Oral fluid PANEL
An alternative specimen for controlled substance monitoring
While the most common biological specimen used for drug testing is urine, oral fluid is now recognized as an appropriate alternative by the American Society of Addiction Medicine (ASAM) and other clinical guidelines to support addiction treatment and pain management.1
Mayo Clinic Laboratories offers a cost-effective immunoassay panel that uses oral fluid to screen for 20 drug analytes across 11 drug classes, including opioids, benzodiazepines, stimulants, and other commonly prescribed or abused controlled substances.
View our oral fluid specimen collection patient and practitioner video.
Oral fluid PANEL Test Menu
Oral fluid PANEL
For patients stratified as high risk for substance misuse, abuse, or diversion, frequent screening may be required, and oral fluid offers an easy and cost-effective alternative to urine drug testing. Especially when prescribing opioids, clinicians should consider drug testing during the initial assessment and then periodically throughout the patient’s care to monitor the effectiveness of the treatment plan and the patient's compliance. Testing can help identify when patients are not taking prescribed medications, which might indicate diversion or adverse drug effects. It can also provide information about other drug use that wasn't reported by the patient. Ultimately, drug testing should be used to support recovery and provide motivation for compliance with controlled substances or reinforcement for abstinence.
This test can be integrated as part of a rotational testing strategy in combination with other clinical monitoring tests and tools. Before utilizing oral fluid as an alternative specimen matrix, providers should consider the analytical limitations and advantages compared to urine. Test results should always be interpreted in the full context of the patient's clinical and behavioral history.
Key testing
- CSMOF | Controlled Substance Monitoring Panel, 11 Drug Classes, Screen Only, Immunoassay, Oral Fluid
Advantages
- Uses an FDA-approved point of care (POC) collection device combined with advanced laboratory analytical methods (i.e., Mayo unpublished method and competitive chemiluminescent immunoassay) to improve presumptive drug detection accuracy.
- Does not require specialized testing facilities (e.g., gender-neutral restrooms).
- Enables direct yet unobtrusive observation of specimen collection, which minimizes specimen adulteration and tampering.
- Accurately reflects recent intake of parent drug compounds soon after ingestion and for approximately 12–48 hours after. Varies by drug type, dosage, and usage.
- Results are available in two days or less.
Clinical utility
- Useful for monitoring acute (i.e., short-term) drug use in addiction treatment or pain management settings as part of a rotational drug testing strategy.
- Enables comprehensive detection of 11 drug classes and 20 drug analytes.
- Opioids (6-mono-acetylmorphine, morphine, hydrocodone, oxycodone, oxymorphone, methadone, fentanyl, tramadol, and buprenorphine)
- Benzodiazepines (oxazepam, clonazepam, lorazepam)
- Non-benzodiazepine sedative hypnotic (zolpidem)
- Stimulants (amphetamine, methamphetamine, methylphenidate, and phencyclidine)
- Marijuana
- Barbiturates
Limitations
- Some drugs may be present at lower concentrations and/or for shorter periods of time. If a longer window of detection is required, urine controlled substance monitoring is available.
- This test is not appropriate for use in forensic or employment settings (e.g., medico-legal, chain-of-custody).
- In instances where an oral fluid specimen cannot be collected (e.g., dry mouth), providers should consider alternative specimen collection methods (e.g., urine).
- It is possible that substances other than those investigated may interfere and cause a false-positive screening result. If specific drug identification is required, we recommend collecting a urine sample and ordering the controlled substance monitoring profile urine (Mayo ID: CSMPU) test, which uses high-resolution accurate mass spectrometry-based targeted testing.
Patient video: Oral fluid specimen collection for controlled substance monitoring
This video is designed to help you feel prepared and comfortable during the oral fluid specimen collection process.
- Section 1: What to expect during your oral fluid specimen collection (00:15)
- Learn about timing your medications and how to approach your oral care routine prior to your collection appointment.
- Section 2: What will happen during your visit (00:47)
- Your healthcare professional will explain the collection procedure, confirm some basic information, do a quick mouth check, ask you to rinse if needed, and ask you to wash your hands.
- Section 3: The collection process (01:35)
- Learn how to safely open the test kit package, handle the transport tube and collection pad, stimulate saliva flow, and collect your sample.
- Section 4: Finishing the test (02:34)
- Once your sample is collected, your healthcare professional will guide you through placing the collection pad in the transport tube and sealing it correctly for labeling and transport.
Practitioner video: Oral fluid specimen collection for controlled substance monitoring
This video walks you through every step of the oral fluid specimen collection process, so you can perform your duties with accuracy and confidence.
- Section 1: Getting ready for collection (00:17)
- Set the foundation for a successful collection with the correct preparation steps: describe the collection process to your patient, explain the procedure, confirm your patient’s identity and review their current medications, inspect the collection kit, perform an oral exam, provide water for rinsing if needed, and instruct the patient to wash their hands before opening the collection kit packaging.
- Section 2: Placing the collection device (02:16)
- Learn how to guide your patient through the collection process. Instruct them how to open the packaging, safely handle the collection pad, stimulate saliva flow, place the pad under their tongue, and tilt their head downward to optimize collection.
- Section 3: Monitoring the collection process (03:16)
- Ensure the patient maintains proper placement of the collection pad and instruct them not to talk, chew, or suck on the device during collection. Wait until the indicator turns blue or until 10 minutes have passed before collection pad removal.
- Section 4: Preparing the specimen for transport (03:55)
- Ask the patient to open the transport tube and place the collection pad inside and close it, being careful not to spill the blue buffer liquid. Apply a label to the transport tube with the patient’s information and store it at room temperature. If you do not ship within 7 days, store the sample frozen.
Highlights
PACE/State of FL - Substance use disorders and the common laboratory tests and matrices used for controlled substance monitoring.
Paul Jannetto, Ph.D., explains the advantages that Mayo Clinic Laboratories' oral fluid drug screening offers over typical urine tests. Oral samples are easier to collect and harder to adulterate.
References
- Appropriate Use of Drug Testing in Clinical Addiction Medicine. American Society for Addiction Medicine. 2017.
- MacCall CA, Ritchie G, Sood M. Oral fluid testing as an alternative to urine testing for drugs of abuse in inpatient forensic settings: giving patients choice. Scott Med J. 2013 May;58(2):99103. doi:10.1177/0036933013482640. PMID: 23728755