Oral Fluid Drug Testing

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.

DOT has approved oral fluid drug testing for transportation regulated employers and final rule takes affect June 1, 2023. See DOT Oral Fluid Drug Testing, Collections & Mocks

Oral fluid drug testing has gained popularity due in large part to it being perceived as less invasive and a perception that it is 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.

The oral fluid test is sometimes called a saliva test. The saliva specimen is collected with a mouth swab. The process detects drug use up to 48 hours from time of collection. The drug test result comes back from the lab to the MRO. Positive rates are about the same as urine drug screening.

DOT has now approved oral fluid as a specimen for DOT drug testing. Learn more about DOT Oral Fluid Drug Testing, Collections & Mocks.

The link above will assist with timelines and requirements for the new DOT oral fluid drug testing.

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 ensure 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 the 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 regard to oral fluid drug testing, the drugs being tested, and the collection devices being used.

Quest Diagnostics:

This laboratory has its 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)
Loss of sense of personal identity

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:

DOT and Oral Fluid Drug Testing

DOT now allows oral fluid drug testing for DOT regulated drug testing. A rule was 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. SAMHSA finalized the rule and added it to the Mandatory Guidelines for Federal Workplace Drug Testing; DOT has decided to adopt most of the provisions into 49 CFR Part 40 – the DOT rule for DOT drug and alcohol testing programs.

DOT has clearly adopted: 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 has written into the Mandatory Guidelines for Federal Workplace Drug Testing and DOT revisions to 49 CFR Part 40 that take effect 06/01/2023.

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 that 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 result 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.

Oral Fluid Drug Testing And Potential Cost Savings

Are you considering oral fluid drug testing for your company? Be prepared! Know what it takes to have your supervisors, HR staff or medical staff perform the oral fluid specimen collections on-site.

Introduction

According to a recent survey, in 2017 over 34 percent of drug testing employers use oral fluid, either by itself or in combination with urine or hair testing. The survey goes on to show that nearly three quarters of drug testing providers see greater interest in oral fluid or anticipate increased interest in oral fluid soon. The reasons to switch are compelling. Oral fluid testing is perceived to be less invasive than urine testing. It offers a detection window that starts within approximately an hour of use and extends 36-48 hours from use. Lab-based oral fluid offers the same level of accuracy as other testing methods. And moreover, it can be more affordable than other specimen types. But where do these cost savings come from?

While lab-based oral fluid testing adds the cost of a collection device, it eliminates the cost of an offsite collection. Lab-based oral fluid can be collected by a trained supervisor or manager on-site after a short training and certification process. The sample is then shipped to a laboratory for analysis and follows the same rigorous processes as other lab based testing methods. For employers who are used to urine drug testing, this may come as a surprise. After all, you pay a third-party administrator to take care of all the leg work, right? Do you really want to get involved with the Do It Yourself (DIY) process of lab-based oral fluid? Consider both sides of the argument.

Obstacles to Self-collection

Imagine that you’re sitting in a conference room brainstorming the pros and cons of switching to lab-based oral fluid and conducting the collection yourself. Your cons list might look something like this.

Let’s start with that first one: training. While oral fluid collection is simple, it still requires training to be done correctly. Although at program launch, companies often work with the lab or device manufacturer to schedule an in-person training, most employers opt to retrain and add additional supervisors by using the online training and certification programs available with most devices. Either way, training means time out of busy schedules and additional administration on the part of the employer. On the upside, once training is finished, it can be covered as refresher material in regular supervisor training meetings. As well, if using online videos, training can be quickly incorporated into supervisor training that is already required by many state drug testing laws. The proverbial two birds with one stone approach.

Next are logistical hurdles, such as finding a room to do collections. Urine collections are complex, requiring private bathroom facilities with no access to water and other safety precautions to prevent tampering. That is not the case with oral fluid testing. While it may seem logical to do collections in a private setting, it is not actually required. There is nothing compromising or embarrassing about having an employee swab his or her mouth. This can simply be done in the supervisor’s or the HR manager’s office. Oral fluids collections do mean that whoever is overseeing collections has to take time out of their day to pull workers off the line and spend the entire collection process present in his or her office, since he or she is doing the collections. In contrast, oral fluid collection administration eliminates the convenience of simply notifying employees of a drug test and letting them find their own way to the collection facility. However, it has the added bonus of keeping your employees at the jobsite, preventing a supervisor from accompanying the donor to an offsite collection facility (in the event of an accident or reasonable suspicion) and paying for the time it takes the employee to drive to and from the collection facility.

Finally, there are legal concerns. Is it legal to do the collection yourself? DOT does not allow oral fluid testing. The laws for oral fluid drug testing are not more complex by state than those for any other testing type. A leading concern is “do state drug testing laws require medical or lab professionals to do collections?” For example, Alabama’s voluntary drug testing law requires that the following individuals conduct collections: physician or assistant, registered nurse, licensed practical nurse, nurse practitioner, certified paramedic, or employee of a certified lab. Maine’s mandatory drug testing law requires that collections take place at a medical facility. Just as with other testing methods, it is important to check applicable state drug testing laws before switching drug testing methods or types.

Benefits of Self-collection

Imagine again that you’re in that conference room we talked about earlier. What would your list of pros of self-collection look like? Maybe something like this:

Self-collection means the employer knows exactly when, where, and how collection takes place. There’s no need to coordinate testing hours of operation, hiring schedules and random events with a third party collection provider. This makes pre-employment testing easier and faster. It makes random testing truly random and a surprise for employees being tested. And in the event of an accident, it eliminates the need to send potentially injured employees to a collection site. Employees are away from work for an average of 15 minutes instead of two or three hours. All an employee has to do is walk to the manager’s office, swab, and go back to work. This approach also means that there is less opportunity for cheating. There’s no such thing as shy-bladder when collecting oral fluid samples, nor can an employee swap out his oral fluid for his buddy’s. And of course, it costs less to do self-collection than a professional collection.

Conclusion

Oral fluid testing is an excellent way for employers to save money on their drug testing program while taking advantage of a lab-based test. When self-collection isn’t feasible in all instances, oral fluid testing can be combined with a different testing methodology or professional collectors can be used. As with any drug testing program, design and implementation are critical and each should be tailored to your organization’s program goals and corporate culture. And, as with any program, compliance with all federal and state drug testing laws, partnership with reputable TPA’s, manufacturers and laboratories, and an updated policy are critical to a successful program. DOT regulations for DOT oral fluid drug testing are critical to review, lean more at: