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Oral Fluid Drug Testing

Oral fluid testing has recently increased in popularity for several reasons: it requires a less private testing environment, less testing time, and less invasion than a urine test. Urine testing can take up to 4 hours, whereas oral fluid testing takes between 1-3 hours.

On May 15, 2015, Health and Human Services (HHS) reported that only around 7% of tests are oral fluid tests, with the rest being urine tests. The hope is that over the course of 4 years, the amount of oral fluid tests should rise to around 25-30% of all testing.

New Guidelines for Lab Based Oral Fluid Testing

On May 14, 2015, SAMHSA (substance abuse and mental health services administration) released a proposal for new guidelines for lab based oral fluid testing. The Department of Transportation (DOT) will develop regulations to allow employers to utilize this kind of testing once these guidelines have been finalized.

The 5 proposed guidelines are:
1. Establish technical requirements and standards for all oral fluid collection devices
2. Initial oral fluid drug test analytes and method
3. Confirmatory oral fluid drug test analytes and methods
4. Processes for a review by a MRO (medical review officer)
5. Requirements for federal agency actions

Along with these five proposed guidelines, SAMHSA discussed the process in which the samples should be collected. The suggestions include collection under supervision, and a requirement of two specimens from each donor to be split. Also, SAMHSA is suggesting that all specimens be tested for immunoglobin or albumin to determine the validity of the specimen. They are also proposing that a urine specimen may be collected when the donor is not able to provide an oral fluid specimen.

Oral Fluid Collection Devices

Two types of collection devices currently exist for oral fluid tests. One collects undiluted (neat) oral fluid by expectoration. The second device uses an absorbent pad inserted into the oral cavity to collect a specimen and is then placed in a tube containing a diluent. All oral fluid collecting devices must contain a sealable, non-leaking container, an indicator that demonstrates the adequacy of the volume of collected specimen, components that ensure pre-analytical drug and metabolite stability, and the components of the device must not interfere or change the composition of the drug and drug metabolites in the oral fluid specimen.

Also, collection devices must either collect 1 mL (minimum) of undiluted (neat) oral fluid or if the device contains a diluent, the volume of oral fluid collected should be within 0.1 mL of the target volume and the volume of the diluent should be within 0.05 mL of the diluent target volume.

SAMHSA is also recommending that split specimens should be collected in one of two ways. The first is to collect the specimen with a device that subdivides the specimen into two collection tubes. The second is that the two specimens are collected either simultaneously or separately in two different collection devices. If the specimens are collected serially, the second sample must be taken within two minutes of the first test.

SAMHSA’s final was the addition of four drugs to oral fluid drug testing. Along with THC, PCP, cocaine, opiates, amphetamines, methadone, propoxyphene, benzodiazepines barbiturates, and methamphetamines, they are proposing that hydrocodone, oxycodone, hydromorphone, and oxymorphone be added to list of drugs tested in the lab based oral fluid drug test.

The increase in accuracy of oral fluid drug testing will help attract more companies that are not currently drug testing. Also, the shorter time frame of oral fluid testing will allow for employers to determine if, for example, employees have been using THC (marijuana) on their own time, versus on the job site.

SureHire offers both urine and oral fluid testing in lab-based forms. Both tests can help companies or individuals keep the workplace safe and ensure all workers carry out their tasks to the best of their abilities.