To counter the widespread use of adulterants and to preserve the integrity of drug testing, several states have enacted laws that bar the sale of adulterants. Currently, these states include Arkansas, Illinois, Kentucky, Oklahoma, New Jersey, and North and South Carolina. At the federal level, both the Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services and the Department of Transportation (DOT) have established guidelines for specimen validity testing (13,14). Table 1 summarizes the validation criteria from DOT and SAMHSA. Both these agencies utilize the paired criteria of creatinine and specific gravity to determine whether a sample is diluted or substituted. These criteria were validated in a study by Edgell et al. in which 56 subjects ingested at least 80 oz (2370 mL) of fluid over a 6-h period. Testing of the urine samples collected the next morning could not meet the paired substitution criteria of urine creatinine <5.0 mg/dL and specific gravity <1.001 or >1.020, suggesting that the established criteria would prevent false diluted or substituted results (15).
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