LAS VEGAS—Oral fluid as a matrix for drug testing shows great promise as an alternative to traditional urine drug testing.

Urine drug testing has a potential for adulteration and substitution. Frank Kunkel, MD, from Accessible Recovery Services, Pittsburgh, Philadelphia, and Richard Stripp, PhD, from Sterling Healthcare Services, East Northport, New York, assessed the use of oral fluid as a matrix alternative for clinical drug monitoring by comparing urine drug testing (UDT) and oral fluid drug testing (OFDT) in patients undergoing treatment for opioid addiction.

Researchers collected 120 paired oral fluid and observed urine collection samples from compliant donor patients at a high volume suboxone clinic; also monitored were levels of buprenorphine, norbuprenorphine, and naloxone. Additionally, a comparison of results from 6928 adult patients (4560 unobserved urine collection, 2368 observed oral fluid collection) monitored for heroin metabolite, amphetamine, benzodiazepines, buprenorphine, THC, cocaine, codeine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone was completed.

Results of this study indicated that the 120 timed, observed collections of simultaneous urine and oral fluid samples from patients undergoing suboxone treatment for opiate dependence exhibited a very high correlation of positivity rates between the matrices when appropriate cutoffs are applied. In contrast, comparison of comprehensive drug testing results for the patients submitting to unobserved urine collection and the patients undergoing observed oral fluid collection yielded significantly different results in positivity rates for several illicit drugs and prescription medications.


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Drs. Kunkel and Stripp noted that an internal, anonymous survey of clinic patients indicated urine tampering during unobserved collection was common practice. They concluded that since observed urine collection is not always practical, OFDT should be considered an effective alternative to detected illicit drug use and non-compliance.