A case of psychosis after use of a detoxification kit and a review of techniques, risks, and regulations associated with the subversion of urine drug tests.

Illicit drug use and the inherent risks involved with such use have been and continue to be a significant concern around the world. The National Survey on Drug Use and Health in 2008 found the overall rate of illicit drug use in the United States among the population aged 12 years and older to be 8.0%, and it rose to 8.7% in 2009.1 When the problem is this significant, it affects not only the individuals using the substances and their families, but also workplaces and educational campuses. As the substance use impairs one’s ability to function in any given setting, it is important that some regulation is in place. The drug-testing movement began in 1986 when former US President Ronald Reagan signed Executive Order 12564. This order required all federal employees to refrain from using illegal drugs, on or off duty, as a condition of federal employment.2 Two years later, the US Congress passed the Drug-Free Workplace Act of 1988.3 That, in turn, spawned the creation of the Federal Mandatory Guidelines for Federal Workplace Drug Testing Programs.4 Although the Drug-Free Workplace Act applies only to federal employees, many state and local governments followed suit and adopted similar state laws and drug-free workplace programs. These developments led to research and subsequent development in the industry of ways to screen for illicit drugs. However, over the years, a parallel industry dedicated to subverting the results of urine drug testing also emerged and has been in service for more than a decade now. A search of the key phrase beat a drug test in 1 of the popular Internet search engines, Google, yields 12 million results. Some of the products available on the market were Urine Aid, Urine Luck, Klear, and Whizzies. The products have little or no regulation by state or federal authorities, and some do not even mention their ingredients. The absence of such regulation makes these products potentially dangerous. We hereby present the case of a patient who developed psychosis secondary to the use of a detoxification kit. In addition, we discuss the literature available on this topic. Clinical Points ♦Contact the laboratory in the case of a negative urine drug specimen when accompanied by a high index of suspicion of drug use. ♦Specimen integrity tests and sample collection procedures should never be ignored. ♦Detoxification kits must be included in the differential for causation of medical and/or psychiatric symptoms. ♦Advocacy for more stringent laws regarding the manufacture, sale, and marketing of drug test tampering products is warranted.