Saliva (Oral Fluid) Drug Test: Definition, Key Points, Usages, Benefits, and Limitations

The saliva drug test, also known as oral fluid drug test, was invented in the 1980s as a non-invasive method of drug testing that detects recent drug use by analyzing drugs and their metabolites present in the oral fluid, making it convenient for various applications such as workplace testing, roadside testing, and rehabilitation programs.

The saliva drug test is used for detecting recent drug use in applications such as workplace testing, roadside testing, and rehabilitation programs.

The benefits of the saliva drug test include non-invasiveness, ease of sample collection, rapid results, and the ability to detect recent drug use.

The limitations of the saliva drug test include a shorter detection window, limited drug panel depending on the test, potential for false results, sensitivity to drug concentration, variability in individual response, and privacy concerns during sample collection.

What is the Saliva (Oral Fluid) Drug Test?

The saliva or oral fluid drug test is a method used to detect the presence of drugs in a person’s system. It involves collecting a sample of saliva, which is the watery fluid in your mouth, and then testing it for the presence of drugs or their metabolites (substances produced when drugs break down in the body).

The saliva drug test is popular because it is non-invasive, meaning it doesn’t require a needle or blood sample. It is also relatively quick and provides results within a short period, usually within a few minutes to a few days depending on the testing method used.

A study by Khazanov et al, titled Validity and reliability of in-person and remote oral fluids drug testing compared to urine drug testing revealed that saliva drug tests have good specificity, ranging from 0.93 to 1.00. The negative predictive value of saliva drug tests is also high, ranging from 0.85 to 1.00. However, the sensitivity and positive predictive value of saliva drug tests are lower compared to other testing methods.

How is the Saliva Drug Test Administered?

The saliva drug test is administered by following 5 simple steps:

1. Collection of the sample

The person being tested will be provided with a collection device, typically a swab or sponge-like device. They will be instructed to place the swab between their lower cheek and gums and move it around gently to allow the saliva to saturate the swab. The swab is usually left in the mouth for a few minutes to ensure enough saliva is collected.

2. Removal of the swab

Once the swab is saturated with saliva, it is removed from the person’s mouth. The swab may be placed into a collection container provided by the testing facility. It’s important to follow any instructions given regarding the proper handling of the swab and the container.

3. Transportation to the laboratory

The collected saliva sample, usually in the container provided, is then transported to a laboratory for analysis. The container is typically sealed to prevent any tampering or contamination of the sample during transit.

4. Laboratory analysis

In the laboratory, the saliva sample undergoes analysis to detect the presence of drugs or their metabolites. The specific testing method can vary, but it often involves using techniques such as enzyme immunoassay (EIA) or chromatography. These methods can identify the presence and concentration of specific drugs in the saliva sample.

5. Reporting of results

Once the laboratory analysis is complete, the results are reported to the organization or individual who requested the test. The results will indicate whether drugs or their metabolites were detected in the saliva sample and, if so, which drugs were found. The turnaround time for receiving the results can vary depending on the testing facility and method used.

Note that the saliva drug test is generally a simple and non-invasive procedure that is performed without any specialized medical training. However, it’s essential to follow the instructions provided by the testing facility to ensure accurate and reliable results.

What Does the Saliva Drug Test Detect and What is the Detection Window?

The drugs that can be detected through a saliva drug test include:

• Marijuana (THC): The test detects the presence of THC (tetrahydrocannabinol), the primary psychoactive compound in marijuana. It indicates recent marijuana use, typically within a few hours to a few days.
• Cocaine: Swab tests detect cocaine and its metabolites, such as benzoylecgonine. It indicates recent cocaine use, typically within a few hours to a few days.
• Amphetamines: The test detects drugs such as amphetamine and methamphetamine. It will indicate recent use of these stimulant drugs, typically within a few hours to a few days.
• Opioids: The saliva test detects opioids such as codeine, morphine, heroin, and oxycodone. It indicates recent opioid use, typically within a few hours to a few days.
• Benzodiazepines: The test detects drugs such as diazepam, alprazolam, and lorazepam, which are commonly prescribed for anxiety and sleep disorders. It can indicate recent benzodiazepine use, typically within a few hours to a few days.
• Phencyclidine (PCP): The test detects PCP, a hallucinogenic drug. It indicates recent PCP use, typically within a few hours to a few days.

The specific drugs detected may vary depending on the testing method and the panel of drugs included in the test. Additionally, the detection window for each drug will vary based on factors like drug potency, dosage, frequency of use, and individual metabolism.

How Accurate is the Saliva Drug Test?

Saliva drug tests are considered reliable for detecting recent drug use, but they are not 100% foolproof. False-positive and false-negative results are possible due to various factors like cross-reactivity, contamination, or errors in the testing process. Proper collection and handling of the sample are crucial for accuracy.

According to research by Krotulski et al, titled Field Detection of Drugs of Abuse in Oral Fluid Using the Alere™ DDS®2 Mobile Test System with Confirmation by Liquid Chromatography Tandem Mass Spectrometry (LC–MS/MS), when conducted correctly, saliva drug tests have been reported to be more than 97% accurate. However, it is important to consider factors that can affect accuracy, such as the specific type of test, the drug being tested, the skill of the person conducting the test, and the testing facility.

What are the Benefits of the Saliva Drug Test?

The saliva drug test offers several benefits, which include:

• Non-Invasiveness: The saliva drug test is non-invasive, meaning it does not require needles or blood samples. This makes it more comfortable and convenient for individuals undergoing the test.
• Ease of Administration: The test is relatively simple to administer and does not require specialized medical training. It can be performed almost anywhere, making it convenient for use in workplaces, schools, or other settings.
• Rapid Results: Saliva drug tests can provide results quickly, typically within minutes to a few days, depending on the testing method used. This allows for timely decision-making and immediate action, such as implementing workplace safety measures or determining eligibility for certain activities.
• Recent Drug Use Detection: Saliva drug tests are effective in detecting recent drug use. They can typically identify drug use within a window of a few hours to a few days, making them suitable for detecting recent impairment or identifying individuals who may pose a safety risk due to drug use.
• Deterrent Effect: The knowledge that saliva drug testing is being conducted can act as a deterrent for drug use among individuals. It can discourage drug use in workplaces, schools, or other environments where testing is implemented, promoting a safer and healthier environment.
• Non-Invasive Monitoring: Saliva drug tests can be used for ongoing or random monitoring of drug use in individuals, such as in rehabilitation programs or workplace safety initiatives. The non-invasive nature of the test makes it easier to conduct frequent or periodic testing as needed.

A systematic review by Nunes et al. (2015) discusses the latest trends in salivary research and its applications in health and disease. The review highlights the non-invasive, easy, and cost-effective collection methods of saliva and its potential utility in monitoring overall health, diagnosing various disorders, and drug monitoring.

What are the Limitations of the Saliva Drug Test?

The saliva drug test falls short in certain instances, including the following:

• Short detection window: Saliva tests detect recent drug use, but may not detect drug use further back in time.
• Limited drug panel: Some tests can only detect specific drugs, potentially missing others.
• Sensitivity to drug concentration: Low drug levels may not be detected, leading to false negatives.
• Potential for false results: False positives or negatives can occur due to cross-reactivity, contamination, or testing errors.
• Variability in response: Individual factors like metabolism and hydration can affect saliva test accuracy.
• Privacy concerns: Saliva tests are often conducted in front of an administrator, raising privacy issues for some individuals.

How Does a Saliva Drug Test Compare to Urine or Hair Tests?

Saliva drug tests, urine tests each has its own advantages and limitations. Below are the differences:

Saliva Drug Tests:

• Detection Window: Saliva tests have a shorter detection window, typically detecting drug use within a few hours to a few days.
• Collection Process: Saliva samples are easy to collect non-invasively, making the process quick and convenient.
• Rapid Results: Saliva tests often provide rapid, onsite results, allowing for immediate decision-making.
• Limited Drug Panel: Some saliva tests may have a limited panel of drugs, potentially missing certain substances.

Urine Drug Tests:

• Detection Window: Urine tests have a longer detection window, ranging from a few days to several weeks.
• Collection Process: Urine samples require more privacy and can be more intrusive to collect, requiring a restroom facility.
• Comprehensive Drug Panel: Urine tests can detect a wide range of drugs and metabolites, providing a broader picture of drug use.
• Cheating Concerns: Urine tests have a higher potential for cheating and tampering due to the opportunity for sample substitution or adulteration.

Hair Drug Tests:

• Detection Window: Hair tests have the longest detection window, typically covering several months to years.
• Collection Process: Hair samples are collected by cutting a small amount of hair close to the scalp, which can be more time-consuming.
• Comprehensive and Historical Data: Hair tests offer a comprehensive detection of drug use history, providing insights into long-term patterns.
• Limited Detection for Recent Use: Hair tests are less effective in detecting recent drug use within a few days to weeks.

The choice of testing method depends on various factors such as the desired detection window, convenience, cost, and the specific needs of the testing situation.

Can secondhand smoke cause a positive saliva drug test?

It is unlikely that exposure to secondhand smoke would cause a positive result in a saliva drug test. The amount of drugs transferred through secondhand smoke is typically minimal and unlikely to exceed the detection thresholds of the test. However, in extreme cases of heavy exposure in enclosed spaces, it is theoretically possible but rare.

Can medications affect saliva drug test results?

Yes, certain medications can potentially affect saliva drug test results. Some medications may cross-react with the test, leading to false-positive results for certain drugs. It’s important to inform the testing facility about any medications you are taking to ensure accurate interpretation of the test results and to rule out any potential interference from medications.

Can alcohol be detected in a saliva drug test?

Saliva drug tests are primarily designed to detect drugs of abuse and typically have a specific focus on illicit substances. While alcohol can be present in saliva, it is not typically included in standard saliva drug tests. Alcohol testing usually requires a separate method, such as breathalyzer or blood tests, which are specifically designed to measure blood alcohol concentration (BAC).

How does a saliva drug test work?

During a saliva drug test, a sample of saliva is collected from the individual using a swab or collection device. The sample is then analyzed for the presence of drugs, typically using immunoassay or chromatography techniques.

Can saliva drug tests detect drug impairment?

While saliva drug tests can detect the presence of drugs in the body, they do not directly measure drug impairment. Additional assessments, such as clinical evaluations or field sobriety tests, may be needed to determine impairment.

What are the benefits and limitations of using the Saliva Drug Test in comparison to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)?

The Saliva Drug Test and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) each have unique benefits and limitations. The Saliva Drug Test provides quick and non-invasive detection of recent drug use, making it useful for immediate screening needs, such as in workplaces or roadside checks. However, it primarily detects recent use and may not indicate long-term patterns of substance use or dependence. On the other hand, the ASSIST test is a comprehensive screening tool developed by the World Health Organization to identify risky substance use across multiple substances, including alcohol, tobacco, and drugs. It assesses the frequency, quantity, and consequences of substance use, offering a broader perspective on an individual’s substance involvement. While it does not provide immediate biological evidence, it is valuable for identifying individuals who may need intervention or treatment for substance use disorders.

How reliable are Saliva Drug Tests for detecting various substances, and what factors can affect their accuracy?

Saliva Drug Tests are generally reliable for detecting a range of substances, including marijuana, cocaine, amphetamines, opioids, and benzodiazepines. Their accuracy can be influenced by several factors, such as the specific testing device used, the timing of the test relative to substance use, and the presence of contaminants in the mouth. Saliva tests are most effective at detecting recent drug use, typically within the past 24 to 48 hours. Factors such as eating, drinking, or smoking shortly before the test can affect the concentration of drugs in the saliva and, consequently, the test results. Proper administration and adherence to testing guidelines are crucial to ensure the reliability of saliva drug tests

How long does it take to get saliva drug test results?

Results can be obtained within minutes to a few hours, as saliva tests often provide rapid, onsite results. However, if the test samples need to be sent to a laboratory for analysis, it may take a few days to receive the final results. The exact turnaround time will depend on the testing method, laboratory processing times, and other logistical factors involved in the testing process.

How does the Saliva Drug Test compare to the NIDA Drug Use Screening Tool in detecting substance use?

The Saliva Drug Test and the NIDA Drug Use Screening Tool serve different purposes in detecting substance use. The Saliva Drug Test is a biological test that detects the presence of drugs in an individual’s oral fluid, providing real-time information about recent drug use. It is non-invasive, easy to administer, and offers quick results, making it ideal for on-the-spot testing in workplaces or law enforcement settings. In contrast, the NIDA Drug Use Screening Tool is a questionnaire-based assessment that evaluates an individual’s drug use patterns and related behaviors over time. While it does not provide immediate biological evidence of drug use, it helps identify individuals at risk for substance use disorders and guides further assessment and intervention.

Can saliva drug tests be cheated or tampered with?

Saliva drug tests are difficult to cheat or tamper with compared to urine tests. The collection process is directly observed by a test administrator, reducing the opportunity for adulteration or substitution of the sample. However, it is still possible for individuals to try to manipulate the results by various means, such as using adulterants or abstaining from drug use for a short period before the test. Test administrators and laboratories take measures to detect and prevent such attempts, but no testing method is entirely immune to potential manipulation.