Can patients cheat the saliva tests?

An expert panel convened by the American Society of Addiction Medicine (ASAM) determined that oral fluid testing is appropriate for detecting substance use in addiction treatment. In fact, oral fluid testing has some benefits over urine testing, such as being harder to tamper or cheat (ASAM, 2017). Adding credibility, the website “StuffStonersLike.com” (2015) complained that “the saliva drug test (mouth swab drug test) is not affected by the typical tricks and techniques that might work to defeat or beat a urine drug test.” They recommend “Ultra Kleen Saliva Cleansing Mouthwash” as a potential solution, but DynamiCare staff tested this product and found it to be ineffective.

Remote selfie videos add complexity to standard saliva tests, and opportunities for cheating (e.g. swapping out saliva swabs or cups). However, the methodology has been demonstrated to be feasible in research for saliva cotinine testing (Kong, 2016).  Our app shows patients their own face on the phone screen during testing and actively emphasizes that they must stay within and keep their test materials within the video frame for the duration of the each test; patients who do not properly follow the procedures must re-test. We expect patients to come up with new and clever ways of cheating the tests, but so far we have not found any, and we expect that we can adapt our processes to deal with them.