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Evaluation of intect test strips for detecting adulteration of urine specimens used for drugs-of-abuse testing.

Common problems in drugs-of-abuse testing are the use of commercial adulterants, dilution of the specimen with water, or the addition of common household products in an attempt to cause false-negative results in screening and confirmation tests (1). Intect 6 test strips from Branan (Santa Ana, CA) were evaluated for their ability to visually detect various common adulterants in urine. Two tests, creatinine and specific gravity (SG), are intended to detect exogenous dilution of urine. Four other tests detect chemical interferants. These are nitrite, glutaraldehyde, pH, and bleach (sodium hypochlorite). Urine samples from healthy volunteers were collected and assayed for creatinine on the Hitachi 911 Auto-analyzer (Roche, Indianapolis, IN). Values ranged from 100 to 225 mg/dL of creatinine. When these urines were assayed with Intect 6 there was little or no reaction noted on the creatinine test pads. Occasional violet mottling was noted on some of the pads. The five other tests performed adequately when dipped into urines from healthy volunteers. Other than creatinine, no false-positive adulterations were noted for these tests. Ten urines were diluted to less than 10 mg/dL of creatinine. The values were confirmed on the Hitachi 911. These were found to test positive for exogenous dilution by the Intect 6 creatinine and SG test strips. The creatinine results were most likely artifacts of the pad's inability to react (2). Intect 6 strips were able to detect the presence of nitrites when the commercial adulterants Klear and Urine-Luck were added to normal urine samples. Specimens spiked with glutaraldehyde were identified by Intect 6 strips (3). Intect 6 pads reacted to the presence of bleach in adulterated urines. However, the pH pad remained at 5-6 even after the addition of 10 mL of bleach to a 50-mL urine specimen. Drano TM, which contains potassium hydroxide and sodium hypochlorite, was added to 50-mL samples of urine. The Intect 6 pH test pad showed that a strong base had been added, indicating adulteration. The bleach pad showed no reaction to the presence of Drano. Although only 2 mL of Drano was added, the SG pad gave a positive result for dilution. The use of this product for the detection of adulteration of drugs-of-abuse samples cannot be recommended. The creatinine assay will show that all specimens have been diluted, and the erratic nature of some of the other tests may lead to interpretation problems at the point of collection.