Tox Tuesday: Oral fluid testing update

NeoSal_blogTo combat issues of paruris, or shy bladder syndrome, as well as a way to improve the accuracy and timing of results, the Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed adding oral fluid drug testing as an approved testing method for use in federal workplace testing and other workplace settings.

Currently urine testing is the only approved method for federal employees—which has been the case since 1988. For several reasons, including the ones mentioned above, organizations and companies in the industry have expressed their frustration with having only one approved method when scientific data has shown several benefits to using oral fluid testing.

SAMHSA first proposed the idea of adding oral fluid testing to the approved methods in 2004, but it was not until last month that the addition gained traction, a comment period was held, and feedback was provided. While some questions still remain and the exact guidelines need to be fleshed out, most of those who were involved in the comment process endorsed adding oral fluid testing, including the Drug and Alcohol Testing Industry Association (DATIA) and several drug testing companies, a recent article states.

Those in favor of the addition say that among other things, oral fluid testing will eliminate issues for those who suffer from shy bladder syndrome. Currently affecting 17 million Americans, shy bladder syndrome can have varying degrees of severity and is considered a social phobia by mental health professionals, another recent article explains.

Therefore, some argue that forcing those with shy bladder syndrome to submit to a urine test in order to be considered for a job or keep an existing job, is discrimination. Because of this, the article states it is only fair that other forms of technology, such as oral fluid testing, should be used for those with this condition.

Not only can oral fluid testing assist those with shy bladder syndrome, but commenters also mentioned that studies have also shown it can detect drug use that occurred in as little as five to 48 hours prior to the test. With urine testing, the detection time is one and a half to four days— or longer with chronic drug use—according to SAMHSA.

In addition, SAMHSA has proposed expanding their workplace testing panel to include commonly abused opiates such as oxycodone and hydrocodone. Currently a standard workplace 5-panel test does not detect these drugs, so employers have to specifically request that these drugs are added to their testing panel— which comes with an additional cost. With oral fluid testing, however, these drugs are already a part of many standard tests and if the SAMHSA guidelines are passed as written, anyone screening oral fluid would be required to have these drugs on their routine panel for workplace testing.

This is important as an estimated 26.4 million to 36 million people abuse opioids worldwide, a number that has quadrupled in the U.S. alone since 1999, a recent article explains. Experts in the field attribute this drastic increase to the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies today.

For example, one study states that pain killers prescribed by physicians, increased 35.2% from 2000 to 2009. Also, the distribution of opioids to U.S. pharmacies, in milligrams per 100 persons, increased by least 100% for all selected opioids during the same time period, and the average size of an oxycodone prescription increased by 69.7%.

As of late however, the U.S has cracked down on pain clinics and the number of prescriptions doctors can write for such drugs. While data is showing that rates of abuse are improving in some areas, the rate of heroin abuse and overdose has begun to climb at the same time. Many predict that this is because heroin and prescription pain killers are such similar drugs, those who can no longer find prescription drugs have turned to heroin to fill the void.

While making these drugs mandatory to screen for in a workplace setting could be done using urine testing as well as oral fluid testing, commenters also stated that oral fluid testing provides a faster collection process compared to urine testing and leads to fewer rejected, invalid, substituted, and adulterated specimens. This is because oral fluid testing is more difficult to cheat.

For example, another article states that dilution is a common problem that occurs with urine testing and involves trying to fool a urine test by consuming extra water or other types of liquid that would render the urine sample too dilute in concentration and thus hide drug metabolites that would otherwise be apparent in the test. Since the oral fluid sample is taken directly from the mouth, any type of extra liquid would easily be detected.

Substitution is another issue with urine testing which occurs when someone tries to sneak in concealed containers of liquid to replace their urine sample. The article explains that some have even tried injecting substitute urine directly into their bladder or have used a catheter to fool a urine test. Substitution is nearly impossible with oral fluid testing.

Adulteration can also occur in urine testing when someone adds a foreign substance to their specimen to either void the results or cover up drug use. Common additives include bleach, juices, soap and eye drops, and requires the donor to smuggle these liquids into the testing room. Because oral fluid testing involves taking a sample directly from the mouth, adulterating the sample would also be very difficult to accomplish in this case as well.

While the majority of commenters endorse the use of oral fluid testing, the article states there a few questions that still need to be answered before a final decision can be made. These include how the use of tobacco products could impede or interfere with the collection of oral fluids, how to deal with orthodontic appliances or piercings, and how other items such as gum, mints or candy will be tolerated.

While it is unknown when to expect a final ruling from SAMHSA, many seem confident that adding oral fluid testing as an approved drug testing method in a workplace setting would offer several benefits. From avoiding issues of shy bladder syndrome that can occur with urine testing, along with improving the accuracy and timing of results, data suggests that having the option to use oral fluid testing when necessary could help improve the state of drug testing today.

For more information, click here.

Neogen has recently released the NeoSalTM Oral Fluid Collection System. This oral fluid collection system is designed for maximum ease-of-use at the collection site and testing laboratory. For more information, click here.

 

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