Oral fluid (saliva) testing provides companies with an effective, easier-to-administer alternative to urine testing — in certain situations. Because of this, some companies are moving away from using urine testing and toward using oral fluid testing. This is despite the fact that federal regulators still don’t recognize oral fluid testing. (Learn more in Everything You Need To Know About Oral Fluid Drug Testing).

Oral Fluid Testing vs. Urine Testing

Like with urine testing, in oral fluid testing, the saliva sample collected is analyzed for the presence of drugs and metabolites. Both oral fluid and urine testing can provide reliable 6-panel and 10-panel drug test results. The differences between the two become apparent when considering the sample collection process, the possibility of cheating the test, the window for detection, and federal regulations.

Collecting Samples

For many employers, the sample collection process for oral fluid testing is easier and provides more transparency.

To collect an oral fluid sample, the person places a collection pad (or swab) in their mouth between their cheek and gum until the pad is saturated. The saturated pad is then sealed inside a vial and sent to a laboratory for analysis. Unlike urine sample collection, the collection of an oral fluid sample can be easily witnessed by a trained, designated person.

Collecting an oral fluid sample takes about 15 minutes and can happen virtually anywhere. All that’s required for privacy is a room with a closed door. Collecting a urine sample requires privacy and a toilet. Depending on the circumstances, collecting urine may also require the person being tested to go to a designated location or lab for the sample to be collected.

Cheating the Test

So far, no reliable way to cheat an oral fluid test has been identified. Urine tests are subject to cheating. Urine tests can be cheated by altering the sample through swapping, adulteration, or contamination. (Learn more in Top 3 Ways Employees Try To Cheat Drug Testing).

The complete collection process, from start to end, for an oral fluid test is easily observable. Because of this, the person being tested doesn’t have an opportunity to swap or alter the sample before it’s submitted for analysis.

Neither dilution tactics (such as drinking excessive amounts of water) or adulteration tactics (such as rinsing with strong mouthwash) have been shown to be effective in changing the results of an oral fluid test.

Additionally, the laboratories testing oral fluids start their analysis by confirming that the sample is human saliva and undiluted. If the sample doesn’t clear this preliminary step a new sample (either saliva or urine) is collected and analyzed.

The Window for Detection of Drug Use

Oral fluid testing can detect the presence of drugs within 30-60 minutes of ingestion and up to 48 hours after use. The results will point to drug use within a clearly defined timeframe.

With urine, the window for detection is considerably longer because the drugs ingested need to make their way through the body’s waste system. It can take up to four hours for the presence of drugs to be detectable in urine. And the results of a urine test can indicate drug use up to several days before the collection point.

This tighter window for reliable results makes oral fluid testing particularly effective for post-incident, reasonable suspicion, and random testing.

Regulatory Limits on Oral Fluid Testing

Unfortunately for many companies, barriers remain to keep them from moving toward using oral fluid drug testing.

Currently, oral fluid testing is not recognized under federal drug testing regulations. Therefore, companies cannot replace urine testing for any employee subject to Department of Transportation (DOT) or other federal drug testing regulations.

And in those states that defer to federal regulation for their drug testing regulations, companies don’t have the option of using oral fluid testing. This restriction can apply even if the person being tested is not subject to DOT or other federal drug testing regulations.

As interest in oral fluid testing grows it’s hoped that these regulatory barriers will come down soon.

Regulators have taken several significant steps toward recognizing oral fluid testing. In 2011 SAMHSA’s Drug Testing Advisory Board voted unanimously to recommend oral fluid testing be allowed for federal tests. The Department of Health and Human Services published guidelines for comment in 2015. Rules adding oral fluid testing as an option for DOT drug testing were expected to be published in 2016. Congress even passed a law requiring (the overdue) guidelines be published in the Federal Registry by the end of 2018.

But, as of the writing of this article, no federal rules or guidelines have been published. Oral fluid testing remains unrecognized by the federal government.

Urine Testing Remains the Regulatory Standard

Despite industry interest and support for expanding federal and state regulations to include oral fluid drug testing, urine testing remains the regulatory standard for job-related drug testing. For those companies whose employees are not subject to limiting drug testing regulations, oral fluid testing provides a more effective, less invasive option. This is especially true when testing in response to an accident, where the tight window of detection for oral fluid testing more clearly establishes the presence of drugs during an incident.