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

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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.
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RESEARCH ARTICLE
Can synthetic urine replace authentic urine to beatworkplace
drug testing?
Victor J. Kim
1
|Catherine K. Okano
1
|Caroline R. Osborne
1
|Deanna M. Frank
1
|
Christopher T. Meana
2
|Marisol S. Castaneto
1
1
Tripler Army Medical Center Forensic
Toxicology Drug Testing Laboratory, Hono lulu,
Hawaii, USA
2
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 (MCHKFT) Tripler Army Medical
Center, HI 968595000, 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 foola 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 Onsite 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 determilitary
and civilian personnel from abusing illicit drugs and misusing prescrip-
tion drugs.
1
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-
tivefederal record.
Due to the possibility of adverse actions, service members may
attempt to beatthe 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.
8
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).
9
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.
10
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.
11
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;15. 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 inhouse drugfree
SU from Microgenics (Fremont, CA, USA) were evaluated. For compar-
ison, five adulterated or substituted samples were prepared. Adulter-
ated/substituted drugfree 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. Onsite synthetic urine (Synthetic UrineCheck) and adulter-
ation strips (Sciteck AdultaCheck
®
6) were provided by Sciteck (www.
sciteck.org).
2.1 |Specimen Accessioning
All authentic deidentified 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 SBdiscrep-
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 cutoff concentrations for damphetamine
(500 ng/mL), benzodiazepines (oxazepam, 200 ng/mL), cocaine
(benzoylecgonine, 150 ng/mL), heroin (6acetylmorphine, 10 ng/mL),
delta9tetrahydrocannabinol (11nordelta9tetrahydrocannabinol
9carboxylic acid 50 ng/mL), opiates (morphine 300 ng/mL and
2000 ng/mL), synthetic opioids (oxymorphone/hydrocodone 300 ng/
mL), and synthetic cannabinoids (JWH018 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 diluteif
creatinine is 2 mg/dL and <20 mg/dL, and specific gravity (SpGr) is
>1.0010 and < 1.0030. A specimen is considered substitutedif 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 onsite 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 UrineCheckwere 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
UrineCheckand AdultaCheck
®
6. An adulterated sample with 1:5
bleach:urine was tested with the AdultaCheck
®
6.
FIGURE 1 Synthetic urine (SU) specimens
purchased at the local smokeshops, Oahu,
Hawaii. Top row (LR): Quick Fix, Field Kit, Dr
Green's X Agent; Bottom row (LR): 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 validor dilutedwith 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 abnormalwhen 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 abnormalresults (Figure 2). Five of eight specimens appeared
colorless, while all SU samples that produced abnormalcolorimetric
results with Synthetic UrineCheckappeared yellow and clear. The
authentic urine controls produced normalresults. 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 bleachadulterated urine
(sample no. 22) appeared abnormalfor 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,
11
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 onsite AdultaCheck
®
6 strips were not able to differentiate
the SU from authentic urine. Furthermore, all the SU products
screened negative with the multidrug 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 SBto 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 observersattention 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 Whizzinatorby
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 (#19), water (#10), authentic urine
(#1120) samples using the Scitex Synthetic
UrineCheck[Colour figure can be viewed at
wileyonlinelibrary.com]
FIGURE 3 Colorimetric results of synthetic
urine (#17, 910), water (#13), authentic
urine (#8, 11, 12, 1421), 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 UrineCheckstrips 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
UrineCheckstrips 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 onsite SU detection
strips or SVT designed for high throughput.
12
An online search of states banning synthetic urinereveals 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.
13
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
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How to cite this article: Kim VJ, Okano CK, Osborne CR,
Frank DM, Meana CT, Castaneto MS. Can synthetic urine
replace authentic urine to beatworkplace drug testing?. Drug
Test Anal. 2018;15. https://doi.org/10.1002/dta.2497
KIM ET AL.5
... The use of urine analytics for drug screening purposes has been on a continuous rise since the federal government mandated the screening of all federal employees in 1988. 1 As is often the case, the market to evade this screening protocol, or create a false-negative, has seen a similar growth. [1][2][3] This case report focused on synthetic urines while on buprenorphine and outlines the numerous ways in which a patient attempted to use synthetic urine to create a false negative on her urine drug screen. ...
... Products available include The Whizzinator™, The Urina-tor™, and Butt Wedge. [1][2][3] The Whizzinator™ employs a prosthetic penis to excrete urine. The Urinator™ has a container strapped to the body with a heating unit and a tube placed near the urethra. ...
... Various methods to detect tampered samples have been described in literature [14][15][16][17] and are now used in toxicology laboratories to identify manipulated samples [14,18,19]. Drug testing clinical laboratories use synthetic urine to make controls, which are unfortunately now commercially sold and can be used to "fool" a positive drug test [14,20]. ...
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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.
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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.
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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.
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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.
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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
  • S Allen
S. Allen. Synthetic Urine Works! Blog About Synthetic Urine. Available at: http://syntheticurineworks.blogspot.com/search/label/News. (Accessed 12 March 2018)