After a Positive DOT Drug Test - MRO Duties

After a positive DOT drug test, the MRO is required to contact the donor. But, what happens when a the MRO is unable to contact the donor to confirm the result?

All positive DOT drug test results are immediately sent to the Medical Review Officer (MRO) for confirmation. It is the role of the MRO to contact the donor by telephone to confirm that there is not a legitimate medical explanation for the positive test result.

The actions that the MRO takes are written into the regulations of 49CFR Part 40. Specifically, the MRO must make reasonable efforts to reach the employee at the day and evening telephone numbers listed on the CCF. Reasonable efforts include, as a minimum, three attempts, spaced reasonably over a 24-hour period, to reach the employee at the day and evening telephone numbers listed on the CCF. If the MRO or her staff cannot reach the employee directly after making these efforts, the MRO or her staff must take the following steps:
(1) Document the efforts you made to contact the employee, including dates and times.
(2) Contact the Designated Employer Representative, instructing the DER to contact the employee and instruct the employee to contact the MRO. If both phone numbers are incorrect (e.g., disconnected, wrong number), the MRO or her staff may contact the DER without waiting the full 24-hour period.

After the employer has been contacted and attempted to contact the employee, the MRO may verify the test result if the employer has reached the employee and instructed him or her to call the MRO, and 72 hours has passed. If neither the MRO nor the employer has been able to contact the employee, the MRO must wait 10 days before verifying the test.

DOT Follow-up Testing Requirements

After a driver who had a positive result on a drug or alcohol test has been evaluated by a Substance Abuse Professional (S.A.P.) and passed a return-to-duty test, he may be returned to work. The DOT requires that the driver have a series of substance abuse follow-up tests over the course of the next year or more.

The testing may be for alcohol, drugs or both as designated by the Substance Abuse Professional (S.A.P.).

As a reminder, the sequence is as follows:
(1) A driver tests positive for alcohol or drugs
(2) The employer decides to retain the driver.
(3) The driver is evaluated by a licensed S.A.P.
(4) The S.A.P. determines what treatment the driver should undergo.
(5) The driver has a negative return-to-duty test and returns to work.
(6) The driver is required to have follow-up testing for a period of no less than one year.

The number of tests and the length of the testing program are determined by the S.A.P. based on his or her evaluation of the driver’s particular substance abuse issues. The D.O.T. requires that the driver undergo no less than six follow-up tests in the next twelve months, but follow-up sequences can go on for years as necessary.

Prescription Drug Abuse - Beyond DOT drug tests

The Department of Transportation testing program includes tests for illegal drugs only; Marijuana, Opiates, Amphetamines, PCP, and Cocaine. However, there are many other drugs that people abuse; often prescribed by doctors!

Prescription drugs are prescribed by doctors to cure people, so how can they be harmful? Because everyone’s body chemistry and tolerance to drugs is different, taking someone else’s prescription drugs can be harmful, even fatal. When doctors prescribe drugs, they evaluate many different factors. Drugs should only be used to alleviate conditions that are painful or harmful to your body, because even taking safe medicines carry risks.

In today’s workplace, employees sometimes take prescription medications not to alleviate medical conditions, but to numb feelings and zone out. This behavior negatively impacts the work being performed and can lead to accidents. Also, even though prescription drugs are legal, employees who sell or use drugs obtained illegitimately are breaking the law.

The two most frequently encountered drugs on the illicit market are Xanax (alprazolam) and Valium (diazepam). These drugs are depressants. Their abuse causes amnesia, hostility, irritability, and eventual physical dependence. When combined with alcohol, they can be deadly.

Abuse of prescription drugs can be detected by using 10-panel drug testing. Also, a Medical Review Officer should review the results to confirm that a person using a prescription drug has a valid prescription.

Employer Page on the DOT Web Site is a Great Resource

The Department of Transportation’s Office of Drug & Alcohol Policy & Compliance has a web site destination specifically for companies that hire DOT drivers. Entitled the "Employer Page", they have posted links to the most important information for employers to know in one place.

The DOT recognizes that employers of safety-sensitive transportation employees play a vital role in ensuring the safety of their employees and the traveling public. Employers are responsible for developing and implementing successful DOT workplace drug and alcohol programs that have as their components clear policies, provisions for education and training, drug and alcohol testing, and when needed, referral for evaluation and treatment.

• Some of the articles and links on the Employer Page include:
• Best Practices for DOT Random Drug and Alcohol Testing
• Current list of HHS certified laboratories
• DOT Agency/USCG drug and alcohol program manager contact information
• DOT Agency/USCG drug and alcohol program facts
• Drug and Alcohol Record Keeping Requirements
• Drug and Alcohol Testing Data MIS Collection Form and Instructions
• Employer Responsibilities under Subpart B of 49 CFR Part 40
• ODAPC - Fact Sheet
• Random Testing Rates
• Release of Information Form 49 CFR Part 40 – Drug and Alcohol Testing (suggested format)

You can browse to the Employer Page by clicking here: DOT Employer Page

US Court of Appeals Issues Stay for Direct Observation Drug Test Procedures

Dateline: October 31, 2008

The U.S. Court of Appeal for the D.C. Circuit has temporarily delayed the November 1st Direct Observation (DO) requirement for DOT return-to-duty and follow-up tests. This is an “administrative stay” until the Court completes its review on the matter.

On June 25, 2008, the Department of Transportation issued a new ruling, 49 CFR part 40.67 that required all Return-To-Duty and Follow-up testing to be conducted using Direct Observation. The initial starting date for the requirement was August 25, 2008, but it was then delayed, and slated to be put into practice on November 1, 2008. Now it has been delayed again by the court's administrative stay.

Until it is officially implemented, Direct Observation for return-to-duty and follow-up testing will continue to be an employer option, rather than mandatory.

A copy of the US District Court stay order can be found here: Direct Observation Administrative Stay

The Five Drugs of the DOT - All DOT drug tests are for five drugs

All Department of Transportation drug screens, whether preemployment, random, post-accident, reasonable suspicion, return-to-duty, or follow-up, test for five drugs.

The D.O.T. five are THC (Marijuana), Opiates (Heroin), Amphetamines, Cocaine and PCP. All five drugs are illegal and are considered to be the most abused illegal drugs in the United States. Knowing something about each of these drugs will help supervisors to recognize references to them, behaviors associated with them and how they are used.


THC (Marijuana)
THC (Tetrahedral Carbonyl) is the active ingredient in Marijuana and Hashish.
Slang terms: pot, grass, smoke, weed, joints.
Form: Dried flowers and leaves of the hemp plant, Cannabis Sativa. Also, green, brown or black block of hashish.
Uses: Primarily smoked in pipes or rolled in papers as cigarettes (joints). Can also be eaten in baked goods.
Effects: Users experience feelings of relaxation and giddiness and often experience dry mouth, rapid heartbeat, loss of coordination and balance, and slower reaction times. Also adversely affects short term memory.
More info: Marijuana


Opiates
Derivatives of the opium poppy. This group of drugs includes morphine and it’s derivative, heroin. It is highly addictive and users who inject it run the extra risks of HIV and hepatitis B and C from sharing needles.
Slang terms: smack, horse, H, junk, scag
Form: Usually a white powder, but runs in color from white to dark brown or even black.
Uses: Often taken orally, it can be inhaled, smoked and injected into the blood stream.
Effects: Intense euphoria, drowsiness, impaired metal function, slowed respiration, disorientation.
More info: Opiates


Amphetamines/Methamphetamine
A powerful central nervous system stimulant or “upper”, it is also addictive.
Slang terms: speed, meth, crank, crystal, glass
Form: Sold as a powder, it can be mixed with water for injection, or sprinkled on tobacco or marijuana and smoked. Purer forms can be in clear chunks, resembling rock candy.
Uses: Taken in pill form, smoked, injected, or vaporized and inhaled.
Effects: Users feel energetic, alert and self confident. Many also feel wired and agitated and their behavior becomes unpredictable. Some feel compelled to repeat small tasks over and over, and others may pick at imaginary bugs on their skin. Users rarely eat or sleep and eventually “crash”, marked by agitation and depression.
More info: Amphetamines/Methamphetamine

Cocaine
The most powerful nervous system stimulant found in nature, it is derived from the coca plant. It causes a short-lived high and is considered addictive. Users may require more and more of the drug to get the same feeling.
Slang terms: coke, crack, snow, blow, sneeze, rock.
Form: It comes in the form of a white powder and also as off-white crystalline chips, rocks or chunks.
Uses: It is usually snorted, and can also be injected. The crystal form is usually smoked or vaporized and inhaled from glass pipes.
Effects: Mild euphoria and feeling of increased energy. Interferes with sleep patterns and can cause muscle spasms and convulsions. Emotional changes include feelings of depression, edginess and craving more of the drug.
More info: Cocaine

Top Supervisory Problems - Respect for workers pays dividends

“My supervisor doesn’t listen to me.”
One of the biggest complaints of employees is that their supervisors are not taking the time to listen to them. This can be very stressful for employees who believe that they could do a better job if certain changes were made. Sometimes supervisors are reluctant to hear workers’ concerns because they worry that they are not in a position to help solve their problems.

Listening to your workers communicates respect for them. Even if you don’t agree to requested changes, employees feel better when they feel heard. Also, employees that know that their supervisors will listen to them, are more likely to pass along information that they have learned from other employees. This keeps the supervisor in the loop and helps them to act on situations that could become bigger problems.

“I am doing the work of 2 or 3 people.”
Sometimes, due to changing workload, we ask our employees to work under less-than-perfect conditions. We may realize that we are asking them to do more in the same amount of time or with limited resources. One of the keys to keeping the overworked employee from burning out is for supervisors to acknowledge the situation. Let the worker know that you are aware that you are asking more from them than usual and thank them for their extra work. Employees will work better if they are acknowledged for their extra efforts.

It is also important to realize that workers who are being asked to get more done in the same time period will eventually get burned out. As soon as possible, add staff or reassign work loads or priorities. If the overworked employee knows that the supervisor is actively working to normalize the workload, they are much more likely to cooperate.

In industries where work loads often vary, many successful companies create built in extra capacity when hiring workers and purchasing equipment. Much of the time the workgroup will work at 80%-90% capacity, but when the workload increases, the extra work can be absorbed and accomplished in a timely manner.

Components of a DOT Drug and Alcohol Testing Program

49 CFR part 382 and part 40, stipulates what employers must do to be in compliance with the Department of Transportation's Substance Abuse Testing program. Employers are required to have all the components in working order when the inspector pays them a visit. Missing even one part can mean a "fail" on the inspection, and even fines.

Required components of a D.O.T. Drug testing program are:

• Each employer is required to have a published Substance Abuse Testing Policy.
  
• Employers must test drivers for drugs in the following six categories; preemployment, random, reasonable suspicion, post accident, return-to-duty and follow-up.
  
• Employers must test drivers for alcohol in the following five categories; random, reasonable suspicion, post accident, return-to-duty and follow-up.
  
• Employers must provide to their drivers, information about the DOT testing requirements. The DOT is specific about the information that must be provided (§382.601). 
  
• Employers must provide one hour of training for each of their supervisors in the signs of substance abuse and one hour of training for each of their supervisors in signs of alcohol abuse.
  
• Employers are required to provide a list of Substance Abuse Professionals to any driver that tests positive for drugs or alcohol.
  
• Employers are responsible for having in their files, results of drug tests as well as quarterly and annual reports of drug testing statistics.
  

Employers regulated by the Department of Transportation should be familiar with the requirements listed. Information can be found here: What Employers Need To Know About DOT Drug and Alcohol Testing

Rapid Drug Screens - One weapon against employee drug abuse

"Instant Drug Tests" or "Rapid Screen Tests" can be a useful weapon in the drug testing arsenal, but employers should be very careful when using them. There are good reasons for doing quick tests, but there are also important safeguards that employers must take to safeguard the rights of their employees and to protect themselves from legal challenges.

First of all, it is important to know that the Department of Transportation does not authorize the use of any kind of rapid or instant test. Any drug testing completed for the D.O.T. MUST be done using a government certified laboratory. The D.O.T. requires that all screening tests that are not negative, be followed by a test with higher level of accuracy, such as a Gas Chromatograph / Mass Spectroscopic test (GC/MS).

In fact, ALL screening tests should be followed by a confirmation test, including rapid or instant tests. Here's why; rapid testing is less accurate than a lab screening test in verifying positive test results. Also, these types of tests are less foolproof than laboratory testing. Thirdly, courts are much more likely to consider as evidence, a drug test result signed by a certified laboratory scientist; instant drug test results are not.

Rapid Drug Screens are great for verifying that a person has not used illegal drugs in the past 48 - 72 hours. Their accuracy in confirming negative tests is excellent. They are convenient because in just about ten minutes, an employer can know if the donor is drug free. They can feel confident that the employee they are putting to work is not impaired.

What Happens When an Employer Receives a Dilute Specimen Drug Test Report?

Dilute Specimen Drug Test Results

For Department of Transportation (DOT) regulated drug testing, if an employer receives a "dilute specimen" test result, action may be required. If the specimen reported as dilute is a positive test result, it is treated just like any other positive drug test.

If the specimen is reported as negative and dilute, the employer may, but is not required to, direct the employee to take another test immediately. Such recollections must not be collected under direct observation, unless there is another basis for use of direct observation.

The employer must treat all employees the same for this purpose. For example, employers may not retest some employees and not others. Different policies may however be established for different types of tests (e.g., conduct retests in preemployment test situations, but not in random test situations). Employers must inform employees in advance of decisions on these matters (usually by including this in the drug testing policy).

If the employer direct the employee to take another test, the result of the second test, not that of the original test, becomes the test of record (the first result is disregarded). If the second test is also negative and dilute, the result of that test still stands; there is no third retest. If the employee refuses to take the second test, this is considered a refusal to test under the regulations.