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Adulterants causing false
negatives in illicit drug testing.
Mikkelsen SL, Ash KO
Department of Pathology, University of Utah School
of Medicine, Salt Lake City 84132.
Illicit-drug users may attempt to falsify results by
in vitro adulteration of specimens. We investigated
eight additives (NaCl, Visine, handsoap, Drano,
bleach, vinegar, golden-seal tea, and lemon juice)
claimed by drug users to invalidate enzyme
immunoassay (EIA) drug assays. We also analyzed
adulterated urine specimens to determine if they
could be identified, adding adulterants at several
concentrations to 222 EIA-positive specimens
confirmed by gas chromatography and mass
spectrometry (GC/MS) to contain illicit drugs. To
identify adulterated urines, we monitored pH,
relative density, and urine color and turbidity at
adulterant concentrations that falsified EIA
results. Specimens contaminated with NaCl had
relative densities greater than 1.035. Liquid Drano,
bleach, and vinegar shifted urine pH outside the
physiological range. Golden-seal tea caused a dark
appearance, and specimens containing liquid soap
were unusually cloudy. Lemon juice had no effect on
the assays. Visine was the only adulterant not
detected. The adulterants interfered somewhat
differently with each of the drug assays. EIA assays
for illicit drugs can be invalidated by specimen
adulteration producing false-negative results.
Therefore, if urine drug testing is to be conducted,
pH, relative density, and appearance should be
assessed and suspect specimens should be rejected.
Not all adulterants can be detected, so observed
collection is strongly recommended.
PMID: 3052928, UI: 89029118
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