Unprecedented Surge: Navigating the Highest Drug Test Cheating Rates in 30 Years

By Alison Adduono, Director of Marketing

According to Quest Diagnostics drug test cheating is becoming more prevalent. In 2023 the lab giant processed almost 9.8 M occupational drug tests and saw a 30 year high in tampering. They saw an increase in drug use too.

Quest saw a significant 633% increase in substituted urine samples (>6000 specimens). A 45% increase (an additional 25K tests) were deemed invalid. Overall occupational drug test positive rates are at their highest in two decades seeing a 5.7% jump.

What is tampering?

Well quite simply it is when the sample has been substituted or has been invalidated using an evasion technique in an effort to conceal drug usage. These drug test evasion techniques include:

Substitute samples – when a donor sample has been replaced with animal urine, another human being’s urine, synthetic urine specimen or another non-biological substance that resembles urine in color.
Invalid samples – specimens that are either dilute or contain additives used to cover up drug use. They are also referred to as adulterated specimens.

What is synthetic urine?

Simply put, it is fake pee. While it might fool the naked eye – it won’t fool sophisticated lab urinalysis testing such as GC/MS or LC/MS.

Synthetic urine is a concoction of various elements that mimic the composition of natural urine, but it’s crafted in a laboratory setting. Urea is the primary component of urine, and in synthetic variants, it’s created artificially and mixed with water, creatinine, and occasionally uric acid.

Manufacturers of synthetic urine strive to replicate the essential characteristics of natural urine that detection tests measure. This includes the chemical makeup, pH levels, specific gravity, appearance, and smell.

How are specimens adultered?

To mask drug use, some donors take to adulterating or tampering with their specimen. There are a couple of different methods:

Internal adulteration
- One way of doing this is by consuming excessive amounts of water or water-based fluids pre-collection. This typically results in what is called a dilute specimen.
- Consuming supplements or other acidic substances that are thought to adjust the pH level of urine and render an immunoassay ineffective.
- Taking diuretics in an effort to flush one’s system (i.e. Golden Seal, Clean-n-Clear, Test Free, Naturally Klean).
External adulteration
- Post-collection specimen dilution by adding drinking, tap, or toilet water to the urine sample.
- The addition of chemical substances such as household cleaners, bleach, etc. or products obtained online such as UrinAid (glutaraldehyde), Stealth® (containing peroxidase and peroxide), Urine Luck (pyridinium chlorochromate, PCC), and Klear® (potassium nitrite).

What caused this jump in drug test cheating?

There are several reasons why we are seeing an increase in drug usage as well as those trying to cheat the tests.

In the US, 24 states have now legalized recreational use of THC (marijuana) thereby decriminalizing its usage and opening up its access. This availability has also had an effect on workplace accidents. In fact, a study published in the Journal of the American Medical Association noted a 10% increase in jobsite injuries among people aged 20 to 34 that were directly linked to recreational marijuana sales.
Society’s “normalization” or drug use. Suhash Harwani, Ph.D., Senior Director of Science for Workforce Health Solutions at Quest Diagnostics stated: “Given the growing acceptance and use of some drugs, particularly marijuana, it may be unsurprising that some people feel it necessary to try and cheat a drug test. It is possible that our society’s normalization of drug use is fostering environments in which some employees feel it is acceptable to use such drugs without truly understanding the impact they have on workplace safety.”
During the Covid pandemic, data (albeit limited) shows that there were significant increases in drug usage among surveyed adults and there is no doubt some carry over with addictions. Usage among adolescents and young adults dropped in 2021.

What does the future hold?

As social norms change, and legal landscapes evolve so will workforce drug testing. With the legalization and decriminalization of certain drugs, such as marijuana, we will see changes in employer drug testing policies. We may even see a reduction in drug testing in non-safety sensitive jobs as a means of attracting labor where there may be shortages.

We can also expect that we will continue to see technological advances in testing – as they become more accurate, convenient and less invasive. Saliva-based testing will continue to improve and we will perhaps see more 510k approved POC devices in the market as well as wearable technology could even become another option for non-invasive testing and monitoring. AI, like our Origin.One app, will also increase in usage and will play a crucial role in enhancing the precision, speed and effectiveness of drug testing and reporting.

In summary, the future of drug testing will remain dynamic and will continue to evolve with societal trends and technological progress.