Process of Hair Drug Testing (HDT)
HDT is often referred to as
hair follicle tests. That is misleading as it is not. The test has nothing to do with testing the follicle and, in fact, HDT doesn't test your hair at all. The hair shaft is but a container used to deliver the drug (or not) to the testing facility. The follicle is the sac from which a hair grows and into which the sebaceous (oil) glands open. The follicle lies below the scalp or skin surface and is lined by cells derived from the epidermal (outside) layer of the skin. Only the hair shaft that part of the hair that projects above the skin, is used in HDT.
Step 1 Hair sample. The sample is cut from your head-as close to the scalp as possible. About 100 hairs strands are required (a section about the size of a pencil) The hair follicle is not disturbed. Those hairs are sent to the testing facility.
Step 2 Decontamination. Removal of external contaminants. A portion of the hair sample is placed in a receptacle and subjected to a chemical wash of one type or another. This is determined by the choice of the laboratory as well as the characteristics of the drug or drugs being tested for. The cleansing solutions/methods vary in ability to decontaminate the hair. The decontaminant ideally will cleanse the exterior of the hair without destroying or diluting the quantity of the drug(s) within. The effectiveness of this step, when properly performed, may vary from 65-93%. None are 100%. So there is always the possibility for external contamination to register on the test, as you will see following.
Step 3 Extraction. There are currently no direct methods for the detection of organic drugs in hair. Therefore drugs must be extracted by solubilisation or digestion of the hair matrix itself. That means that the hair sample is destroyed in order to get to the contents contained within. A method used for pulverizing the hair sample is a ball mill
ball mill - Google Search or it may be chemically dissolved. Once the hair has been reduced to a solution or powder then it is necessary to separate the waste products (actual hair byproducts still remaining) from the drug. An example of the method used is Headspace Solid Phase Microextraction (HSPME). Other methods for solubilisation and separation are also used.
NOTE: Any of the specific drug that was not removed in Step 2 would now become part of the sample to be tested. Therefore the danger of external contaimination.
Following the steps noted above, all remnants of the actual hair are now gone and the drug test begins and from this step forward testing is similar to urine testing.
Step 4 Initial screen. Enzyme-immunoassay antibodies (EIA) or other immunoassay techniques similar to those used to test urine are used for the initial screening test for drugs of abuse in hair; therefore the potential for substances such as over-the-counter medications to cause a false positive screening result does exist. However, the vast majority of errors are false negatives because IA are far less sensitive than the instruments used for confirmatory testing. To eliminate the possibility of reporting a false-positive due to cross-reactivity or other means confirmation testing is essential.
This step cannot identify a particular drug. Only a class of drugs, so an opioid is detected by the presence of morphine (all opiates break down into morphine). So any opioid would return the same positive result but could not be individually identified.
This phase of testing (immunoassay) usually uses a higher cutoff and is far less sensitive than the instruments used at the confirmation step if that occurs.
However, the test ends here unless the sample shows positive for one of the drugs tested for.
Step 5 Confirmatory test. This is the highly sensitive part of HDT although the same instrument is used as in most other drug tests such as urine or blood. An instrument called LC/MS/MS or equivalent is used and capable of measuring down to very low level Picogram = one trillionth of a gram (0.000 000 000 001). In addition, this technology can identify millions of specific drugs and metabolites. It compares them to a data-bank of spectograms (kind of a molecular fingerprint).
The biggest factor influencing test reliabiliy at this step is human error, carelessness on the part of people doing the testing or using a machine that has not been properly cleaned or re-calibrated.
The equipment and technology used in Step 4 (immunoassay) can and does return false positive results (more often false negative). Step 5 should detect that error. The results of a confirmatory test (LC/MS/MS) result is never considered to be a false positive.
However, false negatives are not detected because the test does not progress to confirmation.
It must be kept in mind that while the
instrumental result might be correct it is still possible for the results to be
diagnostically incorrect. As example identifying drug contaminates that resulted from a mistake in Step 2. That is
analytically correct (a true positive for drug) but
diagnostically incorrect as the drug was not ingested.
The commercial testing labs place great emphasis on the use and sensitivity of confirmation instruments. The vast majority of HDTs end with a
negative return at screening (see 4 above) never advance to confirmation and are therefore never subjected to the sensitive instrumentation so widely advertised.
Ref:
Mass Spectrometry Procedures
Guidelines for Testing Drugs et seq (pp 4-11)
Society of Hair Testing (SoHT), 2011