Urine Drug Testing
When an employer requests a drug test from an employee the employee is typically instructed to go to a collection site. The employee’s urine is collected at a remote location in a specially designed secure cup, sealed with a tamper resistant tape, and sent via express delivery service to a testing laboratory to be screened for drugs (typically SAMHSA 5 panel).
The first step at the testing site is to split the urine into two aliquots. One aliquot is first screened for drugs using an analyzer that performs immunoassay as the initial screen. If the urine screen is positive then another aliquot of the sample is used to confirm the findings by gas chromatography – mass spectroscopy (GC-MS) methodology. All test results are relayed to an MRO (Medical Review Office) where a medical physician reviews the results. If the result of the screen is negative, the MRO informs the employer that the employee has no detectable drug in the urine. However, if the test result of the immunoassay and GC-MS are non-negative and show a concentration level of parent drug or metabolite above the established limit, the MRO contacts the employee and to determine if there is any legitimate reason – such as a medical treatment or prescription.
About 5% of the all pre-employment urine samples tested in the U.S. turn out positive for drugs. The percentages are much higher for post-accident and/or reasonable suspicion testing.
The efficacy of urine testing is debatable due to systematic cheating (adulteration and/or substitution of the specimen). Sample substitution and adulteration occur frequently, and both are effective methods of avoiding would-be positive tests. While most laboratories performing drug screens test for adulterants routinely, they can not keep pace with the various forms of adulterants available. [14]
Adulterants can be classified into two categories. The first category includes classic adulterants comprising household substances and other chemicals such as chlorine bleach, liquid drain cleaner, white vinegar, glutaraldehyde, sodium nitrite, and pyridinium chlorochromate. The second category includes commercial adulterants, which can be purchased from certain specialty stores (so-called “head shops”), through magazine advertisements, or via the Web. This second class of adulterants includes brand names such as Urine Luck version 6.3, Stealth, Clean-X, Klear, Purafyzit, Instant Clean, Krystal Kleen, and UR’n Kleen. Some of the commercial adulterants represent a repackaging of classic adulterants. One adulterant, for example, Klear, is made of nitrite and affects the tetrahydrocannibinol (THC) confirmation process but not the immunoassay process. Urine Luck 6.3 is actually hydrofluoric acid, which is an oxidant not generally available in the classic adulterants category because of its corrosive nature. Stealth is an enzyme system that generates hydrogen peroxide.
Abusers can also drink 1 to 2 liters of water to successfully dilute the concentration of drug metabolites in their urine below detectable thresholds, without risking detection. While this results in clear samples that may be rejected on the grounds of being too dilute, the practice is typically successful. A B vitamin will make urine yellow despite this practice of waterloading. Specific gravity testing can be done to identify whether or not the sample is of dilute nature. Vitamin B3 (niacin) is also frequently used for its reported “flushing” effect, though this is also of disputable adeptness.
Adulteration tests can detect the use of some of these “detox” products. Adulteration tests analyze the properties of the urine to identify if the sample is abnormal. Such properties include the pH and specific gravity of the urine. They also test the level of creatinine, nitrite, glutaraldehyde, specific gravity, bleach and pyridinium chlorochromate.
Also, the wide availability of at-home drug screens allows an individual to take their own test before they receive one, thus knowing the results ahead of time – giving the user further opportunity to dilute the sample or to find a substitute.
New regulations from the U.S. Department of Transportation are requiring that specimens which indicate a low temperature or show signs of adulteration be admitted with a second specimen from the donor, which is collected under direct observation. That is, the donor voids in full view of the collector or observer. The new regulations also require that the donor raise and lower clothing and turn around in front of the collector or observer to show that the donor is not in possession of any device or substance with intent to falsify the test. In several states, it is illegal to sell or possess such a device or substance.