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The page below is a sample from the LabCE course The Toxicology Laboratory's Role in Pain Management. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Adulterants and Urine Samples Collected for Prescription Drug Monitoring

As discussed earlier, adulterants are chemicals that can be added to a urine sample to obscure or confound drug screens. Since most urine collections in the pain management setting are self-collected and unsupervised, it is easy for a person to adulterate his/her specimen, if that person wishes to deceive the clinician. Adulteration of a urine sample for drugs-of-abuse screening, performed for employment or legal reasons, may be done to produce a false-negative result. However, adulteration of the urine sample in the pain management setting may be done to produce a false-positive result. That is, a patient may adulterate the urine sample by adding the drug that should be there when in fact, the patient did not ingest the drug. For example, a patient who is being treated with methadone for an addiction to heroin may put methadone pill dust into his/her urine sample to trick the clinician into thinking he/she is compliant with taking the medication. In reality, the patient skipped the methadone dose in order to get a greater "high" when using heroin or other opiates. For this reason, toxicology laboratories should only report methadone as positive when they detect the parent and the metabolite (the metabolite will only be present if the drug was injected and not present if pill dust is added).