Immunochromatographic strips for urine drug screening tests (UDSTs) are common and very suitable for drug abuse monitoring, but are also highly susceptible to adulterants kept in the household, which can significantly alter test results. The aim of this study was to see how some of these common adulterants affect UDST results in practice and whether they can be detected by sample validity tests with pH and URIT 11G test strips. To this end we added household chemicals (acids, alkalis, oxidizing agents, surfactants, and miscellaneous substances) to urine samples positive for amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), tetrahydrocannabinol, heroin, cocaine, or benzodiazepines (diazepam or alprazolam) and tested them with one-component immunochromatographic UDST strips. The UDST for cocaine resisted adulteration the most, while the cannabis test produced the most false negative results. The most potent adulterant that barely changed the physiological properties of urine specimens and therefore escaped adulteration detection was vinegar. Besides lemon juice, it produced the most false negative test results. In conclusion, some urine adulterants, such as vinegar, could pass urine specimen validity test and remain undetected by laboratory testing. Our findings raise concern about this issue of preventing urine tampering and call for better control at sampling, privacy concerns notwithstanding, and better sample validity tests.
4. Ministry of Health of the Republic of Serbia, Institute of Public Health of Serbia “Dr Milan Jovanović-Batut”, European School Project on Alcohol and other Drugs. European Survey on the use of Alcohol and Other Drugs among young people in Serbia, 2008 [displayed 18 March 2020]. Available at http://www.batut.org.rs/download/publikacije/ESPAD%20eng%202008.pdf
5. Standridge JB, Adams SM, Zotos AP. Urine drug screening: a valuable office procedure. Am Fam Physician 2010;81:635–40. PMID: 20187600
6. Manchikanti L, Atluri S, Trescot AM, Giordano J. Monitoring opioid adherence in chronic pain patients: tools, techniques, and utility. Pain Physician 2008;11(Suppl 2):S155–80. PMID: 18443638
7. Schulberg M, Gerostamoulos D. Urinary drug screening. Aust Prescr 2013;36:62–4. doi: 10.18773/austprescr.2013.051
8. Tominaga M, Michiue T, Maeda H. Evaluation of the on-site immunoassay drug-screening device Triage-TOX in routine forensic autopsy. Leg Med (Tokyo) 2015;17:499–502. doi: 10.1016/j.legalmed.2015.10.007
9. Moriya F. Urine levels of drugs for which Triage DOA screening was positive. Leg Med (Tokyo) 2009;11(Suppl 1):S434–6. doi: 10.1016/j.legalmed.2009.01.090
10. Gomolka E. Immunoassay in toxicology diagnosis. In: Abuelzein E, editor. Trends in immunolabelled and related techniques. Rijeka: InTech; 2012. p. 67–82.
11. 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;33:33–42. doi: 10.1016/j.jsat.2006.11.008
12. Zimbardi G. Workplace substance use, the risk of occupational injury, and testing [dissertation]. Pittsburgh: University of Pittsburgh; 2005.
13. Riahi-Zanjani B. False positive and false negative results in urine drug screening tests: tampering methods and specimen integrity tests. PhOL 2014;1:102–8.
14. Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc 2008;83:66–76. doi: 10.4065/83.1.66
15. Schütz H, Erdmann F, Verhoff MA, Weiler G. Pitfalls of toxicological analysis. Leg Med (Tokyo) 2003;5(Suppl 1):S6–19. doi: 10.1016/s1344-6223(02)00084-6
16. Cone EJ, Lange R, Darwin WD. In vivo adulteration: excess fluid ingestion causes false-negative marijuana and cocaine urine test tesults. J Anal Toxicol 1998;22:460–73. doi: 10.1093/ jat/22.6.460
17. Conel EJ, Caplan YH, Moser F, Robert T, Shelby MK, Black DL. Normalization of urinary drug concentrations with specific gravity and creatinine. J Anal Toxicol 2009;33:1–7. doi: 10.1093/jat/33.1.1
18. Dasgupta A. The effects of adulterants and selected ingested compounds on drugs-of-abuse testing in urine. Am J Clin Pathol 2007;128:491–503. doi: 10.1309/FQY06F8XKTQPM149
19. USA Federal Register. Mandatory guidelines for federal workplace drug testing programs using urine specimens, Subpart H - Urine Specimen Collection Procedure. Federal Register Vol. 80, No. 94, 2015.
21. Rahdert E, Czechowicz D. Adolescent Drug abuse: Clinical Assessment and Therapeutic Interventions. NIDA Research Monograph 156. Rockville: National Institute on Drug Abuse Research; 1995.
22. Washio Y, Fairfax-Columbo J, Ball E, Cassey H, Arria A, Bresani E. A review of guidelines on home drug testing websites for parents. J Addict Med 2014;8:258–63. doi: 10.1097/ ADM.0000000000000042
23. Roškar R, Sollner Dolenc M. Determination of benzodiazepines in urine via benzophenone derivatives using liquid chromatography-tandem mass spectrometry. Arh Hig Rada Toksikol 2010;61:381–8. doi: 10.2478/10004-1254-61-2010-2058
24. Schwarzhoff R, Cody J. The effects of adulterating agents on FPIA analysis of urine for drugs of abuse. J Anal Toxicol 1993;17:14–7. doi: 10.1093/jat/17.1.14
25. Cody J, Schwarzhoff R. Impact on adulterants on RIA analysis of urine for drugs of abuse. J Anal Toxicol 1989;13:277–84. doi: 10.1093/jat/13.5.277
26. Mikkelsen S, Ash O. Adulterants causing false negatives in illicit drug testing. Clin Chem 1988;34:2333–6. PMID: 3052928
27. Warner A. Interference of common household chemicals in immunoassay methods for drugs of abuse. Clin Chem 1989;35:648–51. PMID: 2539273