Should Employers Consider Oral Fluid Drug Testing?

There are several advantages to oral fluid drug testing. 

• By John Mallios
• Jun 01, 2022

Substance abuse in the United States isn’t a new phenomenon and, in fact, drugs being abused today were once regarded as medicine. In the 19th century, for example, heroin and cocaine were approved for use as medicinally therapeutic substances before their addictive properties became fully known. In the 1890s, the Bayer pharmaceutical company even promoted heroin as a cough suppressant and for treating the common cold.  

During World War I, soldiers were given stimulants such as cocaine and amphetamine to increase their alertness, their physical performance and to suppress appetite. Additionally, by the mid-20th century, use of hallucinogens (LSD, PCP, mescaline, etc.), stimulants (cocaine, ecstasy, amphetamines, etc.) and marijuana became very popular recreationally, and were more readily available. 

However, by the 1980s, U.S. federal and state governments increased programs and funding to address widespread substance abuse in American society, which ultimately lead to further initiatives designed to combat dangerous substance abuse occurring in the workplace. 

Benefits of Workplace Drug Testing 

Today, although most private employers are not mandated by regulation to conduct drug testing for their job candidates or employees, many still choose to do so, and for good reason.1 Employers are ultimately responsible for maintaining a safe workplace for their employees and for ensuring public safety whenever and wherever their workers interact with society. 

Employers drug test to:       

• Avoid legal liability in the event an impaired employee causes an accident or harms someone while working.   
• Ensure workplace productivity by preventing the potential effects brought about by employee substance abuse.   
• Safeguard company assets and property. 
• Qualify for workers’ compensation premium discounts in states that offer incentives to employers to maintain a drug-free workplace.        

After the 1980s when drug-free workplace testing programs began to take hold, drug testing proved to be a necessary strategy for American employers to help prevent serious accidents and to ensure workplace productivity.     

During these early years, laboratory-based urine drug testing was the predominant sampling and collection method used for workplace testing. With lab-based urine drug testing, a job candidate or employee would be instructed to visit a collection site and provide a urine specimen to be analyzed for specific drugs included in the employer’s testing panel (a bundling of common drugs of abuse). The collector would manually prepare a paper chain of custody/control form (CCF), seal the collected specimen and package it with the CCF, and then set it aside for a courier to pick up later in the day for transport to a testing laboratory for analysis.  

Following analysis of the specimen, the lab reported the result and, if the result wasn’t negative (meaning there was no detection of use for any of the drugs in the test panel), a medical review officer (MRO) would then contact the specimen donor to determine if a valid medical reason prevented a negative result. If no valid medical reason could be established by the MRO, the employer would then be informed that the donor was positive for illegal drug use, either due to using a substance without valid medical authorization or using an illicit substance (one that had no valid medical purpose for use).  

This type of testing process may sound familiar because to this day, it remains the most common method for workplace drug testing. However, several innovations have been made since these early years. These include electronic CCF, use of oral fluid (saliva) or hair sampling rather than urine and use of employer-administered testing devices offering “instant” or “rapid” screening results. Still, most workplace drug testing today still employs lab-based urine drug testing. Lab-based urine testing was established in the late 80s as the only permissible sampling method for federally-mandated testing, and remains so to this day. Employers who implemented their own drug-free workplace program based it on federal requirements, hence lab-based urine’s continued prevalence. 

Some of these innovations may, however, offer notable advantages for employers which simply haven’t been fully considered yet. For example, use of an electronic CCF could help in significantly reducing result turnaround delays which currently exist with the use of paper forms. Additionally, sampling methods other than urine are currently available which can identify more recent use of an illicit drug, or which can identify use over a longer time period.  

This article will explore attributes of oral fluid sampling and also highlight how it contrasts with other sampling methods.    

Oral Fluid Sampling 

“Lab-based drug testing” essentially means that a donor’s specimen (urine, oral fluid, hair, etc.) will be collected by a collector at a “collection site,” which will then be sent to a laboratory for scientific analysis. This lab is a separate facility with proper instrumentation and staff to analyze the specimen and to conduct additional testing, if necessary. 

Lab-based oral fluid drug testing for the workplace has been a valuable service available since the 2000s. However, there are important differences between oral fluid testing and testing using urine, hair or blood sampling.   

How is Oral Fluid Different? To start with, in comparison with urine, hair and blood sampling, oral fluid is a less-intrusive option. For example:       

• Unlike urine, the donor doesn’t need to be given privacy in a bathroom, which also gives donors an opportunity to cheat the testing process.           
• Unlike hair, oral fluid helps avoid complications associated with insufficient hair being available to collect.    
• Unlike blood, oral fluid doesn’t require use of syringe and needle by a trained phlebotomist to draw blood from a donor’s arm. 

How is Oral Fluid Similar? Oral fluid testing is very similar to traditional urine sampling in several ways:       

• Oral fluid testing is scientifically accurate and legally defensible.   
• Chain of custody and specimen retention by the lab is modeled after federal guidelines.         
• Oral fluid testing can be used for detecting the most commonly-abused drugs tested today, including marijuana, cocaine, opiates, amphetamine, methamphetamine, phencyclidine (PCP), ecstasy (MDMA), oxycodone, barbiturates, benzodiazepines and methadone.   
• Result turnaround is very comparable to urine testing.   
• Testing cost is comparable to urine, and even less expensive if the employer performs the specimen collection directly. Hair and blood testing are significantly more expensive than oral fluid and urine testing. 

Advantages of Oral Fluid Testing 

There are also several unique advantages to oral fluid testing:       

• Depending on the substance ingested, oral fluid can detect more recent use than is the case with urine, as soon as within one hour of ingestion.         
• Oral fluid has shown to be more sensitive in detecting marijuana use.   
• An oral fluid collection can easily be performed directly by the employer, thereby avoiding lost employee time traveling to a collection site.   
• An oral fluid collection is performed with the donor under continuous supervision and observation of the collector (or employer), thereby essentially eliminating donor ability to tamper with the specimen.   
• An oral fluid collection will not be interrupted or delayed due to a donor’s inability to provide sufficient specimen, as may be the case with urine. 

Possible Disadvantages of Oral Fluid Testing 

There are some attributes of oral fluid testing that some could possibly view as a disadvantage, including:         

Federally-mandated testing. As is currently the case with the Department of Transportation testing, lab-based urine testing is required for federally-mandated testing. However, the Substance Abuse and Mental Health Services Administration (SAMHSA) published guidelines in October of 2019 authorizing lab-based oral fluid drug testing that will eventually make it possible for federally-regulated workplaces to begin using lab-based oral fluid testing as an alternative to lab-based urine testing.       

Shorter detection window. Depending on the substance ingested, amount of ingestion and an individual’s metabolism, most substances can generally be detected in oral fluid within a one–48-hour period following use.          

• Detection in urine generally falls into a one-to-seven-day period following use (or longer for chronic users).          
• Detection in hair generally falls into a seven-to-90-day period following use provided an inch-and-a-half of hair length is available to be collected (essentially every half-inch of hair from the skin can provide a 30-day window of detection).         

U.S. state restrictions. All states permit the use of lab-based urine drug testing for all testing scenarios. In the case of lab-based oral fluid testing, most states have no restriction for use, but there are a handful that require lab-based urine testing in certain scenarios, or to qualify for workers' compensation premium discounts.       

Oral Fluid testing is also increasing in popularity among employers interested in obtaining an “instant” or “rapid” screening result. Since oral fluid testing is a point-of-collection test, an employer can directly collect a specimen for immediate screening rather than send an employee to a collection site, which may take two or more hours before the employee can return to work. Generally speaking, at least 90 percent of the time, employers will receive a negative screening result, thereby allowing the employer to immediately proceed with an employment decision.2 

A Solution to Consider      

Lab-based oral fluid testing offers some notable advantages for employers to consider. Its ability to detect recent use sooner following ingestion than urine or hair testing, makes it a preferred sampling method for reasonable suspicion and post-accident testing scenarios.       

Recent surveys have also shown that more and more employers are turning to oral fluid testing. According to the Current Consulting Group, 13 percent of drug testing providers and employers reported in a mid-year 2020 survey that their clients switched to or added oral fluid testing to their workplace program.3 In the year-end survey, the percentage increased to 15 percent. Prior to the onset of the Covid-19 pandemic, most experts believed that oral fluid represented about 8 percent of the workplace testing market share.     

Furthermore, with the October 2019 publishing of federal guidelines for oral fluid testing, SAMHSA projects about 7 percent of federally-mandated drug tests will transition from urine to oral fluid in the first year, and increase further to 25-30 percent within four years.4 

Clearly there is a strong expectation from federal regulators as well as private industry that the advantages of oral fluid testing offer notable benefits to workplace safety and drug-free testing programs.    

Sterling is not a law firm. This publication is for informational purposes only and nothing contained in it should be construed as legal advice. Sterling expressly disclaims any warranty or responsibility for damages arising out of this information. We encourage you to consult with legal counsel regarding your specific needs. We do not undertake any duty to update previously posted materials. 

This article originally appeared in the June 2022 issue of Occupational Health & Safety.