How should a Medical Review Officer (MRO) report an adulterated but drug-negative specimen?

From the Guidelines

When an MRO encounters a specimen that is adulterated but negative for drugs, they should report it as "Adulterated" without specifying a negative drug result, as this approach prioritizes the integrity of the testing process and acknowledges the attempt to subvert it. The MRO should document the specific adulterant found and note that this constitutes a refusal to test under federal guidelines, as indicated by the guidelines for handling adulterated specimens 1.

Key Considerations

• Adulteration automatically invalidates the specimen and is considered equivalent to a positive result for compliance purposes.
• The MRO should communicate this finding to the employer or requesting agency using standard reporting channels, clearly indicating that adulteration represents an attempt to subvert the testing process.
• A directly observed collection is recommended for any subsequent testing of this individual to prevent future adulteration attempts, aligning with the principles outlined for ensuring specimen integrity 1.

Clinical Implications

• The presence of an adulterant in a specimen suggests a deliberate attempt to manipulate the test outcome, which has significant implications for the interpretation of the test result and the management of the individual being tested.
• The MRO's role in identifying and reporting adulteration is critical in maintaining the integrity of drug testing programs and ensuring that individuals who attempt to cheat the system are held accountable.
• The approach to reporting adulterated specimens should be consistent with federal guidelines and should prioritize the detection and prevention of substance use disorders, as emphasized in the context of pediatric care 1.

From the Research

Reporting Adulterated but Drug-Negative Specimens

• A Medical Review Officer (MRO) should report an adulterated but drug-negative specimen as such, indicating that the specimen was adulterated but no drugs were detected 2, 3.
• The MRO should follow established protocols for reporting adulterated specimens, which may include noting the type of adulterant detected and the method used to detect it 4, 3.
• It is essential to distinguish between an adulterated specimen and a negative specimen, as adulteration can indicate an attempt to conceal drug use 5, 2.
• The MRO should be aware of the various methods used to detect adulterants, including physical observations, chemical analyses, and DNA tests 3.
• The use of unique oxidation products formed from the reaction of drug analytes with oxidizing adulterants as markers for monitoring drug misuse and urine adulteration may also be considered 2.

Detection of Adulterants

• Various methods can be used to detect adulterants in urine specimens, including rapid spot tests and laboratory-based tests 4, 3.
• The choice of method depends on the type of adulterant suspected and the resources available to the laboratory 4, 3.
• The MRO should be familiar with the different types of adulterants that can be used to manipulate urine specimens, including household chemicals and commercial products 2, 3.

Clinical Interpretation of Urine Drug Tests

• Clinicians should be aware of the potential for adulteration when interpreting urine drug test results 6.
• A negative result in an adulterated specimen does not necessarily indicate that the individual is not using drugs, as the adulterant may have destroyed the drug or its metabolites 2, 6.
• The MRO should provide clear and concise reporting of adulterated specimens to facilitate accurate interpretation of test results 2, 6.