What are POCTs and should we be using them?

There is an increasing buzz around ‘POCTS’ in drug & alcohol testing. Increasingly, companies are starting to consider them alongside, or instead of, their usual laboratory tests. If you’re feeling out of the loop, and don’t know your PoCT from your pots – here’s where to start.

What’s a POCT?

Let’s start with the name. POCT stands for point-of-care testing (or occasionally, point of contact testing). This means that t he sample analysis is done in proximity of the candidate (or patient) being tested.

It’s likely that you have been familiar with point of contact tests for a long time, even if you didn’t know it. If you or anyone you know has ever taken a home pregnancy test – that’s a POCT!

An example that we’re all (regrettably) very familiar with that demonstrates the difference between POCTs and traditional lab testing is COVID tests. A lateral flow test is a POCT – you get the result almost immediately. In contrast, a PCR test (the type that has been, at various times in the last few years, required to travel internationally) must be sent to an accredited laboratory, and your results are usually available within a few days.

It works the same for drug tests. A sample is collected (for drug testing this is either saliva or urine, unlike the nose/throat swabs for COVID tests), and either sent to a laboratory for analysis, or tested immediately using a POCT device.

What do they look like?

A POCT looks very similar to the sample collection equipment used in traditional laboratory testing. For urine, this will be a cup; for saliva, a tube containing a swab. The key difference is that a POCT will have a panel on the side of the tube or cup, which displays the results of the analysis. There will be separate strips on this panel for each substance that is being tested for.

What are the advantages of POCTS?

The most important advantage of using a point of contact test is that you get your results very quickly – usually within 15 minutes. This can be beneficial for companies where downtime is detrimental to business outcomes. For example, if you’re testing an individual using a ‘back to lab’ test, you may have to remove them from their duties until their results are available, often a couple of days. A POCT will give you your result almost immediately, eliminating the need for employee downtime.

Another benefit is cost reduction. Analysis at a reputable, accredited laboratory costs money. By using POCTS you can eliminate a lot of that spend even if you cannot eliminate all of it – more on this later!

Indirectly, a reduction in your testing costs can allow you to test more of your employees, giving you more peace of mind.

What are the downsides?

Back in the old days, drug POCTs were dismissed as unreliable or inaccurate. Luckily technology has moved along since then! The new generation of POCTS are very reliable, with a degree of both sensitivity and specificity. However, they are still not (and are likely to never be) as reliable as laboratory analysis. However, they can be relied upon to give you an indication of a candidate’s substance use.

It is very important to note that, as of publication, results of a POCT have not been ‘legally tested’. This means that it has not yet been established in a court if POCT results are reliable enough to warrant legal action. It is possible that we will see this happen in the future, but in practical terms, if a company dismisses an employee following a non-negative POCT result without sending a sample back to the lab for confirmation testing, there is no guarantee that the company would win in a tribunal.

Which leads us to our next point…

Are POCTS alone enough?

Due to the legal reasons already discussed, no, POCTS alone are not enough. They must be backed up, when necessary, with traditional testing at an accredited laboratory.

So, when is laboratory confirmation testing necessary? Well, if you’re intending to dismiss or discipline a member of your team due to a non-negative POCT (yes, for technical reasons, we refer to ‘non-negative’ rather than positive), it would be in the company’s interest to back this up by sending that initial sample to the lab. A urine sample tested in a reputable lab is still considered the gold standard for drug testing and will protect your company from future litigation.

What happens during confirmation testing?

If a non-negative result is returned on a urine POCT, the same sample is transferred into two containers – these are the A and B samples. For oral fluid POCTs, we use two new mouth swabs used simultaneously for the A and B samples. In both cases, the two samples are sent to laboratory according to Chain of Custody protocol, with paperwork noting the identified substance.

The A and B samples are why laboratory testing is legally defensible. The A sample is analysed, and the B sample is retained. A dismissed employee can have the B sample tested at another laboratory if they wish to contest the outcome in a tribunal. 

So, should I be using POCTS?

Without knowing the specifics of your industry and the types of roles your team are working in, we cannot say for certain. But as industrial regulatory bodies are making moves to support POCTS in their drug testing requirements, it’s a good time to get in touch with one of our experts to find out how using POCTS as screening devices can supplement your testing programme.