Mayo Clinic Laboratories > Therapeutics > Oral fluid

Oral fluid

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.

85%

85% of patients prefer oral fluid to urine collection2

75%

75% lower cut-off concentrations when compared to leading market competitors (15 out of 20 analytes)

Oral fluid Test Menu

Oral fluid Oral fluid

Oral fluid

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

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an FDA-approved point of care (POC) collection device combined with advanced laboratory analytical methods (i.e., Mayo unpublished method and competitive chemiluminescent immunoassay) to improve presumptive drug detection accuracy.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 (i.e., 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 (CSMPU) test, which uses high-resolution accurate mass spectrometry-based targeted testing.
Download Oral fluid specimen collection instructions for controlled substance monitoring

Highlights

Oral fluid offers an alternative specimen for controlled substance monitoring: Paul Jannetto, Ph.D.

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.

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References
  1. Appropriate Use of Drug Testing in Clinical Addiction Medicine. American Society for Addiction Medicine. 2017.
  2. 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
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