The Oral Approach | myADLM.org

An afternoon short course on July 29 at AACC’s Annual Meeting & Clinical Lab Expo, “Should I Add Oral Fluid Specimen Testing to My Urine Drug Program? What You Need to Know to Decide” (74220) will provide a thorough briefing about oral fluid drug testing options and which ones may be the most attractive to large, medium-sized, and small labs.

A number of drugs can be easily detected in oral fluid, including those of medium molecular weight like amphetamines, cocaine, 6-Monoacetylmorphine, methadone, and opioids, the session’s moderator, James Flood, PhD, associate director of the Core Laboratory at Massachusetts General Hospital in Boston, told CLN Stat.

Acidic drugs like primary tetrahydrocannabinol (THC) metabolites and barbiturates are not as easy to detect, he observed. “Benzodiazepines can be problematic, especially if detection of 7-aminoclonazepam (the primary klonopin metabolite) is not used. We experience false-negatives for the large molecular weight molecule buprenorphine perhaps 10%-15% of the time, even though it is a basic amine,” Flood said. Overall, his experience has been that oral fluid and urine results agree almost 95% of the time in the drug classes for which his lab tests. “The major outlier is THC/THC metabolites, which we currently don’t test for in oral fluid.”

Flood will be discussing oral fluid drug testing technologies such as point-of-care testing (POCT) and liquid chromatography (LC)-mass spectrometry (MS). “Currently, chromatographic methods using MS are much more sensitive than lab-based immunoassays. POCT immunoassays for clinical use have been slow in coming to market—only one multi-test device is currently approved by the FDA.” A big take-home message for attendees is that not all oral fluid testing options require on-site LC-MS/MS, he noted.

Joining him will be Stacy Melanson, MD, PhD, an associate pathologist at Brigham and Women’s Hospital in Boston, who will talk about interpreting oral fluid drug results and how they compare with urine results, and Kent Lewandrowski, MD, a pathologist at Massachusetts General Hospital, who will be giving a presentation on the physiology and composition of oral fluid.

According to Flood, labs should consider adding oral fluid specimen testing to their urine drug testing program if:

There’s an adulteration, substitution, or dilute urine problem with their current program;
The observed/same sex urine collection protocols have become overly burdensome on lab staff; or
Labs are looking to improve their detection of some particular drug classes like heroin and stimulants.

Flood noted that this last category usually requires out-of-the-ordinary lab instrumentation like LC or gas chromatography coupled to MS for detection.