By Bill Current, President & Founder
Oral Fluid Testing: The Ultimate Emerging Technology
This information is provided for educational purposes only. Reader retains full responsibility for the use of the information contained herein.
The Grateful Dead, in the song “Truckin’,” sang: “Lately it occurs to me what a long, strange trip it’s been.” I guess that stanza could be used to describe the journey oral fluid drug testing has traversed over the past 25 years. Or as Crosby, Stills, Nash and Young sang: “It’s been a long time comin’” for the drug testing industry’s ultimate emerging technology.
In 1999, Current Consulting Group (CCG) conducted the first drug testing industry survey, which included just four questions: In the future, who will buy drug testing and how will they buy it? And who will sell drug testing and how will they sell it? I repeated that line of questioning for about 10 years with predictable results—mostly lab-based urine testing collected at offsite occupational health centers. But over time, some brave souls began predicting the emergence of new technologies such as rapid-result urine devices, lab-based and rapid-result oral fluid tests, and even some far-out stuff like finger scans, pupillary exams, and other non-bodily fluid fitness-for-duty testing systems.
These responses led to several years of oral fluid testing-related questions in our survey as the federal government’s Drug Testing Advisory Board (DTAB) began signaling an openness toward oral fluid. In anticipation of a day when the Department of Transportation (DOT) would allow oral fluid testing, we started asking survey participants to predict what percentage of the drug testing market would transition to oral fluid testing. Most people predicted 10% or 15%. A few daring souls predicted as much as 25% of the drug testing market would someday be oral fluid tests, which was met with a great deal of skepticism from audiences of drug testing providers when they heard those survey results.
And then there was this one person who offered a very detailed and reasoned explanation for his prediction. It included how employers would someday require faster drug test results from a sample collection that could be performed onsite without the expense of professional collectors. He predicted employers, in response to cultural trends, financial constraints and tight labor markets, would demand a different way to conduct drug testing. He then predicted that 80% of the drug testing market would someday be rapid-result oral fluid tests, that oral fluid testing would become the norm, and that few employers would continue to test using urine and offsite collection facilities.
Needless to say, no one put much stock in his 80% prediction. In fact, by comparison to other predictions it was a classic example of an outlier that, if used in combination with the other more “reasonable” predictions, threw off the averages. Fast forward 20-plus years and the DOT has now approved lab-based oral fluid testing. The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued regulations for lab-based oral fluid testing and predicted in 2019 that within about four years of acceptance 25-30% of all DOT-mandated drug tests would be oral fluid tests.
In Current Consulting Group’s 25th Annual Drug Testing Industry Survey conducted in 2023, 46% of survey participants predicted that oral fluid would be the most used drug testing method in the future, the same percentage that predicted it would still be urine.
In a recent conversation with a client, Brian Feeley, CCG’s Vice President, predicted that between lab-based and rapid-result tests, 50-60% of all drug tests would be oral fluid in the not-too-distant future. Brian spent 26 years leading sales for OraSure Technologies, the number-one recognized brand name in oral fluid testing according to CCG’s survey. He has devoted a large portion of his career to presenting oral fluid testing as an alternative to other drug testing methods. He has seen interest in oral fluid testing increase slowly but steadily during those 25-plus years… until 2019 when SAMHSA approved it, 2022 when DOT issued a Notice of Proposed Rulemaking for oral fluid testing, 2023 when DOT issued its final regulations, and finally 2023 when 86% of drug testing providers in CCG’s annual survey indicated they now offer oral fluid testing, up from 35% just five years ago.
A lot has happened during the past 25 years as oral fluid testing has caught on with providers, government officials, and employers. Can we describe it as a long, strange trip? Absolutely! Has it been a long time coming? For sure. Can we call oral fluid testing the ultimate emerging technology in an industry that has historically been resistant to change? Without a doubt. The big question now is what does the future hold in store—30%? 60%? 80? Only time will tell, and the journey continues.
© 2010-2023 The Current Consulting Group, LLC – No portion of this article may be reproduced, retransmitted, posted on a website, or used in any manner without the written consent of the Current Consulting Group, LLC. When permission is granted to reproduce this article in any way, full attribution to the author and copyright holder is required.
