Oral Fluid Vs. Urine Drug Testing – Which is Better?

The pros and cons of introducing
oral fluid drug testing to the transportation industry.

In the world of commercial vehicle operation, drug testing is a vital part of public safety. As Occupational & Environmental Medicine points out, some truckers may rely on drugs to help keep them awake for long-haul trips. Substance abuse among drivers is also an all-too-common means of self-medicating to relieve stress, boredom, or even physical pain.

As studies have shown, reckless drug use among commercial drivers significantly increases the risk of roadway accidents. That is why the Federal Motor Carrier Safety Administration (FMCSA) established the Omnibus Transportation Employee Testing Act, which charged the Department of Transportation (DOT) with ensuring drivers are routinely tested for drugs.

None of this is news to employers, who are well aware of the problems and the associated dangers posed by drivers using drugs. But now DOT wants to change how drug testing is performed. Let’s dive into the agency’s latest proposal.

Introducing Oral Fluid Drug Tests for Commercial Drivers

In late February 2022, DOT posted a notice of proposed rulemaking in the Federal Register, labeled “Procedures for Transportation Workplace Drug and Alcohol Testing Programs: Addition of Oral Fluid Specimen Testing for Drugs.” 

The notice explains that DOT wants to authorize the use of an oral fluid testing procedure to “give employers a choice that will help combat employee cheating on urine drug tests.” The agency also notes that oral fluid testing is “more economical” and “less intrusive.” After posting the proposal, it solicited comments from the public through April 29, 2022. 417 comments were submitted before that window closed.

While some are cheering for this new proposal, others are criticizing DOT’s move for various reasons. Let’s review a few of the pros and cons of oral fluid testing, plus some real-world feedback left on Regulations gov’s public submissions section.

Decreased Risk of Cheating

Historically, random urine tests have indicated that ~1% or less of drivers tested positive for controlled substances. In 2017, the rate was 0.8%; in 2018, it had increased to 1%, prompting FMCSA to double its testing rates. But as oral fluid testing technology has advanced, it has demonstrated some advantages over traditional urine testing. Now that DOT is ready to slowly introduce oral testing into the mix, it could mitigate cheating and cause a jump in positive test results. 

A key advantage to oral fluid over urine testing is the methodology itself. As the American Association for Clinical Chemistry points out, people have been cheating on urine drug tests for as long as they’ve existed.

The three main ways people cheat on urinalysis drug tests are:

  • substituting urine specimens;
  • contaminating or “adulterating” specimens during or after collection, and;
  • consuming products that “flush” drug traces out of the body.

Oral testing offers better process integrity by making it more difficult to substitute or contaminate a specimen. Collection is “100% observed and can be done anytime, anywhere. As one anonymous commenter suggested, “you can fake a urine sample all day long, but you can’t fake an oral sample.”

Oral Tests Are Less Awkward

Frankly, going into a bathroom stall to urinate on demand in a small cup is a little awkward. In fact, the experience is often embarrassing and uncomfortable for many drivers. Some have difficulty completing the process because of “shy bladder.” Others might try to use “shy bladder” as an excuse, when in fact they are simply stalling.

Oral fluid testing mitigates all these problems, as well as removing the need for gender-specific observers and handling bottles of urine. As DOT suggests, oral fluid drug tests offer an overall “less intrusive” experience. Still, that doesn’t mean everyone is happy with oral fluid testing, either. Some commercial drivers object to any drug testing, feeling it is unfair for them to be singled out while non-commercial drivers may never have to test.

As one commenter declared, “I truly feel that it’s a violation to OUR (cd) human rights. Why should the rest of the general public be allowed to operate any other motor vehicle WITHOUT any testing whatsoever at anytime.”

Decreased Costs?

 DOT’s proposal states that “the cost of a urine test is approximately $50, while the cost of an oral fluid test is $35,” suggesting a $15 savings for each oral test. It estimates “approximately 7% (or 10,500) of the 150,000 specimens tested in the Federal employee program per year would be oral fluid specimens and 93% would continue to be urine specimens.” Its ultimate plan is to slowly transition to ~30% oral fluid testing within a few years.

The argument is that incorporating oral fluid drug testing will lead to “a potential savings of $6.3 million the first year and $27 million in the fourth year, compared to a scenario in which all the tests in question were urine tests.”

However, Register.gov commenters are pushing back on that logic.

“The urine drug collection kits are usually supplied by the laboratory. Therefore, the collector does not see the cost involved,” writes KorManagement Services LLC of South Dakota, continuing, “…but doing oral fluid collections, the kits…will be a cost to the collectors that will be passed to the employer.”

When talking about “savings” it’s always good to ask who is saving money – and are they only saving it by passing costs to someone else?

Testing for Recent Drug Use

One additional advantage of oral testing is speed for and duration of detection. Per Premiere Bio Tech, “Oral fluid testing has the ability to detect recent drug use, whereas urine requires the drug to metabolize after being consumed which can take up to 6-12 hours.” Clearly this ability to test for recent use is invaluable in post-accident investigations, where an employer needs to quickly determine if their driver may have been under the influence of drugs.

As the Alliance for Driver Safety & Security explains it, “a truck driver can submit to an oral fluid test at the scene of a large truck crash, similar to submitting to a breathalyzer test to determine whether a driver has any level of intoxication. While the oral fluid test will not yield the test result at the accident scene, this method will reveal if the driver had consumed illegal drugs prior to the accident.” 

On the flip side of that coin, a Register.gov commenter brought up the point that urine drug testing is “obsolete” because a driver “could fail a urine test even though they’re not under the influence and might have used cannabis up to a month prior to urine test.”

Concerns About Accuracy

Healthline warns that, although mouth swab drug tests are growing in popularity, they aren’t suitable in all circumstances. In particular, it notes that “the general detection window in oral fluids is 5 to 48 hours.” It also raises the concern that “instant oral fluid testing kits and devices aren’t as accurate as lab testing” and that “urine and blood tests are usually more accurate.”

Conclusion

DOT closed the window for the public to submit new comments back in April, but so far it hasn’t announced its plans to move forward. It may still be reviewing and considering the numerous comments sent in, prior to making a decision on whether or not to implement the oral fluid testing change as proposed.

The benefit of trying oral tests (as a small percentage of the overall testing) seems to outweigh the concerns, but it may boil down to making decisions on a case-by-case basis. Stay tuned for updates!