By Bill Current, President & Founder of the Current Consulting Group
The U.S. Department of Transportation (DOT) did a very smart thing when it published a final rule in the Federal Register (88 FR 27596) on May 2, 2023, that, among other things, amended DOT’s regulated industry drug testing program to include oral fluid testing. Essentially, the federal government’s leading authority on drug testing said to the world that lab-based oral fluid testing was just as good as lab-based urine testing, if not better under certain circumstances.
In fact, in October of 2019, when the Substance Abuse and Mental Health Services Administration (SAMHSA) finalized regulations for federal employee drug testing to include oral fluid they offered, perhaps, the most consequential statement ever made about an alternative testing method when it said the following:
“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.”
Wow! Think about the words used here: “scientific basis,” “broadly established,” “same level of confidence.” Whoever wrote this paragraph must be a genius. In a few short words, this concise statement answered the question that employers and drug testing providers had been asking for years: Is oral fluid testing reliable? And the answer is a resounding—Yes!
Of course, much depends on the manufacturer, the laboratory and the device itself. But when SAMHSA issued that statement, it changed the drug testing world forever. As of October 2019, there would now be two drug testing methods endorsed by the federal government: lab-based urine and lab-based oral fluid. Both methods stand side-by-side on the top of the mountain, so to speak, equal but different, perfectly accurate at detecting the most commonly abused illicit drugs, including marijuana.
Oral fluid testing represents a solution to the challenges that many employers face as they grapple with the nationwide increase in drug use, the dramatic increase in post-accident positivity for marijuana, and the ongoing assault on drug testing from the pro-marijuana movement. As employers look for ways to continue using drug testing as a way to keep their workplaces safe and protect the well-being of their employees, they should consider oral fluid testing.
To help them make informed decisions, even in states that have legalized marijuana, here are four questions every employer should know the answers to about oral fluid testing:
1. Is it possible to detect very recent drug use with oral fluid testing?
Yes, and here’s why:
Drug transfer to oral fluid from blood occurs as long as the drug is in the bloodstream, thus detection times start within minutes of ingestion and continue for as long as the drug remains in the bloodstream. Drug detection by oral fluid testing is as effective as urine testing over a comparable time period.
When analyzing oral fluid, it is possible to detect the parent drug itself and not just a metabolite of a drug. Parent THC, for example, typically becomes detectable in an oral fluid sample within minutes after usage, which makes it possible to identify very recent drug use more accurately than urine testing. With urine testing, only drug metabolites (not the parent drug) are identified, which take several hours to become detectable.
This makes oral fluid testing perfect for situations where it is critical to identify recent drug use, such as post-accident and reasonable suspicion testing circumstances or pre-duty/pre-access testing. And because rapid oral fluid testing is so easy to administer, it is ideal in pre-employment testing situations where being able to make a same-day job offer is desirable.
2. Is the window of detection with oral fluid testing different than urine testing?
Yes. But not in a negative way.
Generally speaking, the window of detection with oral fluid is shorter than that of urine. It is important to understand that every drug has its own unique window of detection, regardless of the specimen being tested, and each specimen type has its own unique ability to reveal the presence of a particular drug. As such, even though there are published windows of detection for each specimen and each drug, it is very difficult to say precisely what the window of detection will be for a particular testing situation.
This much we know: the window of detection for oral fluid testing starts earlier than with urine and hair testing. Typically, marijuana is detectable through oral fluid testing within an hour, if not immediately, from the initial usage. With urine testing, the window of detection for marijuana won’t begin for at least 4-6 hours (and certainly not immediately) and with hair testing it won’t begin for several days or longer after usage.
Also, oral fluid and urine provide comparable positivity rates. Oral fluid can pick up drugs early on that urine will miss; urine can sometimes pick up positive results longer, which oral fluid might miss. On balance, cut-off levels for oral fluid produce similar positive rates. Because both testing methods produce similar positivity rates, it really comes down to which testing method best meets a buyer’s needs.
Lab-based oral fluid testing provides a longer window of detection compared to current rapid-result devices. This is due to the cut-offs for rapid devices being higher than lab-based oral fluid tests. All the other attributes of oral fluid testing being equal, it comes down to an employer’s preference—a longer or shorter window of detection. Both are good, just different.
It should be noted that once a rapid-result presumptive positive sample is sent to the laboratory for confirmation testing, the cut-off levels are the same regardless of what type of initial screen was conducted, lab or rapid. Therefore, a confirmed sample will only be positive if it meets those lab-based confirmatory cut-off levels.
3. Is oral fluid testing just as susceptible to cheating as urine testing?
While drug test cheating is a major concern with urine testing because it is particularly susceptible to adulteration, tampering and substitution, oral fluid testing is virtually cheating proof because it is not subject to common cheating methods.
A quick search on the Internet will reveal thousands of sources that sell products that promise to help would-be cheaters successfully pass a drug test. However, some websites advise people who will be subject to oral fluid testing to stop using drugs, at least until they are tested.
A major reason why it is nearly impossible to cheat on an oral fluid test is that every oral fluid collection is 100% “observed” eliminating the possibility of someone trying to tamper with the specimen.
4. Is oral fluid testing legal to use in most states?
The good news is that oral fluid testing is permitted in almost every state.
For workplace drug testing, only two states prohibit the use of lab-based oral fluid testing: Hawaii and Vermont. Additionally, a number of states permit rapid-result testing but require that the device used be FDA-cleared. Most rapid oral fluid devices are not FDA-cleared.
A handful of states do not permit rapid-result testing generally, which eliminates both rapid oral fluid and urine testing.
A number of states with voluntary drug testing laws may restrict how drug testing is conducted, including limiting testing to either lab-based testing only or urine testing only. The conditions of the voluntary laws apply only to those employers who qualify for and actually participate in the program. Outside of the voluntary laws in states like Florida and Georgia, there usually are no restrictions on oral fluid testing.
Workplace drug testing laws do not apply to other markets such as schools, criminal justice, treatment and athletics. Hence, oral fluid testing is typically not restricted in these markets. Oral fluid testing has been in use with buyers in probation, parole, community corrections, drug courts, pre-trial services, diversion programs, law enforcement at all levels (city, county, state), public and private drug treatment programs, and mental health agencies.
It is important to review all applicable state laws before implementing any type of drug testing policy to ensure complete compliance.
Conclusion
When SAMSHA issued the final rule for oral fluid testing of federal workers in 2019, the agency shared the reasons why it made the unprecedented decision to endorse an alternative testing method. These reasons included:
- Enhanced Flexibility— Employers can choose between urine or oral fluid; whichever specimen is best suited to the situation.
- Enhanced Versatility— Oral fluid collections can occur anytime, anywhere.
- Decreased Invalid Tests— Oral fluid collections are 100% observed, which substantially reduces the risks of substitution or adulteration.
- Saves Time— Oral fluid collections likely occur at or near the place of work, reducing the time needed away from work.
- Versatility in Detection— Oral fluid testing is capable of detecting drugs within minutes after usage.
Add to this the agency’s declaration about the science behind oral fluid testing previously cited in this article and employers can confidently consider their options—stick with urine testing, switch to oral fluid testing, or use both testing methods to realize the benefits each has to offer, depending on the circumstances.
Thank you to DOT for doing a very smart thing by embracing the benefits of oral fluid testing so employers can have confidence in what some people consider to be the “ultimate emerging technology.”
Need help with drug testing policy development or state law information? Current Consulting Group can help. Contact Current at info@currentconsultinggroup.com.