Old prescriptions

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drjchill

Old prescriptions

Post by drjchill » Fri Dec 31, 2010 9:05 am

I know I have found a reference either in a FMCSA or a Part 40 FAQ where a recommendation was made regarding "old scheduled medications." The recommendation was for 1 year. Does anyone know where this data can be found? I have searched all over but cannot find my own reference! It's fun getting old(er).



DrSteve

Re: Old prescriptions

Post by DrSteve » Fri Dec 31, 2010 3:11 pm

There may or may not be any "official" reference, but I, and many, MRO's use a year. The thinking that I use is that when an Rx is prescribed, the expiration date is a year after the date it is filled.

So if someone has an Rx, that is older than a year, what do MRO's do?

My thinking is that, although perhaps it is not advisable for someone to take an expired medication, there is no federal or state law that says this is illegal. However, I ask for proof that the individual actually still has the original bottle with the medication. If they can show that to me, I will most likely overturn the test into a negative. I make sure that they really have the original bottle however.

Robert Swotinsky MD
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Re: Old prescriptions

Post by Robert Swotinsky MD » Sat Jan 01, 2011 8:39 am

From 2006 to mid-2010, the FMCSA Office of Medical Programs -- i.e., the medical qualification division and not the drug testing division -- had a Frequently Asked Question #51 on its web site advising MROs that use of a medication that is more than a year old is an unacceptable explanation for a positive drug test result. I've pointed this out in MRO Update articles and elsewhere, along the lines of, What's up with that!? Without comment, FMCSA removed the old prescription FAQ in 2010 from its web site. More recently, the U.S. Army has been considering a one-year threshold for its soldier testing programs.

The "problem" remains, there is no legal basis, nor is there any consensus, for establishing any particular length of time as the upper limit of acceptability. I sometimes hear employers and MROs talk tough on this - nothing acceptable beyond 1 year. I've known of only one test -- and, I've had opportunity to review a lot of what other MROs do -- where an MRO declined to accept an old medicine, and this was with a prescription more than a decade old. I believe some MROs may talk tough but in practice almost all, if not all, MROs accept old prescriptions as explanations.

drjchill

Re: Old prescriptions

Post by drjchill » Sat Jan 01, 2011 4:19 pm

I knew I read it somewhere. I find it "funny" that an agency of the federal government can "remove" data from a FAQ. I guess my mind still works a little. Thanks a lot!!

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Old prescriptions

Post by drjchill » Thu Oct 24, 2019 1:17 pm

I was reviewing Medical Review Officer Guidance Manual for Federal Workplace Drug testing Programs revised March 2018. Page 4-21 reads:

"Therefore, when determining whether a legitimate medical explanation exists for a positive test, the MRO should consider whether a medication was used during the time period for which was legitimately prescribed, if such a timeperiof is specified. If a donor possesses a valid prescription with no time limitations on the drug's use (even if the dispersed prescription is past its expiration date), the donor specimen should be reported as negative."

So is this now the standard for an "old(er) medication?"

I was surprised this was published in 2018 and I am learning about it today!

Robert Swotinsky MD
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Re: Old prescriptions

Post by Robert Swotinsky MD » Thu Oct 24, 2019 6:58 pm

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 several years. In March 2018, HHS reissued that manual with some additions, two that are of major importance to MROs:

1. Clarification of the HHS position on old prescriptions: If the donor can demonstrate that he/she "possesses a valid prescription with no time limitations on the drug's use," the MRO should accept that explanation. (The exact meaning of that phrase in quotes is open to interpretation.) I'm told that some MROs worry that a long-ago prescription will serve as a lifelong get-out-of-jail card. According to HHS, these MROs need to get over it. (btw, DOT currently has no published position on this issue.)

2. HHS is not authorizing MROs to report safety concerns about prescribed drugs. HHS tells MROs they can report safety concerns if they choose, but they're doing so outside the scope of the HHS Mandatory Guidelines. (MROs may recall that effective January 1 2018, DOT softened its position on reporting of safety concerns by including a five-day clock during which the donor can have his/her prescriber contact the MRO to try and reconcile and eliminate any safety concerns the MRO may have.) I believe there were some MROs, including some high-volume MROs, who were reporting even remote safety concerns (e.g., prescriptions for Adderall, gabapentin, PRN alprazolam, etc.) and this became burdensome to employers and pissed off the donors as well. Both HHS and DOT have sought to control and distance themselves from this. While some MROs may believe that drug testing can help promote safety by identifying people at increased risk due to medication use, the science isn't very supportive in tying medication use to increased accident rates and, more importantly, the purpose of drug testing has always been to deter illicit drug use. (And that last point is why I've historically maintained the opinion that testing for prescription drugs like hydro and oxy is not useful. The problems this nation has had with hydro and oxy are primarily problems with prescribed hydro and oxy.)

The HHS guidance applies directly to federal agency testing. It applies indirectly to other testing programs and practices to the extent that they follow HHS rules and guidelines. I've updated the link on the links page of this website to match the March 2018 revised Manual. That link is: https://www.samhsa.gov/sites/default/fi ... h_2018.pdf.

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