Oral Fluid Testing for Drugs of Abuse

Abstract

BACKGROUND Oral fluid (OF) is an exciting alternative matrix for monitoring drugs of abuse in workplace, clinical toxicology, criminal justice, and driving under the influence of drugs (DUID) programs. During the last 5 years, scientific and technological advances in OF collection, point-of-collection testing devices, and screening and confirmation methods were achieved. Guidelines were proposed for workplace OF testing by the Substance Abuse and Mental Health Services Administration, DUID testing by the European Union’s Driving under the Influence of Drugs, Alcohol and Medicines (DRUID) program, and standardization of DUID research. Although OF testing is now commonplace in many monitoring programs, the greatest current limitation is the scarcity of controlled drug administration studies available to guide interpretation. CONTENT This review outlines OF testing advantages and limitations, and the progress in OF that has occurred during the last 5 years in collection, screening, confirmation, and interpretation of cannabinoids, opioids, amphetamines, cocaine, and benzodiazepines. We examine controlled drug administration studies, immunoassay and chromatographic methods, collection devices, point-of-collection testing device performance, and recent applications of OF testing. SUMMARY Substance Abuse and Mental Health Services Administration approval of OF testing was delayed because questions about drug OF disposition were not yet resolved, and collection device performance and testing assays required improvement. Here, we document the many advances achieved in the use of OF. Additional research is needed to identify new bio-markers, determine drug detection windows, characterize OF adulteration techniques, and evaluate analyte stability. Nevertheless, there is no doubt that OF offers multiple advantages as an alternative matrix for drug monitoring and has an important role in DUID, treatment, workplace, and criminal justice programs.

A competitive enzyme immunoassay for the quantitative detection of cocaine from banknotes and latent fingermarks

“…Several studies have shown a strong correlation between cocaine concentration in oral fluid and in plasma, proving oral fluid to be an appropriate sample matrix for the detection of drug use [34,35]. Due to its rapid elimination, with a half-life of only 3 h, the detection of cocaine in oral fluid is a suitable indicator of recent drug use close to the time of sampling [36].…”

The Clinical and Forensic Toxicology of Z-drugs

“…Risk of transmissible infection is much less than blood testing and there is evidence that oral fluid is more likely to show recent drug exposure [63]. With increasing incidence of driving under the influence of drugs, there is an incentive for improving oral fluid testing technique and methodology.…”

Comparison of Cannabinoid Concentrations in Plasma, Oral Fluid and Urine in Occasional Cannabis Smokers After Smoking Cannabis Cigarette

“…In addition, delta-9-tetrahydrocannabinol (THC) is frequently detected in the blood or saliva of impaired drivers suspicious of erratic driving or involved in road accidents [1,2]. Although urine and plasma are commonly utilized for cannabinoid testing, the acceptance of oral fluid as an alternative testing device matrix has increased in the past two decades [3]. Oral fluid is an attractive drug-testing tool because the procedure for obtaining the desired specimens is easier, safer and less invasive as compared to urine and plasma.…”