Alternative Drug Testing Update

In a few short years, oral fluid testing has gone mainstream.

IT has only been a few years since laboratory-based oral fluid drug screening first appeared on the menu of choices for employers' substance abuse testing programs. In the beginning, some in the employer drug-testing market were skeptical of the new screening. Not everyone was convinced that something so simple could be as reliable and accurate as traditional urine testing.

However, as each year of use passed, statistics and satisfied employers have turned the skepticism into acceptance. Today, this once "alternative" method is going mainstream and proving itself as a viable and desirable drug testing option for small businesses and large corporations everywhere.

The Early Days of Oral Fluid Screening
Laboratory-based oral fluid screening is not a new technology. Studies using oral fluid to detect drugs of abuse were published more than 20 years ago, and the methodology has been used in the risk assessment business to test for HIV, cotinine, and cocaine metabolites for almost 10 years. However, it wasn't until 2000 that laboratory-based oral fluid testing become commercially available to the employer drug-testing market.

Suddenly, employers had a new option for trying to create and maintain drug-free work environments. Oral fluid drug screening could be used for the most common tests requested by workplace drug testing--including the SAMSHA 5-panel of marijuana, cocaine, opiates, amphetamines, and PCP. (Recently, oral fluid screens have also been expanded to detect Ecstasy [MDMA].) Plus, the alternative method seemed to be as simple and convenient as it had been marketed.

Benefits of oral fluid screening quickly began to emerge. Anyone who used urine for non-federally mandated testing programs or administered an alcohol- and drug-testing program for non-regulated employers was a candidate to take advantage of the new option.

A survey of more than 1,000 oral fluid employer sites revealed that employers ranked ease of collections, quality, accuracy, and turnaround times as their main reasons for choosing oral fluid testing. Surveyed employers said oral fluid testing was "fast and a very simple test to perform." Others commented on the applicants' positive reaction to the screening: "Applicants were not uncomfortable with process. They liked the fact that there was no cup, and no embarrassing situations."

Why Oral Fluid Went Mainstream
From the beginning, one of the most visible and discussed benefits of oral fluid testing was its less invasive collection method. Employers and donors alike praise it as a more "dignified" collection process than traditional urine testing.

Ease of collection
Most oral fluid collection devices are also simple and easy to use. The collection pad is placed between the lower cheek and gum for two to five minutes. The collection pad is then sealed. The entire collection process is easy and quick. Collections are conducted "on site" and are observed, eliminating concerns of adulteration or dilution of the specimen. Once the oral fluid specimen has been collected, it is sent to a laboratory for testing.

Georgia-Pacific, one of the world's leading manufacturers and distributors of tissue, pulp, paper, packaging, building products, and related chemicals, has utilized oral fluid for all non-DOT drug testing since the beginning of 2002. "We not only appreciate the ease of collection, but the cost savings of oral fluid screening. By not having to send a donor to a collection site for testing, we expedite the process and save time and money," said Donald Barnard, Industrial Relations coordinator.

Quality and accuracy
Once a specimen has been collected, it enters the analysis process at a laboratory. Laboratory-based oral fluid testing adheres to the same high forensic standards as the traditional urine testing method. Samples are first screened using enzyme immunoassay technology, proven reliable for routine drug testing.

Any samples that test positive in the screening process are then subjected to gas chromatography/mass spectrometry/mass spectrometry (GC/MS/MS), the highest standard in drug confirmation technology. This tandem "MS," as it is called, provides the most unique fingerprint of the drug in question. This strict methodology ensures the accuracy and reliability associated with urine screening.

Just like traditional urine testing, the window of detection in oral fluid testing is different for each drug. Urine testing relies on drug metabolites retained in the body's waste supply and may detect some drugs for a longer period than in oral fluid. However, only oral fluid testing can identify very recent usage--which can be missed by urine testing. (For most drugs, the window of detection in oral fluid is about one to three days.) In a recent analysis of THC (marijuana) testing, among all oral fluid devices available, only a laboratory-based oral fluid test was sensitive enough to detect THC at a level equivalent to screening results from urine THC screening.

Turnaround Time
Oral fluid testing allows employers to speed up their hiring process. Specimens can be collected on site immediately after an offer is made to a candidate, often eliminating the 24-hour period that is allowed to report to a clinic for a test. Negative results are reported within 24 hours and positive results within 72 hours after receiving the specimen at the lab.

Employers indicate that using oral fluid testing reduces their overall hiring time compared to the urine drug testing process.

A Program Enhancement
LabOne tested more than 100,000 oral fluid drug screens in 2001. It became the first lab to compile statistical data for presentation to the Drug Testing Advisory Board (DTAB). This group, comprised of government officials, academic researchers, and laboratory personnel, guides SAMHSA in its rulemaking process.

Oral fluid testing data was submitted to DTAB several times throughout the year. As a result, the proposed guidelines include oral fluid pre-employment, random, post-accident, reasonable cause, and follow-up testing.

The 2001 statistics (shown in sidebar, Statistics at a Glance) continue to show that laboratory-based oral fluid is a viable alternative to traditional urine testing. Today, the consensus is that oral fluid drug testing enhances the employment drug-testing program for many employers. Fast, accurate, and convenient, it is a welcome addition to the menu of drug testing alternatives.

Oral Fluid Statistics for 2001

Total Tested


Total Negative


Total Positive












Non-Federally Regulated Urine Stats, 2001

Total Tested


Total Negative


Total Positive












* Drugs that aren't currently tested in oral fluid are included in the urine totals but not listed. All tests performed at the Lenexa, Kansas- based laboratory LabOne, Inc.


This article originally appeared in the January 2003 issue of Occupational Health & Safety.

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