Urine Tests, Hair Tests, and Oral Fluid Drug Tests - Which Should Your Company Use?

Let's talk about the specimen collected during a drug test: urine, oral fluid, or hair. While urine is typically the most common specimen that employers test, oral fluid (saliva) and hair have been gaining traction in recent years. Here are some things to keep in mind as you decide what's best for your drug-screening program.

Consider look-back periods.

With urine, the look-back period is typically within that same week. In some cases—for example, if the person is a chronic marijuana user—the look-back period with a urine test might go back as far as two or three weeks.

In the case of hair testing, the look-back period is 90 days (and in some cases, even longer). The hair test won't indicate immediate drug use, however, but rather a pattern of recurring drug use.

Let's use the following hypothetical to demonstrate the difference. If a person has been drug-free all their life, but used an opioid today and got a hair drug test tomorrow, the result would be negative (but a urinalysis would be positive). On the other hand, if a person took an opioid  for a couple of weeks two months ago, but hasn't done anything since and got a hair drug test tomorrow, the result would be positive, but the urine drug test would be negative.

Why does this matter? Well, many companies do a drug test at the point of hire. If a urine test only looks back a week, then the job candidate (who is likely anticipating the test) can usually get through that hurdle by abstaining from drugs for seven days. But if you conduct hair testing, it's much harder to be clean for three months if you're a regular drug user.

Oral fluid, by contrast, has a similar look-back window to urine, but it also provides even more immediacy than urine. Oral fluid testing can detect certain drugs in as little as 30-60 minutes after ingestion.

Some additional scenarios to consider...

  • Testing hair has become popular with companies that are pursuing so-called "lifestyle testing" to determine if the person's lifestyle includes drug use. The look-back period of 90 days provides better insights than the look-back period for urine or oral fluid.
  • If you conduct random drug testing post-hire, urine might be a good option since the person can't "plan" in the same way they can for a new job. Hair testing might also make sense from a drug-policy enforcement perspective.
  • Hair is not a good specimen, however, for incident-based drug testing like a post-accident test or a reasonable suspicion test. If you're dealing with a person whom you think is high and impaired on the job, testing the person's hair won't work because it takes at least several days for the hair to grow out to the point where the drug could be detected. In this case, urine or oral fluid is a better specimen to test.

Consider ease of collection and the cheating factor.

If your organization opts for urine or hair testing, a trained collector must administer the test. In an oral fluid situation, a trained collector isn't required.

A company can conduct an oral fluid test on site by someone designated within the company, such as an HR manager, nurse, or occupational health professional. The person can administer the test (a simple cotton swab that the candidate puts inside his or her cheek for 10 seconds), package it up, and send it to the laboratory.

If the company doesn't want anyone within the company to conduct the oral fluid test, the candidate/employee can go to a collection site to have the test administered or the company could hire a third-party collector to come on-site. Regardless of where or who conducts the test, this method is known as a Directly Observed Test. The person conducting the test hands the applicant/employee the test swab and directly observes the applicant/employee doing the test.

Why does this matter? Studies suggest the positivity rate is three times higher with oral fluid tests because there's no way to cheat them. With a urine test, the collector hands the person a cup and the person goes behind a closed door; he or she is in there alone with the cup. While various protocols and security measures are in place to prevent cheating, people are very creative and find ways to do it anyway.

In the oral fluid case, there's no way to cheat because it's literally face-to-face: the person conducting the test hands the candidate/employee a swab. The candidate/employee puts it inside his or her cheek. Then, the test is over. So oral fluid testing is appealing because it doesn't require a trained collector and because it's impossible to cheat. (You can't cheat with hair, either, but hair requires a trained collector.)

Oral fluid testing could have significant ramifications, depending on your workforce. For example, if you have employees who use heavy machinery, you might want to consider randomly testing oral fluids as opposed to urine (since there's no way to cheat). This way, you have a better chance of weeding out drug users and, thus, avoiding accidents on the job due to impairment. Hair would also give you relevant insights regarding a pattern of drug use, but, again, hair testing requires a trained collector, which leads to our next section.

A couple additional points about collection sites...

You want to make getting a drug test as easy as possible for your applicants and existing employees, so you should choose a drug-testing vendor that has a large network of collection sites. (Good Egg has over 10,000 collection sites nationwide.)

It's worth noting that hair tests, in terms of the collection sites that do them, are more limited than urine. So if you're leaning towards hair specimens, make sure it's a viable option based on your company's location. Hair testing sites are more readily available in populated areas, but if your company is located in a rural area, it might be more difficult to find a trained hair collector.

On the oral fluid front, the big question you need to ask is whether you want to send people off campus to a collection site or you want to conduct the tests on site (with someone from within your company or a third-party collector who comes to your site).

Creating a drug-testing program can feel like a daunting task.

Whether you need to recalibrate your existing program or you're developing one for the first time, our experts can help. Request a demo of Good Egg's platform and let's discuss your organization's specific needs.



Scott Mogensen

Posted by Scott Mogensen

Scott Mogensen manages the Drug and Alcohol testing program. He has 11 years of experience in drug and alcohol testing and is an expert in DOT drug & alcohol compliance issues. As a Certified Substance Abuse Program Administrator (C-SAPA), he holds the highest credentials available for a program administrator.

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