Urine samples are the gold standard for testing for drug use, but some experts are urging employers and addiction treatment providers to consider adding other specimens to their drug-testing programs. Some of the latest include oral fluid and hair sample testing, says Laura Shelton, CMP, executive director of the Drug & Alcohol Testing Industry Association.

One main reason for this change in thinking is that people still can buy clean urine specimens or adulterants—a process made easier by the Internet. Drug-testing laboratories eventually do detect adulterants, but “it's a kind of cat and mouse game,” Shelton points out. “As soon as the labs are able to detect an adulterant, the people who make it come up with a new formula.”

Laura Shelton

With this in mind, Shelton says employers and addiction treatment providers should consider multiple specimen drug testing that includes urine, hair, and oral fluid samples.

“When a person is called for testing, he doesn't know what kind of specimen he has to provide, which creates an element of surprise,” she explains.

Adding hair and oral fluids to a testing program has an additional advantage: “There are very few adulterants out there for hair and oral fluid testing, and it's really unclear whether they even work,” Shelton says. “Companies are starting to see that if they really want to be serious about drug testing and not simply have a program to say they have a program, but they really do want to make a difference and see a difference, they're starting to go to the oral fluid and hair testing,” she adds.

Using multiple specimens is a new concept for many, and urine samples are still preferred—or mandated. Thus, advocates of drug testing are urging the passage of federal legislation to ban the sale and purchase of adulterants and substitute urine specimens (the legislation has been tied up in committees).

Although some states have such laws, Shelton believes they are ineffective because many transactions occur over the Internet. For example, she cites the case of a company prosecuted and fined under one state's law but then moved to another state that did not ban these products.