Oral Fluid Collection: Can It Be Adulterated?

Oral Fluid is the hot new testing modality in the industry at the moment. While this type of testing has been around for decades, its popularity has remained “underground” at best, limited to the daring few “hipster” drug testing facilities in North America. That’s all changing and oral fluid is ready to sell out to become the new “pop-star” everyone loves to hate, so move over urine testing!

In 2016, federal regulators at the Department of Health and Human Services (HHS) and the United States Department of Transportation and the Office of Drug & Alcohol Policy & Compliance (ODAPC) considered the idea of incorporating oral fluid into the existing drug and alcohol testing regulations. This is a big step as much of the industry looks to ODAPC for guidance on suggested testing protocols even when employees aren’t covered by federal regulations. This increased interest and implementation of oral fluid testing in the workplace and in treatment environments raises concerns about possible methods of adulteration.

Since urine testing has held its rank as the largest market share of testing for over twenty years, it has the weight of legal precedence (an assurance for employers fearful of wrongful dismissal and discrimination suits) and the onslaught of thousands of entrepreneurs seeking to make a little money selling products designed to “beat” the test. In urine drug testing, for every trick they come up with, there is a recommended safeguard against it. Which raises the question: what could they possibly do to adulterate an Oral Fluid test?

To answer this question, it is important to know how the sample is collected. A collector observes while a collection pad (think a small white sponge the size of a nickel on the end of a small plastic rod) is inserted into the mouth of a donor for five minutes where it then collects a saliva sample from the mouth and is then inserted into a vial or other container for testing. There are instant tests which will use the sample for enzymatic testing on-site for instant results, and then there are transported tests (sometimes called “collect-only”) like the OraSure Intercept where the pad is inserted in a vial pre-filled with a preservative to keep the sample valid for transport to a testing laboratory.

The number one problem encountered (whether intentional or unintentional) with this type of test is an inadequate sample amount (not enough saliva). OraSure adds a small amount of salt to encourage salivation and increases pad saturation and that helps to effectively reduce any natural causes for insufficient sample quantity. However, there are ways that an individual can attempt to “adulter” the test to achieve an inadequate sample result that collectors should be aware of:

  • One such method is to dry out the mouth with a highly concentrated saline solution or brine
  • Another is to suck on the pad, or
  • Chew on the absorbent pad which limits its ability to retain enough of a sample for testing.

The best way to avoid this problem is to pay attention during the collection, watch for chewing, listen for sucking, and when returning the collection pad to the vial pay attention to the condition of the pad (does it look frayed/chewed?) and the resistance. An unsaturated or “dry” pad doesn’t slide in easily; like a dried-out sponge, it will be hard and inflexible and will give you more resistance when sliding it down into the vial or instant test.

We offer a course on best practices for oral fluid collection where we go over this and other important protocols necessary to perform a safe and secure oral fluid specimen collection here and it’s a great way to get to know and understand oral fluid testing and whether or not it may be right for your testing purposes.



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