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

doi:10.5055/jom.2015.0252

Authors

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

DOI:

https://doi.org/10.5055/jom.2015.0252

Keywords:

urine drug testing, specimen validity, behavior, adulteration

Abstract

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.

Author Biographies

Kenneth L. Kirsh, PhD

Millennium Research Institute, San Diego, California; Vice President, Clinical Research and Advocacy, Millennium Health, San Diego, California.

Paul J. Christo, MD, MBA

Johns Hopkins University School of Medicine, Baltimore, Maryland.

Howard Heit, MD

Georgetown University School of Medicine, Washington, DC.

Katherine Steffel, PharmD

Millennium Health, San Diego, California.

Steven D. Passik, PhD

Millennium Research Institute, San Diego, California; Vice President, Clinical Research and Advocacy, Millennium Health, San Diego, California.

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