Should Employers Consider Oral Fluid Drug Testing? - Sterling (2024)

August 6th, 2024 | Sterling

Though most private employers are not mandated by regulation to drug test their job candidates or employees, many do, and for good reason. Employers are responsible for maintaining a safe workplace for their employees, as well as ensuring safety for the public that their employees may interact with.

Employers drug test to:

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

The Early Days of Workplace Drug Testing

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 improve 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. The collector would manually prepare a paper chain of custody/control form (CCF), seal the collected specimen and package it with the CCF, and set it aside for a courier to pick up later in the day for transport to a qualified laboratory for analysis.

Following analysis of the specimen, the lab would report the result and, if the result wasn’t negative, an MRO (medical review officer) would 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 learn 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).

If this type of testing process sounds familiar that would be because it remains the most common method for workplace drug testing. Several innovations, however, have been made since these early years, including 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 of the workplace drug testing today employs lab-based urine drug testing.

Some of these innovations may, however, offer notable advantages for employers that simply haven’t been considered. For example, are you aware that use of electronic CCF could help in significantly reducing result turnaround delays that exist with use of paper forms? Or that sampling methods other than urine exist that could identify more recent use of an illicit drug by an employee?

In particular, this blog post will explore attributes of lab-based oral fluid sampling, and why it may make sense for an employer’s drug testing program.

Lab-based Oral Fluid Drug Testing

Lab-based oral fluid drug testing for the workplace has existed since the 2000’s. However, there are some differences between oral fluid and testing using urine, hair, and blood. We will explore the main differences and similarities to help you decide if oral fluid testing is a good fit for your testing program.

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, where opportunity to cheat the testing process exists.
• Unlike hair, oral fluid helps avoid complications associated with insufficient hair being available to collect.
• Unlike blood, oral fluid doesn’t require use of a 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 many 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 common drugs tested today, including marijuana, cocaine, opiates, amphetamine, methamphetamine, phencyclidine (PCP), oxycodone, barbiturates, benzodiazepines, and methadone.
• Result turnaround time 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 several unique benefits of oral fluid testing, including:

• Depending on the substance ingested, oral fluid can detect more recent use than is the case with urine, typically within 1–6 hours of ingestion.
• With its recent use detection window, oral fluid testing detects the parent drug of THC (tetrahydrocannabinol), making it a viable alternative for marijuana testing in California and Washington states, where employers are required to test for THC rather than a marijuana metabolite.
• 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 can be an alternative specimen collection to resolve delays and complications from a donor’s inability to provide sufficient urine specimen (“shy bladder”).
• Effective June 1, 2023, the DOT passed a final rule that makes lab-based oral fluid testing permissible for DOT-regulated drug testing. While regulated oral fluid testing is not yet available as of this publication due to required HHS lab and collector certification milestones that must still be met, it is expected to be available soon. Availability of regulated oral fluid testing will enable employers in states where oral fluid testing is allowed to adopt less intrusive, recent-use testing for their overall drug testing program.
• Historically, there were several states that aligned their state drug testing requirements with DOT testing standards. Since past DOT standards did not include oral fluid testing, this specimen type might not have been permitted in the state. With the passage of the final rule that makes lab-based oral fluid testing permissible for DOT-regulated drug tests, availability of oral fluid testing is expected to expand to include all states.

Possible Disadvantages of Oral Fluid Testing

There aren’t many disadvantages of performing oral fluid testing, however one reason employers may choose to not do oral fluid testing is a shorter detection window. Oral fluid detects more recent substance use, typically use within 1–6 hours, depending on the substance ingested, the amount of ingestion, and other factors.

• Detection in urine generally falls into a 1–7-day period following use (or longer for chronic users).
• Detection in hair generally falls into a 7–90-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).

Oral fluid testing is also increasing in popularity amongst employers interested in obtaining a rapid screening result. As a point-of-collection testing device, an employer can directly collect a specimen for testing rather than sending an employee to visit a collection site, which may result in two or more hours before the employee can return to work. Generally speaking, at least 90% of the time employers will receive a negative screening result, thereby allowing the employer to immediately proceed with an employment decision.

The benefits, trends, latest regulations, and more were covered in a recent webinar produced by Sterling – watch now:

In Conclusion

Lab-based oral fluid testing offers some notable advantages for employers to consider. Its ability to detect recent use sooner following ingestion than is the case with urine or hair 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 a recent Current Consulting Group survey, 86% of drug testing providers offered oral fluid testing in 2023, compared to 39% in 2019.

Furthermore, with the June 2023 DOT final rule permitting regulated lab-based oral fluid testing and current laws in California and Washington states that require recent-use detection of the marijuana parent drug THC, an increasing number of employers are evaluating lab-based oral fluid testing as a necessary alternative to urine testing. Drug testing providers are predicting a significant change is coming. In the same 2023 drug testing industry survey, 45.6% of respondents expressed they believe that oral fluids will be the most common sample type in the future. Just six years ago, the Society for Human Resource Management (SHRM) estimated urine tests comprised 90% of the market.

There is clear expectation from federal regulators as well as private industry that the advantages of oral fluid testing offer notable benefits for drug-free testing programs. What’s more, its use is becoming increasingly important in helping employers maintain a safe workplace for their employees and clients.

Learn more about Sterling’s drug screening services.

Are you an employer who wants to learn more about our drug testing solutions? Contact us now.

Sterling is not a law firm. This publication is for informational purposes only and nothing contained in it should be construed as legal advice. We expressly disclaim any warranty or responsibility for damages arising out 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.