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.
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.
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.
High Blood Pressure
High protein diet
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.
The Pennsylvania Supreme Court ruled that child protection officials may not order drug tests as part of a child abuse investigation on Tuesday, June 16th. The Justices sided with prosecutor David J. Russo who had recently come under fire from CPS agents.
Greene county received a confidential tip that David Russo was seen publicly intoxicated while caring for five children and that he had been charged with spousal abuse. The Greene County child protective service recused themselves and brought in Fayette county officials to complete an investigation.
The unanimous decision says that the law “does not expressly or implicitly authorize collecting samples of bodily fluids, without consent, for testing”.
David Russo said in a phone interview “I think this a great victory for the people against government intrusion. The Supreme Court of Pennsylvania has sided with the people.”
Fayette county lost a decision in a lower court that would have required Russo to submit to a drug screen and allow investigators to inspect the condition of his home. All five of his children were interviewed at school and the state was unable to substantiate any claims from the confidential tip.
David J. Russo was elected as a Republican to the office of District Attorney for Greene county last November. During his campaign he was also successfully representing himself in this legal dispute which he said “had become routine practice in Greene County”. Greene suggested it was very prevalent for child protective services to drug test both parents in every investigation before the superior court ruled in his favor.
The first complaint about Russo came in October 2018. An unidentified source claimed he appeared to be under the influence of drugs or alcohol about two weeks earlier, while he was defending a client before Greene County Children and Youth Services. The second and third reports were in November 2018, alleging he had been “completely out of it” in public and that there was “domestic violence in the home,”.
Russo argued that the order to produce an observed urine drug screen violated his 4th amendment rights and requiring it “will inevitably lead to the forcible extraction of bodily fluids, the incarceration of parents for refusing to comply, or the exile of parents from their children.”
As a business owner it can be hard to decide what drugs to test employees for. Different regions have different drug problems and considerations, but there may be a one size fits all solution. When deciding what drugs to test employees for you should consider these factors:
What drugs are popular in the area of operation?
Are any drugs popular in your industry?
Which drugs have the most potential to negatively affect your business?
Which drugs can be tested for legally, economically and effectively?
What tests are available that are accurate and cost effective?
Most Popular Drugs Among Employees
Most popular illegal drug used in the workplace is recreational Marijuana. Over 20% of respondents of the Drugabuse.com survey admitted to using recreational marijuana during work hours. The second most common class of drug used during work hours was opiate painkillers.
Over the last decade more people with full time employment have admitted to marijuana and prescription painkiller use than all other classes of drugs combined. The effects of most prescription painkillers are mild enough that employees can use them undetected.
Common Drug Tests Employers Use
The most common instant drug test used by employers in the US is the 12 Panel Drug Test Cup. There are currently only 13 drugs that have CLIA waivers available for rapid testing, so a 12 or 13 panel cup offers the most number of tests while staying in compliance for state and federal guidelines.
Many will use a Fentanyl strip (FYL) and ETG (alcohol) strip in addition to a CLIA waived 12 panel cup. These tests are for forensic use and any indication of a positive should be sent to a lab for confirmation. The fentanyl test is becoming more popular because it is commonly being used in fake pharmaceuticals and mixed with heroin to increase its potency.
Having a CLIA waived test is important because other tests will be considered high complexity and will have no legal standing whatsoever in the majority of workplaces.
CLIA Waived Drug Test Strips
Tricyclic Antidepressants (TCA)
Some organizations must adhere to recommendations published by certain branches of the federal government. In the 1990s the NIDA required testing for at least 5 types of drugs to meet the requirements to be a “Drug Free Workplace”. These drugs became known as the NIDA 5 and have since been considered the bare minimum for employer drug testing.
If an organization depends on government contracts or is contracted directly with the federal government you should consult the NIDA, SAMHSA, and Drug Free Workplace acts.
At the very minimum a company should test for the 5 illicit drugs in the NIDA 5. Since it is so cost effective, there isn’t a good reason to not upgrade to the 12 panel test cup and screen for more drugs.
NIDA 5 Drug Tests
In the years since the NIDA 5 was released pharmaceuticals and drugs such as methamphetamine have become much more popular while PCP has fallen out of use almost entirely. Most drug testing programs have implemented changes to reflect that.
Which Drugs Have the Biggest Effect on Business
As previously mentioned in 11 Reasons Why Employers Drug Test, the average drug user has 50% more absences than a regular employee. Employees with a prescription painkiller addiction miss 200% more often than a regular employee. When it comes to turnover 25% of people employed full time have had another employer in the previous year. 36% of average drug users have had another employer in the previous year, but that number climbs to 42% for people with a prescription painkiller addiction.
Over the course of employment opiate users cost a business more consistently, but users of drugs such as methamphetamine and cocaine are prone to have major incidents that have tremendous immediate and long term effects on a business.
Which Drug Tests Are Effective
You will notice that alcohol is often listed as the most abused drug by full time employees. There are tests that can detect alcohol, but the detection period is approximately 12 hours. Since alcohol is legal an employee that had a drink the night before isn’t technically doing anything wrong. Alcohol is also easily detected by coworkers if an employee is drinking on the job without the use of a test.
Synthetic opiates do not consistently show up on Opiate assays so Oxycodone, methadone, buprenorphine and fentanyl have their own specific tests.
In regions where pharmaceutical abuse is high these tests are almost always included in an employer drug test, but in some areas the number of people using prescription drugs legally outweighs those using illegally and companies see these as a nuisance to continuously cross check.
It is also much easier for an employee to obtain a prescription for narcotics in areas with lower rates of prescription drug abuse.
Legal Drug Use and Acceptable Use
Besides having a short detection period, alcohol is widely used legally by employees outside of work hours. It’s more culturally acceptable to drink alcohol than to abuse other illegal drugs.
Marijuana is gaining legal status in many states and is becoming more culturally acceptable in the US with every passing year. New York city recently passed a law that made it illegal to test for recreational marijuana use on a pre employment drug test.
Responsible alcohol use outside of work hours is usually considered a private matter. As marijuana becomes legal in more jurisdictions companies will need to look at their specific laws and situation and determine how to best address drug testing for THC going forward. If your company’s roles require employees to be brand ambassadors 24/7 it might be important to have a drug and alcohol policy that extends to an employee’s personal time.
What is the Best Solution for Employer Drug Testing?
We believe the best solution is to use rapid urine screens for pre-employment and random drug testing and use confirmations for any employee that has a positive result. You can also ask employees that admit to drug use to sign a waiver to save the cost of a confirmation.
This will keep drug testing costs low (our 12 panel drug tests are $2.70 per cup shipped when bought in bulk) while also having a very efficient and accurate drug testing policy. With a CLIA waived test almost any employee can conduct the test. By following on site drug testing guidelines you can eliminate most adulteration and reduce the cost of keeping your business drug free.
So you were given a drug test a recently and when the results came back your were positive for one or more drugs. You may have suspected they would, or in rare cases it’s a total surprise. What should you expect and what should you do when your drug test results come back positive?
Don’t Freak Out When Your Drug Test Results Come Back Positive
A positive drug test is not the end of the world. The first thing to do is settle your mind. You don’t need additional stress and worrying will have no effect on the outcome.
Consequences are hardly ever as severe as people think but people have done many things they regret immediately after receiving bad news. The worst thing you can do is continue using drugs.
What are the consequences of Failing a Drug Test?
Depending on what your drug test was for consequences can range from nothing to prison time. In the vast majority of cases people overestimate the consequences of failing a drug test, and in other cases they are extremely positive about the outcome.
Unless someone has firsthand experience or knows someone that has been through the exact process with very similar circumstances they will rarely have a totally accurate idea of the consequences of failing a drug test. Here are some likely scenarios by case.
If you fail your probation drug test it will most likely be sent to a lab for confirmation giving you several days to worry. The consequences of a failed drug test will be different depending on your original crime, your time on probation, the drugs you failed for and your probation officer’s own discretion.
In most cases someone that has done well for a while and has their first infraction will be referred to a drug counselor and may be asked to attend rehab after an assessment. For someone that has failed multiple tests however you could have your probation revoked. People that do go to jail for a failed probation drug test often get out sooner than expected.
Pre Employment Testing
If you fail a drug test when applying for a job 99% of the time you will not be hired and that will be the end of it. Many employers have a statute about how long a failed drug test will affect hiring, so you may be able to re apply in 6 months to 1 year.
Random Drug Testing At Work
Many employers do random drug testing to comply with federal guidelines and meet insurance requirements. For small businesses the result of a positive drug test will mostly be up to the discretion of the owner and your work history and importance will likely play a big part in how it turns out.
Larger corporations almost always have a drug treatment policy where employees that have a positive drug screen are given the opportunity to attend treatment and accept terms of a more strenuous testing program to continue their employment. A violation of this program will usually result in termination.
Post Accident Drug Test
Employers are required to do a post accident drug test of all involved parties when an on the job accident occurs that causes serious injury or death. This is probably one of the most serious drug tests. You and your company could face lawsuits and even jail time for negligence or manslaughter.
If you drive a vehicle or work around dangerous equipment, consider this before taking drugs even outside of work.
Healthcare facilities drug test patients for many reasons. The most common is when prescribing narcotics. These tests are to inform the doctor about any drugs you may take or addictions you may have and depending on your treatment you may get a prescription anyway. In most cases during a healthcare screening you need to show positive for any drugs you are prescribed and negative for any other drugs. Any other result is a good reason for your Doctor to withhold a prescription or even discharge you from care.
What to Do If Your Drug Test Comes Back Positive
If your drug test comes back positive the first question you need to ask yourself is why you failed the test. If you used drugs accept that it’s your fault and admit guilt; probation officers and employers are more likely to help if you are honest and they will know you’re lying when the confirmation comes back.
If you have not used drugs you should request a confirmation. Make a list of all the medications you have taken in the last month and a list of any unusual foods you may have consumed. Educate yourself about false positives on a drug test and stay confident that it will be worked out at the lab.
If someone was injured you should retain legal counsel and not answer any questions unless instructed to by your lawyer. You should get a quantitative blood screen as soon as possible to document the levels of any drugs in your system. You may be able to use this as evidence in court if your impairment was truly not the cause of the accident.
Immediately quit taking drugs. In many cases you will face suspension or other consequences until you can pass a drug test.
If you have a drug problem seek help. The longer you use drugs the harder it is to quit and there are many benefits to living a drug free life.
The consequences for trying to tamper with a drug test are usually more severe in the legal system and healthcare, and identical to failing in an employment setting. Never attempt to adulterate a test because it will negate any opportunity for leniency or forgiveness.
Dealing With Positive Drug Tests
I cannot stress enough that failing a drug test is not the end of the world and in most cases the consequences are never as dire as people expect.
For organizations and individuals giving drug tests I would like to remind you that everyone deserves respect and just because someone fails a drug test does not make them a bad person. They are likely under a lot of stress and you can really help their state of mind by being understanding. Please do not use drug testing as a tool for personal revenge.
For anyone taking a drug test I’d like to remind you that the person in charge of your test is just doing their job and following procedure. They do not want to see you fail a drug test and it causes them a lot of stress knowing that you may lose your job or suffer other consequences as part of their job.
Most people are familiar with false positives on drug tests, but are unaware of false negatives. What is a false negative on a drug test, what can you do to prevent them and what should you do if you identify one?
What is a False Negative Drug Test?
A false negative is any time that under normal circumstances a drug test would be positive for an individual but for some reason results are negative. An example would be a patient that is prescribed Oxycodone that takes his medication consistently as prescribed, but has a negative drug test during his doctor visit.
In most cases this is caused by the patient either purposefully or accidentally altering their urine sample. The most common false negative drug test is due to water loading.
False Negatives From Water Loading & Adulteration
Water loading is the process where a person drinks an excessive amount of water prior to giving a sample. Urine that is clear with no yellow tint is usually indicative of water loading. You will need to perform separate adulterant tests for Creatinine, pH and protein levels to prove that a test has been diluted by a subject ingesting excessive amounts of water.
Without adulteration testing pure water will show negative on a drug test assay because the tests are only meant to detect the presence of a certain drug or metabolite in a substance, not to detect if the substance is a valid sample. Subjects can simply add water to their urine, but to fool a witness they will ingest an excessive amount of water to dilute the urine that comes from their own body.
There are several products available that claim to help users pass urine drug screens. These products range from nothing more than fortified tea that dilutes your urine to products that claim to seal in fat cells for several hours. Many of these products will speed up the timeframe which a person can pass a urine screen even if it’s for no more reason than they’ve diluted their urine.
Improper Drug Test Selection
A mistake made by organizations conducting drug tests is improper test selection. Every organization will have their own considerations when choosing a testing device, but some drug tests will not detect every illicit substance that people assume.
Many times a doctor prescribes their patient oxycodone or another semi-synthetic opiate, but uses a 5 panel drug test that only has a test for opiates. The doctor has seen positive tests for opiates from his patients that are prescribed oxycodone, but his new patient tests negative. One study found that oxycodone was detected in 12% of opiate immunoassay tests, and many other synthetic or semi-synthetic opiates also require a special test for accurate results.
Most assays for benzodiazepines detect their presence in the urine by testing for nordiazepam and oxazepam, the main metabolites of most benzodiazepines. Agents that follow a different metabolic pathway, such as triazolam, alprazolam, clonazepam, and lorazepam, have poor cross-reactivity with the assay due to the absence of these metabolites and thus frequently produce false-negative results. Some doctors prescribe diazepam, oxazepam, and temazepam instead to reduce lab confirmations.
False Negatives From Very High Cutoff Levels
If your drug tests have high cutoff levels it is more likely for a user that has recently ingested drugs to produce a negative result.
Even though the federal government publishes their own guidelines laboratories and manufacturers can create products that use whatever cutoff level they deem appropriate and the federal guidelines do change from time to time.
For example opiates and morphine have two widely used cutoff levels since the early 2000s because so many people were failing employment tests because the popularity of poppy seed muffins. The recommendation soared from 300ng/ml to 2000 ng/ml. The majority of tests will use this recommendation to stay compliant with as many federal regulations as possible, but the high sensitivity tests are still available.
In practice there is no right answer. Some regions may have popular restaurants that sell poppy seed muffins, and some industries may have a high percentage of clients that anticipate testing and use gray-hat adulteration methods to get their levels under the cutoff.
We advertise our drug tests as being 99% accurate, but in any situation that involves a human there is a possibility of introducing human error. A technician could mislabel tags, forget to confirm the temperauture on a sample or give a patient an opportunity to switch out a sample altogether.
Human error is even more likely in a laboratory where a technician has to prepare an assay, control variables, process and record information and interpret results. Never count out human error entirely and implement procedures that can help reduce the likelihood of human error.
Since the consequences of a failed drug test can be so severe t here is a great deal of work and investment that goes into quality control for drug test devices. Still there are always some faulty tests or batches of tests that slip through.
If you have several tests in a row give unexpected results you should consider that the tests may be faulty. It’s very cheap and easy to use a 2nd drug test if a subject says that their results aren’t accurate.
Our drug test cups are designed to alert the user when there is a problem with the device itself. The control line can alert you to tampering, a faulty test and some forms of improper collection.
Keep in mind that a 12 panel drug test is actually 12 individual tests; most of the time a faulty device means only one of the strips is faulty. A certain percentage of faulty tests is expected in this industry, which is why we offer a 100% satisfaction guarantee that covers any faulty devices and any additional tests you use to troubleshoot a possible faulty test.
There are times when all of the devices are functioning properly, everyone did everything they were supposed to do and a sample is valid in every way and still there is a false negative drug test result.
The Hook Effect
One rare cause which has been addressed by manufacturers in recent years is the “hook effect” where there is so much of a drug present in the urine that there are no more binding sites left on the antibody. This can cause a lower apparent level which can lead to a negative result if it’s below the cutoff level.
One benefit of using a drug test cup is that the receptacle is also the test. There is no lapse in time between collection and testing. In a busy medical office technicians may become distracted or intentionally multi task when working on test results.
When shipping to a lab it could be even more time between collection and testing. The time in transit and any time that the shipment sits in the lab without proper refrigeration is more time for the sample to naturally degrade.
Most metabolites are stable for the short periods common in drug testing, but others are not stable especially when subjected to temperature changes or extremely high temperatures.
One example is 6-monoacetylmorphine (6-MAM), a metabolite of heroin. In the body heroin is metabolized to 6-MAM, which then metabolizes to morphine. 6-MAM lacks stability, is subject to in vitro hydrolysis and also continues to metabolize into morphine even after the urine leaves the body. One study showed that within 7 days at room temperature a urine sample that was positive for 6-MAM had hydrolyzed completely into morphine.
Limiting False Negatives on Drug Tests
Understanding that a false negative is a possibility and the likely causes is the first step in stopping them. Collecting and storing data can be an important part of investigating unexpected or suspicious results.
With enough knowledge and proper analysis many drug test results that are contradictory to expectations can be reconciled and explained. Here are some other tactics you can use to limit the likelihood of false negatives in your drug testing program.
Institute procedures and policies to combat water loading and adulteration
Use a 12 panel drug test to cover many of the synthetic and semi-synthetic opiates
Understand the cutoff levels and detection times for the tests you use
Institute policies and procedures that decrease the likelihood of human error
Report faulty tests to the manufacturer or retailer
When people fail drug tests they often claim that it was faulty or there is some mistake. In most cases this is a ruse and the individual is dirty, but false positives on drug tests are real and many innocent patients have failed a drug test only to be vindicated later on by a confirmation. So what exactly is a false positive on a drug test and when is it just another attempt at subverting drug test results?
What is a False Positive on a Drug Test?
A false positive is a drug test result that is not accurate due to another substance mimicking the target metabolite.
The majority of false positives are caused by medications, foods, and supplements that are well known to cause false readings on a drug test.
Some people have gotten a false positive from second hand marijuana smoke. The most common false positives are for benzodiazepines, amphetamine, methamphetamine, marijuana and opiates.
A presentation given at the American Psychiatric Association’s annual meeting in 2010 by a researcher at the VA Medical Center in Black Hills South Dakota, Dwight Smith, 5 to 10 percent of all drug tests result in false positives and 10 to 15 percent result in false negatives.
My anecdotal research at a healthcare facility where I tested hundreds of patients each month did not support these high numbers, but we did experience a 1 to 3 percent occurrence of false positives.
Most studies show that second hand smoke from marijuana and crack cocaine do not cause false positives but there have been anecdotal cases. The growing popularity of CBD products and confusion about which products contain trace amounts of THC have cause some false positives.
Many drugs have multiple identified metabolites and different immunoassays and equipment use different technologies to bind antibodies. The regeants in multi-drug test cups are generally the most stable and prominent metabolites of each drug.
Some substances will cause a false positive on a specific test under specific circumstances, but will show as negative when retested for different metabolites or using different equipment.
Legitimate false positives are rare unless a patient is prescribed a drug that is well known for causing false positives.
What Should testing Programs Do About False Positives?
Always acquire a thorough list of all the patient’s prescription, over the counter and herbal medications prior to testing. Interview the patient to find out if they drink energy drinks or eat any products that are known to cause a false positive.
Discuss adherence to medications and instruct them about how much water to ingest prior to testing to keep from diluting a sample.
A good practice is to ask an individual that just failed a drug test if they are positive for the substance. Encourage an honest answer and let them know that lying about it will only damage their desired outcome. Many people will admit to a mistake.
Always send contested drug test results to a lab for confirmation. Let the individual know that their sample will be sent to a lab that can confirm exactly what substance triggered the positive result.
When you receive the results back schedule a consultation with the individual and give them another chance to admit to their drug use before revealing the lab results.
Many courts have started programs where criminals that are alcoholic are given home incarceration on non-violent charges if they install a phone that has a breathalyzer built in. Probationers and prisoners that sign up for these programs agree that even if a positive reading comes from using mouth wash that is doesn’t matter and they will be violated as an offence.
A lot of our customers send all positive tests to a lab for confirmation, but also make decisions for care and treatment based on the results of the instant drug test.
Always instruct your clients that false positives are treated as a failed test until a lab returns the confirmation results and it is their responsibility to educate themselves about substances that could possibly affect their test results.
Things That Can Cause a False Positive on a Drug Test
One study found that gentle baby soaps Johnson &Johnson, CVS Nighttime Baby Bath, Aveeno Soothing Relief Creamy Wash, and J&J Bedtime Bath caused false positives for THC for infants being tested due to their mother’s suspected drug use.
Since drug testing is used so frequently in so many applications many organizations conduct studies about false positives. Still there are so many substances humans ingest and interact with that we couldn’t possibly identify them all.
Below is a list of medications and other substances that are known to cause false positives in urine drug screens. Some will often cause an inaccurate result while others almost never do.
Once a possible cross contamination is identified use multiple confirmation methods and research the history of that medication in causing false positives. Most of these medications were identified through scientific research, but a few are from anecdotal observations at medical facilities.
Marijuana (THC) False Positives
In a study conducted to find if second-hand marijuana smoke would cause a false positive 3 non-smokers were exposed to 8 marijuana smokers who smoked 32 joints in total in a 10×10×8-ft enclosed room. No samples from the nonsmokers exceeded the federal mandated threshold. However marijuana has increased in potency since this study.
The metabolite of THC is metabolite 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). Even though excessive intake of several substances have caused a false positive for THC, the only drug that is likely to cause a false positive is Efavirenz (Sustiva). Other known false positives are very unlikely.
In a study to find if being exposed freebase crack cocaine vapors would cause a false positive, 6 volunteers in an 8×8×7-ft enclosed room were exposed to 200 mg freebase cocaine vapor; none of their urine samples exceeded the federal threshold.
Individuals that work in a jobs such as law enforcement and medicine that handle cocaine are at risk for testing positive. Cocaine can be absorbed through the skin.
A study of crime lab technicians showed 33% of subjects tested positive after analyzing solid dosage forms of cocaine. Levels in two criminologists working with large amounts of cocaine in a small room were measured up to 278 ng/mL when wearing a face mask and gloves and up to 1,570 ng/mL when wearing gloves only.
In a study of physicians administering cocaine to a patients, one physician in the group not wearing gloves had a positive test with 53 ng/mL of the cocaine metabolite in his test eight hours following exposure. Results were negative in the group wearing gloves. Another physician in this study was asked to handle cocaine for two minutes and wait 15 minutes before hand washing every two hours. This physician had a positive test of 245 ng/mL 18 hours after exposure.
Many public surfaces have been shown to be contaminated with cocaine. An analysis of 234 banknotes from 18 different US cities found that 90% contained traces of cocaine. 85% of bills in Canada had traces of cocaine and 80% of bills from Brazil. They contained up to 2,350 micrograms.
Scientific studies have found no evidence that Lidocaine or norlidocaine can cause a false positive on standard cocaine tests, but there is anecdotal evidence it is possible.
Opiates False Positives
In 1998, the federal government increased the threshold defining a positive screen for urine morphine and codeine from 300 to 2000 ng/mL to reduce spurious reports of opiate-positive tests from poppy seed consumption.
Synthetic and semi-synthetic opiates are sometimes detected in an opiate drug test, but sometimes are not. One study found that oxycodone was detected in 12% of opiate immunoassay tests.
Given this inconsistency separate tests have been developed for semi-synthetic opiates oxycodone, hydromorphone, oxymorphone, levorphanol, buprenorphine and synthetic opiates fentanyl, methadone, propoxyphene, meperidine, tramadol, pentazocine. The most common pharmaceutical opiates are included in some multi panel tests while others must be performed separate.
Tricyclic Antidepressants replaced PCP on many multi drug screens because so many TCAs cause a false positive for other drugs. Having the TCA strip on your multi-panel drug test can help identify cross-reactions with other drugs.
Seroquel (quetiapine fumarate)
Barbiturate False Positives
PCP False Positives
Dextromethorphan (Robitussin, Delsym)
LSD False Positives
False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review
Alec Saitman, Hyung-Doo Park, Robert L. Fitzgerald Journal of Analytical Toxicology, Volume 38, Issue 7, September 2014, Pages 387–396
Analysis of the cocaine metabolite in the urine of patients and physicians during clinical use
Bruns AD, Zieske LA, Jacobs AJ. Otolaryngol Head Neck Surg. 1994; 111: 722-6
Occupational exposure to cocaine involving crime lab personnel
16. Le SD, Taylor RW, Vidal D, Lovas JJ, Ting E. . Journal of Forensic Science. 1992; 37(4): 959-68.
Almost all point of care drug tests are advertised as CLIA waived. Customers often want to know what does CLIA waived mean, and why is it so important?
CLIA stands for Clinical Laboratory Improvement Amendments. CLIA is a set of guidelines and regulations that are jointly enforced by the CDC (Center for Disease Control), CMS (Centers for Medicare and Medicaid Services) and FDA (Food and Drug Administration).
In its most basic form the FDA categorizes all diagnostic tests according to complexity. There are 3 levels of complexity:
CLIA Waived Drug Tests
For a test to be waived it must :
Require minimal scientific and technical knowledge to perform the test and the knowledge must be easily obtained through on the job instruction with minimal training.
Regeants must be pre-packaged, reliable, stable and require no special handling, precautions, or storage.
Operational is automatic or easily controlled.
Calibration, Quality Control & external proficiency testing materials must be readily available and stable.
Test system troubleshooting is automatic or self correcting, or clearly described and requires minimal judgement.
Minimal interpretation and judgement are required to analyze results.
Have been issued a CLIA waiver and number by the FDA.
Basically a CLIA waived test is a test that can be performed by anyone at home or in any setting without special raining or certification. Besides the requirements for being fool proof, a test must apply and receive a CLIA waiver or be amended onto an existing CLIA waiver with updated inserts and labeling. Someone can build a drug test identical to our CLIA waived 12 Panel Test and it wouldn’t be considered CLIA waived until they were issued the waiver by the FDA.
For a multi-panel drug test each strip and the device must be covered under the waiver, however enforcement is carried out at the state level and many states do not strictly enforce this. Every strip on the test must be CLIA waived for the test to be CLIA waived. Most states have employees within their state health departments that are contracted directly with the CMS as CLIA surveyors.
Some states have their own licensure and infrastructure for enforcing CLIA. Their regulations are usually more stringent, but at the very least meet the federal requirements.
For a test to be CLIA waived the FDA must inspect the facility where it is manufactured. During the Coronavirus pandemic the FDA suspended drug and medical device inspections. For the majority of drug tests an existing CLIA waiver is amended for slight changes to labeling and recently waived tests are produced by facilities that are already producing CLIA waived drug tests.
Just because a drug test is advertised or labeled as CLIA waived does not mean it really is. The only sure way to check is to see if the test and all its component strips are listed correctly in the FDA CLIA medical device database.
According to Alicia Williams, a CLIA Surveyor for the state of Oklahoma, many drug test cups that are re-labeled do not file the appropriate paperwork with the FDA and even though they are advertised as CLIA waived they do not meet the guidelines. Suppliers often sell these tests for months and potentially thousands of labs, healthcare facilities and other businesses are using tests that they believe are CLIA waived but aren’t.
Reasons You May Need a CLIA Waiver
You will need a CLIA waiver if you plan on charging someone for testing and do not have an employee that is properly certified in conducting moderate or high complexity tests.
You will need a CLIA waiver if you charge insurance for drug testing at a medical practice.
You will need a CLIA waiver to test employees if you do not have staff properly certified in conducting moderate or high complexity tests.
CLIA waivers are not available for all types of drugs and it can take years for a facility to get new drugs issued for existing or new waivers. In this case tests can be used “for forensic use only”. For example it currently isn’t possible to get a fentanyl test that is CLIA waived, but the drug is becoming more popular. Some professionals will order a single panel fentanyl strip in addition to a CLIA waived 12 panel cup so they can send a sample for laboratory confirmation if it fails for fentanyl, but for all other purposes their testing is covered by CLIA.
For a laboratory to perform high complexity tests the Executive Director has to be a certified pathologist or have a P.H.D. with related board certification and each technician has to have an Associates Degree minimum.
Even though a test is very simple if the distributor does not complete the required filings and their tests are not listed on the FDA’s CLIA medical device database you still need the infrastructure and certifications that a high complexity lab would need.
“Oklahoma CLIA surveyors can be contacted through email and cell phone. We encourage laboratories or potential laboratory personnel to ask questions. We believe in a partnership between the laboratory and the CLIA State Agency to deliver accurate laboratory test results.”
–Alicia Williams, BS, MS, MLS (ASCP)
Clinical Health Facility Surveyor
Oklahoma State Department of Health
The personnel on staff in your state are usually happy to help with any questions you have. According to Alicia Williams, a clinical health facility surveyor for the state of Oklahoma, “Oklahoma CLIA surveyors can be contacted through email and cell phone. We encourage laboratories or potential laboratory personnel to ask questions. We believe in a partnership between the laboratory and the CLIA State Agency to deliver accurate laboratory test results.”.
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.
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.
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.
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:
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 § 5-60-201is 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.
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 § 6-3-614is a comprehensive bill covering fake urine and popular adulterants. First offense is a misdemeanor, second offense is a misdemeanor.
Michigan Article 23 employees are barred from interfering with any test procedure or tampering with any test sample
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.