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From: Robert Swotinsky MD
Date: 05 Jan 2006
Time: 15:10:25 -0800
Remote Name: 68.166.234.45
Report the positive result to the employer. It's nice of you to try and reach the donor to explain what happened and give him a heads up. But, don't let this get in the way of your responsibility to report the result to the employer. By the way, you mentioned he gave you a copy of a "prescription" on prescription pad paper. Doesn't this suggest an unused (unfilled) prescription? Had the prescription been brought to a pharmacy and filled, the pharmacy would have retained the prescription pad note and dispensed the labeled medication.
Allow me to digress: About a year ago, I told a donor that I'd need "a prescription" to explain her THC positive drug test; otherwise it would be reported as positive. She asked, "For what kind of medicine?" I responded, "Marinol." The next day, the donor faxed me a prescription pad note (i.e., an unfilled prescription) for mineral oil, and it was dated the same day she faxed it to me, i.e., it was dated several days after the drug test specimen had been collected. Out of curiosity, I called the doctor whose name was on the prescription pad note, and that doctor (a woman) said she did in fact write the mineral oil prescription at the patient's request, and didn't understand why this patient wanted a prescription for mineral oil, which is an over-the-counter item. So, I called the donor back and explained the difference between mineral oil and Marinol, and explained that I would be reporting her positive result to the employer. (I can't believe I waited a year to share this story with the world.) So, what's my point?
1. A prescription can serve as an alternative medical explanation if it is a prescription that was filled prior to the test.
2. All doctors are suggestible and to some extent are liable to write the prescriptions that their patients ask for. By contrast, my experience is that no doctor will back-date prescriptions or fudge old medical records for the purpose of helping their patients pass drug tests.
3. We all want to be credible and help donors understand the process. We also owe a responsibility to employers to report results in a timely manner. It can also be argued to some extent that we owe a responsibility to public safety to report results in a timely manner. I understand the question posted to this bulletin board addresses a preemployment test, i.e., one in which the donor had probably not yet started work. However, the longer you wait to report, the more likely the employer will hire the person on the assumption that no news is good news. This is another good reason to move things along.
4. The MRO is supposed to give the donor an opportunity to present alternative medical explanations. To some extent, the MRO helps the donor through this process. However, it is usually unnecessary and (as illustrated above) can be counterproductive to tell a donor that if he or she has a prescription for Marinol, the test will be downgraded to negative. It's usually enough to ask about use of medications and, if Marinol sounds like it might be in the picture but hasn't been named, back into it through a series of questions, e.g., "Was it a brown pill?" "Was it a gelatin capsule?" "Was it for weight gain?" If you're going to ask "Was it Marinol?", best off to reserve that as your very last question, once you're pretty sure the answer will be "yes."