Adulterants impose a new challenge in the testing for abused drugs. Routine specimen integrity testing involving pH, creatinine, specific gravity and temperature is not adequate to detect the presence of more recently introduced adulterants such as Urine Luck, Klear and Stealth. These agents can cause false negative in the immunoassay screening steps and may also affect the GC/MS confirmation step if the abused drugs are present in modest concentrations (100-150% of cut-off concentrations). Therefore, true presence of a drug can be missed if these agents are used for adulteration. Fortunately, spot tests have been introduced and several dipstick tests (AdultaCheck 4, AdultaCheck 6 and Intect 7) are available for validation of specimen integrity. Studies are also needed to investigate effectiveness of hair shampoo to cause false negatives in a hair drug test and mouthwash products to invalidate saliva testing for abused drugs.

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