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Oral Fluid Testing for Drugs of Abuse
Open accessAbstract
Background: Oral fluid (OF) is an exciting alternative matrix for monitoring drugs of abuse in workplace, clinical toxicology, criminal justice, and driving under the influence of drugs (DUID) programs. During the last 5 years, scientific and technological advances in OF collection, point-of-collection testing devices, and screening and confirmation methods were achieved. Guidelines were proposed for workplace OF testing by the Substance Abuse and Mental Health Services Administration, DUID testing by the European Union’s Driving under the Influence of Drugs, Alcohol and Medicines (DRUID) program, and standardization of DUID research. Although OF testing is now commonplace in many monitoring programs, the greatest current limitation is the scarcity of controlled drug administration studies available to guide interpretation. Content: This review outlines OF testing advantages and limitations, and the progress in OF that has occurred during the last 5 years in collection, screening, confirmation, and interpretation of cannabinoids, opioids, amphetamines, cocaine, and benzodiazepines. We examine controlled drug administration studies, immunoassay and chromatographic methods, collection devices, point-of-collection testing device performance, and recent applications of OF testing. Summary: Substance Abuse and Mental Health Services Administration approval of OF testing was delayed because questions about drug OF disposition were not yet resolved, and collection device performance and testing assays required improvement. Here, we document the many advances achieved in the use of OF. Additional research is needed to identify new biomarkers, determine drug detection windows, characterize OF adulteration techniques, and evaluate analyte stability. Nevertheless, there is no doubt that OF offers multiple advantages as an alternative matrix for drug monitoring and has an important role in DUID, treatment, workplace, and criminal justice programs.
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“The rate of diffusion is affected by several factors including lipophilicity of the drug, salivary pH, pKa, molecular size, un-ionized free drug blood concentration and membrane characteristics (8–11).”
From Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities—2021 Update (2021) · cites this paper as [8]
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“Recent developments within the field of forensic toxicology include increased interest in the use of oral fluid as a specimen for drug detection in impaired driving cases (8).”
From Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities—2021 Update (2021) · cites this paper as [8]
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“Drug deposition into oral fluid is via passive diffusion of un-ionized free drug from the blood through the salivary glands and ion trapping of basic drugs in the oral cavity.”
From Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities—2021 Update (2021) · cites this paper as [8]
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Metadata
- Authors
- Bosker, W. M., & Huestis, M. A.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Huestis, Marilyn A
- ORCID
- Huestis, Marilyn A
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11-01
- Volume
- 55
- Issue
- 11
- Pages
- 1910-1931
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- PMC
- PMC3165054
- OpenAlex
- W2062866182
- Cited by
- 378
- References
- 125
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 14 · 2023: 8 · 2022: 19 · 2021: 18 · 2020: 25 · 2019: 22 · 2018: 23 · 2017: 31 · 2016: 27 · 2015: 35 · 2014: 28 · 2013: 33 · 2012: 36
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Drug Abuse (ZIADA000412)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- oral fluid testing, drugs of abuse, drug testing, workplace drug testing, drug-impaired driving, cannabinoids, opioids, amphetamine, cocaine, benzodiazepines, analyte stability, immunoassay, chromatographic methods, drug monitoring
- MeSH terms
- Amphetamines, Analgesics, Opioid, Benzodiazepines, Cannabinoids, Cocaine, Humans, Saliva, Substance Abuse Detection
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