Oral Fluid Testing For Drugs and Alcohol In 2022

Joe Reilly, President of National Drug Screening. Welcome to our 2022 video blog series. Today’s video is going to be about oral fluid drug and alcohol testing in 2022.

2023 UpdateDOT Oral Fluid Drug Testing, Collections and Mock Collections

So we’re going to talk about oral fluid drug testing and oral fluid alcohol testing today. And I’m going to start with what we call instant oral fluid drug testing, as opposed to lab-based oral fluid drug testing. So let’s start with instant oral fluid drug testing.

This is a device where oral fluid or saliva is collected, and an instant drug screen is conducted with what we call point of collection testing. It’s a screening test. And it can tell you positive or negative for drugs. Now, if the instant oral fluid drug test is non-negative or positive, but I prefer to say non-negative because we don’t know for sure that it’s positive, it needs further confirmation testing at a laboratory. And so when you do an instant drug test with oral fluid, you kinda need a second sample, if you have a non-negative, in order to send it to the lab for confirmation testing. You cannot rely on that instant oral fluid drug test device for a reliable positive. It will not be defensible in court. You have to send a specimen to the laboratory for confirmation testing at the laboratory, typically called Gas Chromatography Mass Spectrometry, or GC/MS.

Now, here are a couple of images of some commonly used instant oral fluid drug screening products. And we’re going to move off this topic in just a minute and go to lab-based oral fluid testing and, um, what we call alcohol saliva instant oral fluid testing. But as far as the instant oral fluid drug testing with the products that I’m showing here on the screen, I don’t particularly recommend them. In my experience, since they’ve been around for 20 years, I’ve seen lots of problems with these types of devices. In fact, in some situations I’ve seen hundreds of tests being conducted and no positives show up. Particularly, no positives for marijuana. And that’s concerning to me. So I’m going to leave it at that. I just personally, after 29 years in this business, I don’t recommend instant oral fluid drug testing products.

Now we’re going to move to alcohol testing and then to lab based oral fluid drug testing. Which I recommend both of those. So the instant alcohol, what we call saliva screening, it is also a screen, and if it’s negative, that’s good, we’re good to go. But if it’s non-negative, it needs to be confirmed. Typically with a, with an evidential breath testing device; a breath alcohol test. So even for DOT or Department Of Transportation regulated drug testing and alcohol testing, there are approved devices for instant saliva screening for alcohol. These devices, a couple of them you can see here on the screen, are often used for the initial screen for an alcohol test for both DOT and for non-DOT. And they’ve been used a lot over the last couple of years with the COVID pandemic, being able to be more social-distanced with the donor, because these are tests that the donor could administer themselves with the technician just observing them. Remember again, that these instant saliva screening devices for alcohol do require confirmation with a breath alcohol test.

Now we’re going to move over to what we call lab-based oral fluid drug testing, which is a hot topic. Been a hot topic for the last couple of years, and lab-based oral fluid testing is going to be a hot topic in 2022. And the biggest question is does, is it allowed for Department Of Transportation or DOT drug testing. And currently the answer is, no. Many people think that lab-based oral fluid testing is currently approved by DOT. That is incorrect. It is not currently approved by DOT. It may be some point this year. My best prediction is towards the end of the year. But it’s anybody’s guess.

Now, lab-based oral fluid testing has been used for well over 10 years for non-DOT drug testing programs. And lab-based oral fluid drug testing can be a benefit to be used in many situations. And basically with lab based oral fluid testing, you’re taking a device, which I call something similar to a sponge on a stick, and the donor inserts it into their mouth and oral fluid is collected. And then the device is put into a tube. The tube is sealed up and it is sent to the laboratory for testing. Both initial screening testing, and if necessary on a non-negative, confirmation testing.

Now, these devices are kind of dependent on the laboratory that you’re using, because different laboratories accept different devices and not necessarily will accept all of the available devices. So depending on whether you’re using laboratories like Quest Diagnostics, or Labcorp, or Alere/Abbott, or Clinical Reference Laboratories, you want to be sure that you’re getting the appropriate oral fluid collection device to use that that laboratory accepts.

So I have a couple of these devices that I just wanted to show you, and we’ll show you some images on the screen also, but this one right here is the Oral-eze oral fluid collection device. This is used by Quest Diagnostics. And you see it comes in the package and it’s got the sponge on the stick and it’s got the tube that gets sealed up that gets sent to the lab. It also has an indicator that turns blue when you’ve collected enough oral fluid. So that’s a good thing, because one of the challenges with oral fluid could be you didn’t collect enough specimen. So with this indicator, it tells you you’ve collected enough specimen.

Then we have what’s called the Quantisal device. Okay. Very similar, a sponge on a stick and a tube, and this particular device gives you instructions on the back on how to use it. This device is accepted by Labcorp. It may be accepted by other labs also. We use it with Labcorp.

And then we have what’s called the Intercept device. It’s made by a company called OraSure. Clinical Reference Labs and CRL, and some other labs accept this device. It’s probably the one that’s been around the longest and they are coming out with a new one that will have also the indicator that tells you when you’ve collected enough oral fluid.

So the oral fluid is collected, typically at the employer’s place of business. It’s not typical that your standard collection sites around the United States are stocking these devices and conducting oral fluid testing. It’s typical that an employer will sit down with an employee at a desk, at a table, at some workspace, and administer the testing with that employee or with that applicant and get that specimen sent off to the lab.

So it’s an easy observed collection. The donor pretty much does all the work. They put the device in their mouth, they put it in the tube and then the employer representative fills out the paperwork and seals up the specimen and sends it to the lab. Now that’s a big advantage if you’re doing reasonable suspicion testing. You don’t have to take the person anywhere. It’s also a big advantage for post-accident testing, particularly after hours when collection sites typically aren’t even open. So it’s a big advantage that a safety manager, an employer representative can easily do a post-accident drug test right away and send it in the next day to the laboratory.

Now, one of the differences between oral fluid drug testing and urine drug testing, is the detection time. And this is critically important to determine when you should use oral fluid drug testing. The detection time for oral fluid drug testing is about one to two days from when the drugs were ingested. So it gives you a more recent look back that someone used drugs more recently, potentially, than a urine drug test. With a urine drug test, depending on the drugs, we typically look at a two to three to five day lookback period.

So for reasonable suspicion and for post-accident, we’re trying to determine if someone used drugs recently. For preemployment or random, we might want to stick with urine drug testing because we want to see if they’ve maybe used illegal drugs over the last few days, over the last week, maybe last weekend.

So the big difference between urine and oral fluid, or the two big differences, is the collection process and the lookback period; the detection time. When did the person use the drugs? Never an exact science, but it’s approximately up to two days for oral fluid drug testing and approximately four to five days for urine drug testing.

Now, I recently did a webinar on oral fluid drug testing, similar to the information that I’m providing here in this video. And I got some really good questions. I wanted to share some of those questions with you. Okay?

The first one was, what are my recommendations for instant oral fluid? And as I told you, I don’t recommend instant oral fluid testing. I do recommend lab based oral fluid testing.

Then we got the question, what about alcohol; can oral fluid testing be used for alcohol? As I mentioned, there are a couple of saliva screening devices, instant saliva screening devices that can be used for the initial screen for an alcohol test, and there are a couple, I’ll show them up here on the screen, that are approved for DOT to do the initial screening. If positive, they do require confirmation testing with your breathalyzer machine. So even if you’re doing the instant saliva alcohol testing, you still need a breathalyzer machine on hand.

The next question we got was, which I covered earlier, is oral fluid testing approved for DOT? No, it’s not currently. It has been approved by SAMHSA, which is the substance abuse, mental health services administration. Which is the first step to getting DOT approval. So it’s halfway there, but it’s not there yet.

The next question was from an employer that said, you know, what should we consider if we’re thinking about oral fluid drug testing? Well, what I would consider is, you know, do you have the ability to have your managers, safety managers or HR reps to administer the testing? Is that feasible? And if it is, my recommendation is it’s a really good idea for post-accident testing. And it’s a really good idea for reasonable suspicion testing. Because almost every employer that ever calls me about a drug testing program says, what do we do if we have an accident at nine o’clock at night or four o’clock in the morning? And it’s very difficult to get a urine drug screen done after hours. With the oral fluid drug tests, you can get it done right then, right there.

Then we had, what about non-regulated workplace, is oral fluid testing a reliable option? Yes, it is. For the reasons that I told you.

We have some great, uh, web pages on our website about oral fluid drug testing, with some video presentations. So go to our website, www.nationaldrugscreening.com to learn more about oral fluid drug testing and go to our website to get our contact information if you want to get set up, we can provide you the training, the product and the laboratory services for you to conduct oral fluid drug testing at your business. And that testing will be done with our guidance professionally, with certified laboratories and the results reviewed by a certified Medical Review Officer.

Stay tuned for more great video blogs.

I hope, today, you learned a little bit about oral fluid drug testing.

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