Pretrial Drug Testing

Pretrial Drug Testing: An Overview

of Issues and Practices

In December 1995, President directed Attorney

General to develop and implement a

universal policy providing for the drug testing of all

federal arrestees before the decision is made to release

them to the community pending trial. He also directed

the Attorney General to take steps to encourage states to

adopt and implement the policy.

The President’s rationale for developing a universal

policy was that “too often, the same criminal drug users

cycle through the court, corrections, and probation systems

still hooked on drugs and still committing crimes

to support their habit.” We should react, he argued, “at

the earliest possible stage in a person’s interaction with

the criminal justice system—following arrest.”

1

As a step toward implementing the policy at the federal

level, in 1996 the Attorney General reached an agreement

with the federal courts to implement pretrial drug

testing in 24 of the 94 federal districts. To begin implementing

the policy at the state level, Congress increased

funding for the Byrne Formula Grant program in FY

1997 by million specifically to encourage state and

local jurisdictions to support effective drug testing initiatives

at all stages of the criminal justice process, beginning

with the pretrial stage.

To support this effort, the Bureau of Justice Assistance

(BJA), a grant-making agency of the Office of Justice

Programs in the U.S. Department of Justice, awarded a

grant to the Pretrial Services Resource Center (PSRC)

to provide technical assistance to jurisdictions using

federal funds from the Byrne program to implement or

expand pretrial drug testing functions or to integrate

testing throughout all stages of the criminal justice

system.

This BJA bulletin, prepared by PSRC as part of that grant,

provides an overview of drug testing issues and practices

at the pretrial stage of the criminal justice system.

The Evolution of Drug Testing in the

Criminal Justice System

Drug Testing as a Treatment Tool

The first use of drug testing in the criminal justice

system was as an adjunct to treatment—an aid in

identifying heroin users in need of treatment and then

monitoring their progress. One of the first recorded

applications of drug testing occurred in the mid-1960s

with the California Civil Addict Program. Under this

program, persons convicted of certain offenses could

opt to enter inpatient drug treatment, followed by outpatient

treatment, in lieu of sentencing. Offenders entering

the program were assigned to one of two groups:

those who were tested for heroin use and placed in drug

treatment in addition to other supervision services, and

those who were supervised but not tested for drugs. An

evaluation of the program showed that those who underwent

drug testing and treatment in addition to other

supervision services while in the outpatient phase had

much lower rates of subsequent criminal activity than

both those who were supervised but not tested or

treated and those who received no services.

2

The idea that drug testing and treatment could help reduce

criminality led to the establishment in 1972 of the

Treatment Alternatives to Street Crimes (TASC) program,

a federally funded effort that focused on providing

treatment for drug users involved in the criminal

justice system and bridging the gap between the criminal

justice system and the drug treatment community.

Under the TASC model, all arrestees underwent a drug

test and a drug use assessment upon booking. Those

identified as drug users who met the eligibility criteria

were placed in drug treatment. If treatment was completed,

the charges were dropped. The TASC model

soon evolved to include posttrial processing, in which

individuals were identified and referred to TASC as a

condition of probation.

3 By 1982, TASC projects were

operating in 130 jurisdictions in 39 states.

4 Many still

operate today.

The benefits of drug testing as a treatment tool were further

recognized in the 1975 White Paper on Drug Abuse,

prepared for the President by the Domestic Council Drug

Abuse Task Force. The drafters of this document noted

that the Speedy Trial Act of 1975, which established pilot

pretrial services programs in 10 federal judicial districts,

might “provide the vehicle [to] screen people entering

the federal criminal justice system for drug abuse.” The

Task Force suggested that drug testing of arrestees could

be an effective way to identify drug-abusing defendants.

A pretrial services officer could then help them secure

drug treatment, employment and job training, and medical

and legal services.

5

Drug Testing as a Tool To Monitor

Offenders Under Supervision

Drug testing in the criminal justice system expanded in

the late 1970s and early 1980s as criminal justice officials

began using it as a tool to enforce compliance with

the requirements of supervision, which generally included

abstinence from drug use. Two developments

influenced this expansion. First, advances in drug testing

technology allowed criminal justice officials to set

up their own onsite drug testing programs. In 1977, the

West Texas Regional Adult Probation Department established

one of the first onsite drug testing programs in

the nation, using technology—the Enzyme Multiple Immunoassay

Technique (EMIT)—that allowed staff with

limited technical training to conduct the tests.

6 The experience

demonstrated that criminal justice agencies did

not need to rely on the drug testing resources available

from TASC or other treatment programs.

Second, mounting evidence of the link between drug

use and crime and the devastating impact that drug use

was having on society led to a renewed war on drugs

in which zero tolerance of drug use was an important

aspect. Law enforcement efforts focused on arresting

drug users as well as those who sold drugs, leading to

significant increases in the number of drug arrests.

7

Identification and monitoring of drug use by those under

the jurisdiction of the criminal justice system became

a major concern of the system, with testing used

widely by probation, parole, and correctional agencies.

Drug Testing as a Tool To Predict and Reduce

Pretrial Misconduct

Historically, pretrial programs have inquired about drug

use in their interviews of defendants, believing that

such information is useful to judicial officers when setting

conditions of release. The introduction of onsite

testing provided the opportunity to supplement this information

with an accurate and objective measure of

recent drug use. The District of Columbia Pretrial Services

Agency (DCPSA) was the first to take advantage

of this opportunity when it implemented an onsite pilot

pretrial drug testing program in 1984 with initial funding

from the National Institute of Justice (NIJ). The

program offered two types of urine immunoassay testing

for defendants:

q

Testing before the initial bail-setting appearance

and incorporating the results into the risk assessment

presented to the judicial officer at the

defendant’s bail hearing (preinitial appearance

testing).

q

Testing on a regular basis during pretrial supervision

(pretrial drug monitoring) after a defendant had been

identified as a drug user in initial screening.

Two assumptions underlay this approach. First, DCPSA

believed that knowledge of a defendant’s drug use at the

time of arrest—obtained through a drug test—would

provide an important predictor of pretrial misconduct.

Second, DCPSA believed that monitoring during the

pretrial period, coupled with sanctions, could reduce

any risks of pretrial misconduct.

Based on the success of the Washington, D.C., project,

between 1987 and 1991 BJA provided funding to

five jurisdictions—Maricopa County, Arizona;

Milwaukee County, Wisconsin; Multnomah County,

Oregon; Pima County, Arizona; and Prince George’s

County, Maryland—to establish pretrial drug

testing demonstration projects. These projects were

designed to replicate the D.C. model, incorporating

both preinitial appearance testing and pretrial drug

monitoring. Several of the jurisdictions set up their own

onsite testing facilities, while the others contracted with

outside laboratories.

To determine whether drug testing helped predict and

reduce pretrial misconduct, each of the testing programs,

including the pilot project in D.C., underwent

evaluations under the auspices of NIJ. In testing the

predictive value of preinitial appearance test result information,

researchers sought to determine whether

having knowledge of drug test results when making

bail decisions improved the ability to predict pretrial

misconduct.

The results were mixed. For example, when controlling

for other factors, testing positive for cocaine was related

to higher failure-to-appear rates in some, but not all,

jurisdictions. In some jurisdictions, testing positive for

opiates was related to a higher likelihood of rearrest.

There were inexplicable findings as well, such as the

correlation between testing positive for PCP in D.C.

and a risk of failure to appear that was lower than the

risk for persons testing negative for all drugs. In short,

there were no consistent findings showing that drug use

predicted pretrial misconduct. An NIJ-sponsored review

of the findings speculated that a drug test’s inability to

distinguish between heavy and casual users may be the

explanation.

8

An experimental design was used to test the effectiveness

of pretrial drug monitoring in reducing risks of

pretrial misconduct in each of the jurisdictions. This

design randomly assigned identified drug users to one

of two groups: a control group and an experimental

group. Those in the control group did not undergo pretrial

drug monitoring as a condition of release; those in

the experimental group did. Researchers compared rearrest

and failure-to-appear rates for both groups and

once again found mixed results. The researchers noted,

however, that a number of implementation problems

may have contributed to this result.

9

Although many pretrial programs throughout the country

have the authority to test defendants who are on

supervised release, the use of pretrial drug testing to

predict and reduce the risk of pretrial misconduct has

not spread to other jurisdictions. Even the demonstration

jurisdictions have substantially reduced, or in some

cases eliminated, their testing services; the District of

Columbia is the only jurisdiction that still conducts

preinitial appearance testing.

The question then arises: Why do pretrial programs

continue to be interested in defendant drug use but not

use drug testing as a tool to identify and monitor drug

users? Research and the experience of practitioners

suggest many reasons:

q

The expense of testing.

q

Inconclusive research findings on the value of

testing in predicting and reducing risk.

q

Objections to intruding on a defendant’s privacy

during specimen collection.

q

Objections to imposing sanctions on drug users

who continue to test positive.

q

The belief among some pretrial programs that a

testing program, with its requirements for strict

chain of custody, is too difficult to implement.

To address these concerns, pretrial programs need a

fresh opportunity to implement drug testing applications.

The President’s directive and the funding being

made available by Congress for pretrial drug testing

are critical steps toward that goal.

Drug Testing Technologies

The state of the art of drug testing technology has

changed rapidly in the past 25 years. In the early 1970s,

testing was conducted exclusively in laboratories

with highly skilled technicians using expensive, laborintensive

technologies. Typically, the testing technique

employed was Thin Layer Chromatography (TLC).

With the development of immunoassay methodologies

in the late 1970s and early 1980s, new drug testing

technologies were introduced that simplified the testing

process and made results available much more quickly.

Two such technologies, the Syva Company’s Enzyme

Multiplied Immunoassay Technique (EMIT) and Abbott

Laboratories’ TDX, utilized analyzers (testing machines)

that were simple enough to be used outside

laboratory settings by laypersons with minimal training.

10

Many criminal justice agencies set up onsite testing

facilities using these technologies.

In 1991, NIJ published results of a study examining

these immunoassay technologies, plus Roche Diagnostics’

Radioimmunoassay (RIA) and TLC.

11 The purpose

of the study was to determine how these technologies

rated for false positive (labeling a specimen positive

when it is in fact negative) and false negative (labeling

a positive specimen negative) results.

Testing specimens collected from more than 2,500 parolees

and arrestees in California for opiates, cocaine,

amphetamines, PCP, and marijuana, the study found

that EMIT, TDX, and RIA were equally effective in

correctly identifying drug use, but the accuracy of TLC

was “seriously deficient.”

12 The results of this study

gave confidence to criminal justice officials that immunoassay

technologies, with their time- and cost-saving

qualities, could be relied on for criminal justice

decisionmaking.

About the time this study was completed, the technology

to test urine specimens for drugs advanced with the introduction

of disposable hand-held devices that could be carried

into the field to conduct drug tests in the presence of

the defendant or offender. Results were available within

minutes. Early studies of these devices showed that they

could be effective in detecting drug use.

13

Newer technologies are using specimens other than

urine. One product developed in recent years, a sweat

patch, tests perspiration for the presence of drugs in the

body. Another technology tests hair.

Analyzer-Based Urine Testing

Analyzer-based urine testing is conducted either in a

commercial laboratory or in an onsite testing facility.

Commercial Laboratory Urine Testing. Pretrial programs

using a private, local laboratory to conduct testing

should contract only with laboratories that have

been certified by the Substance Abuse and Mental

Health Services Administration (SAMHSA) of the U.S.

Department of Health and Human Services. SAMHSA

certification provides a greater degree of assurance that

the results will be as accurate as possible.

Assuming that care is taken in the selection of a commercial

laboratory, contracting with such a facility

offers several advantages. Reputable commercial laboratories

will likely have a highly trained staff of technicians

experienced in testing specimens, including a

toxicologist who ensures quality control and is available

for expert testimony if the results are challenged in

court. Moreover, commercial laboratories have the instrumentation

to confirm test results. Laboratories that

are certified by SAMHSA and the College of American

Pathologists have undergone extensive auditing to ensure

that quality testing services are provided.

Many jurisdictions use commercial laboratories for a

portion of their testing. For example, many conduct

initial screening of specimens using either inhouse

analyzers or hand-held devices but send all positive

specimens to the laboratory for confirmation. Other

jurisdictions conduct some testing using hand-held

devices (most commonly when visiting a client in the

field) but conduct the majority of tests at a laboratory.

Onsite Urine Testing. Onsite analyzer-based testing

offers two important advantages over testing through a

commercial laboratory: Results are available much

more quickly, and the chain of custody is simplified. A

number of analyzers on the market may be used for

onsite testing, each offering a different set of features.

Some, for example, are designed for high-volume testing,

whereas others feature rapid reporting of results.

Some analyzers have the ability to interrupt a batch to

test a single specimen immediately. Many can interface

with the agency’s information system to provide automated

transfer of test results. When space is a problem,

desktop models are available.

In many jurisdictions, the various criminal justice agencies

operating there share an onsite analyzer-based

testing facility. The testing may be conducted by the

pretrial services agency, but the agency may also test

other populations such as probationers, drug court

clients, and work-release residents.

14

An advantage of analyzer-based urine testing, whether

conducted in a commercial laboratory or onsite at a

criminal justice agency, over newer testing technologies

is that the results obtained through these analyzers have

been accepted in a number of court cases. The newer

technologies, although the subject of many clinical

studies, have not yet faced the same level of scrutiny

from the courts.

Hand-Held Urine Testing

A variety of disposable, hand-held testing devices are

currently available. Most are similar in appearance—

about the size and shape of a credit card—and in the

procedures required to run a test. A result is obtained by

depositing drops of urine into a sample well. The results

appear within minutes, usually indicated by a colored

line. Several of these devices test for a single drug,

whereas others test for multiple drugs simultaneously.

Hand-held devices have become very popular with

criminal justice agencies due to their portability, ability

to rapidly provide results, and ease of operation. Because

they require no machinery to maintain and calibrate,

they can be used by criminal justice officers with

no formal training in drug testing. Also, it is not necessary

to refrigerate hand-held devices before use, as is

the case with the reagents used in analyzers.

Another advantage of hand-held devices is that they

simplify chain of custody of a specimen by creating a

one-step testing process. At least one vendor has developed

a plastic stick that shows results after being

dipped into a urine collection cup. Another vendor has

created a device that is both collection cup and testing

device, with the testing strip embedded into the side of

the collection cup. With these devices, the same officer

who witnessed the collection of the specimen can also

test it, and the test can be conducted in the presence of

the person who submitted the specimen. With analyzerbased

testing, on the other hand, the specimen is usually

collected by one person, taken to the testing facility

(which may require transporting it outside the building),

and then tested by another individual.

Hand-held devices are being used extensively in the federal

courts. The Administrative Office of the United

States Courts (AOC) recently commissioned a study to

determine whether the devices meet the accuracy and reliability

requirements of the courts. Preliminary results

found that a number of these devices “showed promise.”

15

Testing Perspiration

The PharmChek sweat patch is an adhesive patch attached

to the skin, usually on the upper arm, of a testing

subject. The patch, which can remain on the skin for up

to 1 week, is tamper evident, meaning that any effort by

the subject to remove it is obvious. As the subject perspires,

the sweat is collected by a pad, which is then

tested at the vendor’s laboratory using immunoassay

technology.

The sweat patch has certain advantages over urinalysis.

Depending on the drug, urinalysis can detect drug use

only within 48 to 72 hours, whereas the patch detects

any drug use while it is worn. In addition, testing with

the patch does not involve the degree of intrusiveness

required to collect a urine specimen, nor does it carry

the risks of transmitting disease that accompany the

handling of urine specimens.

Currently, the sweat patch is being used with urine testing

in approximately 40 federal probation agencies.

AOC has recommended its trial use as a supervision

tool in federal pretrial programs.

Hair Analysis

Because drugs are absorbed into hair shafts, a history

of drug use is produced as each hair strand grows. In

1977, researchers developed the means to detect drug

metabolites in hair through RIA. Studies have shown

hair analysis to be very effective in detecting drug use

within 1 week of ingestion. The only limit on the length

of time in which drug use can be detected is the length

of the hair—1 inch of hair can track any drug use over

a 60-day period.

16

Moreover, as is the case with the sweat patch, hair

analysis does not involve the privacy issues and concerns

about disease transmission associated with urinalysis.

Hair analysis, however, is not widely used in

criminal justice settings because it is very expensive

and can only be conducted at qualified laboratories.

Another obstacle is presented by individuals with very

short hair.

17

In addition, several issues regarding the reliability of

hair analysis have yet to be resolved. It is not clear

whether exposure to smoked drugs by a nonusing testing

subject would produce a positive result. It is also

not clear whether some types of hair, such as light,

dark, or thick hair, retain drugs more than other types of

hair do. Furthermore, there are indications that certain

hair treatments hide the use of drugs.

Estimating Pretrial Drug

Testing Costs

A frequently asked question about drug testing in criminal

justice settings is: How much will it cost to set up

and run? The answer is often frustrating: It depends.

Although accurate, this response is hardly helpful. This

section seeks to provide a more satisfactory answer by

providing actual costs for the various approaches to

drug testing, as well as other costs associated with each

approach.

As discussed previously, the options for testing

currently include:

q

Setting up an inhouse analyzer-based testing

facility.

q

Testing inhouse with hand-held devices.

q

Contracting with a local private laboratory.

q

Sending specimens to one of the nation’s larger

private laboratories.

q

Testing with the sweat patch.

q

Some combination of the above.

With each option, different cost factors come into play.

Programs using inhouse analyzer-based testing find that

a urine specimen can be tested for a single drug for an

average of . This figure includes only the costs of

reagents. It does not include the startup costs associated

with an inhouse analyzer-based facility, including

the costs of purchasing or leasing equipment

18 or

renovating the facility.

19 It also does not include the cost

of a maintenance contract for the analyzer(s). Such a

contract, which could run into thousands of dollars per

year, depending on the number and type of analyzers,

ensures that the instruments are serviced and promptly

repaired.

20

Moreover, the figure does not include staff costs.

In an analyzer-based facility, staff time is needed to

calibrate the analyzer, prepare the reagents for testing,

perform quality control checks, and conduct daily

maintenance procedures. Because these procedures involve

multiple steps, staff must be trained thoroughly.

For programs that choose the hand-held testing approach,

there are a variety of portable devices on the

market. The costs of testing with these devices range

from .50 to .50 per test. Programs using hand-held

devices avoid the major expenses of analyzer-based

testing discussed previously: equipment purchase, facility

renovation, and staff time to conduct procedures.

While prices vary, local, private laboratories charge

an average of for each drug for which a test is

conducted. Another option is to ship specimens to a

larger, nonlocal private laboratory. At PharmChem

Laboratories in California, for example, the cost of testing

for a high-volume jurisdiction is to per drug

tested, or to for a 5-drug screen.

The sweat patch is available in packages of 50, at a cost

of per patch, for a total of 0 per package. Each

patch comes with the supplies to apply, remove, and

ship it to the vendor’s laboratory. The laboratory

charges to screen for 5 drugs and an additional

to confirm positive results by Gas Chromatography/Mass

Spectrometry (GC/MS).

21

Confirmation Testing Costs

In many cases, particularly those in which drug use is

not admitted, specimens that test positive should be

tested again to confirm the results. Confirmation testing

can take one of two forms: retesting the specimen using

the same type of test employed for the initial test or

confirming the result through the use of a technology

that is analytically different from and more specific

than the technology used in the initial test. Although

courts have generally approved the admittance of positive

drug test results confirmed through simple retesting

using the same technology,

22 SAMHSA recognizes

followup testing by GC/MS to be the most reliable

means of confirmation.

23

Confirmation of positive results through GC/MS can

be expensive, with the cost ranging from to

per test result. Jurisdictions in which a simple retest

is insufficient for court proceedings could avoid

incurring these high costs by using GC/MS confirmation

tests for only those results that are disputed

by defendants and that would lead to a court sanction

against the defendant.

Specimen Collection Costs

When calculating the costs of a drug testing program, it

is critical that jurisdictions consider the staff time they

will need to collect specimens. If there is a high volume

of testing, separate collection staff may be needed.

For urinalysis testing, specimen collectors should always

wear disposable gloves. Suitable gloves are available

from a number of sources and can be purchased in

packages of 100 for between and . Specimen

containers are available from medical supply companies

in packages of 100 for to . Temperature strips,

which are attached to a specimen container immediately

after a specimen has been collected, measure the

specimen’s temperature to verify that it has been freshly

voided. The strips are available from medical supply

companies in packages of 100 for to .

Other Cost Factors

There are a number of other factors to be addressed in

projecting a jurisdiction’s pretrial drug testing costs,

including:

q

Who will be tested?

q

How often will they be tested?

q

For which drugs will they be tested?

q

What will happen when they test positive or fail to

report for testing?

The answers to these questions will determine the volume

of testing.

24 The volume of testing, in turn, will

determine the most cost-effective approach to employ.

For example, programs with a high volume of testing

(at least several hundred specimens per week) find that

setting up an analyzer-based testing facility, even with

its startup expenses and additional operating costs, is

more cost effective over the long run than is testing

with hand-held devices.

Current Applications of Pretrial

Drug Testing

As noted earlier in this bulletin, the District of Columbia

Pretrial Services Agency established an inhouse

pretrial drug testing program in 1984 with NIJ funding.

BJA then funded replication sites in five counties (see

page 2 for listing) between 1987 and 1991.

At the federal level, the Anti-Drug Abuse Act of 1988

mandated the establishment of pilot pretrial drug testing

programs in eight federal judicial districts. In response,

pilot programs were established in 1989 in the following

eight districts: Eastern District of Arkansas, Middle

District of Florida, Eastern District of Michigan, District

of Minnesota, District of Nevada, Southern District

of New York, District of North Dakota, and Western

District of Texas. In 1995, President Clinton directed

the Department of Justice to develop a plan for implementing

pretrial drug testing of arrestees in all federal

districts before decisions are made on whether to release

them into the community pending trial. In 1997,

24 federal districts began participating in Operation

Drug Test, an effort to demonstrate how such universal

testing would work in the federal system.

These pilot programs identified two purposes for pretrial

drug testing: to assist in identifying drug users and

to monitor users during pretrial release. Several jurisdictions

that participated in these projects provided

information for this bulletin on their current drug

testing practices.

25 All of the jurisdictions contacted

continue to test defendants for drug use during pretrial

supervision, but they vary in their use of drug testing as

a tool to identify drug users.

At the local level, the District of Columbia Pretrial

Services Agency is the only pilot program that currently

tests arrestees before their initial court appearance.

At the federal level, 18 of the 24 federal pretrial

drug testing programs participating in Operation Drug

Test screen defendants before initial appearance. In

these federal sites and in D.C., the preinitial appearance

test is voluntary; that is, the defendant has the

right to decline to submit a specimen. Defendants who

test positive or who have other indicators of drug use

are recommended for participation in drug treatment,

ongoing drug testing, or both as a condition of release.

In six of the federal Operation Drug Test programs, the

initial test is conducted immediately after the defendant is

released, thus saving the cost of testing persons who are

not released. If the test is positive, the defendant’s release

order is modified to require participation in ongoing

drug testing.

With the exception of the District of Columbia Pretrial

Services Agency, none of the local demonstration

programs currently test defendants for the purpose of

identifying drug users. Instead, these programs recommend

testing during the pretrial supervision period

when there are indicators of drug use, such as the defendant

admitting use, a current drug charge, criminal

history of drug-related offenses, or information from

other sources (for example, a family member or probation

officer) that the defendant is a drug user.

Testing Approaches

Table 2 shows that all but two of the federal pretrial

programs use the newer hand-held devices to test

defendants for drug use. The local programs continue

to use the analyzer-based instruments.

In most programs, defendants are tested inhouse by

pretrial program staff. However, in the District of Nebraska,

only the specimens collected for the preinitial

appearance test are tested inhouse. A private agency

under contract collects all specimens for supervision

testing and sends them to a private laboratory for testing.

In Pima County, the specimens are collected by pretrial

staff but tested by the county’s probation department,

which has its own inhouse analyzer-based testing

facility. New Jersey’s federal program uses the sweat

patch if a defendant tests negative on the urine tests

taken during supervision but is still suspected of drug

use.

In several programs, all specimens that test positive are

sent out to a private laboratory capable of conducting

confirmation testing using GC/MS. Other programs

forgo additional testing of specimens that originally test

positive if the defendant admits use.

In the majority of programs, testing is conducted on a

regular schedule. Typically, defendants are required to

report once or twice a week on a set day or days. Other

programs conduct tests on an unscheduled basis; the

defendant will be instructed in the morning to report

for a test by the end of the day. In some programs, the

frequency of testing for a defendant is determined by

a caseworker, who calls the defendant in for tests as

deemed necessary.

Program Responses to Continued Positives

All of the federal pretrial testing programs discussed in

this report notify the court after the first and any subsequent

positive results during the supervision period. No

program recommends a change in release status based

on the first positive result.

All programs—local and federal—offer the defendant a

referral to treatment if the defendant continues to test

positive. Several also increase the frequency of testing.

In several programs, a caseworker uses discretion to determine

when to invoke an administrative sanction such

as increased frequency of testing.

In several programs, court action ranging from a court

reprimand to revocation is requested if the defendant

continues to test positive and does not cooperate with

treatment. In others, court action is requested regardless

of the defendant’s participation in treatment. All programs

recommend court action if the defendant continually

fails to report for testing appointments.

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