July 22, 2023

Staying Current: The Drug Testing Market Shifts to Oral Fluid

By Guest Contributer

By Bill Current

This article was written by Bill Current of the Current Consulting Group (CCG) on behalf of Premier Biotech for publication by NDASA. For further information about the subjects covered in this article, please email Bill at bcurrent@currentconsultinggroup.com or Laura Stamm from Premier Biotech at lstamm@premierbiotech.com. This information is provided for educational purposes only. Reader retains full responsibility for the use of the information contained herein.

What does the future of drug testing look like? Three significant trends are helping to bring that future into better focus:

First, the federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) endorsed lab-based oral fluid testing of federal employees with the issuance of regulations in October of 2019.

Second, the U.S. Department of Transportation (DOT) issued regulations in May of 2023 signaling its intent to allow the use of lab-based oral fluid for DOT-mandated drug testing once at least two laboratories are SAMHSA-certified, thus elevating the perception of oral fluid testing among both sellers and buyers. (Note: oral fluid collector guidelines should be out before the end of the year.)

Third, the legalization of marijuana in many states has caused a growing number of employers across the country to focus on the detection of recent drug use rather than lifestyle drug use, and oral fluid is the only recent-use detection testing method endorsed by the federal government… hence, the only legally defensible recent-use detection method. It should be noted that other drugs in addition to marijuana may also be detectable in an oral fluid sample shortly after the user has consumed the drug.

Do You See a Trend Here?

While urine and hair testing are not going away, nor should they, oral fluid testing clearly represents the future of drug testing, and all indicators suggest the future may have already arrived.

Want more evidence? Look no further than what the drug testing industry is saying.

In Current Consulting Group’s 2022 Drug Testing Industry Survey, providers revealed a dramatic increase in the percentage who now say they offer oral fluid testing—surging from just 36% in 2019 to 85.6% in 2022.[i]  Moving forward a year, in Current Consulting’s 2023 survey, when providers were asked what drug testing method will be most used in the future, 45.6% said urine and 45.6% said oral fluid.[ii] Ten years ago, it’s hard to image that oral fluid testing would’ve registered a response anywhere close to urine’s percentage. Today they are neck-and-neck.

As the survey cited above indicates, there has been a notable increase in acceptance among drug testing providers of oral fluid testing over the past five years, but that was after many years of reluctance within the industry to offer any type of alternative to urine testing. Oral fluid testing’s assent also coincided with the Covid-19 pandemic when it was very challenging for many employers to find collection facilities willing to offer urine collection services. In some cases, some employers may have turned to oral fluid testing because of its comparatively easy, fast, and flexible collection process.

Perhaps, after experiencing first-hand some of the obvious advantages of oral fluid testing, many employers were unwilling to revert back to more traditional collection and testing methods forcing drug testing providers to be more flexible in their service offerings. After all, nothing speaks to the bottom line louder than market demand.

However, SAMHSA’s endorsement of oral fluid testing in 2019 coupled with the new DOT regulations in 2023 have likely had a lot to do with the improved status of oral fluid testing among both sellers and buyers. In a 2022 Current Consulting Group survey, 48% of drug testing providers said the federal government endorsements were motivating them to add oral fluid testing to their offerings while only 4.8% said they still had no plans to offer oral fluid.[iii]

Advantages of Oral Fluid Testing

When SAMHSA issued final Oral Fluid Mandatory Guidelines (OFMG) in 2019, the agency pointed to several advantages of oral fluid testing with an emphasis on the science:

“The scientific basis for the use of oral fluid as an alternative specimen for drug testing has now been broadly established and the advances in the use of oral fluid in detecting drugs have made it possible for this alternative specimen to be used in Federal programs with the same level of confidence that has been applied to the use of urine.”[iv]

When DOT issued its regulations, it cited many of the same benefits of oral fluid testing as SAMHSA had previously highlighted, including:

  • Combatting adulteration/substitution,
  • Directly observed collections,
  • Potential cost savings when collections take place at the workplace, and
  • Quick and easy specimen collections,

Other advantages of oral fluid testing that are often cited include a shorter window of detection compared to urine testing and the fact that the parent drug and not just a metabolite of a drug is detectable in oral fluid making it possible to detect drugs fairly recently after usage. When DOT issued its Notice of Proposed Rulemaking for lab-based oral fluid testing, it provided a chart that compares the window of detection for oral fluid and urine for the drugs included in a SAMHSA drug-test panel.[v]

Now, it is important to clarify that a positive drug test result does not prove, scientifically or legally, that an individual is impaired. Hence, oral fluid, hair and urine test results cannot be used to declare that someone is impaired. However, the tighter oral fluid testing’s shorter window of detection and the ability to detect drug use within a short period of time after usage may be appealing to employers who are more concerned with recent-use detection versus lifestyle use identification.

Transition to Oral Fluid

Included in SAMHSA’s release of the OFMG was a prediction about the transition rate to oral fluid testing. Following an implementation period, SAMHSA predicted that about 7% of all testing of federal employees would be conducted with oral fluid, increasing to 25% to 30% after four years. SAMHSA also speculated that if DOT were to permit oral fluid testing and if 25% to 30% of the 6 million annual DOT-mandated tests also transitioned to oral fluid testing it would eventually equal between 1.5 million and 1.8 million oral fluid tests per year.[vi]

If that same transition rate was applied to the tens of millions of non-DOT-mandated drug tests conducted annually, it would represent a sea-change in the industry as well as the market. It would not only impact how drug tests are conducted but also how sample collections are conducted given the relatively easy collection process of oral fluid. Then add to that the option of using a rapid-result oral fluid test and the future landscape of the drug testing industry changes dramatically.

Rapid Result Testing

The combination of oral fluid with the use of a rapid result device makes oral fluid testing particularly appealing to companies in safety-sensitive industries, those with remote worksites, and industries with high turnover. Oral fluid collections do not require a professional collector, are 100% observable, and can take place anywhere at any time.

As a pre-employment screen, a rapid-result oral fluid test makes it possible for employers to make same day hiring decisions while simultaneously improving the overall screening experience for the job candidate by not asking them to travel to an off-site occupational health facility. One report claims that as much as 60% of job candidates fail to show up at off-site collection facilities to void a urine sample. Instead of waiting hours to find out that a desired candidate decided to interview at a different company rather than wait for two hours or more at a collection site, employers can extend a conditional offer of employment, administer a rapid oral fluid test, and complete the job offer within about 15 minutes.


As the future of drug testing continues to come into focus, expect the following:

  • More employers dropping marijuana from their drug-test panel.
  • More employers determined to continue testing for marijuana turning to oral fluid testing, especially in marijuana-friendly states.
  • More companies are adopting rapid-result oral fluid testing to eliminate the challenges of urine collections and to make the hiring process faster and less intrusive as the crunch on the labor market continues.
  • More employers who dropped marijuana from their panel reinstating it, though that will take time.

In the meantime, the future of drug testing is coming into better focus and oral fluid testing will be a big part of that future.

© 2010-2023 The Current Consulting Group, LLC – No portion of this article may be reproduced, retransmitted, posted on a website, or used in any manner without the written consent of the Current Consulting Group, LLC. When permission is granted to reproduce this article in any way, full attribution to the author and copyright holder is required.

[i] “The 2022 Drug Testing Industry Survey.” The Current Consulting Group.

[ii] “The 2023 Drug Testing Industry Survey.” The Current Consulting Group.

[iii] 2022 Survey

[iv] Mandatory Guidelines for Federal Workplace Drug Testing Programs—Oral/Fluid. Federal Register. October 2019.  https://www.samhsa.gov/sites/default/files/programs_campaigns/division_workplace_programs/final-mg-oral-fluid.pdf

[v] Procedures for Transportation Workplace Drug and Alcohol Testing Programs: Addition of Oral Fluid Specimen Testing for Drugs. Federal Register. February 28, 2022. https://www.govinfo.gov/content/pkg/FR-2022-02-28/pdf/2022-02364.pdf

[vi] Mandatory Guidelines for Federal Workplace Drug Testing Programs— Oral/Fluid. Substance Abuse and Mental

Health Services Administration (SAMHSA), HHS. Federal Register. Page 57572. October 25, 2019. https://www.samhsa.gov/sites/default/files/programs_campaigns/division_workplace_programs/final-mg-oral-fluid.pdf