Oral Swab Sampling

For patients who are unable to provide a urine sample, an oral fluid test can be done as an alternative. Oral fluid can be used instead of urine, donors can collect their own samples on-site and in the presence of a monitor, reducing the likelihood of tampering or a donor challenge later in the screening process.

At Capstone Healthcare, pharmacogenomics and substance detection testing can be performed using a simple oral swab – a swab used to collect saliva from the inside of the mouth for examination. While seemingly simple, the unique technology we employ allows us to glean significant information that can be used to further the quality of care available at your medical practice.

What Is an Oral Swab Sample?

An oral swab sample refers to a small swab of saliva collected from an individual for testing. There are multiple ‘collection systems’ that have been trademarked for this purpose. Some of the test types include “ESwab” by Copan, Quantisal Collection Device, and “E-Swab and Transport System” which goes by the name. These systems and similar ones are generally comprised of a stick-shaped tool with a collection material on the end, generally, a cotton. The technician follows the instructions as provided for their testing equipment to collect the oral fluid (saliva). It should be noted that a saliva sample is different than a Buccal swab, which is a collection of cells from the inside of the cheek for DNA-testing purposes. The sample is then secured and packaged, following the instructions of their swab system. Upon receiving the sample, it is then analyzed using enzyme-immunoassay antibodies and confirmed by liquid chromatography mass spectrometry (LC/MS) to ascertain the content based on ordered tests. Oral swabs can shed light on drug and infectious disease detection as well as pharmacogenomic analysis, providing a breadth of opportunity in expanding testing for your patients.

Where Oral Samples Are Superior

Many other forms of drug and medical screenings are done using blood, urine or other samples and cultures, which many clinicians are inclined to believe are preferable. However, there are several ways in which oral samples are a preferable specimen for testing needs.

Patient Comfort: Patients may not feel comfortable urinating in a cup or undergoing a blood draw, creating logistical problems in your practice. Comparatively, a saliva collection is a quick and painless process that does not require needles or use of restrooms.

Cost: Oral swabs are financially more cost-effective. They do not require the personnel or equipment, such as a phlebotomist or facilities needed, for the other collection methods.

Contamination: With proper handling of the specimen collection unit, there is more security from cross-contamination or hazardous materials. The specimen handled exclusively by the technician and deposited in a secure, marked container ready to be tested by our lab professionals.

The benefits of oral fluid samples are substantial, including:

  • Earlier detection windows
  • Faster turnarounds; oral samples can be collected from anywhere without a need for privacy or discretion
  • Detection of parent compounds
  • Greater accuracy; LC/MS testing is up to 1,000 times more precise than GC/MS technology
  • Harder to cheat; many methods to defeat urine tests are available, but an oral swab taken under supervision cannot be tampered with

Limitations on Oral Swab Testing

Despite the advantages of  oral swab testing, this method is not appropriate for all testing needs and there are limitations.

First, drug testing using oral swabs requires a tight time window for much drug testing; drug presence in the saliva is quite temporary, so samples must be taken within days of ingestion. This could be a benefit if the identification of recently ingested drugs is necessary, however many scheduled drug tests are looking for habitual use. Furthermore, the saliva specimen requires more sensitive measurement than other methods. As you can see in our cutoff tables below, this is a technology and a barrier we have overcome and are confident in, it does, however, require more precision on the testing side. While, it is not yet the ‘gold standard’ of testing this is a benefit, in that, methods to defraud testing are not yet common and are also, hard to implement.

Testing With Oral Swabs

Oral swab testing relies upon LC/MS testing to determine results, providing a competitive landscape that ensures speed, quality, and accuracy. To do this, we embrace cutting-edge breakthroughs in medical science.

Drug Detection

Drug detection can be an important service for medical providers, including hospital and addiction facilities. In addition to identifying substance abuse issues in patients unwilling to discuss their concerns, determining the true extent of a patient’s substance abuse can guide the direction of care both in treatment centers and in standard medical practices.

Drug detection is among our key services, helping physicians to identify drug use in patients to better provide a course of treatment that can both target addiction and abuse as well as overall health. As such, we strive for excellence in every test. These frequently asked questions can shed light on the drug detection process we embrace at Capstone Healthcare, helping to provide confidence and comprehension in what we have to offer.

What is the Time-frame for Testing?

Due to the nature of drug ingestion, saliva tests can be utilized almost immediately, within 30 to 60 minutes for initial detection. This method can catch drug intake that hasn’t metabolized and thus would not yet be present in urine. Much like other forms of drug testing, positives will show for varying lengths of time based on the substance in question, often from 24 to 72 hours.

Are There Ways the Test Can Be Beaten?

Due to the nature of oral swab collection – taken in person by a practitioner who has previously been monitoring patient behavior – it is exceedingly difficult to beat an oral swab test. Further, dilution tactics like those used on urine tests are not successful with saliva.

What Does an Oral Drug Panel Test For?

An oral drug panel can test for virtually any substance, including both illicit and prescription drugs. Capstone Healthcare’s screenings are available for over 60 different drugs.

Is it More Accurate Than Other Alternatives?

At Capstone Healthcare, we are fully confident in our established cut-off levels and we take quality very seriously. We believe that oral swab samples offer highly accurate testing opportunities in all areas that we evaluate. Further, oral swabs are far more convenient for all parties involved, promoting a comfortable experience for both patients and practitioners. However, despite these advantages, oral swabs are not as far-reaching as urine and blood tests in many ways, and may be limited in the possible results.

If you are seeking a way to improve the tests available to your patient population, Capstone Healthcare is prepared to help. Please contact us today to learn more about what we have to offer for you, your patients, and your medical practice.


  • https://www.researchgate.net/publication/238704177_Saliva_Laboratory_Testing_The_Advantages_and_Disadvantages
  • https://en.wikipedia.org/wiki/Buccal_swab
  • https://immunalysis.com/products/oral-fluid/quantisal/
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