HEALTH: Urine drug tests are effective but easy to cheat on

Each day, 91 people die of prescription opioid and heroin (the cheapest form of opiate) overdoses, according to the CDC. Synthetic drugs mixed with heroin are the fastest growing category of abused and misused drugs.

A recent CDC report says past misuse of prescription opioids is the STRONGEST risk factor for starting heroin use — especially among people who became dependent upon or abused prescription opioids in the past year.
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Experts agree that reducing first-time exposure to opiates as well as reducing opiate prescriptions is a start. Pain News Network reported Feb. 3 that the Centers for Medicare and Medicaid Services (CMS) just announced plans to fully implement the opioid prescribing guidelines laid out by the CDC last spring.

CMS is taking the recommendations one step further by mandating them as official policy and taking punitive action against doctors and patients who don't follow them.

One pillar of those recommendations includes monitoring patients receiving opioids for inappropriate drug use with regular urine drug testing (UDT).

Urine drug testing is the most effective diagnostic tool for uncovering misuse and abuse of opiates. Early, accurate detection of inappropriate drug taking behaviors enables earlier intervention.

But what happens when one of the best tools for recognizing opioid misuse is easily cheated?

The urine drug test remains the gold standard diagnostic tool for both the federal workplace as well as clinics prescribing opiates and monitoring addiction recovery. Less well known and rarely spoken about is the quiet war aimed at defeating this important test.

In fact, a quick Google search of "how to cheat a drug test" yields over 1.5 million results. Blogs are found giving detailed instructions on the use and purchase of devices, adulterants and synthetic urine.

The sole purpose of these products and the methods described in great detail is to fraudulently produce a clean UDT result, thus hiding the user's drug misuse, abuse or addiction.

Warming substitute urine provided by another person is touted as the cheapest alternative and remains the "fool proof way to cheat a drug test." Amazon alone gives 400 search results when looking for synthetic or fake urine. This fake urine, when warmed, is almost indistinguishable from the real thing by current lab testing, as a Quest lab in Denver recently discovered.

Worse yet, this same lab found that corrupt sample collectors turning a blind eye make the problem worse.

There is no hard data on the magnitude of urine drug test cheating, largely because the relied-upon sample validity standards can easily be fooled. Research presented last September at the American Pain Management Conference in San Antonio, Tex., reported that more than 98% of samples containing substitute or synthetic urine were undetected using traditional validity measures. The United States Drug Enforcement Agency (DEA) has estimated at least 10 percent of all samples could be adulterated.

What can be done?

Witnessing sample collection might possibly identify attempts to cheat a drug test. However, watching people pee in a cup is somewhat impractical, not easily implemented and cost prohibitive in the clinical setting.

Sadly, motivated patients would just acquire one of the available prosthetic devices designed to fool the sample collection observer by simulating human anatomy.

Saliva, blood and hair samples while witnessed have their own strengths. Unfortunately, they also have real weaknesses when it comes to point of care monitoring of recent use and uncovering the newer synthetics.

Clearly a better version of the urine drug test is urgently needed.

Precision medicine to the rescue

Matching DNA of the urine sample to the DNA of the person being tested would ensure the authenticity of the test results. With the advent of newer instruments designed to identify DNA more rapidly and cheaply, my lab in Austin, Tex., Genotox Labs, has started a quiet, but much needed transformation of the industry.

A team of scientists and I developed, tested and successfully commercialized a new lab method called ToxProtect, which matches the DNA in the sample to the patient and identifies all types of substitute urine, including synthetic urine products.

To date over 10,000 DNA matching tests have been done, and not surprisingly many negative matches (samples not belonging to the sample donor) have been discovered.

Identifying fraudulent sample submission is helping doctors and clinics uncover misuse, abuse and relapse that would have otherwise never been detected using less robust forms of UDT.

With 91 people dying every day we must rethink every part of the solution. Urine drug testing is relied upon as THE early warning system in aberrant drug-taking behaviors that may lead to misuse, abuse, addiction and sadly, even death.

Prevention of this terrible cycle relies on accurate and authenticated UDT results. Using UDT testing that eliminates the risks of sample substitution by those motivated to do so will be a strong step in the right direction.

Dr. Matt McCarty is a board certified, fellowship trained physician specializing in chronic pain management. He is CEO and founder Genotox Laboratories (www.genotoxlabs.com), a rapidly growing national reference lab providing medication monitoring services through urine drug screen confirmations and pharmacogenomics testing.