Search found 880 matches

by Robert Swotinsky MD
Fri Nov 01, 2019 3:47 pm
Forum: Drug and Alcohol Testing
Topic: "Temporary" shy bladder and pre-employment DOT
Replies: 4
Views: 582

Re: "Temporary" shy bladder and pre-employment DOT

The DOT test is supposed to be done first because DOT says so. Nevertheless, the failure to provide a urine specimen after 3 hrs w/fluids offered does trigger a shy bladder evaluation for the purpose of determining if there is a medical reason for inability to provide the urine specimen and if so, i...
by Robert Swotinsky MD
Sat Oct 26, 2019 3:53 pm
Forum: Drug and Alcohol Testing
Topic: "Temporary" shy bladder and pre-employment DOT
Replies: 4
Views: 582

Re: "Temporary" shy bladder and pre-employment DOT

Repeat the DOT pre-employment urine test. A temporary shy bladder does not trigger a directly observed collection procedure. If the donor fails to provide a sufficient specimen, have him return to the urologist. I think recurrent urethral stricture is an indication for surgical repair. Ask for the u...
by Robert Swotinsky MD
Thu Oct 24, 2019 6:58 pm
Forum: Drug and Alcohol Testing
Topic: Old prescriptions
Replies: 5
Views: 3983

Re: Old prescriptions

Thank you drjchill for your post! I was surprised this was published in 2018 and I am learning about it today! I could have/should have mentioned it in the MRO Update newsletter, but didn't. Maybe I'll put something in the next issue about this. In mid-2017, HHS issued a new MRO manual, the first in...
by Robert Swotinsky MD
Tue Oct 22, 2019 4:17 pm
Forum: Drug and Alcohol Testing
Topic: Underage test clients
Replies: 2
Views: 248

Re: Underage test clients

Thank y ou Shawn Harrington for signing into the web site after I accidentally cleared out the member list a few days ago. You get the coveted #2 spot on the (new) members list. ____ MROs should not provide parents with results of drug tests that employers have ordered on their adolescent children. ...
by Robert Swotinsky MD
Wed Oct 16, 2019 6:52 pm
Forum: Drug and Alcohol Testing
Topic: GC-MS failed to distinguish between CBD and THC
Replies: 1
Views: 293

Re: GC-MS failed to distinguish between CBD and THC

The 2012 Journal of Analytical Toxicology article referenced in the NY Times article describes conversion of CBD to THC when incubated w/acid, heat, and time. This phenomenon has been described in other studies, too. The article does not describe the GC/MS being unable to distinguish between CBD and...
by Robert Swotinsky MD
Wed Oct 02, 2019 5:46 pm
Forum: Drug and Alcohol Testing
Topic: Refusal to test with negative result
Replies: 5
Views: 478

Re: Refusal to test with negative result

The collector uses a CCF for the 1st specimen. The collector uses a different CCF for the 2nd specimen. If the 2nd specimen is adequate, the collector sends the 1st specimen (or, if split, the 1st Bottle A and Bottle B) with its CCF and the second specimen (or, if split, the 2nd Bottle A and Bottle ...
by Robert Swotinsky MD
Tue Oct 01, 2019 5:05 pm
Forum: Drug and Alcohol Testing
Topic: Refusal to test with negative result
Replies: 5
Views: 478

Re: Refusal to test with negative result

The collector should have discarded the 1st specimen. At this point, the test outcome is a refusal to test as this "trumps" the negative result from the suspect specimen.
directly observed collection procedure.jpg
directly observed collection procedure.jpg (67.88 KiB) Viewed 468 times
by Robert Swotinsky MD
Wed Sep 18, 2019 6:31 pm
Forum: Drug and Alcohol Testing
Topic: Invalid with pH 9.07
Replies: 2
Views: 413

Re: Invalid with pH 9.07

If the pH is in the 9.0 – 9.5 range and the specimen was exposed to heat over time, the MRO reports the test as cancelled and informs the DER that no further action is required unless a negative result is required. Urine pH can rise into the 9.0 – 9.5 range due to the effects of microbial activity, ...
by Robert Swotinsky MD
Wed Sep 11, 2019 6:44 pm
Forum: DOT Physicals
Topic: No federal requirements for OSA!?
Replies: 4
Views: 1934

Re: No federal requirements for OSA!?

The previous post asks about using a 2-week compliance report as sufficient evidence to certify the driver as having controlled OSA and therefore OK for a year. The benefit of this relatively short compliance report is that it allows for a revision of the DOT physical within the 45 day grace limit, ...
by Robert Swotinsky MD
Thu Aug 22, 2019 10:02 pm
Forum: Drug and Alcohol Testing
Topic: Consecutive invalids - both oxidant activity- nitrite eq >or=200 ug/mL
Replies: 2
Views: 537

Re: Consecutive invalids - both oxidant activity- nitrite eq >or=200 ug/mL

Following the DOT model: The second specimen is a consecutive invalid for the same reason as the first invalid. The test is cancelled. Because a negative test result is required, the employer sends the donor for a clinical assessment to determine if the donor is misusing drugs. This assessment may i...