DOT Oral Fluid Testing – What are Standing Orders?

May 2, 2023, the Department of Transportation (DOT) published a final rule that, among other items, authorizes employers to use oral fluid drug testing as an alternative testing methodology to urine drug testing. The actual testing of oral fluid specimens is not yet available.

DOT oral fluid testing is approved but will not be available until at least two laboratories are certified by Department of Health and Human Services (HHS) – SAMHSA both using the same collection device. One lab for initial testing and one lab for split specimen retest requests.

A big question employers are asking is what are "Standing Orders?"

Employers only have authority to decide for a drug test event if urine is to used, oral fluid or a combination of both. The choice of specimen or whether an alternate specimen should be used is the sole decision of the employer. When there is a need to determine whether an alternate specimen should be used, it is advisable for an employer to have a standing order in place to deal with such situations. The different specimen type could be chosen by the employer through a standing order or a discussion with the collector.

If there is no standing order the collection site could also obtain assistance from the Service Agent or Consortium/third party administrator (C/TPA) as to the employer’s choice or standing order. The DOT has made in clear that the employer Designated Employer Representatives (DER) must provide an accessible phone number for collectors to call the DER in the event a standing order is not available. With no standing order from either the employer or C/TPA, the collector when faced with a decision to make must use the telephone number listed on the CCF where the DER can be reached at any time of the day or night when the testing is being conducted.

Below we have included an example of a “Standing Order” which we will recommend to our clients. Here are some of the scenarios:

If a directly observed urine collection is required, it would be more practical to perform an oral fluid collection. If the employer has a standing order that all directly observed collections will be conducted as oral fluid, then there is no need for the collector to call the DER.

A urine collection is insufficient and goes into a shy bladder process which could take up to three hours. It then become more practical to perform an oral fluid collection. If the employer has a standing order that anytime the event goes into shy bladder process, the collection should continue with an oral fluid specimen; this would perhaps eliminate the up to 3 hour wait time.

There is also a dry mouth scenario if the oral fluid device indicates the employee has not
provided a sufficient specimen. If dry mouth occurs after the initial collection is
attempted, this will begin a one-hour period to allow a sufficient specimen. Also, this
necessitates a second oral fluid collection within one hour, or the employer could have a standing order to require the collector to move on to an alternate methodology (i.e., urine) to complete the collection process for the testing event.

Here is the sample “Standing Order” that National Drug Screening, Inc will recommend to its DOT regulated Clients.

DOT Drug Screen Collections Standing Order Example

Our company continues to utilize urine drug testing, but the collector should use an oral fluid specimen collection in these instances:

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