Is oral fluid analysis as accurate as urinalysis in detecting drug use in a treatment setting?

Background: Technology for testing oral fluid (OF) for the presence of drugs is available for treatment services and is more attractive than urinalysis: its validity is not well established. Aims: Compare the accuracy of methods of on-site testing of OF and urine. Design: Comparison of the sensitivity and specificity of on-site testing of samples of OF and urine collected on the same occasion, using subsequent blind laboratory analysis of the same urine samples as the standard. Setting: British addiction treatment service. Participants: 157 drug dependent persons, 89% with evidence of opiates, 73% mate, and 85% aged between 20 and 35 years. Measurements: Assessment of presence of four drugs using SYVA ETS urinalysis and Cozart Rapiscan OF Drug Test systems. Laboratory urinalysis using microplate enzyme-immunoassay technique. Results: The sensitivity of OF tests and urinalysis were, respectively, for opiates 91 and 91%, methadone 91 and 94%, and benzodiazepines 6 and 72%. The specificity of OF tests and urinalysis were, respectively, for opiates 78 and 67%, methadone 90 and 95%, and benzodiazepines 95 and 96%. Amphetamine usage was rare. Conclusions: OF testing is as accurate as urinalysis in detecting the presence of opiates and methadone, and the absence of methadone and benzodiazepines. (C) 2003 Elsevier Ireland Ltd. All rights reserved.