Occupational Medicine Forum

Hello, I am occ med physician, MRO, and DOT ME. As you know, the DOT long form specifically asks "Have you used an illegal substance within the past two years? " So if a driver marks yes to this question and during my questioning of the driver, the driver says he/she "smoked weed 5 months ago, but not since then." My questions are:

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.

2. I assume this would non-DOT drug test, I am thinking the 5 or 10 panel rapid test?

3. If employed driver, would we need any special authorization from employer to order the drug test? Any different for self pay driver?

4. If employer not willing to pay for it, can we force driver to pay for the drug test?

5. If positive, we would disqualify and if driver is employed than I assume report to employer??

6. Can we put driver on determination pending and tell them they have up to 45 days either provide negative drug screen documentation OR come back to office for drug test (though I think, this might be a mute point, since technically the driver could not use something and wait until it clears their system and come for the drug test)?

7. What if driver or employer not willing to pay for drug test, do we just disqualify the driver?

Sorry for lengthy post, but we have had 4-5 drivers recently in our office with this issue and we want create some guidance on this. Thanks

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 additional testing as part of the evaluation as needed. For example: An exercises "treadmill" stress test. A sleep study. A drug test.

2. I assume this would non-DOT drug test, I am thinking the 5 or 10 panel rapid test?

It is not a DOT test because it is not authorized by 49 CFR Part 40, the DOT Procedures.

3. If employed driver, would we need any special authorization from employer to order the drug test? Any different for self pay driver?

You don't need special authorization from the employer except in the context of payment. This is where the concept of additional testing typically falls apart. The medical examiner wants to order a drug test. The administrative staff know only to do those items ordered b the employer. And, it's not clear that the employer will pay for a drug test as part of a DOT physical, especially where the employer has already been quoted a fee that doesnt include a drug test.

For self pay, similar problem. The examinee is likely to be unhappy being asked to pay more than he/she expected. And, if it's a drug test that may disqualify him from driving, even more so.

4. If employer not willing to pay for it, can we force driver to pay for the drug test?

The medical examiner can leave the exam pending if the examiner believes additional testing is needed (and has not been performed). You can't force the drive to pay for the test. Does the clinic have quick cups that you could use to screen in these situations? They're less expensive, and they give you an immediate negative (or positive).

5. If positive, we would disqualify and if driver is employed than I assume report to employer??

Disqualify if there is evidence of current Schedule I drug use or other drug misuse that is disqualifying under the physical qualification standards. I would document the drug test result as part of the DOT exam, e.g., attached and/or on the long form. If this information gets released to the employer, so be it.

6. Can we put driver on determination pending and tell them they have up to 45 days either provide negative drug screen documentation OR come back to office for drug test (though I think, this might be a mute point, since technically the driver could not use something and wait until it clears their system and come for the drug test)?

Yes and yes.

7. What if driver or employer not willing to pay for drug test, do we just disqualify the driver?

I'd first put it on hold pending for up to 45 days.