Common Adulteration Methods

The method of switching ''clean'' urine for ''dirty'' urine; resubmitting one's own or urine that is provided by someone else are the most common ways to fool the drug screening system. A number of entrepreneurs have attempted to bypass urine-

specimen inspection by substituting clean urine. For example, a company in Florida sells lyophilized (freeze dried) clean urine samples through newspaper and magazine advertisements. Hiding condoms containing ''clean'' urine on the body or inside the vagina is another common trick.

Some have substituted apple juice and tea in samples for analysis. Patients are known to add everything from bleach, liquid soap, eye-drops, and many other household products, hoping that their drug use will be masked. Others may hide a masking substance under their fingernails and release it into the urine specimen. Another method is to poke a small hole into the container with a pin so that the sample leaks out by the time it reaches the laboratory.

Since addition of table salt (NaCl) or bleach to the urine is a common practice, many laboratories routinely test for Na and Cl in the urine. Liquid soap and crystalline drain cleaners that are strong alkaline products containing sodium hydroxide (NaOH) are also used to adulterate the urine sample. These contaminators can be detected by checking for high levels of pH in the urine sample. In-vivo alkalizing or acidifying the urine pH can also change the excretion pattern of some drugs including amphetamines, barbiturates andphency-clidine (PCP).

Water-loading (drinking large amounts of water prior to voiding) poses an interesting challenge to testing laboratories. Specific gravity has been used to detect dilution; however, the measurement range is limited so it is not yet useful. Creatinine levels on random urine samples appear to be a promising method for detection of water-loading. A number of adulteration methods are being advertised on the Internet. Invariably, one of the instructions for adulteration is to drink copious amounts of fluids to bring about in-vivo dilution or water loading. Some Internet sites even sell adulterants that can be added to the urine. Typically these products either try to oxidise the drug present or try to change the pH of the urine to interfere with the analytical method. Most of the laboratories involved in drug testing routinely test for the various adulterants. To detect resubmitted samples a ''urine fingerprinting'' method using dietary components has been described.

Drug users are very resourceful and their ingenuity should not be underestimated. To reduce the opportunities for specimen contamination, some workplaces require that employees provide a urine sample under direct supervision. Another technique used to detect any sample adulteration is to take the temperature of the sample. In a study, we took the temperature of urine samples when taken within one minute of voiding; it falls between 36.5°C and 34 degrees Celsius, reflecting the inner body core temperature. It is very difficult to achieve this narrow temperature range by hiding a condom filled with urine under the armpit or adding water from a tap or toilet bowl to the urine sample. It is important that the temperature of the specimen be measured immediately after the sample is taken, since it can drop rapidly.

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