From the Guidelines
A Medical Review Officer (MRO) should report an adulterated but drug-negative specimen as "Adulterated" rather than negative, as adulteration represents an attempt to mask drug use and is treated as equivalent to a positive result for administrative purposes. This approach is necessary because specimen adulteration is considered deliberate tampering with the testing process, which undermines the integrity of the drug testing program 1. The MRO should clearly document that laboratory testing confirmed adulteration of the specimen, specify the adulterant detected (such as bleach, vinegar, nitrites, glutaraldehyde, or other substances), and note that this constitutes a refusal to test under federal guidelines.
The MRO should also document any interview with the donor regarding the adulteration finding, including any explanation offered. This is crucial in determining the circumstances surrounding the adulteration and in addressing any potential substance use disorder or mental health issues that may be present 1. The final report should be submitted to the employer or requesting agency with the clear designation that this represents a refusal to test, which typically carries the same consequences as a positive drug test result.
Some key points to consider when reporting an adulterated specimen include:
- Specifying the adulterant detected and the method used to detect it
- Documenting any interview with the donor and their explanation for the adulteration
- Noting that the adulteration constitutes a refusal to test under federal guidelines
- Submitting the final report to the employer or requesting agency with the clear designation that this represents a refusal to test
- Considering referral to an addiction specialist or mental health expert for further evaluation and treatment, as adulteration may indicate a substance use disorder or co-occurring mental health or behavioral disorder 1.
It is essential to prioritize the integrity of the drug testing program and to address any potential substance use disorders or mental health issues that may be present, rather than simply reporting the specimen as negative 1.
From the Research
Reporting Adulterated but Drug-Negative Specimens
- A Medical Review Officer (MRO) should report an adulterated but drug-negative specimen by indicating that the specimen was adulterated, but no drugs were detected 2, 3, 4.
- The MRO should also provide the reason for the adulteration determination, such as the presence of an oxidizing agent or other adulterant 5, 6.
- The report should include the test results, including any positive or negative findings for drugs or adulterants, as well as any relevant quantitative measurements, such as nitrite concentrations 6.
- The MRO should be aware that some adulterants, such as nitrite, can be found in normal urine at low concentrations, and therefore, a quantitative measurement of the adulterant is necessary to support a report of adulteration 6.
- The MRO should follow established protocols and guidelines for reporting adulterated specimens, including those set by the Department of Health and Human Services or other relevant authorities 2, 3, 4.