Search found 864 matches

by Robert Swotinsky MD
Fri Jun 07, 2019 6:11 am
Forum: Drug and Alcohol Testing
Topic: Benadryl abuse
Replies: 1
Views: 95

Re: Benadryl abuse

A short-acting, quickly metabolized drug can be present in urine 2 days after its use. The urine that has collected in the bladder includes urine that was produced by the kidneys over a day or so. Thus, it represents a filtrate of the blood over a day or so. - A tablet of Benadryl contains 25 mg dip...
by Robert Swotinsky MD
Sun May 26, 2019 2:42 pm
Forum: Drug and Alcohol Testing
Topic: Buprenorphine
Replies: 3
Views: 228

Re: Buprenorphine

2,000 ng/mL is the federal confirmation cutoff for morphine and codeine.

The federal procedures direct MROs that morphine and codeine concentrations of 15,000 ng/mL or above are not explainable by poppy seed ingestion.
by Robert Swotinsky MD
Wed May 22, 2019 9:36 am
Forum: Fitness-for-duty (e.g., preplacement) exams, non-DOT
Topic: Respiratory mask fit test
Replies: 1
Views: 165

Re: Respiratory mask fit test

There is no CPT code for respirator mask fit tests. Where the electronic medical record and/or billing service requires a billing code for every encounter, you'll need to create faux-codes (with associated real prices) for services like this. For example, assign to the service 99080 "Special reports...
by Robert Swotinsky MD
Mon May 20, 2019 7:21 pm
Forum: Drug and Alcohol Testing
Topic: Buprenorphine
Replies: 3
Views: 228

Re: Buprenorphine

Yes. The reporting of likely safety concerns is based on information ancillary to the drug test result, but which is identified during review of the test result.
by Robert Swotinsky MD
Mon May 20, 2019 7:18 pm
Forum: Drug and Alcohol Testing
Topic: STATES Act
Replies: 3
Views: 186

Re: STATES Act

I saw the flurry of emails on the MRO list serve during the past few days. These emails followed an article on a drug testing advocacy site that said the STATES Act will potentially preclude DOT drug testing for marijuana. What I have not seen is text in the STATES bill that would remove marijuana f...
by Robert Swotinsky MD
Sat May 18, 2019 4:35 pm
Forum: DOT Physicals
Topic: Cleared by psychiatry
Replies: 1
Views: 104

Re: Cleared by psychiatry

was under "addiction treatment" for the past 6 months without relapse for alcohol When your supervising provider evaluates this driver's fitness for duty, the supervising provider should consider obtaining and reviewing the records of addiction treatment. Understand that the DOT Physical Qualificat...
by Robert Swotinsky MD
Sat May 18, 2019 4:25 pm
Forum: DOT Physicals
Topic: Translating for the non-English speaking driver
Replies: 1
Views: 93

Re: Translating for the non-English speaking driver

Yes. Your staff are allowed to help the Spanish-speaking driver complete the English-version form. The regulations and guidelines do not preclude them from doing so. I've worked in various clinics over the years and what you are describing has been standard practice in those clinics.
by Robert Swotinsky MD
Sat May 18, 2019 4:22 pm
Forum: Drug and Alcohol Testing
Topic: STATES Act
Replies: 3
Views: 186

Re: STATES Act

The STATES Act is legislation that was introduced in Congress last year and is being introduced in Congress again this year, currently H.R. 2093/S.1028. If it became law as currently written, it would prohibit the federal government's CSA Schedule I status of marijuana (and actions that derive from ...
by Robert Swotinsky MD
Sun May 12, 2019 10:22 am
Forum: Drug and Alcohol Testing
Topic: Non-DOT GC/MS interference for marijuana
Replies: 1
Views: 170

Re: Non-DOT GC/MS interference for marijuana

The initial result was canceled and the donor should have been tested using a directly observed collection procedure. If the second test was collected w/o direct observation, then the donor should be retested using direct observation. If the second test was collected w/direct observation, then: - If...
by Robert Swotinsky MD
Wed May 08, 2019 3:11 pm
Forum: DOT Physicals
Topic: Remeron, baclofen, and trazodone
Replies: 4
Views: 245

Re: Remeron, baclofen, and trazodone

I don't have a definitive answer about Remeron, baclofen, and trazodone and fitness to drive. But, I do offer this advice about getting sign-offs from the prescribers: My practice has been to ask for the treating clinician to sign off on safety if/when I suspect the treating clinician has concerns a...