To the Editor.
—In the recently published survey on drug testing in the workplace, Hoyt et al1 review the "accuracy and reliability of the various methods commonly used for detection of drugs in urine." Unfortunately, this article does not address the largest source of false results in drug testing: urine sample substitution. The authors assume that witnessing urine specimen collection guarantees sample integrity.According to the Department of Justice, up to 10% of urine samples collected in the military yield false-negative results, and guaranteed drug-free urine can be purchased from a number of commercial sources.2 In addition, direct observation of urination is not practical for widespread use, may represent an invasion of privacy, and, as recent accounts by professional athletes document, does not ensure that the specimens are genuine.Federal guidelines for drug testing programs require that the temperature of the urine specimen be measured at the time
Person NB, Ehrenkranz JRL. Fake Urine Samples for Drug Analysis: Hot, But Not Hot Enough. JAMA. 1988;259(6):841. doi:10.1001/jama.1988.03720060013015
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