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

* not updated past the 2001 rules changes *

    1. Urine test results, although useful for screening, GIVE NO USEFUL QUANTITATIVE INFORMATION This is because urinary excretion is dependent on too many variables: e.g. initial dose, rate of absorption, donor’s level of hydration and general health, and the time between the drug use and the collection.
    2. Urine test results give NO INFORMATION about HOW a substance got into the donor’s system!
    3. Urine test results give NO INFORMATION about HOW MUCH [what dose] of a substance the donor took.
    4. Urine test results give ONLY LIMITED INFORMATION ABOUT WHEN a donor might have taken the substance for which s/he is positive.
    5. Urine test results give NO INFORMATION ABOUT IMPAIRMENT.
    6. Urine test results give NO INFORMATION ABOUT ADDICTION.
    7. NEGATIVE TESTS do NOT mean that a donor is not abusing drugs!
    8. NEGATIVE TESTS also do NOT mean that a donor is not addicted! A negative test merely indicates that, at that biological moment, there was not enough of the tested substance in the urine to make the test positive!
    9. Cannabis, Methamphetamine, and Cocaine all have smokable forms. They are known as Marijuana, Ice, and Crack, respectively. Long and careful research has been done to set the “cutoffs” for these substances to ELIMINATE the second-hand or “passive” smoker. The claim of “second hand” or “passive” inhalation IS NOT A VALID CLAIM!
    10. The accuracy of the current confirmation studies makes it virtually impossible for over- the-counter medications to interfere with the test results!
    11. The exception to this rule is Vick’s inhaler which contains Levo-Methamphetamine and gives a FALSE POSITIVE test for Methamphetamine. The claim of Vick’s Inhaler can be substantiated in the lab by running “isomer” studies which will distinguish “Levo-met” from the Illegal Dextro-methamphetamine.
    12. Many prescription drugs can cause TRULY POSITIVE lab results… for virtually all substances except PCP, LSD, and “mushrooms.”
      Verifying the prescription results in EXCUSING THE DONOR!
    13. For example, Seligiline (used to treat Parkinson’s disease) gives a POSITIVE test for Methamphetamine!
      Verifying the prescription results in EXCUSING THE DONOR!
    14. The metabolite called 6-AM (6-mono-acetyl-morphine) is SPECIFIC FOR HEROIN. As of 1998, regulations require labs to run a gc/ms assay for 6-AM whenever a Morphine level is above 2,000 ng/ml.
    15. Poppy seeds CAN AND DO cause occasional positive opiate results……. but THERE IS VERY LITTLE CODEINE IN POPPY SEEDS!
      A morphine/codeine ratio of less than 2  [M/C<2] indicates use of codeine from a source other than poppy seeds).
    16. Specific Gravity is a logarithmic scale and not linear!
      The change from 1.020 to 1.010 is a TEN-FOLD DILUTION, not two fold! A drug level of 100 at 1.020 would be only 10 at 1.010.
    17. A LOW SPECIFIC GRAVITY IS EXTREMELY IMPORTANT and suggests a FALSE NEGATIVE TEST!
    18. The “answer” to #21:   The Creatinine would be 3… and the Cocaine level would be 60
    19. None of the synthetic opiates [e.g.: Hydrocodone (Vicodin), Oxycodone (Percodan), Meperidine (Demerol), Hydromorphone (Dilaudid), or Methadone (Dolophine)] metabolize to morphine or to codeine and they are therefore not detected with current federal testing protocols.
    20. As a corollary to #18 above, it should not be necessary to remind MRO’s and other competent reviewers that the “claim” of a prescription for any of the above, (even if the claim is true and verified) does not excuse, explain, or resolve a laboratory finding of morphine and or codeine. In such a case, the claim is to be ignored and the verification process should proceed on the basis of the following fact: “THE OPIATES FOUND IN SUCH A SPECIMEN ARE STILL NOT EXPLAINED!”
    21. In Federally regulated testing, a positive result for opiates cannot be reported to an employer unless there is CLINICAL EVIDENCE of opiate abuse in addition to the positive laboratory findings. Although it is clear that an “admission” of unauthorized opiate use, or a positive result for 6-AM are both “clinical evidence,” the rules are vague beyond this. In general, it is the consensus of MRO’s that “clinical evidence” implies a face to face exam wherein unequivocal findings of needle tracks, altered mental status, or symptoms of opiate toxicity or withdrawl could be documented.
    22. When reviewing quantitative results for opiates, a Morphine/Codeine ratio of less than 2 is proof of codeine use from a source other than poppy seeds. With such a result [M/C < 2] the poppy seed claim is not actually “refuted,” but some other source of Codeine is unequivocally demonstrated!
    23. The Heroin for sale on today’s black market is amazingly pure… even “snortable.”   Although dealers will occasionally “cut” Heroin (which COULD involve mixing it with Codein) by and large, it is good to remember the general rule which will usually hold true:
      THERE IS NO CODEINE IN HEROIN (di-acetyl morphine)… nor does it metabolize to Codeine!
      If Codeine and Heroin are found in the same specimen, the Codeine is a “contaminant” or was ingested separately.   The urine of today’s Heroin user will contain a high level of morphine and (maybe) 6-AM in the morning.  It will be rare to see Codeine.
    24. Although a positive 6-AM is forensically valid proof of Heroin use, the converse is NOT TRUE…
      A NEGATIVE 6-AM DOES NOT RULE OUT HEROIN USE! 
      6-AM must be recognized as an extremely low-titre, volatile, and short lived metabolite of heroin. One is lucky to detect it even in the best of circumstances!