European guidelines for workplace drug testing in urine

Taskinen, Sanna; Beck, Olof; Bosch, Tessa; Brcak, Michaela; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Weinmann, Wolfgang

doi:10.1002/dta.2178

Cited by 24 publications

(22 citation statements)

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“…The period between 1.5 and 2.5 hours after water intake was most crucial, during which the lowest values were measured, irrespective of the amount of fluid ingested. Guidelines provided by the EWDTS propose two consumptions of 0.25 L of fluid within 1 hour, followed by sampling within 2 to 3 hours, in cases where the subject is unable to provide a urine sample . Our data suggest that the application of this guideline may lead to dilute urine samples.…”

Section: Resultsmentioning

confidence: 99%

“…The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Health and Human Service (HHS) define “a dilute urine aliquot” within the Mandatory Guidelines for Federal Workplace Drug Testing Programs . In addition, the World Anti‐Doping Agency (WADA) in its Guidelines for Urine Sample Collection and the European Workplace Drug Testing Society (EWDTS) in their European Guidelines for Workplace Drug Testing in Urine define the term “diluted urine.” These thresholds for creatinine and specific gravity are summarized in Table . Osmolality has not been considered in any of these guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Creatinine excretion in consecutive urine samples after controlled ingestion of water

Franz¹,

Skopp²,

Boettcher³

et al. 2018

Drug Testing and Analysis

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Highly diluted urine is among the most commonly observed factors affecting the validity of urine testing for drug abuse. A minimum creatinine concentration of 20 mg/dL urine has been proposed as a marker for dilution of a urine sample. This study investigates the effect of water consumption on creatinine concentration, as well as its effect on specific gravity and osmolality. In this study, 22 subjects (17 women and 5 men) were included to determine the influence of sex and weight on the impact of excessive water consumption on these markers of urine dilution. The subjects consumed 0.5 L, 1.0 L, and 1.5 L of water, respectively, within 15 minutes.The mean minimum creatinine concentrations (Jaffé reaction) for the void 2 hours after fluid intake were 60.4 mg/dL, 15.8 mg/dL, and 10.9 mg/dL for the respective ingested volumes of water. Mean creatinine concentrations excreted by men were significantly higher than those excreted by women. Participants with a weight below 60 kg tended to excrete lower urine creatinine concentrations. 50% of the volunteers with a BMI < 20 kg/m 2 and 20% of the volunteers with a BMI > 20 kg/m 2 exhibited creatinine concentrations below the threshold value of 20 mg/dL. A similar pattern was established for gravity and osmolality. Due to its simple determination, creatinine may be preferred over specific gravity or osmolality. In order to evaluate the internal dilution of a urine sample for legally defensible drug testing, it may be necessary to account for sex and body weight.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Creatinine excretion in consecutive urine samples after controlled ingestion of water

Franz¹,

Skopp²,

Boettcher³

et al. 2018

Drug Testing and Analysis

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show abstract

“…29 In this study, the sample that contained Ativan (ie, Lorazepam) was used to test the benzodiazepine assay. 29 In this study, the sample that contained Ativan (ie, Lorazepam) was used to test the benzodiazepine assay.…”

Section: Benzodiazepine Assaymentioning

confidence: 99%

“…Testing Society testing guidelines have suggested an appropriate cutoff level for benzodiazepines at 200 ng/mL, which was the threshold used in this study to determine a potential false negative result. 29 In this study, the sample that contained Ativan (ie, Lorazepam) was used to test the benzodiazepine assay.…”

Section: Benzodiazepine Assaymentioning

confidence: 99%

Determining the effects of adulterants on drug detection via enzyme‐linked immunosorbent assay and adulterant tests strips

Olivieri

Marić

Bridge

2018

Drug Testing and Analysis

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The use of immunoassays for drug screening has increased due to their sensitivity towards target analytes, specifically the enzyme-linked immunosorbent assay (ELISA) technique. Adulterant test strips are commonly used in conjunction with immunoassay tests to ensure the integrity of the specimen has not been altered prior to drug screening. This research focuses on determining which adulterants can produce a false negative result, not only with 1 of the screening tests, but throughout the entire screening process. Seven adulterants were tested for their ability to generate false negative results for the ELISA by decreasing the detectable antigen concentration to below industry-used cut-off levels. Each adulterant was added to a urine sample containing 1 of 5 different drugs at 5 different concentrations (0, 5, 10, 25, and 50%). Five different urine samples that contained drugs and drug metabolites of benzoylecgonine, THC-COOH, α-PVP, D-amphetamine, and Diazepam, were treated with each of the 7 adulterants and analyzed on the ELISA and subsequently by 2 different test strips. The results indicated that 4 adulterants (ie, bleach, Drano®, vinegar, and sodium nitrite) generated the most false negatives for both test strips and the ELISA at surprisingly low concentrations, ~5% v/v. Thus indicating that there are still ways that a urine sample that contains drugs could be analyzed and labeled "clean and free of drugs" after going through a common screening process. These results suggest that new drug screening techniques need to be developed to detect adulterants in urine samples for drug screening.

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“…In summary, the only non-amphetamine-based drug where we have substantial evidence of a risk of 'false positive' results is bupropion. However, when proper confirmatory methods are used that are regarded as mandatory in urine drug testing (Taskinen et al 2017), substances such as bupropion or methylphenidate will not be mistaken for amphetamine or visa versa, nor will they mask use of amphetamines (Breindahl and Hindersson 2012). We do, however, note that only few studies have looked at the crossreactivity between non-amphetamine-based drugs used in ADHD treatment and amphetamine screening.…”

Section: Atomoxetinementioning

confidence: 82%

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

Jensen

Breindahl

2018

ADHD Atten Def Hyp Disord

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The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro-and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.

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European guidelines for workplace drug testing in urine

Cited by 24 publications

References 0 publications

Creatinine excretion in consecutive urine samples after controlled ingestion of water

Creatinine excretion in consecutive urine samples after controlled ingestion of water

Determining the effects of adulterants on drug detection via enzyme‐linked immunosorbent assay and adulterant tests strips

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

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