ArticlePDF Available

Can synthetic urine replace authentic urine to “beat” workplace drug testing?

September 2018
Drug Testing and Analysis 11(2)

Authors:

Synthetic urine (SU), which was primarily utilized by drug testing laboratories as matrix for quality control preparations, are now commercially sold and can be used to “fool” a positive drug test. To determine if SU can pass as authentic urine, we challenged Army urine drug testing collection and testing procedures using eight different commercial SU products. Adulteration (Sciteck AdultaCheck® 6) and Onsite SU (Synthetic UrineCheckTM) test strips were also evaluated. Five of the eight SU were identified by physical observation. All SU products screened negative in the drug immunoassay and additionally passed the SVT as authentic urine. Furthermore, SU was not detected as adulterated with the adulteration test strips (Sciteck AdultaCheck® 6) but was successfully detected as synthetic urine with the On‐site synthetic urine (Synthetic UrineCheckTM). To deter SU use, direct observation, as utilized by the military may be recommended during the collection process.

Synthetic urine (SU) specimens purchased at the local smokeshops, Oahu, Hawaii. Top row (L-R): Quick Fix, Field Kit, Dr Green's X Agent; Bottom row (L-R): S5 Synthetix, Ultimate Gold, UPASS, XStream [Colour figure can be viewed at wileyonlinelibrary.com]

…

Colorimetric results of synthetic urine (#1-9), water (#10), authentic urine (#11-20) samples using the Scitex Synthetic UrineCheck™ [Colour figure can be viewed at wileyonlinelibrary.com]

…

alidity test results of synthetic, adulterated, and authentic urine samples analyzed at the Forensic Toxicology Drug Testing Laboratory,

…

Figures - uploaded by Victor J. Kim

Content may be subject to copyright.

Content uploaded by Victor J. Kim

Content may be subject to copyright.

RESEARCH ARTICLE

Can synthetic urine replace authentic urine to “beat”workplace

drug testing?

Victor J. Kim

|Catherine K. Okano

|Caroline R. Osborne

|Deanna M. Frank

Christopher T. Meana

|Marisol S. Castaneto

Tripler Army Medical Center Forensic

Toxicology Drug Testing Laboratory, Hono lulu,

Hawaii, USA

Naval Criminal Investigative Service, Hawaii

Field Office, Honolulu, Hawaii, USA

Correspondence

Dr Marisol S. Castaneto, Commander, Forensic

Toxicology Drug Testing Laboratory, 1 Jarrett

White Road (MCHK‐FT) Tripler Army Medical

Center, HI 96859–5000, USA.

Email: marisol.s.castaneto.mil@mail.mil

Abstract

Synthetic urine (SU), which was primarily utilized by drug testing laboratories as a

matrix for quality control preparations, is now commercially sold and can be used

to “fool”a positive drug test. To determine if SU can pass as authentic urine, we

challenged Army urine drug testing specimen accessioning and testing procedures

using eight different commercial SU products. Adulteration (Sciteck AdultaCheck

6) and Onsite SU (Synthetic UrineCheck™) test strips were also evaluated. Five of

the eight SU were identified by physical observation. All SU products screened neg-

ative in the drug immunoassay and additionally passed the specimen validity testing

(SVT) as authentic urine. Furthermore, SU was not detected as adulterated with the

adulteration test strips (Sciteck AdultaCheck

6) but was successfully detected as

SU with the On‐site synthetic urine (Synthetic UrineCheck™). To deter SU use,

direct observation, as utilized by the military, may be recommended during the col-

lection process.

KEYWORDS

drug abuse, synthetic urine, urine adulteration, workplace drug testing

1|INTRODUCTION

The primary mission of the Department of Defense (DOD) Drug

Reduction and Deterrence Program is to “detect and deter”military

and civilian personnel from abusing illicit drugs and misusing prescrip-

tion drugs.

Urine is still the preferred matrix for drug testing due to its

ease of collection, sufficient volume, analyte stability, and longer drug

windows of detection. Urine specimens are collected from service

members under direct observation by a designated observer who

ensures urine is voided by the donors.

If a specimen is reported positive, the service member can likely

receive punishment in accordance with the Uniformed Code of Mili-

tary Justice to include separation from military service and a “nega-

tive”federal record.

Due to the possibility of adverse actions, service members may

attempt to “beat”the drug test. Previous practices include excessive

hydration hours before the specimen collection, specimen adultera-

tion,

2-7

and specimen substitution using a prosthetic penis such as

the “Whizzinator.”

In April 2017, Diagnostic Laboratory Services

(DLS) on Oahu, Hawaii, believed that the decline in methamphetamine

positive specimens received and tested in DLS was due to the substi-

tution of urine with synthetic urine (SU).

In the news release, the lab-

oratory director claimed that they were able to differentiate SU from

authentic urine.

There are two differences between military and civilian drug test-

ing: (a) In the military, urinalysis (UA) has to be observed, and (b) the

military specimens are not required to undergo specimen validity test-

ing (SVT) unless there is suspected urine adulteration or substitu-

tion.

Upon requests from unit commanders, these specimens are

sent to Fort Meade forensic toxicology drug testing laboratory

(FTDTL) to be tested for urine creatinine level, oxidant activity, pH,

and if necessary, specific gravity.

The concerns with SU raised valid questions in the military urine

drug testing of whether specimen accessioning personnel can cor-

rectly identify urine as synthetic and if so, will it pass the SVT. The pri-

mary objectives of these studies are (a) Will SU be detected during

Received: 29 March 2018 Revised: 16 August 2018 Accepted: 31 August 2018

DOI: 10.1002/dta.2497

Drug Test Anal. 2018;1–5. Published 2018. This article is a U.S. Government work

and is in the public domain in the USA

wileyonlinelibrary.com/journal/dta 1

physical examination of the urine specimen? (b) Will SU sample yield

invalid screening results? (c) Will SU pass or fail the SVT? (d) Can com-

mercially available SU and adulteration test strips differentiate SU

from authentic urine samples?

2|MATERIALS AND METHODS

A total of nine SU samples consisting of seven bought from local

smoke shops (Figure 1), a powdered SU included in the “Whizzinator”

reconstituted in deionized water (100 mg/mL), and in‐house drug‐free

SU from Microgenics (Fremont, CA, USA) were evaluated. For compar-

ison, five adulterated or substituted samples were prepared. Adulter-

ated/substituted drug‐free samples included 1:5 10% sodium

hypochlorite (bleach):water; 1:5 bleach:authentic urine, apple cider

vinegar, apple juice; and 1:5 10% hydrogen peroxide:authentic urine.

Authentic negative urine purchased from UTAK (Santa Clarita, CA,

USA), two donor urine samples, and deionized water were used as

controls. On‐site synthetic urine (Synthetic UrineCheck™) and adulter-

ation strips (Sciteck AdultaCheck

6) were provided by Sciteck (www.

sciteck.org).

2.1 |Specimen Accessioning

All authentic de‐identified negative urine specimens and SU/adulter-

ated samples were handled in accordance with theTripler Army Medical

Center (TAMC) FTDTL laboratory procedures. Mock chain of custody

forms were prepared for each specimen. Additionally, each specimen

was labeled with a unique laboratory accession number and placed

into screening batches in accordance with the laboratory procedures.

To evaluate whether the technician could distinguish a SU or

adulterated urine from authentic urine, three specimen accessioning

technicians with a minimum five years of experience were tasked to

aliquot the urine samples for immunoassay screen. None of the tech-

nicians had prior knowledge of which bottles contained adulterated or

SU samples. Technicians are trained to flag (i.e. assign “SB”discrep-

ancy code) any specimen suspected of adulteration or substitution

by smell (or absence of), color, and other physical characteristics such

as bubbles produced when sample is gently swirled or presence of

clots or undissolved objects in the urine. Once the technicians had

completed pouring the aliquots, the batches were processed for

immunoassay testing.

2.2 |Immunoassay screening

All specimens were analyzed in the Beckman Analyzer AU5800. The

analyzer is calibrated once every 24 hours. Calibrators were prepared

in house at the DOD cut‐off concentrations for d‐amphetamine

(500 ng/mL), benzodiazepines (oxazepam, 200 ng/mL), cocaine

(benzoylecgonine, 150 ng/mL), heroin (6‐acetylmorphine, 10 ng/mL),

delta‐9‐tetrahydrocannabinol (11‐nor‐delta‐9‐tetrahydrocannabinol‐

9‐carboxylic acid 50 ng/mL), opiates (morphine 300 ng/mL and

2000 ng/mL), synthetic opioids (oxymorphone/hydrocodone 300 ng/

mL), and synthetic cannabinoids (JWH‐018 pentanoic acid, 10 ng/

mL). Open quality controls were screened to verify acceptable

calibration.

2.3 |Specimen validity testing

For this study, eight SU (excluding Microgenics), three authentic urine,

and four adulterated/substituted samples were sent to Fort Meade to

assess SVT performance. A specimen is reported valid (i.e., authentic

urine), if the pH is between 4.5 and 9, creatinine >20 mg/dL, and there

is no presence of an oxidizing agent. A specimen is considered “dilute”if

creatinine is ≥2 mg/dL and <20 mg/dL, and specific gravity (SpGr) is

>1.0010 and < 1.0030. A specimen is considered “substituted”if creat-

inine is <2 mg/dL and SpGr is ≤1.0010 or ≥1.020. A specimen is adul-

terated if the pH is <4.0 or >11.0 and the nitrite level is ≥500 μg/mL. A

specimen is invalid if (a) creatinine <2 mg/dL but has acceptable SpGr,

or (b) SpGr ≤1.0010 but has acceptable creatinine, or (c) abnormal pH

(<3 or >11), or (d) oxidant activity ≥200 μg/mL.

2.4 |Field kits

Furthermore, the laboratory evaluated the on‐site test strips (Syn-

thetic UrineCheck™) with nine known SU samples and 116 randomly

collected urine specimens to determine if SU could be detected at

the point of collection. Any samples or specimens that produced

abnormal results on the Synthetic UrineCheck™were further evalu-

ated with the Sciteck AdultaCheck

6 to test for oxidant, creatinine,

nitrite, glutaraldehyde, pH, and chromate. Three authentic urine sam-

ples and water were included as controls for the Synthetic

UrineCheck™and AdultaCheck

6. An adulterated sample with 1:5

bleach:urine was tested with the AdultaCheck

FIGURE 1 Synthetic urine (SU) specimens

purchased at the local smokeshops, Oahu,

Hawaii. Top row (L‐R): Quick Fix, Field Kit, Dr

Green's X Agent; Bottom row (L‐R): S5

Synthetix, Ultimate Gold, UPASS, XStream

[Colour figure can be viewed at

wileyonlinelibrary.com]

2KIM ET AL.

3|RESULTS

3.1 |Specimen accessioning

The first technician flagged two samples (10% bleach in water and

water), while the only SU in the batch (Field Kit) was missed. The sec-

ond technician flagged all four SUs (UPASS, Quick Fix, Synthetix5, and

Dr Greens) and two substituted (water and apple cider) as “SB.”The

third technician flagged 4 out of 8 samples that either were SU or

adulterated. The technicians who correctly identified the SU samples

noted that these were yellow, clear, and odorless. Overall, six out of

nine SU samples were correctly assigned “SB”, while apple juice and

urine adulterated with 10% peroxide were missed. Results are summa-

rized in Table 1.

3.2 |Immunoassay screening

The immunoassay results were reviewed by a certified QC technician

and all the SU samples screened valid negative per the laboratory's

acceptance criteria.

3.3 |Specimen validity testing

All eight SU samples (excluding Microgenics) shipped and analyzed at

FTDTL Fort Meade were reported as “valid”or “diluted”with pH

between 5.4 and 8.1. All had creatinine >20 mg/dL except for the

“Whizzinator”(9.6 mg/dL), which was identified as diluted. Except

for Quick Fix at 3 μg/mL nitrite equivalent, all SU produced no oxidant

activity. Since SpGr was not measured for any sample with creatinine

>20 mg/dL, measurements were subsequently taken at the TAMC

Clinical Laboratory. SpGr for all SU were within normal range

(>1.0010 and ≤1.020). A summary of the results is listed in Table 2.

3.4 |Field kits

With the Sciteck Synthetic UrineCheck™, urine is supposed to turn the

test strip ranging from light yellow to dark yellow orange color. Results

are considered “abnormal”when the test strips are a pinkish color or

red. Using the Sciteck Synthetic UrineCheck™, all nine known SU sam-

ples, 8/116 (6.9%) randomly selected urine specimens and water pro-

duced “abnormal”results (Figure 2). Five of eight specimens appeared

colorless, while all SU samples that produced “abnormal”colorimetric

results with Synthetic UrineCheck™appeared yellow and clear. The

authentic urine controls produced “normal”results. When further

evaluated with AdultaCheck

6, seven out of eight SU samples pro-

duced normal results comparable to the authentic urine controls

(Figure 3). An abnormal oxidant colorimetric result was observed with

QuickFix SU (sample no. 2), but produced acceptable nitrite level

(150 μg/mL) per Sciteck acceptance criteria. None of the eight

TABLE 1 Samples identified as “suspected adulteration”(flagged) by technicians who were tasked to prepare aliquots for immunoassay

screening

Batch Number (n = total specimens) Flagged Not Flagged

1(n= 96) 5:1 Water with 10% bleach, water Field Kit (SU)

2 (n = 96) UPASS (SU), QuickFix (SU), Synthetix5 (SU),

Dr. Green's (SU), water, apple cider

3(n= 116) Microgenics (SU), Whizzinator (SU), UTAK (AU),

5:1 urine with 10% bleach

Xtreme (SU), Liquid Gold (SU), apple juice,

5:1 urine with 10% hydrogen peroxide

Abbreviations: SU (synthetic urine), AU (authentic negative urine).

TABLE 2 Validity test results of synthetic, adulterated, and authentic urine samples analyzed at the Forensic Toxicology Drug Testing Laboratory,

Fort Meade, Maryland, USA

Sample No. Description Creatinine (mg/dL) Specific Gravity pH

Oxidant Activity

(μg/mL nitrite equiv) Interpretation

1 Bleach w/water 18.6 1.0093 11.93 317 Adulterated

2 Field Kit 92.6 1.013* 7.2 0 Valid

3 UPASS 94.8 1.013* 7.2 0 Valid

4 Apple Cider Vinegar 1.1 1.0123 <2.94 0 Invalid

5 Quick Fix 21.4 1.008* 7.4 3 Valid

6 Synthetix5 61.8 1.011* 5.4 0 Valid

7 Dr. Greens 67.1 1.013* 7.7 0 Valid

8 Apple Juice 25.9 Not tested 3.63 0 Adulterated

9 UTAK 91.4 1.012* 6.5 0 Valid

10 Whizzinator 9.6 1.0014 8.1 0 Valid/Dilute

11 Xstream 58.9 1.009* 6.8 0 Valid

12 Liquid Gold 36.8 1.009* 7.8 0 Valid

13 10% peroxide (1:5) 78.2 Not tested 6.7 11 Valid

14 Donor (authentic) 39.8 Not tested 6.1 0 Valid

15 Donor (authentic) 55.2 Not tested 6.6 0 Valid

*Measurements taken separately at Tripler Army Medical Center Clinical Core Laboratory.

KIM ET AL.3

authentic urine specimens produced abnormal colorimetric results

with the AdultaCheck

6 test strips. The bleach‐adulterated urine

(sample no. 22) appeared “abnormal”for oxidant.

4|DISCUSSION

Adulteration of urine specimens is a concern for any forensic urinaly-

sis program, including the DOD military urinalysis program. The avail-

ability of SU commercially has added another avenue in which

urinalysis may be “beaten.”Whereas civilian urinalysis involves SVT

as part of the urine drug testing, DOD compensates for this by having

direct observation during urine collection. Although civilian urine

specimens undergo mandatory SVT, the rate of authentic urine substi-

tution with SU during the collection process is unknown. The imple-

mentation of SVT has assisted laboratories and medical review

officers in identifying adulterated or substituted specimens,

but

may not be sufficient for SU detection of either civilian and military

specimens.

Based on the SVT results observations, SU are formulated to con-

tain creatinine >2 μg/mL with pH between 5.5 and 7.5. This explains

why the on‐site AdultaCheck

6 strips were not able to differentiate

the SU from authentic urine. Furthermore, all the SU products

screened negative with the multi‐drug immunoassay test and SVT,

which makes them even more appealing as urine substitutes for civil-

ian urine drug testing.

Since SVT is not mandatory for service member urine specimens,

the military relies on trained technicians to identify possible adulter-

ated or substituted urine specimens by their color, odor, and other

physical characteristics. In the past, technicians have correctly

assigned “SB”to specimens due to lack of color and/or odor while

other specimens produced bubbles and sweet odor similar to hand

soap. Specimens with bleach give out a strong odor and can be easily

identified. However, repeated exposure to strong urine odor can mask

or weaken the technician's sense of smell. Thus, SU that appears as

the same color and has similar characteristics as authentic urine can

be missed in the process.

The use of direct observation in urinalysis is another viable way to

decrease the use of adulterants and SU. In the DOD forensic urinalysis

program, an observer must be present to observe the active stream of

urine leaving the donor's body. Even this does not deter substitution

of the urine in the military and direct observation is only as good as

the observers’attention to detail. This was tested by the use of

“Whizzinator,”a prosthetic penis attached to a bladder with a temper-

ature strip. We evaluated the effectiveness of the “Whizzinator”by

asking volunteers to wear the contraption under direct observation

of trained urinalysis coordinators. Two out of four observers observed

the donors wearing the device (unpublished data).

FIGURE 2 Colorimetric results of synthetic

urine (#1–9), water (#10), authentic urine

(#11–20) samples using the Scitex Synthetic

UrineCheck™[Colour figure can be viewed at

wileyonlinelibrary.com]

FIGURE 3 Colorimetric results of synthetic

urine (#1–7, 9–10), water (#13), authentic

urine (#8, 11, 12, 14–21), and urine

adulterated with bleach (#22). Sample no. 22

is 1 part bleach to 5 parts authentic urine

[Colour figure can be viewed at

wileyonlinelibrary.com]

4KIM ET AL.

Interestingly, the Synthetic UrineCheck™strips were able to dis-

criminate the SU products from authentic urine. Because the SU prod-

ucts passed as authentic urine (valid) in the SVT at Fort Meade, it is

not surprising that these products also passed for authentic urine

using the adulteration strips (AdultaCheck

6). The Synthetic

UrineCheck™strips were designed to detect artificial urine versus

authentic urine. They can be used as a qualitative tool. However,

diluted specimens could result in an abnormal reading (Figure 2) and

should be further evaluated with SVT.

Goggin et al recently proposed unique markers (antifungal, ethyl-

ene glycol, and uric acid) identified in artificial urine samples that can

be used as targets in improving the specificity of on‐site SU detection

strips or SVT designed for high throughput.

An online search of “states banning synthetic urine”reveals the

state itself can vote to ban the sale of SU, include fines, and even

make it a crime if used for cheating a drug test.

5|CONCLUSION

We determined that commercially available SU products are acceptable

authentic urine substitutes in defeating the urine drug testing. We also

strongly believe the most effective way to deter and detect adulterated

and/or SU is improving the collection process. The observer should be

made aware that bags, tubes, and prosthetic penises can be hidden

under clothes. The environment where collections are performed

should provide good visibility between the observer and the donor.

SVT still remains the most effective method in identifying adulteration

and can be further supplemented with test strips or reagents that may

discriminate between SU and authentic urine.

DISCLAIMER

The opinions or assertions herein are those of the authors and do not

necessarily reflect the views of Department of Defense, Army, Navy,

or Air Force.

ACKNOWLEDGEMENTS

Assistance and support of SA Adam Kapp (Naval Criminal Investigative

Service, Hawaii Field Office); the staff of Forensic Toxicology Drug

Testing Laboratories at Tripler Army Medical Center, HI and Fort

Meade, MD; and the staff of Army Substance Abuse Program, Schofield

Barracks, HI in the conduct of this study are greatly appreciated.

ORCID

Marisol S. Castaneto http://orcid.org/0000-0003-4426-6663

REFERENCES

1. Department of Defense Drug Reduction Program Mission Statement.

Available at: http://prhome.defense.gov/Readiness/ForceResiliency/

DDRP

2. Wu AHB, Bristol B, Sexton K, Casella‐McLane G, Holtman V, Hill DW.

Adulteration of Urine by “Urine Luck”.Clin Chem. 1999;45:1051.

3. Cody JT. Adulteration of urine specimens. In: Liu RH, BA, eds. Hand-

book of Workplace Drug Testing. Washington, D.C.: AACC Press;

1995:181.

4. Jaffee WB, Trucco E, Levy S, Weiss RD. Is this urine really negative? A

systematic review of tampering methods in urine drug screening and

testing. J Subst Abuse Treat. 2007;33:33.

5. Dagupta A. The Effects of Adulterants and Selected Ingested Com-

pounds on Drugs‐of‐Abuse Testing in Urine. Am J Clin Pathol.

2007;128:491.

6. Paul BD, Martin KK, Magluilo J, Smith ML. Effects of Pyridinium

Chlorochromate Adulterant (Urine Luck) on Testing for Drugs of Abuse

and a Method for Quantitative Detection of Chromium (VI) in Urine. J

Anal Toxicol. 2000;24:233.

7. Lin SY, Lee HH, Lee JF, Chen BH. Urine specimen validity test for drug

abuse testing in workplace and court settings. J Food and Drug Anal.

2018;26:380.

8. The Real Whizzinator. Retrieved at: http://www.realwhizzinatorxxx.

com (Accessed 12 March 2018)

9. Hawaii News Now. Synthetic urine could be covering up meth use in

Hawaii's workforce. Available at http://www.hawaiinewsnow.com/

story/35093325/synthetic‐urine‐could‐be ‐covering‐up‐meth‐use‐in‐

hawaiis‐workforce (Accessed 12 March 2018)

10. Department of the Army. The Army Substance Abuse Program AR

600–85, 2016. Available at: https://armypubs.army.mil/Search/

ePubsSearch/ePubsSearchDownloadPage.aspx?docID=

0902c85180061a0a (Accessed 12 March 2018)

11. Substance Abuse and Mental Health Services Administration. Medical

Review Officer (MRO) Resources; Medical Review Officer Guidance

Manual. 2017,3,3–3. Available at: https://www.samhsa.gov/sites/

default/files/workplace/mro‐guidance‐manual‐oct2017_2.pdf.

(Accessed 12 March 2018)

12. Goggin MM, Tann CM, Miller A, Nguyen A, Janis GC. Catching Fakes:

New Markers of Urine Sample Validity and Invalidity. J. Anal. Toxicol.

2017;41:121.

13. S. Allen. Synthetic Urine Works! Blog About Synthetic Urine. Available

at: http://syntheticurineworks.blogspot.com/search/label/News. (Ac-

cessed 12 March 2018)

How to cite this article: Kim VJ, Okano CK, Osborne CR,

Frank DM, Meana CT, Castaneto MS. Can synthetic urine

replace authentic urine to “beat”workplace drug testing?. Drug

Test Anal. 2018;1–5. https://doi.org/10.1002/dta.2497

KIM ET AL.5

A critical review of workplace drug testing methods for old and new psychoactive substances: Gaps, advances, and perspectives

Article

Full-text available

Apr 2024

Ahmed I Al-Asmari

Workplace drug testing (WDT) is essential to prevent drug abuse disorders among the workforce because it can impair work performance and safety. However, WDT is limited by many challenges, such as urine adulteration, specimen selection, and new psychoactive substances (NPS). This review examined the issues related to WDT. Various scientific databases were searched for articles on WDT for drug detection published between 1986 (when WDT started) and January 2024. The review discussed the history, importance, and challenges of WDT, such as time of specimen collection/testing, specimen adulteration, interference in drug testing, and detection of NPS. It evaluated the best methods to detect NPS in forensic laboratories. Moreover, it compared different techniques that can enhance WDT, such as immunoassays, targeted mass spectrometry, and nontargeted mass spectrometry. These techniques can be used to screen for known and unknown drugs and metabolites in biological samples. This review assessed the strengths and weaknesses of such techniques, such as their validation, identification, library search, and reference standards. Furthermore, this review contrasted the benefits and drawbacks of different specimens for WDT and discussed studies that have applied these techniques for WDT. WDT remains the best approach for preventing drug abuse in the workplace, despite the challenges posed by NPS and limitations of the screening methods. Nontargeted techniques using high-resolution liquid chromatography-mass spectrometry (MS)/gas chromatography–tandem MS can improve the detection and identification of drugs during WDT and provide useful information regarding the prevalence, trends, and toxicity of both traditional and NPS drugs. Finally, this review suggested that WDT can be improved by using a combination of techniques, multiple specimens, and online library searches in case of new NPS as well as by updating the methods and databases to include new NPS and metabolites as they emerge. To the best of the author's knowledge, this is the first review to address NPS as an issue in WDT and its application and propose the best methods to detect these substances in the workplace environment.

Advances in testing for sample manipulation in clinical and forensic toxicology - Part A: urine samples

Article

Full-text available

May 2023
ANAL BIOANAL CHEM

In many countries, adherence testing is used to monitor consumption behavior or to prove abstinence. Urine and hair are most commonly used, although other biological fluids are available. Positive test results are usually associated with serious legal or economic consequences. Therefore, various sample manipulation and adulteration strategies are used to circumvent such a positive result. In these critical review articles on sample adulteration of urine (part A) and hair samples (part B) in the context of clinical and forensic toxicology, recent trends and strategies to improve sample adulteration and manipulation testing published in the past 10 years are described and discussed. Typical manipulation and adulteration strategies include undercutting the limits of detection/cut-off by dilution, substitution, and adulteration. New or alternative strategies for detecting sample manipulation attempts can be generally divided into improved detection of established urine validity markers and direct and indirect techniques or approaches to screening for new adulteration markers. In this part A of the review article, we focused on urine samples, where the focus in recent years has been on new (in)direct substitution markers, particularly for synthetic (fake) urine. Despite various and promising advances in detecting manipulation, it remains a challenge in clinical and forensic toxicology, and simple, reliable, specific, and objective markers/techniques are still lacking, for example, for synthetic urine.

Identificación de adulteración de muestras de orina en el análisis toxicológico

Article

Full-text available

Sep 2022

p>La muestra de orina es una de las más comunes para la determinación de sustancias de interés forense en matrices biológicas debido a su poca invasividad y la relativa facilidad con que se puede realizar en ella las pruebas presuntivas y su preparación pre-analítica para los análisis confirmatorios. Sin embargo, es una muestra que fácilmente puede adulterarse por sustitución, adición de sustancias que alteran el pH, adición de sustancias oxidantes, dilución in vitro o in vivo e incluso con productos caseros como sal de mesa o ablandadores de carne, que se añaden a la muestra con la intención de afectar los resultados del análisis. A pesar de esto, existen métodos para identificar estas adulteraciones, implementar algunos de ellos de forma rutinaria en los laboratorios forenses es importante para incrementar la confiabilidad de los resultados del análisis de sustancias de interés en orina.</p

Emerging Markers and Technologies in Urine Sample Validity for Drug Detection: A Brief Review of Detection Methods and Applications

Article

Aug 2024

Ammar Adel Koujan

Urine sample validity testing is critical in medical diagnostics, forensic investigations, and workplace drug screening to ensure accurate and reliable results. The increasing sophistication of tampering methods, such as adulteration and substitution, necessitates the development of advanced testing techniques. This review explores the latest advancements in urine validity testing, including the integration of machine learning (ML) and artificial intelligence (AI) with high-resolution mass spectrometry (HRMS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). These technologies enhance the detection of novel chemical and biological markers, such as unique metabolite profiles, polyglycole patterns, and DNA methylation markers (e.g., TWIST1 and NID2). The identification of new biomarkers and the application of multi-modal analytical approaches provide comprehensive and sensitive detection of tampering. Future directions in the field focus on refining these technologies, ensuring ethical data handling, and expanding regulatory frameworks to protect privacy and enhance the reliability of testing protocols. The advancements discussed promise significant improvements in the detection and prevention of urine sample tampering, ensuring the integrity of testing processes across various applications.

Bioactive tri-component nanofibers from cellulose acetate/lignin//N-vanillidene-phenylthiazole copper-(II) complex for potential diaper dermatitis control

Article

Mar 2022
INT J BIOL MACROMOL

Current research targets innovative medical textiles of nanofibrous nature and antibacterial activity to prevent diaper dermatitis. The work is based on electrospun nanofibers from cellulose acetate (CA) and lignin (Lig) polymers. A series of new copper complexes were synthesized and loaded to the CA/Lig solution mix then subjected to electrospinning, giving rise to the tricomponent bioactive mats CA/Lig/Cu-complex. The surface morphology of electrospun nanofiber mats was smooth and homogenous as the concentration of lignin increased in the mixture. The incorporation of lignin improved the electrospinnability of the cellulose acetate; however, it increased the fiber diameter. The water contact angle, absorption underload were significantly improved as lignin content increased. The incorporation of Cu-complex in electrospun CA and CA/Lig fiber mats occurred without any substantial change in the surface morphology, indicating well encapsulation of the complex. The electrospun mats were active against Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus epidermidis, and Streptococcus faecalis. The cytotoxicity, protein leakage, and biological results, together with the above studies, would advocate copper complex loaded CA/Lig fibers as a potential candidate for hygienic applications.

Systematic web monitoring of drug test subversion strategies in the United States

Article

Mar 2024
Drug Test Anal

As negative drug tests are frequently a condition for employment, some people who use drugs will try to subvert the testing. In this study, systematic web monitoring was used to investigate how drug test subversion is discussed online. Posts pertaining to drug test subversion were obtained from public websites and the dark web ( n = 634, July–December 2021). Most information from public websites came from Twitter (65%), and 94% of dark web posts were from Reddit. The posts were manually coded to extract quantitative and qualitative information about drug test subversion tactics. Most posts discussed urine drug tests (85%), followed by hair (11%) and oral fluid (2%), and the most discussed drugs were marijuana (72%) and cocaine (7.3%). Urine drug test subversion mainly pertained to specimen substitution, with synthetic urine or urine from another person. Another strategy was to mask diluted urine by ingesting creatine. Urine adulteration was rarely discussed. Hair test subversion involved harsh treatments with products such as bleach, baking soda, and/or detergent. Hair removal was also discussed. Oral fluid test subversion focused on removing drugs from the oral cavity through vigorous brushing of teeth and tongue as well as the use of mouthwash, hydrogen peroxide, gum, and commercial detox products. This study highlights subversion strategies used by donors. Although little evidence was provided as to the effectiveness of these strategies, this information may help guide future studies and development of specimen validity testing to minimize the impact of drug test subversion attempts.

The impact of several urine adulterants on samples that test positive for Tetrahydrocannabinol using screening tests

Article

Full-text available

Jul 2023

Evaluation of Biochemical Assays and Optimization of LC-MS/MS Analysis for the Detection of Synthetic Urine

Article

Nov 2023
J ANAL TOXICOL

Ensuring specimen validity is an essential aspect of toxicological laboratories. In recent years, substituting authentic urine specimens for synthetic urine has become increasingly popular. Such synthetic urine products consist of components expected in normal urine and show physiological values for specific gravity and pH. Thus, standard specimen validity testing may fail in revealing adulteration by synthetic urine. The present study investigated three methods to distinguish authentic and synthetic urine specimens: enzymatic detection of uric acid, the commercially available Axiom Test True Synthetic Urine, and LC-MS/MS analysis of 10 endogenous biomolecules. Additionally, novel direct markers of synthetic urine were investigated. Two specimen sets were analyzed by each method. Specimen set A consisted of 8 synthetic urine products purchased from the Austrian/German market and 43 urine specimens from volunteers of known authenticity, which underwent double-blind analysis. Specimen set B consisted of 137 real urine specimens submitted for drug testing, which were selected due to initial suspicious test results in adulteration testing and reanalyzed by all three methods. Uric acid and LC-MS/MS-based endogenous biomolecule testing showed 100% sensitivity and specificity for set A. The commercial test had 87.5% sensitivity and 97.7% specificity for set A. For set B, uric acid and LC-MS/MS analysis showed almost similar results, even if uric acid was missing one presumptive authentic urine specimen according to LC-MS/MS findings. Nearly half of the synthetic urine assignments for the commercial test were presumptive false positives. New synthetic urine markers were observed for synthetic urine products from the Austrian/German market. One specimen in set B had both endogenous biomolecule pattern and synthetic urine markers suggesting urine dilution with synthetic urine. In conclusion, several analytes or methods should be used rather than one, and the most reliable results are achieved if both indirect and direct markers of urine substitution are analyzed.

Knowledge and Compliance among Staff Nurses in Collecting Urine Culture from Patients on Indwelling Catheter in A Medical Ward

Article

Full-text available

Oct 2022

Urine specimens can easily be contaminated by microbes in the genital area, which often leads to false positive results and antibiotic over-prescriptions. This study aimed to evaluate nurses’ knowledge and compliance regarding urine collection with an indwelling catheter in a medical ward. A total of 101 registered nurses participated in this study from September 2020 to January 2021 at the Hospital Raja Perempuan Zainab II (HRPZII). A total of 118 nurses participated in this study. Generally, the nurses had sufficient knowledge of the correct urine specimen handling. Cramer’s V analysis showed a moderate association between hand hygiene knowledge and practice among the nurses (φc: 0.273, p = 0.046). In addition, the knowledge and practice of decontaminating continuous bladder drainage areas displayed a relatively moderate association (p = 0.01). While most nurses showed knowledge of the contamination preventive measures, initiatives should be taken so that all nurses would be more likely to comply with the recommended procedure and reduce specimen contamination.

Update on Urine Adulterants and Synthetic Urine Samples to Subvert Urine Drug Testing

Article

May 2022

To avoid a positive urine drug test, donors might try to subvert the test; either by adulterating the specimen with a product designed to interfere with testing, or by substituting the specimen for a synthetic urine. A market search conducted in December of 2020 identified three adulterants and 32 synthetic urines, and a selection was procured based on specific criteria. Samples prepared with the three adulterants and ten synthetic urines were submitted for testing at five forensic drug testing laboratories to perform immunoassay screening, chromatographic confirmation analysis, and specimen validity testing (SVT). One adulterant determined to contain iodate reduced THC-COOH concentrations by 65% and the concentrations of 6-acetylmorphine, morphine, oxycodone, oxymorphone, hydrocodone and hydromorphone by 6-27%. Another adulterant determined to contain nitrites reduced THC-COOH concentrations by 22%, while the third did not affect drug screening or confirmatory testing. Both active adulterants could be identified through positive oxidant screens, as well as through signal suppression in cloned enzyme donor immunoassay (CEDIA). The synthetic urines could not be identified through traditional SVT, nor by the AdultaCheck10 dipstick. The Synthetic UrineCheck dipstick produced a difference in response between the authentic urine specimen and the synthetic urine samples, but the difference was small and difficult to observe. While most synthetic urines now contain uric acid, magnesium and caffeine, results indicated that a biomarker panel including endogenous and exogenous markers of authentic urine performed well and clearly demonstrated the absence of biomarkers in the synthetic urines. The SVT assay also offers potential targets for future screening assays.

Urine specimen validity test for drug abuse testing in workplace and court settings

Article

Full-text available

Feb 2017
J FOOD DRUG ANAL

In recent decades, urine drug testing in the workplace has become common in many countries in the world. There have been several studies concerning the use of the urine specimen validity test (SVT) for drug abuse testing administered in the workplace. However, very little data exists concerning the urine SVT on drug abuse tests from court specimens, including dilute, substituted, adulterated, and invalid tests. We investigated 21,696 submitted urine drug test samples for SVT from workplace and court settings in southern Taiwan over 5 years. All immunoassay screen-positive urine specimen drug tests were confirmed by gas chromatography/mass spectrometry. We found that the mean 5-year prevalence of tampering (dilute, substituted, or invalid tests) in urine specimens from the workplace and court settings were 1.09% and 3.81%, respectively. The mean 5-year percentage of dilute, substituted, and invalid urine specimens from the workplace were 89.2%, 6.8%, and 4.1%, respectively. The mean 5-year percentage of dilute, substituted, and invalid urine specimens from the court were 94.8%, 1.4%, and 3.8%, respectively. No adulterated cases were found among the workplace or court samples. The most common drug identified from the workplace specimens was amphetamine, followed by opiates. The most common drug identified from the court specimens was ketamine, followed by amphetamine. We suggest that all urine specimens taken for drug testing from both the workplace and court settings need to be tested for validity.

The Effects of Adulterants and Selected Ingested Compounds on Drugs-of-Abuse Testing in Urine

Article

Full-text available

Oct 2007

Amitava Dasgupta

Household chemicals such as bleach, table salt, laundry detergent, toilet bowl cleaner, vinegar, lemon juice, and eyedrops are used for adulterating urine specimens. Most of these adulterants except eyedrops can be detected by routine specimen integrity tests (creatinine, pH, temperature, and specific gravity); however, certain adulterants such as Klear, Whizzies, Urine Luck, and Stealth cannot. These adulterants can successfully mask drug testing if the concentrations of certain abused drugs are moderate. Several spot tests have been described to detect the presence of such adulterants in urine. Urine dipsticks are commercially available for detecting the presence of such adulterants, along with performance of tests for creatinine, pH, and specific gravity. Certain hair shampoo and saliva-cleaning mouthwashes are available to escape detection in hair or saliva samples, but the effectiveness of such products in masking drugs-of-abuse testing has not been demonstrated. Ingestion of poppy seed cake may result in positive screening test results for opiates, and hemp oil exposure can cause positive results for marijuana. These would be identified as true-positive results in drugs-of-abuse testing even though they do not represent the actual drug of abuse.

Catching Fakes: New Markers of Urine Sample Validity and Invalidity

Article

Nov 2016
J ANAL TOXICOL

Urine drug testing is common for workplace drug testing, prescription management, emergency medicine and the criminal justice system. Unsurprisingly, with the significant consequences based upon the results of urine drug testing, a donor in need of concealing the contents of their sample is highly motivated to cheat the process. Procedures and safeguards ensuring sample validity are well known, and include measuring sample temperature at the time of collection, and laboratory measurements of creatinine, specific gravity and pH. Synthetic urine samples are available and are designed to deceive all aspects of urine drug testing, including validity testing. These samples are sophisticated enough to contain biological levels of creatinine, and are at a physiological pH and specific gravity. The goal of our research was to develop new procedures designed to distinguish authentic samples from masquerading synthetic samples. We aimed to identify substances in commercial synthetic urines not expected to be present in a biological sample distinguishing fake specimens. Additionally, we aimed to identify and employ endogenous compounds in addition to creatinine for identifying biological samples. We successfully identified two compounds present in synthetic urines that are not present in biological samples and use them as markers of invalidity. Four new endogenous markers for validity were successfully evaluated. Validity assessment was further aided by monitoring metabolites of nicotine and caffeine. When the method was applied to patient samples, 2% of samples were identified as inconsistent with natural urine samples, even though they met the current acceptance criteria for creatinine, pH and specific gravity.

Workplace Drug Testing

Chapter

Dec 2015

It is now recognized that workplace drug testing is a complex interdisciplinary science, with the choice of the sample to use in drug testing depending on the purpose of the testing. Where it is necessary to ensure that no employee is working under the influence of drugs, urine or oral fluid samples can be used, whereas hair as a sample for drug testing allows a long-term historical window of the subject’s drug use. This window is extremely useful for recruitment decisions, as it enables drug users to be excluded when their drug use would be incompatible with their activities were they are to be employed. Guidelines for drug testing using hair samples do exist, covering sample collection, advice as to suitable analytical procedures, and best practice in interpreting results. These ensure that all users, whether an individual or a large organization, can clearly understand the potentials of drug testing in hair.

Adulteration of urine by ‘Urine Luck

Article

Aug 1999

In vitro adulterants are used to invalidate assays for urine drugs of abuse. The present study examined the effect of pyridinium chlorochromate (PCC) found in the product "Urine Luck". PCC was prepared and added to positive urine controls at concentrations of 0, 10, 50, and 100 g/L. The controls were assayed for methamphetamine, benzoylecgonine (BE), codeine and morphine, tetrahydrocannabinol (THC), and phencyclidine (PCP) with the Emit II (Syva) and Abuscreen Online (Roche) immunoassays, and by gas chromatography/mass spectrometry (GC/MS). Two tests were also developed to detect PCC in urine: a spot test to detect chromate ions using 10 g/L 1,5-diphenylcarbazide as the indicator, and a GC/MS assay for pyridine. We tested 150 samples submitted for routine urinalysis, compliance, and workplace drug testing for PCC, using these assays. Response rates decreased at 100 g/L PCC for all Emit II drug assays and for the Abuscreen morphine and THC assays. In contrast, the Abuscreen amphetamine assay produced apparently higher results, and no effect was seen on the results for BE or PCP. The PCC did not affect the GC/MS recovery of methamphetamine, BE, PCP, or their deuterated internal standards, but decreased GC/MS recovery of the opiates at both intermediate (50 g/L) and high (100 g/L) PCC concentrations and apparent concentrations of THC and THC-d3 at all PCC concentrations. Two of 50 samples submitted for workplace drug testing under chain-of-custody conditions were positive for PCC, whereas none of the remaining 100 specimens submitted for routine urinalysis or compliance drug testing were positive. PCC is an effective adulterant for urine drug testing of THC and opiates. Identification of PCC use can be accomplished with use of a spot test for the oxidant.

Effects of Pyridinium Chlorochromate Adulterant (Urine Luck) on Testing for Drugs of Abuse and a Method for Quantitative Detection of Chromium (VI) in Urine

Article

May 2000

Pyridinium chlorochromate (PCC) as an adulterant is popular for concealing drug-positive results. When 11-nor-Δ9-THC-9-carboxylic acid (THC-acid) in urine was treated with 2 mmol/L of PCC (Cr6+ 104 pg/mt), 58–100% of the THC-acid was lost. The loss increased with decreasing pH and increasing reaction time (0–3 days). Free codeine and free morphine remained unaffected by PCC at pH within the physiological range of the urine (pH 5–7). At lower pH, the loss of free morphine varied from 0 to 100%. Amphetamine, methamphetamine, benzoylecgonine, and PCP remained unaffected by PCC when exposed to the oxidant for three days in urine pH of 3–7. Chromium (VI) from PCC in a urine solution was detected by a color reaction with 1,5-diphenylcarbazide (DPC). When the reagent was added to the urine, an immediate red-violet color appeared. The chromium-DPC complex showed a characteristic absorption peak at wavelength 544 nm with a shoulder at wavelength 575 nm. The ratio of absorption was used to identify the chromium compound. The concentration of chromium (VI) was determined by measuring absorption at wavelength 544 nm and was linear over 0.5–20 µg/mL. The limit of detection of the procedure was 0.37 µg/mL.

Is This Urine Really Negative? A Systematic Review of Tampering Methods in Urine Drug Screening and Testing

Article

Aug 2007
J SUBST ABUSE TREAT

Adulterants and urine substitutes that are designed to defeat drug tests are readily available and can be easily researched or purchased over the Internet. Utilizing Google, PsychInfo, and Medline, we searched the Internet and psychiatric and medical literature to identify a comprehensive list of products, compounds, and methods of urine tampering, as well as data on their efficacy. These products, compounds, and methods are described, and literature on their effectiveness in masking drug use is reviewed. Additionally, we identify and review methods for detecting tampering of urine screens and tests. It is recommended that clinicians and researchers involved in urine drug screening and testing consider the possibility of tampering when designing treatment programs and research protocols and employ methods to detect its occurrence when appropriate.

Synthetic urine could be covering up meth use in Hawaii's workforce

Hawaii News Now

Hawaii News Now. Synthetic urine could be covering up meth use in Hawaii's workforce. Available at http://www.hawaiinewsnow.com/ story/35093325/synthetic-urine-could-be-covering-up-meth-use-inhawaiis-workforce (Accessed 12 March 2018)

Synthetic Urine Works! Blog About Synthetic Urine

Mar 2018

S Allen

S. Allen. Synthetic Urine Works! Blog About Synthetic Urine. Available at: http://syntheticurineworks.blogspot.com/search/label/News. (Accessed 12 March 2018)