Oral Fluid Drug Tests: Concerns and Recommendations
Key findings
- Twenty-four states have statutes that authorize the use of roadside oral fluid tests.
- Drugs do not affect users uniformly or in a manner that is easy to measure. Differing characteristics of the drug, of the user, and of the circumstances
in which the drug is used renders distinguishing between presence of drugs and impairment by drugs an opaque endeavor. - There are no consistent standards in the manufacture of oral fluid tests. The lack of industry-wide consensus reflects research challenges like a dearth of quality studies and information challenges.
- Laws concerning the use of oral fluid tests are inconsistent across all 50 states.
- Language in manufacturers’ instructions states that oral fluid tests are presumptive in nature and must be confirmed with laboratory testing. Additionally, cross-reactivity with other, legal substances can introduce errors into the testing process.
Impaired driving is an issue affecting Americans every day. A 2021 report found that 56% of drivers involved in car crashes that resulted in a fatality or serious injury tested positive for at least one drug. Polysubstance impaired driving—operating a vehicle while under the influence of more than one drug or using drugs and alcohol together—has increasingly become a concern, especially in the face of the ongoing opioid epidemic and the increased legalization of recreational marijuana. These recent developments have led grassroots organizations and scholars to demand greater action to deal with substance-impaired drivers. There is growing interest in roadside drug tests to identify impaired drivers who may otherwise escape detection and decrease preventable traffic fatalities.
At the same time, the U.S. criminal legal system's approach to drug use is defined by a punitive ideology that privileges retribution over treatment and prevention. Over 360,000 people are in prison in the U.S. for drugs, most simply for possession. The enforcement of laws criminalizing drug use has a disproportionate impact on communities of color and people experiencing poverty. Any plan to address substance misuse ought to include a clear understanding of that broader context.
