Drug testing just underwent a historic change. Effective June 1, 2023, the Department of Transportation (DOT) will soon allow the use of oral fluid testing as an alternative to urine tests, as outlined in its final rule (published in Federal Register 88 FR 27596). The news has been greeted with enthusiasm by affected employers, but it’s critical to point out that there is work to be done before employers can begin incorporating oral fluid testing into their DOT drug testing programs.
Failure to implement and carry out oral fluid testing procedures to the letter could add more hassles and headaches than it’s worth. For starters, employers can’t implement the new test on the effective date, because (as of this writing) the Department of Health and Human Services (HHS) hasn’t yet certified any specimen labs to process the tests. But of more long-term importance are the several factors employers must take into account to ensure specimen collection is done by the book.
Employers Decide Which Test to Use
Employers are responsible for deciding which collection method to use for most reasons for testing, e.g. “pre-employment, reasonable suspicion/for cause, post-accident, return-to-duty, or follow-up.” The only exception to this is random drug testing. During a DOT random drug screen, the urine testing method must be used first. Employees, meanwhile, don’t have a say as far as which test they prefer to take.
Forge Strong Relationships with Your Drug Testing Partner
Many employers already have this handled, but it is important to make sure your testing company has trained oral fluid collectors who intend to send those specimens only to the labs approved by HHS. Employers who act now will be in a position to get rolling as soon as HHS certifies the two labs it needs.
DOT recommends that companies set up a “standing order” so collection sites will have supplies and staff ready. This is especially crucial due to the short window of detection that oral fluid tests provide, as we’re about to explain.
Know The Benefits & Limitations of Oral Fluid Testing
Oral fluid screening makes it easy to conduct direct observations (without giving test takers any excuse, such as shy bladder). The actual test is far less intrusive than blood, urine or hair testing. It is also harder for employees to tamper with their specimens, likely leading to the discovery of more illicit drug use.
Oral fluid tests are most suitable for detecting more recent drug consumption, with a general detection window between 1 – 48 hours post use. Compare that to a urine screen, which has an average window of detection up to 72 hours. But when we are talking about cannabis, a urine drug screen has been known to detect the presence of THC and/or its metabolite for up to two weeks or longer, depending on an employee’s frequency of use.
As employers struggle to maintain the focus on an employee’s fitness for duty, oral fluid screening is advantageous with its more limited window of detection.
Designated Employer Representative (DER)
Regardless of the type of drug test being administered, an employer’s Designated Employer Representative plays a critical role in its drug and alcohol testing program. This is where a solid relationship between the employer and its drug testing partner comes into play. Oral fluid collectors need to have the DER’s phone number on hand and listed on the Custody and Control Form (CCF) so they can reach out if a problem occurs. The collector acts as the eyes and ears of the employer, but the DER is the one to make the call concerning problem collections to include determining if an employee’s behavior constitutes a refusal to test.
Specimen Collectors
Assigned collectors must receive training on and be proficient in the use of whatever oral fluid collection device your company opts to use. They need to be kept fully aware of the employer’s “preferences and standing orders for regular and problem collections.”
As always, collectors must complete the CCF correctly and use devices that are not expired. A collection will be considered a fatal flaw and the specimen unusable if an expired device is used. They must be sure not to use any device that’s past its expiration date (as listed on the device or its packaging).
Laboratories
Labs also have to keep an eye out for expired oral fluid devices. They’re directed by DOT rules to “reject the specimen for testing” if the device is expired. The lab must also reject a specimen if the collector didn’t enter the device expiration date on the CCF or listed it wrong. The only exception is if the lab can verify the right date in time.
Medical Review Officers (MRO)
MROs are strongly encouraged to “seek supplemental information about oral fluid testing by the time HHS certifies at least two laboratories to conduct oral fluid testing.” They must be up-to-date on all new relevant guidelines, including what to do if an employee can’t provide “a sufficient oral fluid specimen after an insufficient urine specimen or vice versa.”
Rules on Refusals
Employers should stay mindful of the rules around refusals. Only an employer can decide whether or not an employee or potential employee has technically refused to provide a sample. DOT states that “if an employee does not appear for a pre-employment drug test or leaves the collection site before receiving a cup (for a urine collection) or unwrapping the device (for an oral fluid collection) it is not a refusal.”
Substance Abuse Professionals (SAP)
SAPs are allowed to perform remote evaluations only if they meet certain criteria. The criteria includes using technology that:
- Permits “real-time two-way audio and visual interaction between the SAP and the employee;
- Is of sufficient quality that it allows the SAP “to gather all the visual and audible information the SAP would normally observe in a face-to-face in-person interaction;” and
- Incorporates “sufficiently robust security to protect the confidentiality of the conversation.”
Of note, SAPs cannot conduct remote evaluations outside of the geographic area in which they are certified and/or licensed.
Conclusion
There are several potential benefits for employers to start incorporating oral fluid testing—but preparation is the key to enjoying those benefits.
The above are just a few highlights of criteria companies must consider when implementing oral fluid testing. The rules get complicated and confusing at times, making it easy for mistakes to occur. That’s why we recommend employers consult with us first!
At Protected At Work, we’re experts in the field of workplace drug and alcohol testing and reasonable suspicion training. Our affordable, engaging training sessions teach your employees everything they need to know about DOT’s new oral fluid testing regulations, helping to reduce costly mistakes while decreasing the risk of workplace accidents.
