapid or instant testing, is a method that allows employers to test and interpret results on-site. (Learn more in "Drug Test Types: 5, 7, and 12 Panel Urine Screening Differences and Reasons to Use ".) Urine and oral fluids can be used, depending on which drugs are being screened. The technology behind portable testing is not yet as accurate as laboratory testing, but initial results are available within minutes, compared to days for lab-based screening. Only positive results are sent to a certified laboratory for confirmation. (Learn more in "POCT vs. Lab Testing: What is the Difference?")
  3. Express-to-Lab Testing: A hybrid of POCT and Lab-based methods, samples are obtained on-site and immediately tested, then sent to a certified laboratory for secondary testing, regardless of the initial interpretation. Reasons to use Express-to-Lab testing are similar to POCT, but with an added layer of security from the sample being sent for further evaluation.

When each type of drug testing is used

1. Laboratory Testing:

Free Download: What Your Company's Drug and Alcohol Policy May Be Missing (and How to Get It Right)

2. Point-of-Collection Testing (POCT):

  • Pre-employment
  • After an accident or safety-related event
  • Random testing
  • Reasonable suspicion
  • Per company policy

3. Express-to-Lab Testing:

  • After an accident or safety-related event
  • Random testing
  • Reasonable suspicion
  • Per company policy

Strengths and weaknesses of each type of drug testing

1. Laboratory Testing:


  • Most accurate testing method
  • Fewest false results, both positive and negative
  • Legally defensible
  • Many drug panels to choose from


  • Turnaround time is longer than other methods
  • Blood draws may be considered invasive
  • Urine sample can be tampered with
  • Can prevent employee from working until final results are available

2. Point-of-Collection (POCT):


  • Results are available within an minutes
  • If results are negative, employees can return to work
  • Urine results are dependable
  • Oral fluid results detect drugs recently taken


  • Results are interpreted by the specimen collector
  • Lab-testing is required if results are positive
  • Higher risk of false positives and false negatives
  • Not allowed for DOT testing
  • Limited drug types can be tested (Learn more in "Drug Abbreviations Used in Drug Testing".)

3. Express-to-Lab Testing:


  • Automatic double-testing of every sample
  • Initial results are available within minutes
  • If negative, employee can return to work


  • If rapid test is a false negative, employee may be allowed to return to work and employer will be liable if work-related accident occurs before final results
  • Can be more expensive, since all samples are tested twice
  • Company must provide a site and possibly trained staff to conduct testing

Things to consider regardless of testing type chosen

Employers who choose to do POCT or Express-to-Lab testing should verify that that it is allowed by the state in which the company operates. While rapid testing is legal in the United States, it is prohibited in Kansas, Minnesota, Vermont, and the territory of Puerto Rico.

Regardless of which method, or combination of methods, used, employers should always begin with a written policy regarding drug testing. Employees should be informed about the policy, when testing occurs, what drugs are included in the screening, and consequences of a positive test result or refusal to give a sample when requested. (Learn more in "The Importance of a Good Drug and Alcohol Policy in the Workplace".)

The company should also have a guide explaining the types of testing methods used and which circumstances will be subject to testing. Employees should understand the definition of each situation, such as reasonable suspicion or random screening.


An essential component of any drug testing program is to strictly follow policies regarding consistent screening and disciplinary actions. For example, if the policy states that an employee will be terminated for a positive test result, or for refusing to supply a sample at the time of request, then the employer must adhere to the policy each time. If not, the employer can be sued for discrimination.

Finally, if a company decides to use POCT or Express-to-Lab testing, security measures must be in place to ensure confidentiality in handling samples and sharing information. Results must be kept in a locked file separate from employment records and shared with as few people as possible. Even the fax machine or computer used to send or receive information must be in a secure area with limited staff access.

As testing technology improves and employers have more options for testing to maintain a safe, drug-free work environment, policies should be updated and employee training documented. Always check with state regulations before implementing a new testing method.


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Written by Suzanne Ball

Profile Picture of Suzanne Ball

Suzanne Ball is an experienced Registered Nurse with a Masters Degree in Health Sciences. She has worked in a variety of settings, including acute care, quality improvement, and research. She is a freelance writer who specializes in writing about medical and health topics.

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