الفهرس 
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Abstract
Conclusion
1- If urine drug testing is to be conducted, specimen integrity should be assessed and suspected specimens should be rejected.
2- Specimen integrity tests are inadequate in detecting adulterants but helpful to exclude adulterated samples before testing which can save time and money
3-RIA assays for drugs of abuse can be invalidated by specimen adulteration producing false-negative results so confirmation should be done.
4-Chromatographic methods as HPLC and GC-MS have an important role in confiramation of drug of abuse testing as they are less affected by different adulterants.
5- from the studied adulterants, Vinegar at high concentration 40%, drano at conc. 40% and 20%, and hand soap at different conc. had the largest influence (false negative results) on the urine drug tests on both tramadol and cannabis.
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Recommendations
1-Collection of urine samples must be occur under human supervision to decrease possibility of adulteration.
2- Specimen integrity tests should be assessed before urine drug testing and suspected specimens should be rejected.
3-Chromatographic methods as HPLC and GC-MS have an important role in confiramation of drug of abuse testing as they are less affected by different adulterants.
4-Further studies should be conducted to detect effects of other different adulterant on different substances of abuse and how to overcome this problem.
5-Study of mechanisms of different adulterants.
Summary
Substance abuse in Egypt is a serious public health threat. Recent studies have demonstrated increases in the prevalence of the use of cannabis and tramadol.
Urine testing for drugs of abuse become an integral weapon in the nation’s war against drugs. These drug tests are used in pre-employment screening, post-accident assessment, probation control, and inmate determent.
Drug testing occurs in two phases: screening and confirmation. Historically, the initial screen has been a chemical test or immunoassay (IA) that can provide a reasonable turnaround time with minimal labor and resources .A limitation inherent in all urine drug testing is the possibility of sample adulteration or substitution
Adulteration process is defined as the tampering or manipulation of a urine sample with the intention of changing the test results. Sample adulteration is usually performed by substitution, dilution or the addition of adulterants agents including so called ”masking agents” sold commercially.
The use of adulterant agents can cause false negative results in drug tests by either interfering with the screening test procedure and/or destroying the drugs present in the urine sample.
This study was conducted in urine samples collected from patients attending Sohag Clinical Toxicology Laboratory. Urine samples were tested for integrity including measurement of (PH, specific gravity, creatinine ) before testing.
The samples were tested by immunoassay for tramadol and tetra hydro cannabinoid (THC), positive samples only were included.
Positive samples for tramadol were retested by HPLC for confirmation of its result and quantification of conc.
Positive samples for THC were retested by GC-MS for confirmation of its result and quantification of conc.
Five Types of of adulterants were used.
-Vinegar ,bleach ,visine eye drops and liquid drano at 3 conc. 10%.20% and 40%.
-Liquid hand soap at 3 conc.5%,10% and 20%.
Addition of vinegar at conc.40 % and 20% to urine samples lead to decrease in pH below normal range.While addition bleach at conc.40% and 20%,drano at conc.40% and 20%. and liquid hand soap at conc. 20%,10% lead to increase in pH.
Addition of vinegar at conc.40 % and 20%,bleach at conc.40% and 20%and hand soap at conc 20% and 10% to urine samples lead to increase in specific gravity above normal range. While addition of drano at conc.40% and 20% lead to decrease in specific gravity above normal range.
Addition of vinegar at conc.40%,bleach at conc.40%,drano at conc.40%and 20% and liquid hand soap at conc. 20% lead to decrease in creatinine level below normal range.
Addition of visine by any conc. not affected pH, specific gravity nor creatinine
As regard effect of different urine adulterants on RIA screening for tramadol ,addition of vinegar at conc.40 % drano at conc. 40% and 20% and hand soap by any conc. even low conc.5 % were able to mask positive response of tramadol in tested urine samples. On other hand addition of bleach,visine whatever their conc. failed to mask tramadol detection by RIA.
As regard effect of different adulterants on tramadol and o-des methyl tramadol (ODT) confirmation and quantification by HPLC ,addition of vinegar, drano and liquid hand soap lead to decrease tramadol and ODT significantly with increased concentration.
As regard effect of different urine adulterants on RIA screening for THC-COOH, addition of vinegar at conc.40 % and visine at conc.40% &20% were able to mask positive response of THC-COOH in tested urine samples. On other hand addition of bleach, drano hand soap whatever their conc. were able to mask THC-COOH detection by RIA.
As regard effect of different adulterants on THC-COOH confirmation and quantification by GC-MS, addition of vinegar,bleach,visine ,drano and liquid hand soap decrease THC-COOH significantly with increased concentration.