Announcement: New office hours

Starting March 6, 2017 Nationwide Medical Review will observe new office hours:

Monday through Friday:  8am – 7pm EST

Saturday:  9am – 12pm EST


HISTORY:

Federally legislated drug testing is a relatively NEW phenomenon in our history. Drug testing legislation can be traced back about 25 years — and was always “CATASTROPHE DRIVEN.” The recent breakthroughs in legislation are more PRO-ACTIVE with philosophy emphasizing DETERRENCE and NOT DETECTION! DFW professionals should be familiar with the “highlights” as follows:

KEY LEGISLATION:

DRUG-FREE-WORKPLACE ACT …1988 (President Reagan)
Citation: HR-5210-124 Section 5152 (1988)
This act laid the groundwork for the current regulations (49-CFR-40) for most of the workplace drug-testing regulations and procedures currently in force.

OMNIBUS TRANSPORTATION EMPLOYEE TESTING ACT OF 1991 (President Bush)
This Act codified as law the previous Department of Transportation (DOT) regulations (49 CFR Part 40) requiring drug testing of safety-sensitive employees in the transportation industry and, among other things, added alcohol to the list of drugs to be tested for!

[Click here for a well done short summary of these DOT rules]
http://www.drugs.indiana.edu/druginfo/dotrules.html
COMPLETE FEDERAL DRUG & ALCOHOL REGULATIONS:

http://www.occenvmed.net/dot
[Note: Driver Fitness regulations are also posted at this site!]
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KEY REGULATIONS: 


49 CFR Part 40
Covers the entire domain of safety & fitness for duty in the transportation industry!

49 CFR Section 382
Covers (in greater detail) the domain of workplace drug & alcohol testing for D.O.T.!

These regulations are posted at http://www.occenvmed.net/dot
RESULTS OF THIS LEGISLATION:

DRUG TESTING IS NOW A MAJOR INDUSTRY IN THE U.S.A.
40 million (or more) American workers will be tested for drugs in 1997.WHO MUST COMPLY?

ALL MILITARY AND SAFETY SENSITIVE GOVERNMENT EMPLOYEES
ALL EMPLOYERS IN THE TRANSPORTATION INDUSTRY
ANYONE HAVING GOVERNMENT CONTRACTS OVER $25,000 PER YEAR.
IMPORTANT EXAMPLES ARE: INDUSTRY: # OF EMPLOYEES: Safety-Sensitive Employees:
Aviation (FAA) 340,000 Flight crew, Attendants, Instructors, Dispatchers, Air Traffic Controllers Maintenance, et. al.

CMV (FWHA) 6,600,000 All CDL holders (Drivers)

Railroad (FRA) 80,000 Hours of Service Act employees, Engine train & signal services, dispatchers.

Mass Transit (FTA) 200,000 Vehicle operators, controllers, mechanics, & Armed security personnel

Pipeline (RSPA) 120,000 Operations, maintenance & Emergency-response personnel

Maritime (USCG) 120,000 Crewmembers operating a commercial vessel

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WHAT IS REQUIRED FOR DRUG-FREE WORKPLACE PROGRAM? 


By mandate, each program must include 5 elements:
There are also 5 “agents” in every drug testing sequence. This mnemonic of “5’s” is the inspiration for our pentagon logo.

By mandate, each program must include 5 elements:

Formal written policy
2 E.A.P. (the transportation industry currently exempt from this requirement)
Training for supervisors
Employee Education
5 Drug Testing
THE PLAYERS IN THE DRUG TESTING “GAME” ARE AS FOLLOWS:
Five “every-time” players:
The employer.
The donor.
The specimen collection site.
The laboratory.
The M.R.O.
Two “sometimes” players:
The Substance Abuse Professional (SAP)
The Consortium/T.P.A. (Third Party Administrator)
TESTING MUST BE CARRIED OUT FOR:
5 SUBSTANCES:
Marijuana, Cocaine, Amphetamines, Opiates, PCP.
This battery of 5 substances (or tests) is referred to collectively as the “NIDA-5” …..and more recently, as the “SAMHSA-5.”
5 SITUATIONS:
Pre-employment, Random, Post-Accident, Probable-Cause, and Return-to-duty/Follow-up!
Memorize these 5 — but be aware of “other” occasions for testing.

ADDITIONAL SUBSTANCES MAY BE TESTED FOR:
FOR POST ACCIDENT, REASONABLE SUSPICION, — even RTD or follow-up.
(This is at employer’s discretion — but requires the following:)
Must be defined in Company DFW Policy!
Employees must be notified via Employee “Drug Policy” document.
Requires “PARALLEL COLLECTIONS” — (NOT just a split specimen; but a SEPARATE urination just for the additional tests.)
Requires a separate C.O.C. form. [Robert Ashby, Atty for D.O.T.]
Procedure would be:
A. The usual “standard” split specimen N.I.D.A.-5 collection using the usual C.O.C. form.
B. Before leaving collection site, donor is requested to void a second specimen which is sent in using a separate C.O.C. form requesting the additional tests as per the employer’s policy.
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ALCOHOL TESTING IS NOW MANDATED: 

(by 1994 amendments to Part 40)
These are separate regulations (NOT requiring MRO)
[Click here to review the section on alcohol testing.]

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LAB CERTIFICATION (BY DHHS) IS MANDATED: 


CURRENTLY OVER 80 CERTIFIED LABS THROUGHOUT U.S.
List is published regularly in the Federal Register.
View recent list of approved labs at http://www.workplace.samhsa.gov/DrugTesting/Level_1_Pages/CertifiedLabs.aspx

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COLLECTION STANDARDS/PROCEDURES ARE MANDATED: 


CHAIN OF CUSTODY PROCEDURE IS MANDATED:
Universal Chain of Custody form became effective January 1995!
[Click here to review the section on collections and chain of custody]

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M.R.O. FUNCTION IS DEFINED: 


[Click here to review definition and rules governing MRO]
[Click here to review the VERIFICATION process which is main function of MRO]

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RANDOM TESTING IS MANDATED: 


FOR “NIDA-5” DRUGS

DOT adjusts Random Rates annually based on the annual MIS reports required of employers each March 15. New rates take effect on January 15. 1998 DOT RANDOM TEST RATES — AS OF 1/15/98
Operating Administration % Random Rate for Drugs % Random Rate for Alcohol
Federal Aviation Administration 25 10
Federal Highway Administration 50 10
Federal Railroad Administration 25 25
Federal Transit Administration 50 10
Research/Special Programs Adm. 50 N/A
U.S. Coast Guard 50 N/A
[Abstracted from MRO Update, September 1998]

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ANNUAL M.I.S. REPORT IS MANDATED: 


Must summarize employers drug testing results giving total number of tests, numbers of positive tests AND FOR WHICH SUBSTANCE! Because of this reporting requirement, employers may be told substance for which donor is positive, BUT EMPLOYER MAY NOT BE GIVEN QUANTITATIVE RESULTS!

Note that the “random rates adjustments” (see under RANDOM above) will be based ONLY on the industry-wide results of RANDOM tests. Pre-employment, Post-Accident, Reasonable-Suspicion, and RTD/Follow-up data will not be included.

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Quality Control (via BLIND SAMPLES) IS MANDATED: 


“BLIND” QC SAMPLES:

DOT regulations require employers to submit three “blind” samples for every 100 employee samples, up to a maximum of 100 blinds per quarter. Consortia are also subject to the 3% rule.
With fewer than 2,000 employees, specimens can be collected from “presumptive Negative” non-covered employees.
Over 2,000, the samples must be from a vendor of certified negative and positive samples.
“Full service” vendors do all the work: rig fictitious C.O.C. forms, mail specimens etc.
VENDORS OF “BLIND” QC SAMPLES:
SAMHSA PUBLISHES LIST available by request @ (301) 443-6014 (Dr. Vogel)

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SPLIT SPECIMENS ARE MANDATED: 


ALL EMPLOYEES REGULATED BY DOT MUST SUBMIT “SPLIT SPECIMENS”
Bottle A is property of employer — Bottle B is property of donor!

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TRAINING & EDUCATION IS MANDATED: 


FOR EMPLOYEES: [382.601 (b)]
[J.J.Keller booklet M4132-0085 assures compliance & is well written. All DFW Professionals should read!]
Order at http://www.jjkeller.com [ask for free samples!]

Personnel file must contain signed affidavit that employee has received this training and complied with 382.601.
[Click here to see a suggested sample]

FOR SUPERVISORS: [382.603]
One hour annual training on drug abuse PLUS one hour annually on alcohol!
2 excellent videos which comply w/ this reg can also be ordered at JJ Keller @ above address

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PHILOSOPHY BEHIND THE WHOLE DFW PROGRAM:

The entire thrust and philosophy is DETERRENCE and NOT DETECTION!
No matter who pays us, the primary role of the physician is that of ADVOCATE for the donor and for the integrity of the total system The employee always gets the benefit of the doubt and the benefit of the MRO’s advocacy.

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TWO TYPES OF TESTING:

“REGULATED:”

This refers to employers in the transportation industry and other industries under D.O.T. jurisdiction, Safety sensitive Federal employees, and employers with Federal contracts of over $25K/yr. They are regulated strictly by the details of 49-CFR-Part 40 and 49-CFR-Section 382.

“NON REGULATED:”

This refers to private sector employers who are not required by law to have a DWF program; but who decide to do so volunatarily. The term “unregulated” also carrries the meaning that an MRO is not required and that the employer is not subject to inspection by any federal agency. It is felt prudent for unregulated employees to use MRO service even though not mandated.

Use of MRO’s by non regulated Employers rose from 48% in 1994 to 76% in 1995.
[MRO UPDATE: June, 1996]

REGULATED AND NON-REGULATED PROGRAMS ARE BOTH SUPPORTED BY N.I.D.A./S.A.M.H.S.A. Including the “hot line.

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FEDERAL AGENCIES PROMINENT IN THE DRUG FREE WORKPLACE SYSTEM:

[This set of “browsing” links is presented only for the sake of completeness. It is not recommended as a good set of links for a DFW professional to use for study or updating. The best system of links for learning and reviewing the DFW business is the DFW homepage and its reticular system of links within the text itself.]

DHHS – Department of Health and Human Services
SAMHSA – substance Abuse and Mental Health Services Administration
NLCP – National Laboratory Certification Program
NIH – National Institutes of Health
NIDA – National Institute on Drug Abuse
DOD – Department of Defense
DOE – Department of Energy
DOT – Department of Transportation
FAA – Federal Aviation Administration
FHWA – Federal Highway Administration
FRA – Federal Railroad Administration
RSPA – Research and Special Programs Administration (Pipelines)
FTA – Federal Transit Administraton (mass transit)
NHTSA – National Highway Traffic Safety Administration
USCG – U.S. Coast Guard
OTHER ABBREVIATIONS
NRC – Nuclear Regulatory Commission
MRO – Medical Review Officer
BAT – Breath Alcohol Technician
SST – Saliva Screening Technician
SAP – Substance Abuse Professional
BAT – Breath Alcohol Technician

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