The Lab Behind the Standard: Ensuring Trust in DoW Drug Testing

Before a drug test result can be forensically defensible, the laboratory producing it must first demonstrate that it can be trusted.

For the federal government, responsibility falls, in part, to the Department of War Quality Assurance Laboratory (QAL) at the Armed Forces Medical Examiner System. This specialized laboratory provides quality oversight for the six forensic toxicology drug-testing laboratories supporting the DoW’s Drug Demand Reduction Program (DDRP).

The six laboratories are located at Fort George G. Meade, Maryland; Tripler Army Medical Center, Hawaii; Naval Station Great Lakes, Illinois; Naval Air Station Jacksonville, Florida; Joint Base San Antonio-Lackland, Texas; and Dover Air Force Base, Delaware. Together, those laboratories process more than one million samples each year for random drug testing.

“We are the accrediting laboratory for the six drug labs,” said Capt. Thomas Burke, DoW QAL chief.

While those six laboratories conduct all of the high-throughput testing, the QAL works behind the scenes to ensure they meet established standards through proficiency testing, inspections and certification.

“It’s a mission no one really talks about,” Burke said. “It’s something we do in the background, so it’s almost unseen.”

Putting the Standards to the Test

One of the primary ways the QAL evaluates the six drug-testing laboratories is through proficiency testing.

Each month, the team prepares open and blind proficiency samples. Open samples tell laboratories what they are being asked to test, while blind samples resemble specimens from a collection site without revealing that the QAL prepared them.

Blind testing evaluates more than a laboratory's ability to identify a substance. The samples can also contain deliberate administrative discrepancies, such as missing initials, incorrect identification numbers, or problems with tamper-evident seals. This allows the QAL to evaluate whether laboratories identify problems beyond the analytical result itself.

Tiffany Lavin, Forensic Toxicology specimen processor, is one of the people responsible for preparing those samples.

“My main objective is to prepare monthly urine samples as part of the External Proficiency Testing Program for the six DDRP laboratories,” she said. “This specific program is designed to monitor and evaluate the performance of those six DDRP laboratories.”

Her work requires weeks of preparation. Samples are screened, prepared with specific analytes, labeled, sealed and packaged before they are shipped to the drug-testing laboratories.

“The majority of my role requires attention to detail,” she said. “Once samples are shipped out, we don’t have the option of getting them back for any corrections.”

The scale is significant: Lavin's team prepares more than 15,000 blind proficiency samples and 4,000 open proficiency samples each year.

When a laboratory's results do not match the expected results, the QAL initiates an investigation. Depending on the issue, the laboratory may face corrective action, suspension, or recertification.

Looking Beyond the Result

Proficiency testing determines whether laboratories can produce expected results. Inspections look at how they operate.

The QAL inspects each of the six drug-testing laboratories three times a year. The inspection team consists of military members, Government Service civilians, DoW contractors or HealthWest civilian contractors.

The inspections evaluate laboratories against the requirements in Department of Defense Instruction 1010.16, “Technical Procedures for the Military Personnel Drug Abuse Testing Program.” Findings can identify requirements that must be corrected or recommend improvements to laboratory practices. Laboratories have 30 days to respond, and subsequent inspections can verify whether they addressed the issues.

The inspections also encourage collaboration. Personnel can observe how other laboratories operate, identify effective practices, and bring those ideas back to their own organizations.

Demonstrating Capability

The QAL also certifies laboratories to perform specific testing.

Before a DDRP laboratory begins testing for a new substance, it must complete a validation process on that substance, then the QAL verifies its results. Once the results are consistent, the laboratory can receive approval to begin testing.

The process can also work in reverse. When a laboratory does not meet required standards, the QAL can initiate suspensions or decertification.

Together, proficiency testing, inspections and certification provide multiple layers of oversight.

Holding Themselves to the Standard

Those responsible for evaluating other laboratories must also show their own work is accurate.

“We have to be held to a higher standard as well,” Burke said. “Because if we're going to tell them how to perform their job, we have to be able to perform our jobs.”

The QAL participates in external proficiency testing through the College of American Pathologists and undergoes its own external inspection.

For Lavin, that responsibility comes down to getting the details right.

“The proficiency samples shipped out from the DoW QAL must be accurate,” she said. “Our role is to help ensure DDRP Drug Testing laboratories are processing service member samples properly and the results they produce are scientifically sound.”

Why the Standard Matters

The work ultimately supports more than laboratory consistency. The QAL's oversight helps ensure the drug-testing laboratories produce results that are accurate, precise and forensically defensible.

The work of the people behind the QAL extends far beyond preparing proficiency samples or conducting inspections. They establish and maintain the standards that allow DoW drug-testing laboratories to demonstrate confidence in their results.

Burke said that reliable laboratory results support the broader DDRP mission by helping deter drug use and protect military readiness.

“We're protecting the mission,” he said. “We're supporting the DDRP mission to make sure that those labs are producing good results.”

For the people behind the QAL, that responsibility begins with getting the details right. For Lavin, it is reflected in every sample she prepares. For Burke, it is reflected in the standard the entire team holds itself to.

Their work may happen largely behind the scenes, but the mission is clear: help ensure the laboratories responsible for DoW drug testing can produce results that are accurate, consistent and scientifically sound.

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