Hair Follicle Drug Test

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Hair Follicle Drug Test Results

Receiving test results

Results of hair follicle drug testing are generally available within a few business days after the laboratory receives the sample. Processing times vary, so patients may find it helpful to ask their doctor or the laboratory when to expect results.

Depending on the reason for testing, patients may learn about their test results through a health care professional or the organization that required testing.

Interpreting test results

The results of hair follicle drug tests may be reported as positive or negative. Positive test results indicate that a drug or its metabolite was detected in the sample of hair submitted for testing.

Negative test results indicate that no drugs or drug metabolites were detected in the hair sample. Negative results suggest that a person didn’t consume the drug targeted by the test, that they used a drug outside of the test’s detection window, or that an insufficient amount of the drug was consumed to be detected in the hair.

When interpreting results, it may be helpful to understand the laboratory method used for testing. Laboratory methods used in hair follicle drug testing are similar or slightly modified versions of those used in more common forms of drug testing, like urine drug testing. Laboratory methods used in drug testing are generally categorized as initial or confirmatory methods:

  • Initial test methods: Immunoassays are a common method of drug testing but provide only preliminary results. Results include which drug or drug classes were detected above the lab’s cutoff for positive results. In order to reduce the risk of inaccurate results on initial testing, positive test results should be followed by testing using a confirmatory test method.
  • Confirmatory test methods: Confirmatory test methods, such as gas or liquid chromatography, provide more detailed results than initial test methods, including specific metabolites detected in hair.

Although cutoff values for positive test results are not standard in all laboratories, the Society of Hair Testing, an organization that promotes research in hair testing, has proposed the following cutoff values:

Are test results accurate?

Although hair follicle testing is an accepted form of drug testing, the results of this test can be affected by a variety of factors, including environmental exposures, hair composition, use of hair products, and even hair color. Additionally, some drugs attach to the hair more easily, like nicotine and heroin, while other drugs are more difficult to detect in hair. Factors that affect test results include:

  • Environmental exposures: Inaccurate results can also occur due to environmental exposure to drugs. For example, during ​​exposure to secondhand smoke from cocaine or tobacco some of the smoke or vapor can enter the hair and lead to a positive test result. Washing hair samples prior to testing may not remove all of the drug residue from an environmental exposure.
  • Hair color: Hair color can also lead to inaccurate or biased results of hair follicle drug testing. Drugs like cocaine, methamphetamine, and opioids may bind more easily to melanin in dark hair, leading to higher concentrations in hair testing.
  • Hair treatments: Hair treatments, including shampooing, coloring, relaxing, and bleaching the hair, can affect the concentration of drugs and drug metabolites detected during testing. Chemically treated hair may not be appropriate for testing, and untreated hair may need to be taken from another part of the body.

Other concerns about the accuracy of hair follicle drug tests include:

  • Lack of standard cutoff values: Although some organizations have proposed guidelines for the use of hair follicle drug testing, standard cutoff values for the concentration of drugs in hair samples is still being established.
  • Challenging to interpret: Hair follicle drug testing may be more challenging to interpret than other types of drug tests due to the many factors that may affect the interpretation of test results. For example, drug metabolites in a person’s sweat can travel up the hair shaft and may make it more challenging to determine when drug exposure occurred.
  • Hard to detect low-level use: It can be difficult to detect low-level or one-time drug use or misuse using a hair sample for drug testing. Use or misuse of some drugs must be relatively heavy in order for a positive result on hair follicle drug testing.

Do I need follow-up tests?

Follow-up testing after a hair follicle drug test depends on the test results and the purpose of drug testing. If only an initial test was performed, a confirmatory test may be ordered to confirm preliminary results.

If a drug test result is positive, a health care provider may ask questions to evaluate the patient for a substance use disorder or addiction. The health care provider may ask about the impact of drug use or misuse on a person’s health and social obligations, any history of attempting to reduce or stop taking drugs, as well as whether the patient uses drugs in dangerous situations. Regardless of whether a patient meets the criteria to be diagnosed with a substance use disorder, treatment is available for drug use and misuse.

Questions for your doctor about test results

Drug test results can be difficult to interpret and patients can ask their doctor or the testing facility about the meaning of test results. Questions about test results include:

  • Why am I being tested for drug use or misuse?
  • What is the detection window of this test?
  • What is the test result?
  • Who will have access to my test result or medical record?
  • Will I be retested in the future?

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