Drug Testing – Urine and Oral Fluid Comparison


GENERAL COMPARISON

Urine

  • Used as workplace standard and for federally regulated testing e.g., Dept. of Transportation (DOT). Also widely used for non-regulated workplace drug testing
  • Ideal for detecting historical drug use (1-7 days). Estimates depend on the substance, amount, and frequency of use
  • May require gender-specific staff to observe collection (depends on regulation or employer policy)
  • Issues with “shy bladder”
  • Possibility for adulteration if collection not observed
  • If problems occur during collection, and another specimen is required, donor may not be able to provide urine immediately
  • Less expensive when comparing actual urine to oral fluid tests. Wider range of urine test panels and drug configurations available

Oral Fluid

  • Ideal for detecting recent drug abuse. Popular with programs that require convenient, gender-neutral specimen collection. Not used for regulated workplace testing (DOT)
  • Ideal for detecting recent drug use (4-24 hours). Estimates depend on the substance, amount, and frequency of use
  • Conveniently collected on-location. Specimen directly and easily observed. No gender-specific staff needed
  • Minimal chance of specimen adulteration
  • Additional oral fluid specimens can be provided immediately, or within minutes when mouth is dry
  • Cost-effective when considering collection overhead factors: reduced collection time, no need for gender specific staff, or separate rest room/collection facility
  • May be more effective for post-accident and reasonable suspicion testing

COMPARISON WITH LABORATORY DRUG TESTING

Urine

  • Initial screening may feature EIA, GC/MS, or LC/MS/MS1. Presumptive positive specimens may be confirmed by a second, more sensitive test method: GC/MS or LC/MS/MS. (Varies by lab)
  • Certified laboratory’s test methods are scientifically accepted, provide highly specific drug identification, and are legally defensible
  • 24 hours for negative results, 24-72 hours for positive results
  • Accurately detects a broad range of drugs, detailed toxicology reports, and technical staff support. Permitted for federally regulated testing e.g., DOT
  • Adulteration concerns; shipping and handling requirements

Oral Fluid

  • Initial screening may feature EIA, GC/MS, or LC/MS/MS1. Presumptive positive specimens may be confirmed by a second, more sensitive test method: GC/MS or LC/MS/MS. (Varies by lab)
  • Certified laboratory’s test methods are scientifically accepted, provide highly specific drug identification, and are legally defensible
  • 48 hours for negative results, 48-72 hours for positive results
  • Accurately detects a broad range of drugs, detailed toxicology reports, and technical staff support
  • Currently, not permitted for federally regulated testing e.g., DOT
  • Shipping and handling requirements

COMPARISON WITH INSTANT OR POINT OF COLLECTION (POCT) DRUG TESTING

Note: National Drug Screening does not recommend instant or POCT oral fluid drug testing.

Urine

  • Test method - lateral flow chromatographic immunoassay screen targets multiple drugs and drug metabolites in urine
  • Qualitative screen provides a preliminary result
  • Many products available - collection/test cups, dip cards, cassettes
  • Results typically 5 minutes. (Varies by manufacturer)
  • Store at room temperature with approximate 24 month shelf life. (Varies by manufacturer)
  • Simple to follow procedures. Rapid test negative results on-location
  • Adulteration concerns. “Shy bladder” concerns (difficulty urinating)
  • May require separate, gender specific collection facility
  • Cross reaction interferences can arise, thus false-positive results are possible
  • Laboratory confirmation testing is absolutely necessary for non-negative instant results
  • NexScreen product is sold with the instant device, lab confirmation and MRO included

Oral Fluid

  • Test method - lateral flow chromatographic immunoassay screen targets multiple drugs and drug metabolites in oral fluid
  • Qualitative screen provides a preliminary result
  • Collection is by mouth swab plus test device
  • Results typically 10 minutes. (Varies by manufacturer)
  • Room temperature with approximate 18 month shelf life. (Varies by manufacturer)
  • Simple to follow procedures.
  • Convenient collections and rapid test results on-location
  • Most U.S. states require use of a FDA cleared device for initial testing in a workplace setting. At present, only one device is cleared: Oratect®
  • Cross-reaction interferences can arise
  • Laboratory confirmation testing is absolutely necessary for non-negative instant results
  • There can be a challenge having enough sample available for the confirmation testing
  • Many employers report very few positive results