Oral Fluid Testing: Six Considerations

The value of any drug-testing program can be appreciated only if you monitor its progress.

• Aug 01, 2003

For many years, urine-based laboratory testing was the only drug testing method available to employers. Today, however, many options exist. In addition to traditional, urine lab-based testing methods, employers have their choice of a variety of on-site, instant-result test devices, as well as a number of specimen alternatives to urine as the sample to be tested. Without question, these new technologies have made drug testing far more accessible to many more employers than ever before.

Though these relatively new technologies are not yet permitted as part of U.S. Department of Transportation testing regulations (although guidelines for on-site and alternative specimen testing methods are pending), many employers have found them useful and more cost effective in non-mandated drug testing circumstances. These new methods also work well with most types of drug testing currently used by employers: pre-employment, post-accident, reasonable suspicion, random, return-to-duty, and follow-up testing.

One of the most interesting new approaches to drug testing involves the use of saliva or oral fluid as the test specimen. When used in conjunction with on-site test methods, saliva-based testing offers some unique advantages when compared to some of the other testing methods. The advantages of saliva testing often cited by industry experts and internal drug testing program administrators include:

• Deterrent to adulteration or substitution (with the opportunity for an observed collection every time)
• Alternative to urine (elimination of the "yuck" factor involved in handling urine)
• More easily administered on-site (reduction in collection site fees)
• Less invasive to those being tested (compared to urine or hair)
• Saliva cannot be manipulated with products such as shakes, shampoos, or additives.

Internal program administrators are being challenged to justify the expense of drug testing. They are being asked to prove the return on investment from drug testing or face the real possibility of having drug testing discontinued. On-site testing (broadly) and saliva-based testing (more specifically) are seen as ways for employers to streamline the costs, creating more efficient drug testing programs that are more effective in their ability to prevent donors from "beating the system."

Because of the numerous benefits listed above, there is considerable interest about this relatively new approach among the providers of drug testing services and the employers who either buy drug test services or buy the products and test the employees themselves. In fact, some companies not only have investigated saliva-based testing but also have converted at least part of their drug test programs to the use of this specimen. What are these fresh converts saying about saliva-based drug testing?

Making the Switch
Switching to saliva-based drug testing does not have to be complex. However, there are several things to consider in order to ensure a smooth transition. Consider the following five things:

1. Legal Considerations
Different states may regulate when and how you conduct saliva-based drug testing. While almost all states allow saliva or "other bodily substance" testing, a couple do not. Ensure your policy contains amendment language for any state with laws that deal with saliva and/or on-site testing in a way that varies from your standard policy language.

2. Drug Testing Policy
Your drug test policy is the cornerstone of your overall program. As you prepare to implement saliva-based drug testing, review and revise the following components of your policy:

• Coverage
. Who will be subject to a saliva-based drug test? All applicants who receive a conditional offer of employment? All employees? Employees in safety-sensitive positions?
• Types of testing
. When will saliva drug testing take place? Will saliva be used for pre-employment testing? (The current SAMHSA draft guidelines include the use of saliva for pre-employment testing.) What about post-accident and reasonable suspicion or for-cause circumstances? (Saliva, like blood, provides information for "under-the-influence" results and is ideal for post-accident, for-cause, reasonable suspicion, and fit-for-duty testing.) Will it be used for random testing? (Saliva, unlike urine, provides for an observed collection.)
• How testing will be administered
. Will applicants and employees still be sent to a collection site, or will the entire process take place at the workplace? Who will administer the test if it is conducted on site? What training will the person receive? What will happen if the initial test is positive? How will confirmation tests, if needed, be conducted? Who will be authorized to know test results, and how will those who test positive be informed?

3. Testing Procedures
Written drug testing procedures should serve the function of walking a supervisor through the entire process of a drug test. Look for the following areas and make the appropriate revisions:

• Referral to be tested (for applicants and employees)
• Collection of a sample for testing purposes
• On-site analysis
• Recording results
• Chain of custody paperwork (only needed for samples to be confirmed)
• Sending a sample to a lab for confirmation
• Reporting results to management and to the tested donors
• State-specific procedural requirements
• Ordering additional saliva test kits and chain of custody forms

4. Collections
One of the advantages of saliva-based testing is that it can be administered on-site without the worry of securing a bathroom, shutting off the hot water, dyeing toilet water, or any of the other precautions required for urine testing. Some of the collection issues to cover in the policy include: 1) who will oversee the collection and administration of each saliva test; 2) where a collection may take place; 3) any specific training requirement needed in order to perform a collection and analysis; 4) the actual process of the collection; 5) the role of the donor; and 6) any chain of custody paperwork that may be involved.

5. Confirmations
If saliva is used for the initial test, then it should be used for any needed confirmation tests, as well. The process is very easy. The packaging of the saliva sample can take place at the workplace immediately following the initial analysis. Your laboratory will need to be alerted that saliva samples will be coming instead of urine. Not all labs are equipped or willing to test saliva; check with your current provider.

6. Results Reporting
With the test results available immediately, and in many cases on site, there may be a temptation to overlook the importance of how results are reported. However, how results are reported and recorded will be more important than ever. The integrity of your program is, for the most part, entirely in the hands of those employees who will be administering and reading test results . . . how they do so is an important process to monitor.

A couple of the newer automated test systems now available will not only store results electronically, but also help in managing the correct reporting of results.

Conclusion
Although saliva-based drug testing may not be right for every company, its virtues are too attractive to ignore. If you think your company might benefit from switching to saliva-based testing, ensure a smooth transition by taking the time beforehand to revise your policy and procedures, and finalizing how you will collect specimens, test the specimen, record on-site results, send needed specimens for confirmation, and report results.

When considering saliva-based testing, it is important to remember that saliva correlates to blood levels because saliva is derived from blood plasma. Saliva cannot be manipulated by detoxifying products such as shampoos and shakes, which simply mask metabolites shortly before analysis so drugs go undetected. (Recently, The Wall Street Journal reported companies that sell detoxifying products will report estimated annual retail sales of $60 million to $80 million next year.)

The value of any drug-testing program can be appreciated only if you monitor its progress. The switch to saliva-based testing is a perfect time to implement a mechanism for measuring the effectiveness of your new program. Your projected ROI is likely to the biggest selling point of a saliva-based drug testing program.

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