Does Table Salt Help Pass A Drug Test In Urine? - Soycan Mızrak* UEFLM 2018, Antalya, Turkey - EFLM-UEMS

Does Table Salt
 Help Pass A Drug Test In Urine?

                                Soycan Mızrak*

* Clinical Biochemistry Laboratory, Usak Training and Research Hospital, Usak, Turkey

                         UEFLM 2018, Antalya, Turkey
                                12/10/2018

Background
Common areas for drug testing

                             workplace
                                         Criminal
             Health care                 situations

                              Drug
                             testing
              Legal                      Military

                             Athletics

Background

Urine is most often the preferred test substance. WHY??

   1. Easy and non-invasive collection.
   2. Shows recent exposure
   3. Concentrations of drugs and metabolites also tend to be
      high concentration in the urine according to blood or
      body fluid.
   4. Is a relatively safe biological product to handle.

Background

Our goal is
to provide clinically relevant information that can be used
to interpret urine drug screens (UDSs) for commonly
abused drugs

Proper evaluation of urine specimens,
including detection times, are discussed, as well as false-
positive results and potential false - negative results.

Backround

 Scientists have spent a significant amount of time and
  effort in developing countermeasures to fight the act of
  urine adulteration.

Backround

Validities
Use at least four “validity” parameters: temperature, pH, nitrit, specific
gravity and creatinine.
These tests are performed to test for ADULTERANTS.

Backround
Acceptable ranges for urine validity are listed below.

 Temperature: 32°C – 37,2°C (within 4 minutes of
  collection)
 pH: 4.5 - 8.0
 The specific gravity: 1005-1030
 Creatinine concentrations: 20-400 mg/dL
 Nitrite levels: < 500 µg/mL.

Background
• Two types of UDSs are typically used,
• Immunassay………..for screening
• Gas Cromatography……..for confirmation
• Immunassay systems:
   • Relatively quick.
   • Sensitive but not always specific.
   • Prone to cross-reactivity.
• Cromatography-mass spectrometry systems:
   • Performed using LC-MS/MS and GC-MS/MS.
   • Sensitive and Specific. Identifies each drug with
     certainty.
   • Checks performed at every step of setup &
     identification to ensure highest quality of sample.
   • Confirmation testing requires time.

Backround

 The Department of Health Services has established specific
  cutoff levels that define a positive result for the workplace.
 These values were developed to help eliminate false-positive
  results.
 Values below the cutoff levels are reported as negative,
  which can lead to false-negative results.

Materyal and Mehod

 In our study;
 20 urine samples
 10 cannabinoid +
 5 amphetamine +
 5 opiate +
 0,25 g table salt ……1 mL urine

                                          Warner et al, 1989

Materyal-Method

Cannabinoid, amphetamine and opiate assays were analyzed
using the CEDIA method.

Creatinine assays were measured using the jaffe method with an
Abbott Arhıtect C 8000 analyzer.

pH, nitrite and densities were measured with strips.

Results

 After adding the table salt to the samples we then repeated
  the drug and urine integrity tests utilizing the same methods.
 The urine integrity tests (pH, nitrite, density and creatinine)
  produced results that were within the acceptable range
 The 10 samples for which previously the cannabinoid tests
  were positive produced negative test results.
 Amphetamine and opiate tests produced the same results as
  before the table salt was added.

Discussion

 This study differs from others due to the use of actual positive
  urine samples. The other studies use artificial drugs in urine for
  making them positive.
 The increased ionic strength due to addition of NaCl could alter
  protein structures to affect drug binding or enzyme activities.
 After addition of salt, all drug levels were negative.
 This result has been formed because they are perhaps artificial
  drugs

Conclusion

 The study shows the importance of surveillance while
 obtaining the sample as it is not possible to identify a
 possible manipulation of the urine specimen during
 analytical and post-analytical phases.

Thank you for your attention…….

     UEFLM 2018