Roadside Drug Testing Approaches
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Medical Review Officer Manual
Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention Medical Review Officer Manual for Federal Agency Workplace Drug Testing Programs EFFECTIVE OCTOBER 1, 2010 Note: This manual applies to Federal agency drug testing programs that come under Executive Order 12564 dated September 15, 1986, section 503 of Public Law 100-71, 5 U.S.C. section 7301 note dated July 11, 1987, and the Department of Health and Human Services Mandatory Guidelines for Federal Workplace Drug Testing Programs (73 FR 71858) dated November 25, 2008 (effective October 1, 2010). This manual does not apply to specimens submitted for testing under U.S. Department of Transportation (DOT) Procedures for Transportation Workplace Drug and Alcohol Testing Programs (49 CFR Part 40). The current version of this manual and other information including MRO Case Studies are available on the Drug Testing page under Medical Review Officer (MRO) Resources on the SAMHSA website: http://www.workplace.samhsa.gov Previous Versions of this Manual are Obsolete 3 Table of Contents Chapter 1. The Medical Review Officer (MRO)........................................................................... 6 Chapter 2. The Federal Drug Testing Custody and Control Form ................................................ 7 Chapter 3. Urine Drug Testing ...................................................................................................... 9 A. Federal Workplace Drug Testing Overview.................................................................. -
Quantitative Drug Test Menu Section 2
1 Guthrie Square, Sayre, PA 18840 Bill To: Client GMG Toxicology Laboratory Requisition Toll Free Phone (844) 617-4719 Insurance Request Date: _____/______/______ Medical Director: Hani Hojjati, MD Fax (570) 887-4729 Patient PATIENT INFORMATION (PLEASE PRINT IN BLACK INK) INSURANCE BILLING INFORMATION (PLEASE PRINT IN BLACK INK) Pt Last Name First M I PRIMARY Medicare Medicaid Other Ins. Self Spouse Child __ Subscriber Last Name First M Address Birth Date Sex M F Beneficiary/Member # Group # City Pt. SS# or MRN Claims Name and Address City ST ZIP ST ZIP Home Phone (Attach a copy of the patient's insurance card and information) SECONDARY Medicare Medicaid Other Ins. Self Spouse Child Employer Work Phone Subscriber Last Name First M Work Address City ST ZIP Beneficiary/Member # Group # __ CLIENT INFORMATION - REFERRING PHYSICIAN Claims Name and Address City ST ZIP Client Address: (Atttach a copy of the patient's insurance card and information) COLLECTION / REPORTING INFORMATION Copy to: FAX Results to __ CALL Results to Phone: Fax: Date Collected: Time Collected: AM PM Specimen Type: Urine Saliva Other ___________________ Physician Signature (legible - No Stamp) For Lab Use Only (Required for Medicare & Medicaid patient orders) Signed ABN Obtained Place Lab Label Here Contact Laboratory Medical Director (570-887-4719) with questions concerning medical necessity PHYSICIAN When ordering tests, the physician is required to make an independent medical necessity decision with regard to each test thelaboratory will bill. The physician also understands he or she is required NOTICE to (1) submit ICD-10 diagnosis supported in the patient's medical record as documentation of the medical necessity or (2) explain and have the patient sign an ABN. -
Substance Abuse in the Workplace Policy
Substance Abuse in the Workplace Policy Rexnord (herein referred to as “Rexnord” or the “Company”) has a strong commitment to its employees to provide a safe work environment and to promote high standards of employee performance. Consistent with the spirit and intent of this commitment, the Company has established a policy regarding substance abuse in the workplace. Further, the Company is committed to maintaining a drug-free workplace as required by “The Drug-Free Workplace Act of 1988.” Therefore, compliance with this Policy is a condition of continued employment with Rexnord. I. PURPOSE To outline the procedures to be followed by each location in order to ensure that the safety and performance of employees is not impaired by alcohol, illegal drugs or other substances. II. APPLICABILITY This policy shall apply to all employees (full-time, part-time, exempt, and non-exempt employees) as well as to all applicants who have received a conditional offer of employment. Personnel who perform their services on Company property or on a third party’s property at the request of the Company (e.g., a Company customer site), as provided under a contract either directly with the Company or through the services of an outside firm, are required to abide by this policy. It is the responsibility of the contracting firm (at its cost and expense) to ensure that its personnel are tested in conformance with this policy prior to working at / on behalf of Rexnord. III. SUBSTANCE ABUSE It is the Company’s policy that the following is prohibited and will result in discipline up to and including termination: A. -
Drug & Alcohol Testing Be a Driver in the Know
Controlled Substances Consequences FEDERAL The regulations require 5-panel testing for the 3 A positive test result or a following classes of substances: refusal requires the driver to be immediately removed from Drug & Marijuana n operating any CMV on public n Cocaine roadways. The employer must provide you with a list of Alcohol n Opiates — opium and acceptable SAPs from which to codeine derivatives choose to begin the “return-to- ” n Amphetamines and duty process. This process must Testing meth amphetamines be completed before a positive or REGULATIONS refusal driver can legally return to n Phencyclidine — PCP driving CMVs for any employer, including himself. For more information, visit www.usdoj.gov/dea/concern 3 The impact of testing positive or refusing to test can be devastating for a driver and his family. It often results in extended periods of unemployment, due to the time necessary to complete the “return-to-duty” process with a qualified SAP and the tendency of employers not to hire drivers with drug or alcohol histories. 3 Even after completing the “return- to-duty” process and finding employment, the additional return- to-duty and follow-up testing often adds increased stress and financial strain on the driver. For additional research and reading on the Federal Motor Carrier Safety Administration’s Drug and Be a Alcohol Testing Regulations, please visit our web site at: www.fmcsa.dot.gov/ Driver In rules-regulations/topics/drug/drug.htm the Know... FMCSA-E-06-003 Revised July 2010 The U.S. Department of Transportation (DOT) whenever they are involved in a fatal accident, or professional (SAP) drug and alcohol testing regulations for receive a traffic citation resulting from an injury or who signs the return- commercial driver licensed (CDL) employees are vehicle-disabling accident. -
Considerations for the Use of Saliva As Sample Material for COVID-19 Testing 3 May 2021
[Type here] ECDC TECHNICAL REPORT Considerations for the use of saliva as sample material for COVID-19 testing 3 May 2021 Key messages • Nasopharyngeal specimens remain the gold standard for COVID-19 testing for use with RT-PCR and rapid antigen diagnostic tests. • Studies on the performance of RT-PCR tests have variously reported both higher and lower sensitivity for saliva samples compared with nasopharyngeal swabs. However, meta-analyses of such studies suggest an overall similar or non-statistically significant lower sensitivity associated with the use of saliva samples. • The reported heterogeneity is likely to, in part, reflect differences in sampling techniques, sampling times and the type of population being tested, with evidence that RT-PCR tests with saliva as sample material show similar sensitivity to those using nasopharyngeal swabs for symptomatic patients, if the sample collection is performed within the first five days from onset of symptoms, and when the viral load is high. • Saliva sample collection is easy, non-invasive, more acceptable for repeat testing and can be performed by non-healthcare professionals or individuals themselves who are properly instructed. • Evidence supports the conclusion that saliva can be used as an alternative sample material for RT- PCR testing when nasopharyngeal swabs cannot be collected in the following scenarios: in symptomatic patients and for repeated screening of asymptomatic individuals. • Further clinical studies are warranted on the sensitivity of saliva as sample material for RT-PCR analysis for symptomatic and asymptomatic children, and to standardise the sampling collection methods. • Current limited evidence does not support the use of saliva as an alternative sample material for rapid antigen or antibody tests. -
Hormone Testing
Hormone Testing Saliva Testing The Nutrition and Health Center utilizes the leading salivary-based testing and research laboratory in the United States to measure hormones. This method is called Enzyme Linked Immunosorbent Assay; it measures “free fraction hormone levels,” giving more information than measuring “bound hormone levels.” The commonly used blood and serum hormone tests look only at the level of hormones that are present in a person’s tissues; this is known as “bound hormone levels.” Saliva testing has many advantages over blood testing including: • Saliva specimen collection does not require a blood draw and there are no risks to you • Saliva collections are convenient and can be done at work or at home • When stored properly, saliva samples are stable for several weeks • With an accuracy of 92-96%, saliva testing is more accurate than blood testing • The ability to collect more than one specimen which provides more information than a single collection • Compared to blood testing, saliva testing is also more affordable • Saliva testing looks at the “unbound hormone levels” also known as “free fraction hormone levels” which are the hormone levels that are available to be used by the body’s tissues. This gives a better idea of the levels of hormones that are actually influencing the tissues, rather than just the level of hormones that are present in the tissues Types of Saliva Tests There are various hormones in your body, so there are various corresponding saliva tests that can be administered. The tests that we use are the Female Hormone Panel™ (FHP™) test, Adrenal Stress Index™ (ASI), and the Flexi-Matrix Customized panel. -
Ncaa Drug Policies
MEDICAL EXCEPTIONS APPEALS The NCAA recognizes that some banned substances The NCAA drug-testing program allows an are used for legitimate medical purposes. According- institution to appeal a positive drug test on behalf ly, the NCAA allows exception to be made for those of a student-athlete who has tested positive or who student-athletes with a documented medical history violated NCAA drug-testing protocol. demonstrating the need for regular use of such a drug. Exceptions may be granted for substances • The institution must submit in writing the included in the following classes of banned drugs: grounds for the appeal and a summary of the stimulants (including those used to treat ADHD), institutional drug-education program. beta blockers, beta-2 agonists, diuretics, peptide • At least three members of the drug- hormones, anabolic agents and anti-estrogens. education and drug-testing subcommittee of the • Pre-approval is required for the use of peptide NCAA Committee on Competitive hormones or anabolic agents. The institution Safeguards and Medical Aspects of Sports must submit required documents to the NCAA (CSMAS) hear appeals. ([email protected]) prior to the student-athlete competing while using medications containing • Appeals are conducted by telephone these substances. conference. • For all other drug classes, the institution should • The director of athletics or designee and the maintain documents from the prescribing student-athlete must be on the appeal call. physician in the student-athlete’s medical record on campus that include the diagnosis, course of • The NCAA does not restrict the nature of the treatment and current prescription. appeal, that is to say that the NCAA will not restrict access for any reason to an institution that wishes • In the event that a student-athlete tests positive to appeal and has satisfied the appeal procedures. -
Frequently Asked Questions About Marijuana
Frequently Asked Questions Marijuana Q: What is marijuana? A: Marijuana is the product of the hemp plant, Cannabis sativa, containing the psychoactive chemical delta-9-tetrahydrocannabinol (THC) and other related compounds. Popular names/slang for the drug include weed, pot, or cannabis. Q: How do people use marijuana? A: Marijuana is typically smoked using rolled paper cigarettes (joints), pipes, water pipes (bongs), and vaporizers. However, the drug is also mixed into edibles and drinks and extracted into oils and waxes. Q: How does marijuana affect users? A: Marijuana use impacts the human body both physically and mentally. The “high” from the drug can include distorted senses, impaired judgment, lack of balance and coordination, increased appetite, elevated heart rate, and sometimes anxiety and panic. Q: How many people use marijuana? A: Below is the most current data estimating marijuana use. • The National Survey on Drug Use and Health (NSDUH) reports more than 26 million Americans aged 12 or older, or 9.6% of the total population, were current users of marijuana in 2017. • The World Drug Report 2019 estimates that there were 188 million global cannabis users in 2017. • Marijuana comprised the most common substance use disorder, impacting an estimated 4.1 million Americans in 2017, according to the NSDUH. Q: Can an employer drug test for marijuana? A: Yes. There are currently no restrictions (other than New York City which is expected to implement restrictions beginning in May 2020) limiting an employer’s ability to drug test for marijuana, although there may be limitations on permissible disciplinary action that an employer may take if an employee is using marijuana in accordance with that state’s marijuana laws. -
Fact Sheet: Drug Testing in the Criminal Justice System
DOJ/OJP logo, Adobe Illustrator, 11/89 T O EN F J TM U R ST A I U.S. Department of Justice P C E E D B O J C S F A V M F O Office of Justice Programs A I N C I J S R E BJ G O OJJ DP O F PR Bureau of Justice Statistics JUSTICE Drugs & Crime Data March 1992 Fact Sheet: Drug Testing in the Criminal Justice System As part of ongoing research the Drugs & tion hearings. Drug tests in prisons can that a positive immunoassay be retested Crime Data Center & Clearinghouse pre- also assist in monitoring drug use in cor- and confirmed, preferably by a different pared this fact sheet on drug testing in rectional facilities and by inmates during technique of equal or greater sensitivity, the criminal justice system. “Drug test- temporary absences from the institution. such as gas chromatography/mass ing” in this fact sheet refers to urinalysis, spectrometry.4 ● Identify persons in need of treatment. since that is the testing methodology Drug tests can identify drug users who Chromatography involves separating typically used throughout the criminal can be placed in treatment. Drug testing and identifying the components of a justice system. is also used to monitor persons undergo- specimen. GC/MS (gas chromatogra- ▲ ing drug treatment. phy/mass spectrometry) is considered to Who is tested? be “the most legally defensible” method ▲ Drug testing can take place in all stages Drug testing technology of urinalysis.5 GC/MS testing, however, of the criminal justice system: arrest, in is more expensive than immunoassay There are two primary methods of the pretrial phase, and during incarcera- testing (typically between $25 and $100 detecting drugs in the urine: immunoas- tion, probation, and parole. -
Adrenal & Male Hormone
ADRENAL & MALE HORMONE BLOOD SPOT Lifestyle, physical and psychological stresses put constant demands on the adrenal glands. If they get depleted adrenal fatigue or insufficiency may be experienced. Symptoms include fatigue, hypotension, and lowered resistance to stress, salt cravings, hypoglycaemia, and lowered immunity. Assessing cortisol, DHEA and other adrenal hormone levels may help to identify these patients and will assist effective therapy. The aging male experiences a decrease in testosterone at a rate of 10% per decade from the age of 30. This reduction of testosterone and other androgens experienced as a consequence of the aging process has been named andropause or androgen deficiency of the aging male (ADAM). Symptoms associated with ADAM can be associated with impaired 5α reductase or aromatase activity, enzymes responsible for conversion of testosterone to dihydrotestosterone (DHT) or estrogens. Diagnosing and treating androgen deficiency is vital for improving quality of life and reducing age-related health decline in the aging male population. This test provides a focused overview of the adrenal and male hormones: Salivary DHEAs and Cortisol, and Estradiol (E2), Testosterone, SHBG and PSA via blood spot. Stress, Hormones and Aging Lifestyle, physical and psychological pressure puts constant demands on the adrenal glands. Although they are designed to cope with stress, changing physiological functions to deal with the ‘fight or flight’, the adrenal glands suffer in today’s high stress society. Most individuals however who have depleted adrenal glands are not medical emergencies. They just go through life with fatigue, not knowing what is wrong with them. These people may be suffering from adrenal fatigue which is also known as hypoadrenia, subclinical hypoadrenia, subclinical adrenal exhaustion or adrenal insufficiency. -
Mandatory Drug and Alcohol Testing (MDAT) Frequently Asked Questions
Mandatory Drug and Alcohol Testing (MDAT) Frequently Asked Questions Why is drug and alcohol testing required? Individuals seeking employment in “safety-sensitive” positions shall be subject to drug testing. Per the Child and Youth, Safety and Health Omnibus Amendment Act of 2004 (D.C. Law 15-353, D.C. Official Code § 1-620.31 et seq.), a “safety- sensitive” position is defined as “employment in which the District employee has direct contact with children or youth; is entrusted with the direct care and custody of children or youth; and whose performance of his or her duties in the normal course of employment may affect the health, welfare, or safety of children or youth.” Who is subject to testing? All employees in school-based positions, both instructional and non-instructional, are subject to testing. Which substances does DCPS test for? The drug test is used to determine the presence of the following illegal drugs/controlled substances – marijuana, cocaine, opiates, amphetamines, and phencyclidine. Employees are also tested for the presence of alcohol. Are employees required to disclose to DCPS any prescription medications that they are taking? If the results are positive, you will receive a call from The Medical Review Officer (MRO). The MRO will contact you to determine whether there is a legitimate reason for the positive test, and that’s where you will present your prescription. The MRO will then contact the employee’s physician to verify the prescription. If you are currently registered in a medical marijuana program, please send that evidence to the DCPS Mandatory Drug and Alcohol Testing program at [email protected]. -
Hormone Testing Jim Paoletti, B.S
Hormone Testing Jim Paoletti, B.S. Pharmacy, FAARFM Establish the Need – Lab tests – Correlate patient assessment with testing results – Lab tests alone do not always tell the whole story – Lab values are guides to which direction therapy should be considered – Lab values should be used to “confirm the diagnosis” Testing Considerations • Limitations – Timing of cycle – No individual baseline in many cases – Lack of correlation of symptoms to levels – No consideration of influences on free hormone levels (such as SHBG) – Dosage form differences • Don’t rely on lab tests alone— Treat the patient, not the labs Testing Considerations • Are you comparing to the range of a person of the reported life stage or the range of the age you are attempting to replicate? – We don’t want menopausal levels in most cases Testing Considerations • When was the test done compared to the timing of the last dose? – Make sure patient is at steady state if possible • 8 -24 hrs post topical application • 4-8 hrs post oral dosing (SR capsules) • Be consistent with subsequent testing • Pay attention to changes in: • Site of application • Base • Volume applied Body Fluids Commonly Used for Testing Steroid Hormones • Serum/plasma • 24-hour urine • Saliva • Capillary blood (dried blood spot) Serum Testing Advantages • Wide range of hormones available • Familiar reference ranges • Many laboratories to choose from • Standard automated methods with appropriate proficiency testing • Insurance coverage Serum Testing Considerations • Established “gold standard” based on