Oral Fluid Toxicology

AbstractTechnological advances over the past decades have enabled oral fluid testing for the presence of numerous drugs, narcotics, and hormones. The advantages of oral fluid over traditional fluids are that collection is almost noninvasive, is relatively easy to perform, and, in forensic situations, can be achieved under close supervision to prevent adulteration or substitution of the samples. Moreover, concentrations of many drugs in oral fluid correlate well with blood concentrations and, therefore, the analysis of oral fluid specimens can be used to determine the current degree of exposure to a definite drug at the time of sampling. These characteristics have resulted in the use of oral fluid for drugs of abuse testing in the workplace, in testing of intoxicated drivers, for monitoring illicit drug use in drug treatment. There are now sensitive and reliable analytical methods available both for screening and confirmation analysis of oral fluid specimens. External proficiency testing is being developed and cutoff concentrations have been proposed by scientific organizations. Appropriate certification of laboratories worldwide and the introduction of legal provisions in several countries will be the next step. However, a number of concerns require further research. The search for an on‐site screening method that can provide acceptable accuracies for the detection of cannabinoids in oral fluid remains a major hurdle. Additional considerations that have received attention are the variability in the volume of sample collected and the drug recovery from the many different specimen collection systems on the market. This article discusses developments in the field of collection devices, pharmacokinetics of common drugs of abuse in oral fluid, and recent technological advances and guidelines that increase the actual use of oral fluid testing in a legal context and its acceptance by the criminal justice system.