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Tampering is best detected by validating the specimen’s integrity through validity testing. This means checking multiple markers that reveal whether the urine is genuine and uncompromised, rather than relying on a single clue. By evaluating temperature at collection to ensure the sample is fresh, plus creatinine concentration and specific gravity to gauge urine concentration, along with pH and the presence of adulterants such as oxidants, you get a clear signal of substitution, adulteration, or dilution. Substitution often shows very low creatinine and low specific gravity; adulteration can produce abnormal pH and detectable oxidants; dilution lowers creatinine and specific gravity but may not change appearance. Because tampering can present in different ways, a panel of validity markers provides the most reliable detection.