Flushing and detoxification are frequently advertised as effective means of passing drug tests. Cone et al. evaluated the effect of excess fluid ingestion on false-negative marijuana and cocaine urine test results. The authors studied the ability of Naturally Clean Herbal tea, Golden Seal root and hydrochlorothiazide to cause false-negative results. Volunteers drank 1 gallon of water (divided in four doses over a 4-h period) or herbal tea or hydrochlorothiazide 22 h after smoking marijuana cigarettes or intranasal administration of cocaine. The creatinine levels dropped below the cut-off 2h after intake of excessive fluid. Marijuana and cocaine metabolite levels (as measured by both EMIT and TDx) reduced significantly, and results frequently switched from positive to negative in subjects after consuming 2 quarts of fluid. Even excess water was effective in diluting a urine specimen to cause false-negative results. Consumption of herbal tea produced dilute urine faster compared to subjects who drank water alone (12). Consumption of Golden Seal tea produces dark urine and can be identified by visual inspection (13). A more sophisticated approach to identify marker compounds of

Golden Seal tea in a specimen suspected of contamination requires application of high performance liquid chromatography to identify such compounds (14). Diuretics are used in sports for two purposes: first to flush out previously taken banned substances by forced diuresis and second to achieve quick weight loss to qualify for a group with a lower weight class. Ingestion of salicylate-containing drugs and sodium bicarbonate by individuals can also occur in order to avoid positive results in drug testing (2). The Medical Commission of International Olympic Committee bans diuretics. There is no commercially available immunoassay for detecting diuretics such as hydrochlorothiazide in urine. Therefore, a sophisticated technique such as liquid chromatography combined with tandem mass spectrometry is necessary to confirm the presence of diuretics in doping analysis (15).

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