On May 1, 2023, the U.S. Department of Transportation announced a new rule allowing the use of oral fluid testing for their safety-sensitive employees. This change aims to prevent common adulteration methods that occur with urine tests, while also addressing privacy concerns for those being tested.
Oral Testing Timeline:
-In October 2019, the Substance Abuse and Mental Health Services Administration (SAMHSA) published the final regulations for lab-based oral fluid testing, thereby giving federal employers the choice between urine testing or oral fluid for the first time ever.
-Fast forward to May 2023, the US Department of Transportation (DOT) issued final regulations that will allow DOT-regulated employers to choose between lab-based oral fluid testing or traditional urine tests.
Does that mean DOT-regulated employers can start using oral fluid testing right away?
Not quite yet!
Before DOT oral fluid testing can be fully implemented, the Department of Health and Human Services (HHS) needs to certify at least two labs—one to handle primary testing and another to serve as the split specimen laboratory.
Despite recent implementations, oral fluid drug testing has been around for more than two decades.
Oral fluid drug testing works by analyzing saliva, the fluid produced in the mouth. When drugs are consumed, they enter the bloodstream and pass into saliva through passive diffusion. This process allows oral fluid tests to detect substances within a specific time frame, usually between 24 to 48 hours. Because of this, oral fluid testing is especially useful for identifying recent drug use.
Similar to urine testing, oral fluid testing is effective at detecting recent drug use and can even catch usage that may slip past urine tests. While oral fluid has a slightly shorter detection window (varies depending on the drug and usage patterns), various studies show that oral fluid testing delivers higher positivity rates for nearly all drugs.
Common Questions:
What is the detection window for oral fluid?
The answer depends on a few factors, like the type of drug (marijuana, cocaine, etc.) and whether the test is done in a lab or at the point of collection, but generally from five to 48 hours.
What are the advantages?
One of the key advantages of oral fluid testing is its ability to detect drugs soon after use, as it identifies the parent drug in saliva, not a metabolite. This is why oral fluid testing is often called a "recent use" detection method and is the closest option we have to an impairment test. On the other hand, drugs typically show up in urine only after the body has metabolized the substance, which can take around 6-7 hours. Drugs remain detectable in urine for 24-72 hours, with certain drugs such as marijuana sometimes lasting longer, depending on the user and usage patterns.
Additionally, another advantage of oral fluid testing is how straightforward it is to collect samples compared to urine. Collections can happen almost anywhere, anytime, without the need for a special facility. In addition, since the donor and collector are in full view of each other throughout the collection process, without invading one’s privacy, it is much harder to tamper with the sample—a widespread issue with urine testing. This added security layer makes oral fluid testing a more reliable choice when preventing substitution or adulteration.
For transgender and non-binary individuals needing a DOT Direct Observed collection, oral fluid drug testing is the required method.
The DOT’s new rule allowing oral fluid drug testing makes the Direct Observed Collection process easier for transgender or nonbinary employees. It states that for any test requiring direct observation involving transgender or nonbinary individuals must be oral fluid.
In the case where a DOT Direct Observed Collection is required, but a same-gender observer is not available, the testing method will change to oral fluid.
The Future of Oral Fluid Testing:
A recent 2023 survey of workforce drug testing providers showed a significant shift in favor of oral fluid testing: 87% reported offering oral fluid testing currently, compared to just 39% in 2019.
This trend indicates an expansion of the benefits of oral fluid testing. When participants were asked which method they believe will dominate the future of drug testing, 46% chose oral fluid testing— a significant improvement from the same percentage favoring urine testing back in 2019. Attitudes and perspectives are changing, and oral fluid testing is gaining traction as a logical and viable option in the workplace.
References:
Current Consulting Group. 2023 Drug Testing Industry Survey. Accessed October 01, 2024.
US Department of Transportation. Part 4 final rule – DOT summary of changes. Accessed October 2024. https://www.transportation.gov/odapc/Notice_Summary_May_2023
“Understanding Advancements in Employee Drug Testing: Dot Approves Oral Fluid.” LabCorp, 10 Aug. 2023, www.labcorp.com/understanding-advancements-employee-drug-testing-dot-approves-oral-fluid. Accessed 01 Oct. 2024.
DISA, ASK. “Why the DOT Approved Oral Fluid Testing, but You Can’t Use It Yet.” DISA, 11Aug. 2023, disa.com/news/why-the-dot-approved-oral-fluid-testing-but-you-cant-use-it-yet. Accessed 01 Oct. 2024.