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

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Helent

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

Post by Helent » Thu Aug 22, 2019 4:04 am

I am reviewing a pre-employment non-DOT test - consecutive invalids for the same reason - oxidant activity nitrite equivalents >=200 ug/mL.

The first collection was reported to be invalid and nitrite equivalents in urine was 301 ug/mL.

The second collection was reportedly done under direct observation and sent to another lab - reported to be invalid and nitrite equivalents in urine was >/= 200 ug/mL.

I looked up previous "related topic" posts - Invalid vs adulterant ( July 22, 2019) and Consecutive invalids (June 28, 2019) - and have some suggestions I can use to proceed - e.g. question the collector on steps used in the observed collection process, ascertain level of nitrite equivalents from second lab.

If both levels are under 500 ug/mL and if the observed collection procedure was deemed to be acceptable, what might be reasonable next steps in this review of a pre-employment test?

Thank you for insight.

HT



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

Post by Robert Swotinsky MD » Thu Aug 22, 2019 10:02 pm

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 include a non-urine drug test.

mikesuls

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

Post by mikesuls » Wed Sep 18, 2019 9:11 am

The first test is cancelled. If the second test is invalid for the same reason and a negative result is required, a substance abuse evaluation is performed. The examiner MAY use alternative methods, such as hair or oral fluid. If there is no clinical evidence of a substance abuse disorder, then the second test is NOT CANCELLED, it is reported as NEGATIVE. Furthermore, depending on the outcome of the MRO interview, you may need to report a safety-concern if the donor admits to the use of either illicit substances or impairing medication (following the DOT model).

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