Instant Oral Fluid Drug Tests 101
Instant oral fluid drug tests are gaining in popularity but regulations have yet to catch up.
As employers seek efficient ways of maintaining a Drug-Free Workplace Program, the use of instant oral fluid drug tests may be one of the methods considered for drug testing. Other names for instant testing include: rapid testing; rapid-result testing; on-site testing; and point-of-collection testing (POCT). These terms refer to any instant testing and the type of testing sample should be specified for clarity (for example, oral fluid or urine). (Learn more in "Oral Fluid, Urine, and Hair Testing: What's the Difference?")
Instant Oral Fluid Drug Testing Approvals
The Food and Drug Administration (FDA) approved the use of the first oral fluid drug testing device in 2013, after rigorous review of the design and reliability of the tests, to avoid as many false results as possible. The FDA also ensures that the instructions are clear and easy to understand. This is especially important for instant testing, since the person who oversees the procedure may not be a healthcare professional.
As with all forms of drug testing, if the initial screen shows a positive result, the same specimen is sent to a laboratory for confirmatory analysis using “the gold standard” accuracy method, gas chromatography coupled with mass spectrometry (GC/MS).
It is important to note that at the present time, oral fluids (saliva) may not be used for any Department of Transportation (DOT) regulated testing. The DOT testing procedure is done with urine specimens. There may be a future change in policy, allowing for use of oral fluid testing but it is not currently valid under regulations. The DOT has been working with the Department of Health and Human Services (HHS) since 2015 to pass a final rule that is consistent with the Omnibus Transportation Employee Testing Act of 1991. (Learn more in "DOT vs. Non DOT Testing: What's the Difference?")
What Does an Instant Oral Fluid Drug Test Detect?
The test is used to screen for six commonly abused substances:
- THC (Marijuana)
- PCP (Phencyclidine) (Learn more in "Drug Abbreviations Used in Drug Testing".)
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Instant Oral Fluid Drug Test Advantages
For employers who aren’t affected by DOT or state law restrictions, instant oral fluid testing has several advantages:
- Because the test is FDA-approved, results are considered reliable
- On-site collection means less time away from the job
- No special or private location for testing is necessary
- Gender-specific staff is not needed
- Specimens are very difficult to tamper with or adulterate (such as diluted urine specimens)
- Results are available within a few minutes
- Drugs can be detected shortly after use (<1-24 hours)
Specimen collection takes less than five minutes. The employee generally performs the collection on himself or herself with instructions from, and in full view of, a trained in-house employee. From a public health perspective, saliva is not considered to be a bio-hazard material, so it does not fall under the Occupational Safety and Health Administration (OSHA) guidelines regarding bloodborne pathogens. (NOTE: Dentists and dental professionals are advised to follow precautions, because they encounter blood and bloody saliva as part of their work.)
Factoring in reduced collection time, no need for a special place or staff, and quick results, instant oral fluid testing can be cost-effective. The test can quickly be administered for post-accident and reasonable suspicion situations as well. As with other instant tests, if the sample yields positive results, it must be sent to a laboratory for a confirmatory analysis. (Learn more in "Everything You Need to Know about Oral Fluid Drug Testing ".)
Instant Oral Fluid Drug Test Disadvantages
Before proceeding with instant oral fluid testing, employers should also be aware of the disadvantages:
- Initial screening results are interpreted by the collector
- Poor detection of THC, the active substance in marijuana
- Cut-off levels of drugs being screened may differ by testing kit brand
- May not be used in all states
- Limited number of FDA-approved devices
Special Concerns Over THC
Detecting the presence of THC in the initial screening can be a concern. After smoking marijuana, THC will be present in saliva as soon as three minutes later, indicating that it is also in the blood stream, going to the brain. It can remain in oral fluids for up to 36 hours. However, if the cut-off level of an instant test is 50 ng/mL, detection drops to just a couple of hours after use. If an employee or job candidate knows about the test, avoiding marijuana for a few days prior can provide a negative test result. In comparison, a urine test can show THC up to 7 days after use with regular users potentially testing positive for up to 45 days.
With more states passing legislation that permits the use of medical or recreational marijuana, employers may not be comfortable relying on the results of an instant oral fluid drug screen. Liability risk can increase, especially for jobs that could harm an employee or others. Every employer that does drug testing should select the most accurate method of screening for marijuana/THC. (Learn more in "Medical Marijuana Law Differences and Contradictions".)
Things to Do Before Implementing Instant Oral Fluid Drug Testing
If state law permits drug screening with oral fluids, it can be practical and efficient. Before implementing instant testing, employers should do the following:
- Know state statutes regarding workplace drug testing
- Seek legal advice from attorneys and Human Resources experts
- Select only FDA-cleared testing devices and approved laboratories for confirmation
- Utilize a Medical Review Officer (MRO) in the process and test result reviews
- Designate who will oversee the collections and provide training for those chosen
- Make sure company drug policies include all testing methods and when they will be utilized
- Train supervisors and managers on the legal and practical aspects of instant testing
- Educate staff about instant oral fluid testing and when it will be conducted
- Document all training
While urine testing continues to be the standard method, using simpler and less invasive ways to collect specimens, such as saliva or hair, will become more common. Employers will have the ability to perform accurate screening in the workplace setting without worry. Instant oral fluid testing can be a good addition to a robust workplace safety program.