Mediterranean

Urine Testing:

In the period after 1990 with the enactment of the DOT drug testing program, employers saw the value of drug testing their employees and developed their own versions of Drug-Free Workplace Programs for workers who were not safety-sensitive transportation workers as defined by the DOT. Most employers who started drug testing programs tested pre-employment applicants only and only tested drugs of abuse using urine. Most employers now make use of an MRO for all test results review and use the same collection requirements that DOT mandates except very few non-DOT regulated employers require a split (A and B) specimen to be collected. Employers generally require the laboratory to perform specimen validity testing although it is not a requirement in all states.

Companies with non-regulated workers (Non-DOT) copied certain aspects of the federal DOT program but many wanted to test for more than the five required drugs that DOT mandated. Unlike the federal DOT regulations most employers were allowed to test employees for different drugs at different screening levels. Below is a list of the drugs for which employers can test their employees:

Amphetamines (amphetamine and methamphetamine)
Cocaine metabolite
Marijuana metabolite
Opiates (codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone)
Phencyclidine
Barbiturates
Benzodiazepines
Methadone
Propoxyphene
MDMA (Ecstasy)

Expanded Opiate Testing:

Many prescription opiates such as Oxycodone and Hydrocodone are being widely abused today. In 2007, 5.2 million Americans age 12 years or older were nonmedical users of prescription pain pills (National Survey on Drug Use and Health 2007).

These prescription drugs are either purchased on the street or from individuals who visit multiple physicians with phony symptoms in order to get prescriptions for the various pain relief medications.

The standard DOT drug test with an opiate cutoff of 2000 ng/mL will not usually detect the expanded or synthetic opiates seen below. DRUGSCAN® now offers an expanded opiate panel with any routine (Non-DOT) drug screen that includes Codeine, Morphine, Hydrocodone, Hydromorphone, Oxycodone, and Oxymorphone. Now you can detect these opiate prescription pain relievers routinely.

Ecstasy (MDMA) Testing:

Ecstasy is a methamphetamine that is not normally detected in the standard Amphetamine/Methamphetamine urine drug test. It requires a separate testing procedure using a state-of-the-art immunoassay (EIA) and confirmation by gas chromatography/mass spectrometry (GC/MS) to detect this drug. Ecstasy (MDMA) is a widely abused drug with such adverse physical effects as paranoia, confusion, depression, anxiety, and sleeplessness. Although specific testing for Ecstasy is not permitted for Department of Transportation testing it is allowed for non-DOT testing. DRUGSCAN® can easily add this test to your existing drug screen.

Alternative Testing Methods:

In the late 1990’s as technology changed and developed, other testing methods for the drugs of abuse were developed. Drugs of Abuse can now be detected using other types of specimens such as oral fluid and hair.

METHODS TO DETECT DRUGS OF ABUSE

• Urine
• Oral fluid
• Hair

These other methods of testing for illicit drugs are becoming widely accepted and permitted in most of the 50 states although they are not allowed for Department of Transportation safety-sensitive workers’ testing at this time.

Detection Times:

Detection time is the length of time the drug can be detected in the urine after it has been ingested. The detection time for the numerous non-DOT drugs varies with the dose of the drug, the weight of the individual using the drug and the frequency of times the individual has used the drug.  The average detection time for a urine drug screen is 24-72 hours after the drug is taken.

Collection:

During the collection process a urine specimen collector will do the following:

• Create a secure collection site.
• Verify the donor’s identity using a current valid photo ID, such as a driver’s license, passport, or employer issued picture.
• Afford the donor privacy to submit a urine specimen.
• Ask the donor to remove any unnecessary garments and empty their pockets.
• Instruct the donor to wash and dry their hands.
• Select or have the donor select a sealed urine collection kit.
• Request the donor to provide a urine specimen with a minimum of 45 mL of urine into the collection container.
• Check the temperature and color of the urine specimen.
• In the presence of the donor pour the initial specimen into two separate bottles (A or primary and B or split), seal them with tamper-evident tape, and then ask the donor to sign the seals after they have been placed on the bottles.
  (Remember neither the collector nor the donor should let the specimen out of their sight until it has been poured into two separate bottles and sealed.)
• Instruct the donor to read the certification statement in Step 5 on the Medical Review Officer Copy (Copy 2) of the Non-Regulated Drug Testing Custody and Control Form (CCF) and to sign and print their name, date of birth, daytime and evening phone numbers after reading the certification statement.  If the donor refuses to sign the certification statement, provide a remark in Step 2 on Copy 1 of the CCF.
• Complete Step 4 on Copy 1 of the CCF.
• Give the Employee Copy to the donor.
• Package and ship both sealed bottles and completed CCF to DRUGSCAN®, a U.S. Health and Human Services (HHS) certified testing laboratory as quickly as possible.

Laboratory Testing for Drugs of Abuse:

At DRUGSCAN®, the certified laboratory, our staff will do the following:

• Determine if the urine specimen was collected correctly and no flawed or improper collection has occurred. If there is a flaw in the collection, the specimen is rejected for testing.
• If there are no flaws, the “A” bottle is opened and used for the screening test. Specimens that screen positive will be confirmed using an alternative method of testing, GC/MS.
• If the specimen tests negative, the result will be reported as negative.
• If the specimen tests positive under both methods (Immunoassay and GC/MS), the specimen will be reported as positive to the Medical Review Officer (MRO), if applicable.
• Both negative and positive test results must be reported to the MRO, if applicable.
• Store the “A” and “B” bottles for any reported positive, adulterated, or substituted result for at least 12 months.

Laboratory Testing for Specimen Validity Testing (SVT)

DRUGSCAN® follows the federal requirements which mandate that each urine specimen must be tested to determine if it is actually urine and that tampering has not occurred. This is done by the laboratory when they test for Creatinine, specific gravity, pH, and adulterants (substances added to the urine specimen at the collection site to affect the test results. The laboratory must determine if the specimen has undergone the following:

• Substituted: another liquid substance has been substituted for urine. Creatinine and specific gravity testing are used to determine if the specimen was substituted.
• Diluted: the donor has either consumed a large amount of a liquid to affect the test results or the diluted specimen could be a natural occurrence. Creatinine and specific gravity testing are used to determine if the specimen was diluted.
• Adulterated: a specimen that contains a substance that is not expected to be present in human urine, or contains a substance expected to be present but is at a concentration so high that it is not consistent with human urine. Ph testing and testing for specific adulterants will help determine if the specimens was compromised.

Laboratory test results can be affected by adding common household products such as acid, ammonia, lye, vinegar or chemical additives such as glutaraldehyde, nitrite, chromates, and halogens. Lemonade, soft drinks, sports drinks and water can be used as a substitute for human urine.

The laboratory must determine if the specimen is actually human urine or if tampering has occurred by adding a chemical substance.

Review of the Test Results:

Non-Regulated laboratory tests can at the employer’s discretion (where not mandated by law) be reported to a certified Medical Review Officer (MRO). Upon receipt of the test result from the laboratory, the MRO will do the following:

• Review all the paperwork for accuracy.
• Report any negative test result to the Designated Employer Representative (DER).
• If the result is positive, conduct an interview with the donor to determine if there is a legitimate medical reason for the test result. If a legitimate medical reason is established, the MRO will report the result to the DER as negative.
• If there is no legitimate medical reason for the positive test result, the MRO will report the positive result to the DER.
• If the test result is reported as adulterated or substituted, the MRO will conduct an interview with the donor to determine if there is a legitimate medical reason for the adulterated or substituted test result.
• If there is a legitimate medical reason for the adulterated or substituted test result, the MRO will report the test result as cancelled to the DER.
• If there is no legitimate medical reason for the adulterated or substituted test result, the MRO will report the result out to the DER as “Refusal to Test”.
• The MRO will report a non-negative to the DER if the donor refused to discuss the test results with the MRO or the donor did not provide acceptable medical documentation to the MRO.

Medical Review Officer:

A Medical Review Officer (MRO) is a licensed physician with knowledge and clinical experience in substance abuse disorders. They must also complete qualification training courses and fulfill requirements for continuing education courses on an ongoing basis. MROs serve as independent, impartial gatekeepers to the accuracy and integrity of the DOT testing program. All laboratory test results are sent to the MRO for verification before any company representative is informed of the test result. As a safeguard to determine the accuracy of the test result, the MRO reviews each test and determines if any legitimate medical explanation exists before verifying the results as positive, adulterated, or substituted.

(See Comparison of laboratory based urine, oral fluid and hair testing for specific information on each testing type).