Forensic Nursing Chronicles

Substance abuse, and the impact it may be having on employee health and workplace safety, continues to receive increasing attention in companies across Canada. Much data is now available to Canadian employers especially aimed at the transportation industry, (truck and bus drivers, and railway), as well as oil field and construction workers, machinery operators and automakers. This data can support the development of comprehensive workplace policies to reduce health and safety risks, and address potential legal liabilities.

The Alberta Alcohol and Drug Abuse Commission has been very aggressive in their researching and finding solutions to the problems of substance use. In a 2002 survey of 755 employees, 8% reported that their companies had alcohol or drug testing programs, whereas in the 1992 survey only 1% reported such programs. A provincial review of toxicology data from 290 fatal workplace incidents between 1990 and 2001 found that 11% of the dead had alcohol or illicit drugs in them.

Alcohol and drug screening tests are used for three purposes:

1. Medical purposes – to monitor progress in a treatment program
2. Legal purposes – to determine substance use prior to accident or crime
3. Medicolegal purposes – Employer program aimed at preventing accidents/crimes and treating employees with substance use / abuse problems.

As workplace drug testing becomes more common, the science of “Urine Sample Adulteration” is also becoming more prevalent. Adulteration is defined as the tampering or manipulation of a urine specimen with the intention of altering the test results and can usually be achieved by substitution, dilution or the addition of adulterants called masking agents. Adulterants can cause a false negative result by interfering with the screening test or by destroying the drugs present in the urine. Urine adulteration products such as the Whizzinator, Dr Green’s Agent X, Strip Extreme Cleaner and real, dried urine can be purchased at local stores or via internet. The brisk business in the sale of these products to help drug users pass a urine test have become a serious problem in forensic urine drug testing.

Proper procedural collection and processing of urine samples is vital to the overall process. The following is an outline of guidelines that can be used to reduce or eliminate the opportunity for adulteration of urine samples.

Urine Specimen Collection Procedure:

Collector: a trained person who instructs and assists individuals who receives and makes an initial inspection of the urine specimen and completes and submits all relevant documentation.

Collection site: the place where individuals provide the urine specimen.

Collection supplies: items that must be available at the collection site in order to conduct proper collections.

Individual Identification: individuals must provide appropriate original identification to the collector. Acceptable forms of identification include: photo identification such as driver’s license or other government issued photo identification.

Ideal Qualities of Collector and Collection Site:

1. The collector must be someone in which there is no conflict-of-interest, or in a situation that may preclude any potential appearance of collusion or impropriety.

2. The collection site may be a single-toilet restroom or a multi-stall restroom that will provide visual privacy. Hand washing facility (water faucets & soap dispensers) should be outside the stall or room area so that no water sources are accessible to the individual privately. Water within the toilets should be coloured with a bluing agent and flushing handles and toilet tank lids secured. Only authorized personnel should be in the collection area. Collectors should ensure that individuals do not have access to items that could be used to adulterate or dilute the specimen such as soap, disinfectants, cleaning agents and water.

The collection site must also have a clean surface for the collector to use as a work area and for completing the required documentation.

3. Collection supplies should include the following:

• An approved urine collection kit.
• Appropriate forms for documentation – may be specific to lab, company or agency.
• Bluing agent for toilets.
• Disposable gloves.
• Tamper-evident tape for securing faucets, flusher handles and toilet tank tops.

Steps in Urine Collection

1. Prepare collection site and collect all supplies required.
2. Begin procedure for collection immediately upon individual’s arrival to collection site.
3. Individual supplies appropriate form of photo identification.
4. Collector explains the basic collection procedure to the individual.
5. Ensure all require information is provided for accurate documentation and that the individual’s specimen ID number is present on all forms and specimen containers.
6. All outer clothing such as hats, coats and personal items; briefcases, purses or lunch bags must remain outside the collection site.
7. Individuals are directed to empty pockets and display all items to ensure no adulteration items are present. Collector assesses the need for further investigation of adulteration products on client’s person.
8. Individuals are instructed to wash and dry hands under supervision, and also instructed not to wash hands again until after the specimen has been collected.
9. Individual personally selects the collection container and with both parties present the seal of the container is broken.
10. Individual is directed to go to the room used for urination and provide a specimen of at least 45 ml. within designated time frame not to flush the toilet return with the specimen after completing the void
11. Urine is immediately tested for temperature. (acceptable range 32º to 38ºC) Voiding periods of longer that 4 min. must be repeated under supervision.
12. Specimen should be inspected for unusual colour, presence of foreign objects, or materials, or other signs of tampering. If it is apparent that specimen has been tampered with – collector should then follow procedures outlined in the Problem Collections Section of the collection kit instruction manual.
13. The collector divides the urine sample from the collection container into 2 specimen bottles. Bottle A – 30 ml. and Bottle B – 15 ml. Ensure that lids are secured tightly to prevent leakage.
14. Each bottle must have correct ID labels and tamper-evident tape is applied over the lids and bottoms and extending down the sides so that lid cannot be opened without destroying the seal. The collector dates each seal and the individual should initial each seal.
15. The collector completes all relevant documentation, ensuring that the individual signs where required.
16. The collector transfers specimens to laboratory ensuring that the procedure for chain of custody is followed.

This entry was posted on May 23, 2006 at 9:18 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.