Search found 924 matches

by Robert Swotinsky MD
Fri Nov 20, 2020 8:15 am
Forum: Fitness-for-duty (e.g., preplacement) exams, non-DOT
Topic: Pre employment & Methadone
Replies: 1
Views: 93

Re: Pre employment & Methadone

If the electrician job involves high voltage, working unprotected at heights, or other particularly hazardous environments, you may want to inquire in more detail. Ask for a couple of office notes and the most recent two or three compliance monitoring drug tests. While you mention a negative drug te...
by Robert Swotinsky MD
Wed Nov 11, 2020 6:22 pm
Forum: Drug and Alcohol Testing
Topic: Buprenorphine positive oral fluid test with interesting reason provided by donor
Replies: 1
Views: 108

Re: Buprenorphine positive oral fluid test with interesting reason provided by donor

The medical literature does not describe positive buprenorphine results from inadvertent exposure. The medical literature does describe buprenorphine, including street (nonprescribed) buprenorphine, as a drug taken by opioid-dependent people to help ward off withdrawal symptoms. A SAP could offer su...
by Robert Swotinsky MD
Mon Oct 26, 2020 2:29 pm
Forum: Drug and Alcohol Testing
Topic: Amphetamine, methamphetamine, medical marijuana
Replies: 1
Views: 285

Re: Amphetamine, methamphetamine, medical marijuana

Yes, ask for d & l isomers if they have not already been performed. The methamphetamine is not explainable by the use of Adderall (amphetamine). Methamphetamine is metabolized to amphetamine. But, amphetamine is not metabolized to methamphetamine. That's why you need to get d & l isomers - to help f...
by Robert Swotinsky MD
Thu Sep 10, 2020 8:49 pm
Forum: Drug and Alcohol Testing
Topic: 6th Edition Update
Replies: 3
Views: 908

Re: 6th Edition Update

The MROCC recertification examination has been updated as new regulations, science, and practices evolve. The MROCC exam has been updated since I wrote the 5th ed in 2014 -2015. I help write the MROCC exam. But, I'm just one of a team who do that, and the others are experts in MRO related topics but...
by Robert Swotinsky MD
Wed Sep 09, 2020 10:00 pm
Forum: Drug and Alcohol Testing
Topic: 6th Edition Update
Replies: 3
Views: 908

Re: 6th Edition Update

The 6th ed and CME program should be available by the end of the year. It's in copyediting right now.
by Robert Swotinsky MD
Tue Sep 01, 2020 8:05 pm
Forum: Drug and Alcohol Testing
Topic: CBD:THCA Ratios
Replies: 1
Views: 1070

Re: CBD:THCA ratios

I think the question is, How reliable is it so use the THCA-to-CBD ratio to determine if the THC came from CBD?

A positive test result for CBD can demonstrate that the person ingested CBD. There is no consensus on the use of THCA-to-CBD ratios to rule in, or rule out, the use of THC.
by Robert Swotinsky MD
Sat Aug 29, 2020 11:53 am
Forum: Fitness-for-duty (e.g., preplacement) exams, non-DOT
Topic: Police officer on warfarin
Replies: 2
Views: 1411

Re: Police officer on warfarin

The American College of Occupational and Environmental Medicine publishes medical evaluation guidelines for law enforcement officers, available by subscription. With respect to warfarin, the guideline is, "approved only if assigned to restricted duty; medication may cause significant bleeding (parti...
by Robert Swotinsky MD
Tue Aug 25, 2020 3:04 pm
Forum: Drug and Alcohol Testing
Topic: Morphine positive at 600 ng/mL
Replies: 2
Views: 924

Re: Morphine positive at 600 ng/mL

The result is negative because the morphine level is attributable to consumption of poppy seeds, even if the donor does not recall having consumed them. The information as posted does not indicate a likely safety or medical qualification concern that would require an alert to the employer.
by Robert Swotinsky MD
Sat Aug 15, 2020 2:12 pm
Forum: Drug and Alcohol Testing
Topic: Drug testing reference
Replies: 1
Views: 919

Re: Drug testing reference

The American Society of Addiction Medicine's 2017 consensus document on the use of drug testing in clinical medicine discusses the value of monitoring by drug testing. I am not aware of studies that have assessed the effectiveness of drug testing in reducing relapse. See: https://www.asam.org/docs/d...
by Robert Swotinsky MD
Wed Aug 12, 2020 3:14 pm
Forum: DOT Physicals
Topic: DOT Physical and Drug Testing
Replies: 1
Views: 1327

Re: DOT Physical and Drug Testing

1. Do we as the ME have the right/authority to order a drug test on the driver, since a drug test is not standard procedure for the usual DOT physical. Yes. The dipstick UA, visual acuity, blood pressure, pulse, and whisper test are minimal requirements for testing. The medical examiner can include...