For the first time, beginning January 1, 2018, truck drivers taking random pre-employment and post-accident drug tests will be screened for four additional highly-addictive opioid drugs. While indications are that most of the private drug-testing labs are ready to conduct the additional mandated tests, the new rule will likely slow down the process for medical review officers to screen an increasing number of positive test results, according to Quest Diagnostics Inc., a leading U.S. drug test provider.
Testing for hydrocodone, hydromorphone, oxymorphone and oxycodone could result in drivers – even with prescriptions for the pain killers – failing their tests, and those positive test results being referred to a medical review officer (MRO) to determine if a driver should be allowed to drive. The primary responsibility of an MRO is to verify if an employee has an alternative medical explanation for a lab-confirmed positive test result. A lab sends all test results, positive or negative, to an MRO. With this new rule in place, NTA fully expects to see a sharp increase in positive results.
Right now, if someone gets dinged as positive, an MRO must review it, and if the MRO finds that the person had a legitimate prescription under the controlled substance act, then it will most likely be marked negative. This is known as a false positive. But, someone who has a valid prescription for one of these drugs may be able to pass a DOT test, but may still not be considered medically-certified to drive by the MRO. Opiates are very potent drugs, and some of them have addiction qualities like heroin – they can be very dangerous. The FMCSA, as an industry, is focused on preventing these drugs from being used by drivers.
The DOT final rule, announced November 9, will continue to make MROs the ultimate decision-makers of whether a driver, with or without a legal opioid prescription, is fit to drive. If the driver with a prescription for an opioid passes the drug test, but still is not deemed fit to drive, the MRO can forward a “safety concern” letter to the driver’s employer, but only after a five-day waiting period. The waiting period would allow the driver’s physician to further discuss the matter with the MRO.
During the comment period for the proposed rule earlier this year, many were concerned that the added tests would increase the likelihood of drivers legally using opioids for pain management being unfairly treated as drug abusers, which could harm their careers. In response, DOT said it added language in the final rule to prohibit an MRO from denying a legitimate explanation based on whether the officer thinks the doctor should not have prescribed the medication. Yet, the agency also said in its final rule that it’s important to note that when there is a valid concern about whether the driver can continue performing safely, the doctor may still be asked to reconsider prescribing the medication. The MRO can also still forward a safety concern letter to the driver’s employer, even if the prescription was deemed legitimate.
The odds of failing an opioid test with a valid prescription are “very dependent” on the pattern of use, dosage, frequency of use and an individual’s metabolism. The detection window for the new opioid tests is shorter than for many other drugs. Generally, most drugs on the (opioid) urine screen will be able to detect usage within the last 72 hours. Opioids are sedating and may cause decreased reaction time and increase sleepiness. But, some drivers may actually be more effective in carrying out their duties if they are not debilitated by pain. So, it’s somewhat of a balancing act, in trying to ensure that the driver is being treated for their pain, but not in a way that might impact negatively their ability to operate their vehicle in a safe manner.
Switching gears to another controversial drug, most states now have some form of legalized medical marijuana. While some patients can now try this experimental drug, it’s employers who will be the real lab rats. Ever since Nancy Reagan started telling kids to “Just Say No” to drugs, employers have been doing the same, as zero tolerance policies have become the norm. There are some cases working their way through the courts that seek to give the protections of the Americans with Disabilities Act (ADA) to medical marijuana users, but nothing has changed yet.
It is essential for employers to know that, at least for now, marijuana is still illegal on the federal level. That means you are perfectly within your right to demand a drug-free workplace. The fact that marijuana is now going to be prescribed by physicians raises a lot of questions for employers. If an applicant or employee has a prescription, should the drug be considered a medication? And, should patients using it be protected?
You might be asking yourself, “What is the harm in that? Why shouldn’t medical marijuana users be treated the same as people with other disabilities?” To answer that question, there are a few things you need to know about this “new” wonder drug.
Medical marijuana is the ONLY drug on the market that has skipped all FDA testing and approval processes. Pharmaceutical companies spend millions to ensure their products are safe and effective. Every drug you buy – whether over-the-counter or by prescription – has gone through rigorous safety and quality testing. When you take a medication, it is clearly labeled. You know exactly how much active ingredient it contains, and if you take the time to read the label, you can even find out what fillers are used.
Appropriate dosing is also included in the instructions for every prescription or over-the-counter medication. This ensures the side effects of the medication do not outweigh the benefits. Medical marijuana has no standard dosing instructions, so you don’t know what you are getting. Because of this lack of testing and standards, every plant, oil, and edible could have a different amount of cannabinoids that seem to relieve disease symptoms. In addition, the marijuana today is very different from years ago. THC, the psychoactive chemical in marijuana, is now three times stronger than 20-30 years ago. Conversely, cannabidiol (CBD), the non-intoxicating element that shows anti-psychotic and therapeutic value, has decreased almost at the same rate.
According to a study conducted by Johns Hopkins University School of Medicine, only 17% of the packaged edibles they studied were accurately labeled. A study by the University of California, Davis Cancer Center found that most of the medical marijuana samples they looked at were contaminated with dangerous bacteria and fungi. Part of the problem is that marijuana is still categorized as a Schedule I substance, which means there are many restrictions and that scientists have not been able to conduct much rigorous research. But, the National Academies of Sciences, Engineering and Medicine looked at more than 10,000 studies that were conducted and found no solid, conclusive evidence that marijuana is safe to be used as a medication. Time will tell. Stay tuned!