The defined HHS/DOT substituted urine criteria validated through a controlled hydration study.

This controlled hydration study was designed to validate the substitution criteria used by the Substance Abuse and Mental Health Services Administration (SAMHSA) to classify a workplace urine specimen as inconsistent with normal human urine. Study participants (n = 56) ingested at least 80 oz (2370 mL) of fluid over a 6-h period, 40 oz during the first 3 h (DOT hydration protocol) and 40 oz during the second 3-h period. Urine specimens (n = 498) were collected upon awakening, just prior to hydration, at the end of each hour of the 6-h test period, and upon awakening the next day. No urine specimen satisfied the paired substitution criteria of urine creatinine < or = 5.0 mg/dL and specific gravity < or = 1.001 or > or = 1.020. Seventy-three percent of the participants produced at least one specimen meeting the criteria for dilute urine: urine creatinine < 20.0 mg/dL and specific gravity < 1.003. Fifty-five percent of the participants produced at least one dilute urine specimen during the first 3 h of hydration. In conclusion, this controlled hydration study supports the criteria set by SAMHSA for classifying a specimen as substituted (inconsistent with normal human urine).

In vitro formation of acetylmorphine from morphine and aspirin in postmortem gastric contents and deionized water.

Forensic toxicologists consider detection of 6-acetylmorphine (6-AM) definitive evidence of heroin abuse. This study investigated the possibility that aspirin, when in solution with morphine, may acetylate morphine to produce acetylmorphine (AM). Morphine sulfate-extended release tablets (15 mg) and aspirin (325 mg) tablets were incubated in 50 mL postmortem gastric contents or deionized water at 37°C. One-milliliter aliquots were taken at timed intervals, extracted by solid-phase extraction, derivatized and analyzed by the gas chromatograph with a mass selective detector. Both 3- and 6-AM were detected in samples containing morphine and aspirin in combination; no heroin was detected. Production of AM was pH dependent with optimal formation at pH ≥4. In gastric contents, concentrations of 3-AM exceeded that of 6-AM by ∼10-fold. Production of 3-AM in gastric contents was approximately twice as high as it was in water, while matrix did not appear to affect 6-AM production. Urine specimens (10,602) assayed at a pain management laboratory and postmortem cases (>6,000) were investigated for in vivo formation of AM. Three cases exhibited unexplained 6-AM results. These data indicate that in vivo formation of 6-AM from the co-administration of aspirin and morphine, if it happens, is quite rare. In instances where this is suspected, 3-AM should be monitored.