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Specimen validity testing in urine drug monitoring of medications and illicit drugs: Clinical implications

Kenneth L. Kirsh, PhD, Paul J. Christo, MD, MBA, Howard Heit, MD, Katherine Steffel, PharmD, Steven D. Passik, PhD


Objective: To discuss the importance of specimen validity testing (SVT) in urine drug testing (UDT) and the clinical role it plays in identifying efforts to subvert the UDT process.

Methods: A discussion of the clinical impact of SVT is presented.

Results: A discussion of pH, specific gravity, creatinine, and oxidation for monitoring the adulteration of UDT samples is presented along with the clinical significance of such tests.

Significance: SVT has a significant place in healthcare efforts to measure patient adherence, behavior, and honesty in communication with clinicians. SVT is typically ordered by treating clinicians who use the results to make therapeutic decisions regarding specific medical problems of their patient, including those related to medication and illicit drug use. In the absence of SVT, a healthcare provider may fail to identify a patient's adulteration of their urine sample in an attempt at deceiving the provider. Moreover, the presence of some underlying medical conditions may obfuscate the UDT results.


urine drug testing, specimen validity, behavior, adulteration

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