Testing for Synthetic Urine
Synthetic Urine - What is it, how widespread is it and how to deal with it.
What is It?
Workplace Health and Safety Legislation have placed the responsibility on employers to provide a healthy and safe working environment and to identify and manage hazards in the workplace.
One part of this responsibility involves the detection and management of the risks associated with the misuse of drugs and alcohol by employees and contractors in the workplace.
Detection of drug abuse by employees may be complicated by active efforts to thwart the testing. Synthetic urine is a derivative fluid, designed to be similar to human urine, which is commonly used by drug users to cheat urinary drug tests – either with mandatory pre-employment checks or with routine workplace drug testing.
Synthetic urine does have a legitimate use, primarily for laboratory calibration of screening equipment needed for urine examination, but also for the assessment of urine leakage of urine collection devices and diapers.
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How Widespread is the Problem?
The popularity of synthetic urines rose with the widespread institution of workplace drug testing in the US and has led to a virtual population explosion among syntheticurines: common brands of products available in Australia include QuickFix, Agent X, and TestClear as well as others too numerous to mention.
Although the composition of synthetic urine is similar to human urine, it necessarily lacks many of the constituents of real urine. In 2010 testing for these absent constituents led to a marked decline in the use and popularity of synthetic urine as cheaters began to get caught. This decline in use slowly reversed over the next four years as the synthetic urine manufacturers improved their products.
The problem of urine substitution is widespread and is definitely growing: in the journal Australian Mining, Validakis (2012) noted the recurrent rise of the practice among miners in the Pilbarra and, more worryingly, in 2014 Lorin Eleni Gill in Pacific Business News noted a sudden, recent and sustained jump in synthetic urine use from 0.4% of all collected specimens in early 2014 to 0.9% after the third quarter of the same year in Hawai, which has been mirrored by a similar rise in Australia (see also Perallon 2014).
Synthetic urines are easily purchased and cheap – with prices currently ranging from AU$ 30 to 95. The situation is further complicated by the confused legal situation : although many U.S. states have already outlawed synthetic urine and Australia may eventually follow suit, at present the Australian laws are not clear on whether selling fake urine is illegal or not, and the possession of synthetic urine has not yet been addressed by our lawmakers (Kruger 2010, Passmore 2012).
How Do We Deal With It?
Drug test cheats often try adulterating their specimens with household chemicals or attempt to substitute their specimens with synthetic urine products to mislead drug tests, but the vast majority of such cases can detected by specimen integrity testing.
As Dasgupta (2015) points out, and Pidd et al (2014) reiterated, there are five common indices which will detect the overwhelming majority of synthetic, adulterated or substituted urines. These include:
i) Urine spot temperature measurement at the time of collection. The Australian Standard AS/NZS 4308 states that urine sample temperature should be 33-38° C within 4 minutes of collecting the sample. Although substitute urines like SweetPee and Whizzinator, come with prosthetic penises to facilitate substitution, even the most vigorous and skilled urine substitutor would find it difficult to effect a convincing substitution (in terms of maintaining the correct temperature of the sample sufficient to satisfy the AS/NZS4308 strictures) in the absence of sufficient prior warning.
ii) Specific gravity (SG), which is the ratio of the density of the urine sample to the density of pure water, should be between 1.005–1.020 (with an absolute rejection criterion for any SG greater than 1.035). Measuring the SG of a sample will often detect attempts to adulterate, dilute or substitute the urine. Adding sodium chloride (kitchen salt) to samples is a common, time-honoured adulteration method which interferes with drug screening tests, but not with the confirmatory tests. Unfortunately for the cheaters, it raises urine SG above 1.035 when it is in concentrations sufficiently high to produce a false-negative result in a screening test and is easily detected.
iii) pH, which is a measure of the acidity of the sample, is likewise constrained and should always be between 4.0–10.0. Most synthetic urines are only poorly buffered and the detection of a sample with a pH outside the physiologic range, in the absence of significant renal or urinary tract disease is taken as proof of adulteration or the use of a cheap urine substitute.
iv) Creatinine is a breakdown product of (principally muscle) creatine in the body and the creatinine concentration in an otherwise healthy adult is restricted to between 10 mg/dL (< 884umol/L) to 400 mg/dL (35,360umol/L), although many labortaories use a 15 mg/dL (1,326umol/L) lower limit cut-off to detect synthetic urine, as urinary creatinine levels below this cut-off are very rare in healthy adults. Many syntheticurines have relatively low creatinine concentrations and thus are easily detected. Likewise the finding of a creatinine level incommensurate with the urinary SG and urea concentration suggests substitution or adulteration of the sample may have occurred.
v) Uric acid is a breakdown product of nucleic acids, which is rarely ever included insynthetic urines. Undetectable uric acid levels are almost always proof of syntheticurine (US Substances Abuse and Mental Health Services Administration guidelines 2012; Sterling Reference Laboratories 2013). Although there are some rare clinical conditions which are associated with low to undetectable uric acid levels in urine, such as hereditary xanthinuria, lead toxicity or folic acid deficiency, these conditions are associated with significant medical problems and are easy to diagnose.
As well as directly substituting natural urine with a synthetic analogue, drug test cheats also may take commercially available products to flush out drugs or add an adulterant to the urine specimen immediately after collection.
Commercially available products that adulterate urine or flush out drugs include fluids or tablets that, along with drinking large amounts of water, dilute urine thus pushing the concentration of a drug below the reportable threshold. Examples of such agents include Absolute Detox XXL drink, Absolute Carbo Drinks, Ready Clean Drug Detox Drink, Fast Flush Capsules, and Ready Clean Gel Capsules. Such efforts are wasted because attempting to dilute urine samples this way can be detected by testing the Specific Gravity, Urea and Creatinine levels in the sample – any or all of which may be inappropriately low.
Urinary adulterants are substances that are added to urine after collection to interfere with drug tests. Examples include Stealth (peroxidase and peroxide), Klear (nitrite), Clean ADD-IT-ive (glutaraldehyde) and Urine Luck (pyridinium chlorochromate [PCC]).
Most often these products are not as potent as they claim. Wu et al (1999) reported that the popular adulterant “Urine Luck” which contains a strong oxidizing agent, only affected EMIT II drug screens and not other commercially-available screening assays such as those used by Safework Laboratories.
One lasting irony is that Urine Luck often produces a false-positive amphetamine result on screening tests, alerting the laboratory to the possibility the ‘urine’ sample may be bogus. None of the commercially available adulterants interfere with LCMS confirmatory testing.
Nitrite containing products like “Klear” (which contains potassium nitrite), can cause interference in the GC/MS confirmatory test for THC from cannabis, but Klear does not significantly affect LCMS confirmatory methods such as the ones used by Safework Laboratories(El-Sohly et al 1997). Small amounts of nitrite are found in urine of patients with urinary tract infections or patients taking medications like nitroglycerin and nitroprusside, but the nitrite concentration in these cases is always below 36 ug/mL, whereas the nitrite concentration in adulterated specimens is typically greater than 1900 ug/mL (Urry et al 1998) and such concentrations can easily be detected by simple spot urine tests.
Specially designed urine dipsticks such as AdultaCheck 4, AdultaCheck 6, or Intect 7 can be used to detect nearly all commercially available adulterants in urine by checking for oxidants, nitrite, glutaraldehyde (which only affects EMIT II screening immunoassays not used by Safework Laboratories), pH, and chromate (the principal component of the ‘Stealth Stealth’ adulterant product) (Dasgupta 2015).
Synthetic Urines and adulterants are a growing problem facing workplace drug testing programs. However, the challenge they pose is hardly insurmountable – by ensuring specimen integrity checks are properly performed, collecting samples under properly controlled conditions and relying on the diagnostic skills of an experienced laboratory one can confidently ensure that cheating at drug testing will be curtailed (Pidd et al, 2014).
Dasgupta A. How People Try to Beat Drug Testing: Clinical Laboratory News 1 February.2015
Dasgupta A, Wahed A, Wells A. Rapid spot tests for detecting the presence of adulterants in urinespecimens submitted for drug testing. Am J Clin Pathol 2002;117:325–9.
ElSohly MA, Feng S, Kopycki WJ, et al. A procedure to overcome interferences caused by adulterant “Klear” in the GC-MS analysis of 11-nor-D9-THC-9-COOH. J Anal Toxicol 1997;20:240–2.
Kruger, P. (2010, September 16). Fake Urine Compromises Work Place Drug Testing. Retrieved from ABC News PM Australia: http://www.abc.net.au/pm/content/2010/s3013991.
Passmore, D Miners use substitute urine kits news.com.au 11-11-2012vi) Perallon, D. “Taking Action Investigation: Are your employees acing drug tests with fake urine?” WHNTNews 24-9-2014
Pidd K, Roche AM. How effective is drug testing as a workplace safety strategy? A systematic review of the evidence. Accid Anal Prev 2014;71:154–65.
Urry F, Komaromy-Hiller G, Staley B, et al. Nitrite adulteration of workplace drug testing specimens: Sources and associated concentrations of nitrite and distinction between natural sources and adulteration. J Anal Toxicol 1998;22:89–95ix) Validakis V. New Tests target miners using fake urine. Australian Mining 22 November 2012x) Wu A, Bristol B, Sexton K, et al. Adulteration of urine by Urine Luck. Clin Chem 1999;45:1051–7.
Source: Safe Work Laboratories
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