Search found 874 matches

by Robert Swotinsky MD
Thu Sep 19, 2019 2:18 pm
Forum: Drug and Alcohol Testing
Topic: Invalid with pH 9.07
Replies: 4
Views: 48

Re: Invalid with pH 9.07

The MRO tries to interview the donor for some types of invalid results, but not for others: MRO Interview attempted if invalid due to - A possible adulterant - Abnormal physical characteristics of the specimen(s) No need for MRO interview if invalid due to: - Abnormal pH - Discrepant creatinine/spec...
by Robert Swotinsky MD
Wed Sep 18, 2019 6:31 pm
Forum: Drug and Alcohol Testing
Topic: Invalid with pH 9.07
Replies: 4
Views: 48

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: 1243

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: 187

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...
by Robert Swotinsky MD
Fri Aug 16, 2019 8:49 pm
Forum: Drug and Alcohol Testing
Topic: MRO conflict of interest ?
Replies: 2
Views: 371

Re: MRO conflict of interest ?

There are no regulations or standards about this. MRO reviews are among the most fact-based, rather than subjective, determinations that an occupational medicine physician has the opportunity to provide. I supposed a donor could claim the MRO is biased because that MRO works in-house. Perhaps just a...
by Robert Swotinsky MD
Mon Aug 05, 2019 12:44 pm
Forum: Drug and Alcohol Testing
Topic: Breath alcohol test and diuretics
Replies: 3
Views: 404

Re: Breath alcohol test and diuretics

One Internet dictionary defines fair as, "in accordance with the rules or standards; legitimate." The rules and standards are to report the result as is, and to help assure that at the result is legitimate, e.g., performed on a calibrated device, and after a 15-30 minute interval between tests #1 an...
by Robert Swotinsky MD
Sun Jul 28, 2019 5:19 pm
Forum: Drug and Alcohol Testing
Topic: CBD and marijuana
Replies: 5
Views: 546

Re: CBD and marijuana

On May 28, 2019, the National Laboratory Certification Program issued a Notice that it was investigating what appeared to be several THCA-positive results above the limit of quantitation but below the cutoff values, results thought to represent conversion of CBD to THCA during sample preparation wit...
by Robert Swotinsky MD
Sat Jul 20, 2019 8:45 pm
Forum: Drug and Alcohol Testing
Topic: SAMHSA certified vs CLIA certified
Replies: 1
Views: 501

Re: SAMHSA-certified vs CLIA certified

Laboratories must be certified by the Department of Health and Human Services (HHS) in order to test specimens in federally regulated workplace drug testing programs. The certification program resides in the Substance Abuse and Mental Health Services Administration (SAMHSA) within HHS. Thus, the ter...
by Robert Swotinsky MD
Tue Jul 02, 2019 5:57 am
Forum: Drug and Alcohol Testing
Topic: Consecutive invalids
Replies: 2
Views: 970

Re: Consecutive invalids

If the second specimen is invalid for the same reason as the first specimen, the MRO reports test cancelled. No further action is required unless a negative result is required, i.e., pre-employment, return-to-duty, or follow-up. If a negative result is required, the employer sends the donor for a cl...
by Robert Swotinsky MD
Fri Jun 28, 2019 5:42 pm
Forum: Drug and Alcohol Testing
Topic: Cannabidiol
Replies: 10
Views: 3599

Re: Cannabidiol

The MRO review is based on whether or not the donor has a legitimate medical explanation in the context of applicable drug testing regulations and guidelines, e.g., the HHS Guidelines, the DOT Procedures. The DOT rule [49 CFR §40.151(d)] and the SAMHSA Medical Review Officer Manual instruct the MRO ...