Clinical evaluation of oral fluid point-of-care testing for drugs of abuse compared to urinary point-of-care testing at a large-scale music festival

Urinary point-of-care testing for recreational drugs is commonly used in clinical settings. An oral fluid-based point-of-care test is a less invasive alternative, but the reliability and clinical applicability in a real-life acute care setting is unclear. To assess the concordance of oral fluid point-of-care testing compared to urine point-of-care testing for recreational drugs in a prehospital clinical setting. This study was conducted during a large-scale dance music festival in October 2023. Urine and oral fluid samples were collected at the event medical station from volunteers with a suspected drug intoxication. Participants aged 18 years and older were included if both samples were provided and at least one substance tested positive. The percentage of positive oral fluid test results per recreational drug were compared with those of the urine point-of-care test. A total of 78 patients were included. For most drug substances, positivity rates were similar between the two test types. Methamphetamine/3,4-methylenedioxymethamphetamine was the only substance that showed significantly more positive results in oral fluid compared to urine (p<0.001). For all other substances, the differences between the two tests were small, with slightly higher positivity rates (on average 3.9%) detected in oral fluid. Oral fluid point-of-care testing shows potential in specific scenarios but requires further validation. It is a less invasive alternative to urine point-of-care testing for recreational drugs in a clinical setting. Nevertheless, it is important to consider the differences in test characteristics, such as detection window. Further research is needed to evaluate the reliability in other populations and settings. • Saliva drug testing was evaluated in an acute clinical setting during a festival • 78 patients with suspected drug intoxication provided both urine and saliva samples • Detection rates were similar for most substances in saliva and urine tests • Methamphetamine/MDMA was more often detected in saliva than in urine • Saliva testing is a promising and less invasive alternative to urine drug testing