Loading

Oral Fluid Drug Testing

Oral Fluid Sample

With lab based oral fluid drug testing, an oral fluid or saliva specimen is collected and sent to the laboratory for screening and confirmation testing. The procedure at the lab is similar to urine drug testing. Oral fluid drug testing is sometimes referred to as saliva drug testing.

Oral fluid drug testing has gained popularity due in large part to it being perceived as less invasive and a perception that it less expensive. The oral fluid drug test captures oral fluid with a device that appears to be a sponge on a stick. The donor inserts the oral fluid collection device into the mouth to collect the oral fluid. Most devices will take at least two minutes for the collection pad (sponge) to collect a sufficient amount of oral fluid.

As of the spring of 2016, oral fluid drug testing remains prohibited for DOT drug testing but for many years it has been allowed for non-DOT drug testing. The oral fluid drug test is marketed as a product that may be used by the employer to collect the specimen at the employer place of business. Often employers engage mobile collectors to come to the business and collect specimens from multiple employees at one time. While some mobile collectors will do oral fluid collection, neither LabCorp nor Quest Diagnostics offer oral fluid drug test specimen collection at their Patient Service Center (PSC) collection sites. Most third party collection sites are also not offering oral fluid drug test collections at this time. An employer using a specific collection site on a regular basis may request that a collection site stock oral fluid collection devices and perform oral fluid collections.


Oral Fluid vs Urine Drug Testing

Unlike urine drug screens, it is very difficult to cheat a saliva based or oral fluid drug test as the collection is witnessed or directly observed. It is important however to carefully monitor the donor to insure they do not introduce something onto the pad or collection vial. Labs are seeing a higher percentage of positive drug tests with oral fluid testing particularly with marijuana. This may be due to the difficulty in cheating on an oral fluid drug test as opposed to urine drug testing and they detection window may also be a factor. Oral fluid drug testing will detect more recent use of the drug particularly for marijuana.

One of the major differences between oral fluid drug testing and urine drug testing is the detection time. The detection time is different for each drug tested. The notable difference is that the detection time is shorter for oral fluid drug testing and recent drug use is more likely to be detected with oral fluid drug testing. The window of detection for oral fluid drug testing is from several hours after use to two days. The narrow but immediate detection window makes oral fluid drug testing a natural choice for reasonable suspicion testing and for post-accident testing.

Different labs are testing for different drug panels utilizing oral fluid testing and we also see the labs using different collection devices. Below is a summary of what we have observed from the various labs in regards to oral fluid drug testing, the drugs being tested and the collection devices being used.

Quest Diagnostics:

This laboratory has their own collection device called the Oral-Eze collector. This is a patented oral fluid collection system with built-in indicator window that turns indicating that there is an adequate sample collected for drug testing. Quest Diagnostics provides this device with orders for oral fluid drug testing laboratory accounts. The drug panels currently available from Quest Diagnostics are:

  • Five panel oral fluid drug test with expanded opiates: amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine, hydrocodone, hydromorphone, and 6-AM), cocaine (metabolite), marijuana (THC), and phencyclidine (PCP). This test can also be provided without the expanded opiates – hydrocodone – hydromorphone.
  • Four panel oral fluid drug test which excludes marijuana. It tests for the following: amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine, hydrocodone, hydromorphone, and 6-AM), cocaine (metabolite) and phencyclidine (PCP).

LabCorp:

This lab uses a collection device called Quantisal which has as a unique “volume adequacy indicator” that ensures enough specimen for screening, confirmation and repeat testing. LabCorp offers some additional panel options for oral fluid drug testing including:

  • Five panel oral fluid drug test - amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine, 6-AM), cocaine (metabolite), marijuana (THC), and phencyclidine (PCP).
  • Five panel oral fluid drug test with alcohol – Ethyl alcohol, amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine, 6-AM), cocaine (metabolite), marijuana (THC), and phencyclidine (PCP).
  • Five panel oral fluid drug test with expanded opiates – amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine, hydrocodone, hydromorphone, 6-AM), cocaine (metabolite), marijuana (THC), and phencyclidine (PCP).
  • Nine panel oral fluid drug test with expanded opiates – amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine, hydrocodone, hydromorphone, 6-AM), cocaine (metabolite), marijuana (THC), phencyclidine (PCP), barbiturates, Benzodiazepines and Propoxyphene
  • Nicotine – Cotinine oral fluid test for nicotine. Cotinine is found in tobacco and is also a metabolite of nicotine.

Alere Toxicology:

This lab uses the Intercept oral fluid drug testing collection device. The original Intercept does not have a volume indicator. The Intercept 2 oral fluid collection device as of this writing is awaiting FDA clearance for workplace drug testing and does have a volume indicator. The panels available from Alere Toxicology include:

  • Five panel oral fluid drug test: amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine and 6-AM), cocaine (metabolite), marijuana (THC), and phencyclidine (PCP).
  • Five panel oral fluid drug test with expanded opiates: amphetamine, methamphetamines (including MDMA and its metabolite), opiates (codeine, morphine, hydrocodone, hydromorphone, and 6-AM), cocaine (metabolite), marijuana (THC), and phencyclidine (PCP). This test can also be provided without the expanded opiates – hydrocodone – hydromorphone.
  • Nicotine – Cotinine oral fluid test for nicotine. Cotinine is found in tobacco and is also a metabolite of nicotine. Cotinine testing can be combined with testing for the drugs of abuse testing offered by Alere Toxicology.
  • Alere also offers a large number of other oral fluid drug test panel configurations that include the following additional drugs of abuse: barbiturates, barbiturates, methadone, meperidine, buprenorphine, ethanol (alcohol)

Omega Laboratories:

Primarily testing with hair follicle and oral fluid, this lab uses the Intercept oral fluid drug testing collection device. Omega offers panels as follows:

  • 6-Panel oral fluid drug test - marijuana, cocaine, opiates, amphetamine, methamphetamine (including Ecstasy), and PCP.
  • 10-Panel oral fluid drug test - marijuana, cocaine, opiates, amphetamine, methamphetamine (including Ecstasy), PCP, oxycodone, barbiturates, methadone and benzodiazepines.
Oral Fluid Drug Testing

DOT and Oral Fluid Drug Testing

Although not currently allowed, DOT is considering including oral fluid drug testing for DOT regulated drug testing. A rule has been proposed in the Mandatory Guidelines for Federal Workplace Drug Testing; it was opened for comments and the comment period closed on July 14, 2015 with 120 comments received. Once SAMHSA finalizes the rule and adds it to the Mandatory Guidelines for Federal Workplace Drug Testing; DOT will then decide whether to adopt it into 49 CFR Part 40 in its entirety or perhaps a portion of it.

Two things DOT will clearly adopt: split specimen collections and strict collector training including qualification and proficiency demonstration requirements. Laboratories and MRO’s will also have to come up to speed on the requirements that SAMHSA writes into the Mandatory Guidelines for Federal Workplace Drug Testing. It is my professional opinion that we will not likely see oral fluid drug testing for DOT until 2018.


Costs of Oral Fluid Testing

It is often stated that oral fluid drug testing is less expensive than urine drug testing. That is typically only true when the employer is collecting the specimen, completing the custody and control form and processing the specimen out to the laboratory. The reason it is stated that oral fluid drug testing is less expensive is because the cost of the collector and the collection site is eliminated. The challenge for the employer is training a staff member to collect the oral fluid specimen, complete the custody and control form and process the specimen out to the laboratory. Each of these steps are absolutely essential to the oral fluid testing process and can have serious consequences if not completed properly.

Several years back, Publix Supermarkets, located in the southeast; replaced urine drug testing with oral fluid drug testing. This large retail grocery chain calculated hundreds of thousands of dollars in savings as a results of no longer utilizing collectors or collection sites. Store managers were trained to perform the oral fluid collections and processing out to the laboratory.

Implementing oral fluid testing in any business will require thought and action. Drug free workplace policies will need to be updated and specimen collection procedures will need to be created including getting training for the employer staff to perform the specimen collections and process the specimens to the laboratory. Important decisions will have to be made that may dramatically affect the business. It is important to review carefully at all layers of management a decision to change from urine drug testing to oral fluid drug testing.