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What is Creatinine?

The most popular and consistent test for adulteration of drug tests is creatinine. Many people confuse this with creatine, but what is creatinine and how does it indicate that a drug test has been tampered with? Creatinine concentration is checked during standard urine drug tests.

What is Creatinine?

Creatinine is the primary metabolite of creatine that is produced when creatine is broken down in muscles. It is then expelled in the urine.

Since creatine is produced by the body at a consistent rate and it’s almost entirely removed from the blood stream by our kidneys it can be used to tell if our kidneys are functioning properly and also as a benchmark for the dilution of a urine sample.

Creatinine cycle
This graphic details the generation, filtering and expulsion from creatinine in the human body.

What is a Normal Level for Creatinine Testing?

The amount of creatinine in urine varies depending on a person’s age, sex, muscle mass, water intake, activity level and overall health. Individuals with more muscle mass will produce more and so will individuals with higher activity levels.

The normal range for human urine is measured in milligrams per 24 hours. The expected range is 955 to 2,936 milligrams (mg) per 24 hours for males, and 601 to 1,689 mg per 24 hours for females. For medical testing a patient is often asked to capture their urine for a 24 hour period to get a more precise reading. For drug test adulteration testing the creatinine level is just a snapshot from a single sample.

For a urine adulteration test the cutoff level for creatinine is usually very low, often <5mg per deciliter. Levels in urine lower than this cutoff are not consistent with human urine and usually indicate an individual has engaged in water loading before being tested.

creatinine activity table
This table shows the average difference in test results for individuals with varying levels of activity.

Usually for a sample that fails an adulteration test the urine will be clear and the urine sample will also have a specific gravity that falls outside the normal range (1.003 to 1.030). Some of the color can be replaced by ingesting a high level of vitamin B12, but not enough.

Levels in Blood

If a physician finds creatinine levels in someone’s urine to be abnormally low and they do not suspect adulteration they will schedule other tests to determine the cause. If levels in the blood are high this usually means there is an issue with kidney function.

The normal range for a blood test is 0.84 to 1.21 milligrams per deciliter.

Causes of Abnormal Creatinine Levels

Several diseases and scenarios can cause abnormal readings.

  • Diabetes
  • High Blood Pressure
  • High protein diet
  • Kidney infection
  • Kidney Failure
  • Kidney Stones
  • Muscular Dystrophy
  • Myasthenia Gravis
  • Kidney Damage

When testing levels physicians will instruct patients to stop taking certain medications including Cefoxitin, Trimethoprim, and Cimetidine.

There are several supplements and activities that can alter levels.

Increase Creatinine Levels

  • Vigorous Exercise – Exercise increases creatinine levels in the blood stream and urine, at least temporarily.
  • Creatine Supplements – Creatine supplements are used to fuel muscles and slow down the production of pyruvic acid. More creatine leads to more creatinine by product.
  • High Protein Diet – High protein intake has been shown to increase creatinine levels.

Reduce Creatinine Levels

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How Much Water Will Dilute a Drug Test?

The most common drug test adulteration technique is drinking water to dilute a urine sample. The variation in water expelled in urine from person to person makes it hard to detect and since the urine still comes from the subject’s body temperature strips and observation witnesses cannot detect water dilution. How much water does it take to dilute a drug test enough to pass though?

How Drug Tests Work

The first thing you need to know is how urine drug screens work. They contain antibodies that attach to metabolites in the urine of the person being tested. The test determines if the amount of antibodies which correlate to a drug in the urine are over or under a specified cutoff level.

Other testing methods determine the exact quantity of metabolites as well as several other levels such as creatinine, protein and pH. In these more advanced laboratory tests the creatinine level in the sample is a clear indication of water loading and the sample will either be corrected and normalized based on the creatinine levels in your urine or will be marked a failure for dilution outright.

Past a certain point urine dilution will raise suspicions or lead to a failed test, however for someone that doesn’t drink the recommended daily allowance of water under normal circumstances drinking water can significantly lower the concentrations of metabolites in your urine without turning the urine completely clear and without failing an analysis for low creatinine levels.

Did You Know? The average person urinates between 35-50 ounces every day and makes an average of 4-10 trips to the bathroom.

Federal Recommendations for Drug Test Cutoff Levels

  • THC 50 ng/mL
  • COC 300 ng/mL
  • OPI 2000 ng/mL
  • AMP 1000 ng/mL
  • MET 1000 ng/mL
  • BZO 300 ng/mL
  • MDMA 500 ng/mL
  • MTD 300 ng/mL
  • OXY 100 ng/mL
  • BUP 10 ng/mL
  • BAR 300 ng/mL
  • TCA 1000 ng/mL

How Water Dilution for Drug Testing Works

The average healthy adult has a bladder that will comfortably hold 16 ounces or 2 cups of liquid. Water loading works by increasing the excess water in your body so the bladder will refill with excess water before the normal mixture of byproducts and the normal level of water used to expel these byproducts accumulates back into the bladder.

The timeframe of ingestion matters as much as how much water you drink. It takes between 45-120 minutes for ingested water to start pushing urine out of your body.


Urine color chart
Witnesses and technicians will expect to see some tint to your urine sample. A sample that is entirely clear is a big red flag, but even the slightest tint is acceptable in most cases.


Since a drug test captures a single photograph of your urine content, the goal of someone trying to adulterate their urine by water dilution is to have the optimum ratio of excess water and normal urine at the time they submit their test.

When it comes to urine dilution you really need to ask yourself 2 questions.

How much water can I ingest without turning my urine totally clear?

How much water will it take to reduce metabolite concentrations under the most likely cutoff levels?

How much water can I ingest without turning my urine totally clear?

It is hard to say exactly how much water you can ingest before your urine starts to come out clear because there are so many variables, but in a 1-2 hour timeframe approximately twice bladder capacity plus the amount of water your body is expelling through sweat and cellular process results in clear urine. Roughly 32 ounces of water in a 1-2 hour period will bring your urine to the point it will start to be completely clear.

A study in the Annals of Pediatric Edocrinology Metabolism found that the maximum amount of water a person should ever drink is between 27-33.8 ounces per hour. This is the maximum amount of water a healthy human body can process without causing harmful effects to electrolyte ratios.

Medical review

How much water will it take to reduce metabolite concentrations under the most likely cutoff levels?

Now that we know the level of each metabolite your urine must be under you need to know the level of the metabolite currently in your urine. You could send a urine sample off for a laboratory gas chromatography and mass spectrometry test but that would be prohibitively expensive. The best most people can do is guess.

In one study Urinary Elimination of 11-Nor-9-carboxy- 9-tetrahydrocannnabinol in Cannabis Users found that out of the 60s subjects admitted to the test they were evenly spread out between the groups of <50ng/ml, 50-150ng/ml and >150ng/ml. The studied showed that higher concentrations took much longer to eliminate detectable levels from their system.


THC drug test levels graph
As you can show the metabolite for THC is detectable far longer for heavy users.


Users that were under the 50ng/ml cutoff at the beginning routinely started passing drug tests on the first or second day. All subjects that were under the 50ng/ml cutoff had eliminated all detectable THC metabolite (<5ng/ml) by day 8. It took 15 days for half the users between 50-150ng/ml to eliminate detectable THC metabolite. 80% of users that started over 150ng/ml level still had a detectable amount of THC in their urine at the end of 30 days.

The good thing for a user wanting to pass a drug test is that instant drug tests have a 50ng/ml cutoff. That means that light users will pass a normal test in 3-7 days and the average user that starts below 150ng/ml will be able to dilute their urine by half on the 2nd day and pass a test, which is the top of the range of how much water you can ingest without turning your urine totally clear.

Is Water Dilution Illegal or Unethical?

The god news is that the optimum water content of urine to have the best chances of passing a rigorous drug test is also around the normal recommended daily allowance for water. Since you do not want your urine to be totally clear you’re aiming for a pale straw coloration that is indicative of optimum water intake.

Most people do not drink the recommended amount of water, and it also causes their urine to have longer detection times than people that stay well hydrated.

If you drink so much water that your urine is clear and your body is passing urine with low levels of creatinine it is unethical and it could also lead to punishment depending on the circumstances of your drug test. Adulterating a drug test is illegal in many states and some prosecutors would make the argument that urine diluted by drinking an excessive amount of water is a clear case of adulteration.




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Can Fake Pee be Detected in a Drug Test

Can fake pee be detected in a drug test

One of the most recent trends in tampering and adulteration of drug testing is people using fake pee as a substitute for their own sample. Subjects have been using other people’s clean urine for decades, but have sometimes been surprised when the urine they brought failed for more drugs than their own urine would have. More and more people ask us “can fake pee be detected in a drug test?” because it would be a more convenient method of defrauding tests for them.

Using fake pee is more convenient and more trustworthy for someone trying to tamper with their drug test. It’s developed to match the composition and appearance of real urine as closely as possible.

Can Fake Pee Be Detected in a drug test?

Fake pee is easily detected in a drug test. Since more people are using fake pee to tamper with their drug test labs have started testing for analytes that are found in human urine but aren’t found in fake pee. Uric acid for example isn’t a common ingredient in much of the fake urine available.

Chemical makeup of human urine
This graph shows the chemical makeup of human urine. Fake pee is often made of urea, but doesn’t have other components that affect shelf life.


Have you ever forgot to flush after urinating and came back later to an awful smell coming from the toilet? Uric acid and certain bacteria present in urine are left out of fake pee so it has a longer shelf life. Fake pee wasn’t designed to completely fool lab equipment, so it will likely always be detected when your sample is sent to a lab for confirmation. Besides uric acid there are approximately 12 other analytes that are expelled in human urine that would not be stable in a product that needs to be stored more than a few days.

Other components of human urine
This graph represents the 0.2% of components that are categorized as “other” in the first graph. All of these substances are expected to be found in your urine sample.


We suggest that companies and medical practices perform visual confirmations on their drug tests. This means an employee will confirm that the sample originated from the donor as a witness.

It would be very challenging for someone to substitute fake pee for their own urine with a proper visual confirmation. Prosthetics are made to help trick employees, but they have been known to malfunction and are easily noticed by most witnesses.

There are also belts available that have a reservoir and tubing to help trick a witness. The belt uses body heat to keep the temperature of the urine warm enough to activate a temperature strip. Again, these devices are fairly easy to identify especially if the witness has been trained to catch people smuggling clean urine.

Fake Pee Belt
The fake pee belt is easy to conceal, but would be easily spotted during a visual screening.

So can fake pee be detected in a drug test? It can easily be detected in a drug test and a witness can negate people’s ability to defraud simpler tests.

Does Fake Pee Ever Work?

Fake pee was originally developed as a control tool for scientists and lab technicians to use for testing. It helped eliminate variables such as dilution, composition, and contamination during experiments that required human urine. It could be stored for longer periods without refrigeration.

If you are trying to cheat on a drug test the likelihood of being caught is directly related to the policies of the organization testing you. The more time and money they invest on stopping adulteration the harder it will be for you to tamper with a test.

As far as a home test cup goes there are basically 2 categories. Cups with adulteration strips and cups without adulteration strips. Most fake urine available will pass on both cups because they are engineered to have perfect readings on most adulterant tests. Urine adulteration checks include:

  • Creatinine
  • pH
  • Nitrite
  • Specific gravity
  • Glutaraldehyde
  • Bleach
  • Oxidant/pyridium chlorochromate
urine adulterant strip guide
This key shows the results of common urine adulteration strips. Some strips test the properties of urine and some check for the presence of adulterants.


However all it takes is for the person who is giving you the drug test to watch you pee and you won’t get a chance to substitute your fake pee for your sample.

Both types of cups usually have a temperature strip however, and a sample that doesn’t register will likely trigger suspicions.

If the witness isn’t paying attention and you have taken measures to keep your fake pee warm enough to register at body temperature then you might get away with it. The real question is, are you willing to get caught?

Risks and Consequences of Using Fake Pee

The investment in combating adulteration is often directly correlated to the consequences of catching someone tampering with their drug test. A person on probation will face a zero tolerance policy and tampering with a urine sample will result in immediate jail time. A patient that is prescribed narcotics may not be watched as closely but will be expected to produce a sample that is positive for the drugs they are prescribed. Most doctors will refuse to prescribe and note it on their chart if a patient is ever caught tampering with a drug test.

Employment tests vary, but most of the time they either outsource their testing to a company that has strict guidelines for identifying adulteration, or they run their own program and probably put a lot of effort into making sure it’s not wasteful. An exception would be a company with relaxed guidelines that only drug tests to satisfy an insurance guideline.

In any case, it would put a company in a position of liability if they hired a potential employee that tampered with their drug test. In almost every case you will not be hired, and in some cases you could be blackballed by an entire industry for tampering with a drug test. Tampering with a drug test is in many ways worse than failing one.

Boeing fired CNC Machinist Michael Kelly after catching him trying to substitute a liquid for his own sample during a drug test. Kelly sued Boeing for wrongful termination, but lost the suit and could not have won even it was proved he did not tamper with the drug test because Boeing acted in good faith.

The consequences of attempting to defraud a drug test are becoming more serious. Several states have passed laws that make it illegal to use, possess, sale, manufacture or distribute fake pee. In many of those states there are sections that stipulates that if a technician catches someone using fake pee or attempting to defraud a drug test they must report it to the authorities or risk being penalized themselves.

Synthetic Urine Bans by State

In the United States there is currently no federal law banning the sale or use of fake pee, but 19 states have enacted legislation regarding synthetic urine.

  • Alabama’s SB111 prohibits the manufacture, marketing, sale, distribution, use, and possession of synthetic urine or a urine additive. 1st offense is a class B misdemeanor.
  • Oklahoma Code §63-7002 is a comprehensive bill covering fake urine and popular adulterants. The penalty is a misdemeanor.
  • Arkansas Code § 5-60-201 is a comprehensive bill covering fake urine and popular adulterants. The penalty is a class B misdemeanor.
  • South Carolina Code 16-13-470 is a comprehensive bill covering fake urine and popular adulterants. First offense is a misdemeanor, second offense is a felony.
  • Mississippi H.B. 1080 the popular “Urine Trouble Act” is a comprehensive bill covering fake urine and popular adulterants. The penalty is a misdemeanor with a 6 month jail sentence and $1,000 fine.
  • Tennessee § 39-17-437 makes it illegal to use, possess or sale synthetic urine. Use or possession is a class A misdemeanor, sales is a class C misdemeanor.
  • Florida Statute 817.565(b) doesn’t mention fake urine specifically, but makes it illegal to sale, use, distribute, manufacture or advertise substances intended to defraud a drug test.
  • Missouri Representative Nate Tate has been presenting bills to revise Chapter 579 to include bans on synthetic urine.
  • Utah HB 0016 76-10-2203 makes it a criminal offense to distribute, possess or sell synthetic urine.
  • New Hampshire 2016 SB 361 bans the sale and possession of synthetic urine and urine additives.
  • West Virginia §60A-4-412 makes it illegal to sell, give away, distribute or market synthetic urine. It also makes it illegal to knowingly try and defraud a drug test.
  • Indiana’s Adulterant and Synthetic Urine Ban makes distributing synthetic urine with the intent of assisting a person in defrauding a drug screen a misdemeanor.
  • North Carolina General Statutes § 14-401.20 is a law covering many aspects of fake urine and drug test cheating with the penalty of a class I felony for a 2nd offense.
  • Wisconsin 2015 AB658 criminalizes the use, possession, manufacture, distribution and advertisement any substance or device meant to defraud, circumvent, interfere with or provide a substitute for a bodily fluid sample.
  • Wyoming § 6-3-614 is a comprehensive bill covering fake urine and popular adulterants. First offense is a misdemeanor, second offense is a misdemeanor.
  • Kansas
  • Michigan Article 23 employees are barred from interfering with any test procedure or tampering with any test sample
  • Arizona
  • Georgia

So in conclusion, can fake pee be detected in a drug test? Yes it can, and you’re even more likely to be caught by a witness or technician. It can be detected and penalties are getting stiffer for people that get caught.