title: Comparison of Urine and Oral Fluid for Workplace Drug Testing.
abstract: OBJECTIVE
  To determine the relative detection rates of urine versus oral fluid testing in a safety sensitive industry and the correlation with diagnosed substance use disorders and possible impairment at work.
  
  
  METHODS
  The trial involved 1,500 paired urine and oral fluid tests performed in accordance with Australian Standard/New Zealand Standard (AS/NZS) 4308:2008 and AS 4760:2006. Workers who returned a positive test were screened for substance use disorders, as defined by DSM-5, and for possible impairment at work following that particular episode of substance use.
  
  
  RESULTS
  Substances were detected in 3.7% (n = 56) of urine samples and 0.5% (n = 8) of oral fluid samples (p < 0.0001). One worker (0.07%) had a substance detected on oral fluid alone versus 49 workers (3.3%) who had substances detected on urine alone. Twelve workers returned a positive result, defined as being consistent with the use of an illicit drug or a controlled substance without a clinical indication and prescription. Nine workers tested positive on urine alone, one on oral fluid alone and two on both (p = 0.0114). Of note, 6/11 workers who tested positive on urine had possible impairment at work and 2/11 had a substance use disorder versus 2/3 and 0/3, respectively, who tested positive on oral fluid.
  
  
  CONCLUSIONS
  Urine drug testing performed in accordance with AS/NZS 4308:2008 is more likely to detect overall substance use and illicit drug use than oral fluid testing conducted in accordance with AS 4760:2006. Urine testing performed in accordance with AS/NZS 4308:2008 may also be more likely to detect workers with possible impairment at work and substance use disorders than oral fluid testing performed in accordance with AS 4760:2006.
authors.affiliation: Sydney Trains, 477 Pitt Street, Sydney, New South Wales 2000, Australia armand.casolin@transport.nsw.gov.au.
authors.forename: Armand
authors.initials: A
authors.lastname: Casolin
mesh_terms: D006801:Humans; D013287:Illicit Drugs / Q000097:blood / Q000378:metabolism* / Q000652:urine; D057230:Limit of Detection; D012463:Saliva / Q000737:chemistry; D015813:Substance Abuse Detection / Q000379:methods*; D014556:Urine / Q000737:chemistry; D017132:Workplace
chemical_list: D013287:Illicit Drugs