Urine Creatinine & Sample Tampering. By: Paul L. Cary Toxicology Laboratory University of Missouri

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1 Urine Creatinine & Sample Tampering By: Paul L. Cary Toxicology Laboratory University of Missouri

2 The ramifications of a positive drug test (i.e. sanction, program expulsion, imprisonment, etc.) combined with the denial component of substance abuse often create circumstances whereby clients feel the need to beat the drug test by tampering with the sample. Sample tampering represents a significant challenge to a the court s mission and can threaten to undermine the legitimacy of the court s policies and procedures as well as it s decisions. It s a matter of control.

3 Creatinine testing is a specimen validity issue! The most common form of specimen tampering is sample dilution.

4 Creatinine Discussion urine as a specimen of choice for drug testing challenging collection strategies using creatinine for dilute determination court responses to dilute samples the inadvertent dilute creatine supplement issues what is specific gravity

5 Why Use Urine for Drug Testing? generally readily available in large quantities drug & metabolites are highly concentrated extensive scientific basis for methodology results accepted in court provides both recent and past usage uniform testing criteria (established cutoffs) easily tested (laboratory & on-site) quality assurance practices well-established

6 Problems With Urine as a Specimen: YUCK factor! biological waste product distasteful qualities & invasive collection NOT QUANTITATIVE cannot use concentration to evaluate client drug use history susceptible to tampering drug concentration influenced by fluid intake necessities witnessed collection

7 Creatinine & Dilute Samples

8 What is creatinine? creatinine is produced as a result of muscle metabolism creatinine is produced by the body at a relatively constant rate throughout the day creatinine is a compound that is unique to biological material (i.e. urine, other body fluids) creatinine measurements can: determine the strength or concentration of a urine sample ensure the sample being tested IS urine

9 EVERY urine sample used for drug detection should be tested for creatinine!

10 Two Types of Urine Specimen Dilution pre collection dilution consumption of large quantities of fluids prior to collection post collection dilution adding fluid to specimen post collection

11 Pre-Collection Dilution high-volume ingestion of fluids (water loading, flushing, hydrating, etc.) may be in conjunction with products designed to enhance drug elimination or removal of drugs (Gold Seal, Clean n n Clear, Test-Free, Naturally Klean, etc.) no evidence these products have any additional effect on drug elimination

12 Water contains no drugs! easiest, cheapest, simplest urines with a creatinines of less than 20 mg/dl are considered dilute and rarely reflect an accurate picture of recent drug use dilute samples are more like water than like urine all drug court/criminal justice samples should be screened for creatinine

13 How are creatinine measurements used? normal human creatinine levels will vary during the day based upon fluid intake - healthy individuals will rarely produce urine samples with creatinines of less than 20 mg/dl incidence of creatinines less than 20 mg/dl in a normal population is approximately 1% urines with a creatinines of less than 20 mg/dl are considered dilute and often do not reflect an accurate picture of recent drug use

14 Creatinine Facts some diseases that produce low urinary creatinines muscle wasting disease - RARE some kidney aliments - RARE low creatinines ARE NOT routinely associated with: pregnancy diabetes obesity exercise high-blood pressure being vegetarian

15 The Normal Creatinine incidence of low creatinines in a population undergoing random drug testing is significantly (up to 10 times) greater than a non- drug tested population any fluid intake dilutes the concentration of drugs in urine (along with the creatinine) normal urine creatinine: 2005 study Urinary Creatinine Concentrations in the U.S. Population determine the mean (based upon 22,245 participants) was 130 mg/dl less than 1% below 20 mg/dl less than 1% greater than 400 mg/dl

16 More Creatinine Issues rapid ingestion (90 minutes) of 2-4 quarts of fluid will almost always produce low creatinines & negative urine drug tests within one hour recovery time of urine creatinine and drug concentrations can take up to 10 hours incidence of drugs in urine of diluted specimens is over 5 times greater than in samples with normal creatinine levels

17 Dilute Result Interpretation: negative or none detected results should never be interpreted as indicating no drug use (abstinence), because if, in fact, drugs were present, they probably could not be detected by the test positive drug test results from a dilute sample however, are considered valid (donor was not able to dilute the sample sufficiently to deceive the test)

18 The Inadvertent Dilute My sample is dilute because I work as a roofer, on a black roof, in the middle of August when the temperature is 400 F. it is possible for a client to achieve a urine creatinine of less than 20 mg/dl under extreme conditions court needs to develop creative solutions: collect samples before work collect samples on days off use alternative specimens

19 Creatinine Sanctions no national standard adjudicate as tampered sample - more severely than positive sample adjudicate as positive sample - court utilizes positive sample sanctions adjudicate as dilute sample - unique sanctions some courts allow one dilute sample per phase/quarter regardless of sanction - court MUST address this issue

20 Two final thoughts about dilute urine samples..... a creatinine of less than 20 mg/dl (associated with a drug test) is nearly always an attempt by the donor to avoid drug use detection - REGARDLESS of how much liquid was consumed in order to achieve this result place a dilute sample prohibition in your client contract and sanction for repeat dilute samples

21 On-Site Drug Testing

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23 The Creatine Supplement Issue: creatine is the pre-cursor of creatinine creatine supplements may increase the amount of creatine in the muscles muscles may be able to generate more energy or generate energy at a faster rate creatine supplements (along with training) may improve performance by increasing energy for activities such as sprinting and weightlifting but that s s NOT why our clients take it!

24 The Creatine Supplement Issue: consuming over-the-counter creatine can disguise pre-collection hydration and a diluted urine creatine converted to creatinine will mask the dilution efforts in reality - very difficult to coordinate the intake timing and volume of creatine and dilution liquid creatinine greater than 300 mg/dl - increased monitoring creatinine greater than 400 mg/dl - sanctionable

25 What is Specific Gravity? measure of total dissolved solids in a liquid urine SpGr includes creatinine alternative method of determining sample dilution introduced in 1988 with federal workplace drug testing common test performed by forensic labs

26 My Advice on Specific Gravity use creatinine levels only to define dilute samples samples less than 20 mg/dl science-based approach very defendable policy easier to understand & explain to both clients & court professionals than SpGr

27 SUMMARY TEST FOR CREATININE! incorporate creatinine guidance in your SOPs and client contract institute a dilute sample prohibition understand low urine creatinine levels are NOT normal dilute samples are nearly always an attempt by the donor to avoid drug use detection sanction for repeat dilute tests

28 Specimen Tampering

29 Basics of Specimen Tampering - The Three Approaches dilution adulteration substitution

30 Urine Specimen Dilution most common form of tampering pre collection dilution (hydration, water loading, diuretics) post collection dilution creatinine measurement dilution detection (validity checks)

31 Urine Specimen Adulteration addition of foreign substances designed to mask drug presence post-collection tampering low-tech adulterants that cause ph shift (lime, vinegar, bleach, ammonia, lemon, drano) low-tech adulterants that disrupt testing chemistry (salt, methanol, detergent) five common high-tech adulterants

32 Urinaid, Byrd Laboratories gluteraldehyde sterilization chemical deactivates most screening tests - producing false negative results can be identified by laboratories employing specimen validity tests effects can not be reversed

33 Klear & Whizzies potassium nitrite, sodium nitrite analytical chemistry compromises the confirmation (GC/MS) of some drugs, notably carboxy-thc oxidizes drug and standards can be identified by laboratories employing specimen validity tests (SVT) effects can be reversed

34 Urine Luck pyridinium chlorochromate/dichromate oxidizing agent in organic synthesis compromises the confirmation (GC/MS) carboxy-thc and opiates can also effect screening tests oxidizes drug and standards can be identified by laboratories employing specimen validity tests (SVT) effects can not be reversed

35 Latest Update: New Adulterants Bake N Shake (sodium persulfate) Urine Luck 6.8 (hydrofluoric acid) Clear-X (potassium nitrite) Diamond Purifier (unknown) Eradicator (probably chromate) NuKlear (unknown) Purafyzit (probably chromate) Randomizer (unknown)

36 Checking for Adulterants not necessary on all samples creatinine - YES suspicious sample collection unusual sample characteristics client suspected of relapse who continues to produce negative test results

37 Urine Specimen Substitution replacing donor urine sample with another drug-free specimen biological substitution - someone else s clean urine non-biological substitution - replacing urine with urine look-a-like sample (diet Mountain Dew, water with food coloring) non-biologicals can be detected with creatinine testing

38 Specimen Validity Tests (SVT) creatinine, UUN specific gravity ph nitrites gluteraldehyde pyridine chromium Request SVT from testing laboratory or use dip-stick SVT products for on-site testing

39 Controlling Specimen Tampering develop challenging collection strategy - ie. make the testing unannounced and RANDOM! directly observed collections is the most effective approach to preventing adulteration and substitution inspect sample - train collection staff keep abreast of tampering techniques take temperature measurements ( F) use laboratory employs specimen validity tests & use with on-site devices

40 Confront Specimen Tampering with Facts: actively engage clients about tampering issues illustrates court s s tampering knowledge discuss specimen tampering in court prepare a fact-based presentation on the myths of tampering highlights the futility of tampering testimony from former clients constantly reinforce the honesty component of drug court

41 Prepare a fact-based presentation on the myths of tampering what does that mean?

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51 Sure Jell/Certo - Reality Don't believe in the Certo or Sure Jel method. I tried it...failed all the drug tests I took every time I used it...i was being tested for marijuana for Arkansas Drug Court. Tested me every week...failed all three drug screens...they use a new on site screening ening machine that spins the sample around...supposedly it can even detect meth for up to 10 days...and can detect adulterants too...i I cleaned up rather than try to cover up.

52 Engage clients in an honest discussion regarding tampering!

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