Oral Fluid Testing: Promises and Pitfalls

Abstract

Oral fluid is a promising new matrix for drug-testing programs for drug treatment, the workplace, pain management, and driving under the influence of drugs (DUID)7. As with any new technology, there are strengths and limitations. We discuss with international experts the role this new alternative matrix will play in diverse drug-monitoring settings, and the research, development, and legislation needed to permit oral fluid testing to best take its place in the modern laboratory armamentarium.8 Do you believe oral fluid testing will become the most prevalent matrix tested in these programs and why? What are the strengths and limitations of oral fluid testing for each type of program? Alain Verstraete: Oral fluid will probably become the most prevalent matrix for DUID, certainly for roadside screening. Legislators and police officers want to rapidly perform DUID testing at the roadside, eliminating transport to hospitals or police stations. Oral fluid is used for DUID in 5 Australian states, Belgium, and France and is described in Swiss and United Kingdom legislation. The main advantages are ease of collection and a generally shorter window of drug detection than urine, hence a better correlation with duration of impairment. Limitations include difficulty of collection following recent drug use and the potential for passive contamination. For DUID confirmation, presently only Belgium and 4 Australian states utilize oral fluid; in other jurisdictions, positive oral fluid presumptive test results are confirmed with blood tests. Oral fluid also could become the most prevalent matrix for drug treatment due to ease of sampling, despite the shorter drug-detection window. In this setting, cost may play a more important role. If additional visits are required for oral fluid testing, urine testing might remain dominant. A strong advantage of oral fluid testing for drug treatment is the greater detection of 6-acetylmorphine, a marker …