Adulterant Tests

“beating the test”

Beating the drug test is a game that is being played with increasing ingenuity, as drug testing becomes a bigger part of peoples' daily lives. There are nearly as many strategies being employed to beat the test, as there are reasons to interfere in the testing process. There has been a rapid proliferation of internet web sites containing information about drug testing policies and procedures as well as advice on techniques and products that might help a drug user avoid detection. Unions and civil rights groups circulate information though trade journals and other publications. Probably the most active, if not always accurate, method of sharing information is the drug users' grapevine.

It takes constant vigilance for drug testing laboratories to stay current and maintain systems that can detect attempts to thwart the testing process. SRL assesses the potential for adulteration by observing specimen appearance in addition to testing for three indicators of specimen quality:

1. Creatinine: a metabolic byproduct of muscle metabolism, which is excreted into the urine at a relatively constant rate by the kidneys. Its measurement gives an indication of the relative dilution of the urine.
2. pH: a measure of the specimen's relative acidity or alkalinity.
3. Nitrite: a test for a commercially available adulterant product known as "Whizzies" or "Klear".
4. Specific Gravity: a measure of dissolved solids in the specimen, which gives additional information as to the relative dilution of a urine.
5. Physical Inspection: visual and olfactory observations are made on each specimen to detect the presence of abnormal constituents (i.e., bleach, soap, etc.).

The human body is a remarkably efficient machine. A healthy, reasonably well-nourished and hydrated person with normal kidney function will produce urine with fairly predictable characteristics. The kidneys are designed to maintain a proper fluid and electrolyte balance, as well as eliminating certain metabolic waste products from the body. A normal, healthy urine specimen will have a slightly acid to neutral pH (5.0 - 7.0), a specific gravity of 1.015 ± .005 and a creatinine of 50 - 350 mg/dL. We can measure these parameters and use the results to establish the likelihood that a specimen might be less than ideal for assessing an individual's drug free status.

Selling products designed to beat drug testing is an ever-expanding business. The products are of two general classes: products sold as cleansing or purification agents which are intended for consumption and products that are meant to be added directly to a specimen to cause interference in the testing processes. While it would be impossible to develop assays that could detect every conceivable adulterant product available, it is possible to use our knowledge of human physiology to include tests that will improve our ability to flag specimens that are potentially unreliable for monitoring drug use.

SO WHAT DOES THIS MEAN TO ME?

First, the most effective way to beat a drug test is to know when a specimen is scheduled for collection. Most drugs have a relatively short window of detection. There are some exceptions, but a person who is able to abstain from drug use for about 48 to 72 hours has a good chance of passing a drug test, thus allowing a person to continue to use drugs sporadically without detection. This is a risky strategy since it takes a great deal of planning and self-control to successfully maintain a pattern of use without eventually getting caught.

The second most effective method of avoiding detection is by dilution of the specimen, either by directly adding water to the specimen, or by consuming excessive amounts of fluid. The body will recognize excessive fluid intake and eliminate this unneeded fluid through the kidneys, resulting in a urine specimen that is mostly water. Either method of dilution will be detected by measuring urinary creatinine. A creatinine level less than 20 mg/dL is very unlikely in a normally hydrated individual with normal kidney function and would indicate some degree of dilution. Likewise, a specimen with a specific gravity below 1.003 is too dilute to be accepted as a reliable indicator of drug free status and will be flagged as a potentially compromised sample.

Most of the products on the market that are taken internally rely on the individual knowing when a test is scheduled. Although these products are very diverse in formulation, ranging from herbal teas such as Golden Seal to elaborate combinations of carbohydrates, gelatins and other substances, they all share common instructions for use.

These instructions include avoiding "partying" or exposure to "toxins" for at least 48 hours and consuming the product with large amounts of water (up to a gallon) within a specified time period prior to giving the specimen. The goal of these products is to reduce drug levels below detection limits by a combination of abstinence and dilution. Creatinine and specific gravity measurements and random, unpredictable collection schedules are effective tools in combating this strategy.

It is important to note that there is no component in any of the known products intended for internal use, including vinegar, pickle juice, bleach, vitamins, etc., that is capable of binding drugs, neutralizing them, or otherwise interfering in any of the testing processes in use at SRL. However, there are some newer products that contain ingredients that will allow internal dilution of the specimen while at the same time protecting the sample from tripping the automatic adulteration flags. These products contain significant amounts of sugars, which could exceed renal thresholds, causing the specific gravity reading to register in the acceptable range. They also contain Creatine to influence creatinine levels and B vitamins to produce a yellow color so that creatinine or sample appearance will also be less reliable indicators of sample dilution.

There are a wide variety of substances that are introduced into a specimen, hoping to directly interfere with the testing process's ability to detect a drug. These include any cleaning products (cleansers, bleach, liquid hand soap, etc.) or other substances that are available in the collection room. Any thing that is carried into a collection room such as perfume or cologne, Visine®, contact lens solutions, salt, sugar, etc. could be added to the specimen. Commercially available adulterant products, most of which are sold in liquid form in small vials, can easily be concealed. The amount of liquid added to the specimen is usually small enough that it won't significantly affect the temperature or appearance of the specimen. The list of potential adulterants is only limited by access and the imagination and ingenuity of the donor. The most effective deterrents to these tactics include keeping the collection room clear of potential adulterants; not allowing coats, sweaters, purses, bags, children, etc. in the collection room; using temperature indicators on collection vessels; careful examination of the specimen; using observed collections; etc.

The drug screening assays in use at SRL are fairly robust and are generally able to detect drugs even in the presence of foreign materials at moderate levels. Many of the products on the market, especially the soap-based products will produce certain false positive results in our assays. These products can often be recognized by their unique result pattern. Some of these products may affect a specimen enough to be detectable by pH or other types of tests, but most will be detected by the unique manner in which they interfere with the testing processes. For instance, nitrite-containing products don't affect the screening assays, but interfere in a unique manner in the confirmation assays.

HOW DO I INTERPRET THE RESULTS FOR THESE TESTS?

pH: (Range is 3.5 to 11.0)

Any result less than 3.5 or greater than 11.0 is physiologically improbable and indicates adulteration. Normal dietary intake is unlikely to produce a urine pH of less than 4.5. Certain physiological conditions such as urinary tract infection can produce alkaline urines in the range of 8.0 to 9.5. It is not uncommon for urines that have remained at room temperature for an extended period of time before testing to demonstrate an elevated pH.

Nitrite:

A positive Nitrite result indicates a strong probability of adulteration of the sample with a nitrite-containing compound.

Creatinine:

Any result below 20 mg/dL indicates specimen dilution, either from excessive fluid intake or addition of water to the specimen. When a sample is less than 20 mg/dL, a specific gravity test will also be performed as a confirmation test for dilution. When the creatinine is less than 20 mg/dL and the specific gravity is less than 1.003 the specimen by definition is considered to be dilute and will be indicated as such on the report.

Any result greater than 400 indicates a relatively concentrated specimen and typically will not affect the drug testing process, but could also indicate a medical problem. Increased values can be due to physiological reasons as simple as dehydration to more serious problems such as kidney disease.

Specific Gravity:

Any result less than 1.003 is proof of specimen dilution, either from excessive fluid intake or addition of water to the specimen. When a sample is this dilute it cannot be used to assess an individual's drug free status. Diseases that result in low specific gravity (loss of the ability to concentrate urine) are rare and not likely to be encountered in an out patient population.

Any result greater than 1.030 indicates a potential sample integrity problem, but could also indicate a medical problem. Elevated specific gravity in an adulterated specimen is generally an indication that a physical solid such as salt or sugar has been added to the sample. This could also indicate the substitution of something other than urine for the specimen. Increased values can be due to physiological reasons as simple as dehydration to more problems such as diabetes or kidney disease.

Any result greater than 1.036 is physiologically improbable. They may be encountered after certain medical procedures such as an IVP due to the elimination of products used in the procedure, but generally are not related to any physiological causes, indicating a strong probability of specimen adulteration.

SUMMARY - Some Important Considerations

• Adulteration tests are measurements of physical characteristics of a urine sample that will help detect atypical specimens. They are not absolute proof of intentional specimen adulteration.
• A low creatinine (<20 mg/dL) in combination with a low specific gravity (< 1.003) is the only finding that will invalidate a negative test result. This combination indicates that the specimen is primarily water, either because water has been added directly to the specimen or because of excessive fluid intake.
• All other out of range values or a positive response in the nitrite assay indicates that a specimen is compromised in some manner. This could be due to physiological problems, hygiene issues, specimen substitution, or foreign substances being added to the specimen.
• These flagged results do not automatically invalidate the other test values. Confirmed positive results should be considered valid.
• Any flagged result is cause for concern. Some follow-up is always indicated with persistent out of range values. This may include such steps as consulting a health provider, counseling on health issues, or more monitoring subsequent collections.

---