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Part 4: Biological Matrices
Urine
Use of Urine Drug Testing (UDT) in Addiction Treatment
Î Urine should be considered the most well-established and well-
supported biological matrix for presumptive detection of substance
use in a clinical setting.
• Urine should be considered the best established matrix for POCTs.
Î If tampering is of high concern or appropriate measures to reduce the
likelihood of tampering cannot be taken, providers should consider
using an alternative specimen type.
Urine Sample Integrity
Î Urine should be considered the matrix most prone to sample
tampering through dilution, adulteration and substitution.
Î Providers should choose collection methods that protect patients'
dignity and privacy while minimizing opportunities for tampering.
Î Observed sample collection can deter urine sample tampering. If there
are concerns about tampering, collection should be observed by a
same-gender staff member.
Î Observed urine sample collection does not completely prevent sample
tampering. Providers should consider other strategies to mitigate
urine sample tampering.
Î Providers should consider the use of an unobtrusive sample collection
method for patients with a history of psychological trauma, especially
sexual trauma.
Î Providers should employ appropriate measures in the facility where
patients provide specimens to decrease the likelihood of urine sample
tampering during unobserved collection.
• Do not allow personal items in the collection area.
• Ensure that potential adulterants, such as soap, ammonia, or bleach are not readily
available in the collection area.
• Consider placing blue dye in the toilet and turn off the water source to the
collection area during collection.
Î If a provider suspects that a patient has engaged in substance
use but continues to produce negative urine test results, sample
collection should be observed and specimen validity testing should be
conducted.
Î If a sample is suspected of having been tampered with, it should be
tested for specimen validity including creatinine concentration, pH
level, specific gravity and adulterants.
