Innovative Strategies and Emerging Technologies in Urine Toxicology: Protecting Test Integrity Against Sample Manipulation

Urine sample manipulation is a critical challenge in clinical and forensic toxicology, necessitating advanced detection technologies to ensure test integrity. This review examines recent innovations in detecting sample tampering, including chemical adulterant detection, biomarker analysis, spectroscopy, and artificial intelligence (AI). It also explores the application of omics technologies, such as metabolomics and proteomics, to provide deeper insights into drug use and toxic exposures. These advancements enhance both the detection of manipulated samples and personalized assessments by considering individual variability in drug metabolism. The review discusses the ethical and legal implications of these technologies, including privacy concerns and the need for updated regulations. It concludes by highlighting future trends in urine toxicology, such as wearable devices, blockchain for chain-of-custody management, and expanded multi-analyte panels, emphasizing the importance of continuous innovation to counter emerging manipulation techniques.