Category: Drug-Free Workplace

Fentanyl – What the Employer Needs to Know

Posted by on in Drug-Free Workplace, Medical Review Office, Workplace Drug Testing

By now, most employers are aware of the Opioid Epidemic. But are they aware of another dangerous epidemic that is growing? Fentanyl- a potent opioid has been steadily on the rise. And even more disturbing, is the combination of Fentanyl and Cocaine, and the combination of Fentanyl and Heroin. The City of Baltimore, a city heavily affected by the opioid epidemic, recognizes that most of the heroin on the street is now almost always laced with the highly dangerous synthetic opioid fentanyl, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

Public Health Challenges

A recent study highlighted some public health challenges caused by fentanyl-adulterated cocaine:

  1. First responders and those present at the scene of a cocaine overdose may consider administering Naloxone even if the patient denied using opioids.
  2. Fentanyl is very dangerous and powerful and dramatically increases the risk of lethal overdose.
  3. Opioid-naïve individuals that have been using fentanyl-free cocaine lack a potentially life-saving tolerance for opioids. Adding fentanyl to their drug of choice puts this group at an even higher risk of fatal overdose.
  4. Opioid-naïve cocaine users are typically not targeted by current harm reduction strategies and public messages concerning opioid overdose. A lack of education and access to critical resources, including naloxone —the lifesaving overdose reversal drug— render this population more vulnerable to a fatal overdose.

What Steps Can the Employer Take?

Consider adding Fentanyl to your current non-DOT testing program. But even more important is educating your management team and employees on the dangers of substance abuse. An effective substance abuse policy paired with employee education will not only enhance your testing program but may save a life.

Citation

*Nolan, M. L., Shamasunder, S., Colon-Berezin, C., Kunins, H. V., & Paone, D. (2019). Increased presence of fentanyl in cocaine-involved fatal overdoses: implications for prevention. Journal of Urban Health, 1-6.

What Happens to a Specimen after Collection?

Posted by on in Drug-Free Workplace, Medical Review Office, Non-DOT Drug Testing, USDOT Drug Testing, Workplace Drug Testing

What happens to a specimen immediately after it is collected?

1. From the point of collection, the specimen is packaged & sent to the laboratory via carrier or FedEx.

2. Specimens are processed in a strategic fashion by the certified laboratory. Once the specimen arrives at the lab, the specimen and the accompanying COC are unpackaged. The COC and the specimen vials are scanned at multiple points in each process for record keeping & also to guarantee accuracy.

3.The specimen is divided into equal parts for the testing process & the first immunoassay test is conducted. If the preliminary finding suggests that the specimen is positive, it is sent to another part of the lab for GC/MS confirmation testing. Another primary reason for dividing the specimen is to also reserve a portion in the event that a split specimen test is requested by the donor.

4. The specimen is then tested via the GCMS or Gas Chromatography/Mass Spectrometry. Gas chromatography-mass spectrometry (GC-MS) combines the features or gas-liquid chromatography (GC) and mass spectrometry (MS) & makes it possible to identify different substances within the sample. Initial (immunoassay) and confirmatory (gas chromatography-mass spectrometry [GS-MS]) tests are the methods most frequently utilized for drug tests. Implementing these tests allows a high level of sensitivity and specificity. The approach also reduces the chance for false positives or false negatives greatly.

5. The exact findings of the screening test are confirmed and the laboratory generates an official report to record their findings. The report will include the specific test performed, the panels or drugs that the specimen was tested for, and the final verdict for each panel (positive, negative, or a cancelled specimen as a whole). Positive results will also feature the appropriate quantitative level for the verified substances and corresponding panels listed.

6. Normal negative results are reported immediately by the applicable reporting arrangements determined by the lab account profile.

7. If a result is positive, it is sent to the MRO or Medical Review Office for a final review. Multiple attempts are made to contact the donor in an effort to obtain a valid medical explanation. Quality and accuracy are of utmost importance to NTA, Inc. as the valid medical explanation is determined. Since drug tests are based on the detection of drug metabolites, it is of primary importance that the correct medication causing the positive is identified. In short, the goal of the Medical Review process and steps is to verify that the prescription serving as the contributing factor was legally prescribed to the donor prior to the drug test collection date. The Medical Review Officer or Medical Review Assistants attempt to contact the donor adhering to a high-level of procedural standards and practices based on the type of test being processed, for example;

7a. DOT Results are processed in accordance of DOT Regulations and federal guidelines and with respect to the Medical Review Officer’s responsibility.
7b. NON-DOT Results are processed according to NON-DOT procedures and are generally processed by our highly-qualified Medical Review Office Assistant Staff.

8. If the laboratory determines that a result is cancelled, the MRO Office will review the result and attempt to make contact with the donor as outlined above. A cancelled result can be attributed to a multitude of scenarios and findings. Examples of Cancelled Result causes or contributing factors include fatal flaw detection or rejection, abnormal PH, immunoassay interference, or abnormal creatinine level.

9. Once the full medical review process has concluded, the result is reported to the client as a verified result, negative result, or cancelled result.

  •          Normal Negative tests are usually reported within 24-48 hours from the time they enter the laboratory for analysis.
  •          Positive or Cancelled tests are usually reported from the laboratory within 5-7 business days from the time they are received for processing.

NTA, Inc. has one of the best Medical Review Offices in the country and we guarantee that diligent care is taken for each result that we review and process!

Marijuana In The Workplace

Posted by on in Drug-Free Workplace, Medical Review Office, Workplace Drug Testing

THC in marijuana is linked to adverse changes in appearance, behavior, and job performance. The use of marijuana in the workplace is a safety risk. Marijuana use affects depth perception, reaction time, coordination, and other motor skills. Some studies say that 1 to 2 joints will decrease motor skills by as much as 70%.

According to a study reported by the National Institute on Drug Abuse, employees who tested positive for Marijuana were associated with 55% more industrial accidents, 85% more injuries, and a 75% higher absenteeism rate than those who tested negative. Employees using marijuana contribute to decreased productivity, increased worker compensation and unemployment compensation claims, high turnover, and lawsuits. Some studies put the cost of employees who abuse drugs at $7,000 per employee per year and this does not include unemployment claims or legal action.

It is important to remember that, according to federal law, marijuana is still illegal. The DEA  continues to classify marijuana as a Schedule I drug, which means that it has no accepted medical use and a high potential for abuse. Federal law supersedes state law. Employers must decide how they want to position themselves as an organization. A robust workplace drug policy can go a long way in keeping your organization safe and drug-free.

Studies show drug testing works; employees are three times less likely to produce a positive test result if they know they will be tested. Drug testing is primarily a deterrent; if you choose to implement a drug testing program, you will need a substance abuse policy. A substance abuse policy should consist of:

  • Proper management training that encourages managers to enforce the policy
  • Access to support for employees with drug problems, which can range from a formal assistance program to a referral to local resource
  • Clearly defined use and possession parameters for employees
  • Established rules for post-accident testing
  • Rules on how you will handle an employee’s conviction or arrest.

Your drug policy must be very specific and supported by workplace procedures to reduce the chance of litigation. Drug policy and workplace procedures should be reviewed by a lawyer to ensure they comply with state laws. And, policies must be updated frequently to keep up with changing laws and attitudes. The health and safety of your workforce depend on it!

If you would like our help in creating a workplace policy, give us a call at 1.800.452.0030, ext. 0!

Have you thought about oral fluid testing?

Posted by on in Drug-Free Workplace, Non-DOT Drug Testing, Workplace Drug Testing

Would oral fluid testing work in your workplace? For 30 years, the most widely used testing method has been urine drug testing. Why should you look at oral testing instead? Oral fluid testing detects recent drug use and may also identify current usage that may not be captured by urine testing. While oral Fluid has a shorter detection window depending on the drug/metabolite and usage pattern, recent research has shown that oral screening has a higher positivity rate for almost all drugs.

What are some advantages of oral fluid testing? The industry sees oral fluid drug testing as a reliable testing method. The collection process is always directly observed, which helps reduce the opportunity for a donor to adulterate or tamper with their specimen. Both the urine and oral fluid testing can include specimen validity testing, which tells the laboratory if the sample is “human saliva” or “human urine.” The turnaround time is often quicker; most normal negative oral fluid tests will result back to the client the same day that the lab receives them.

Currently, oral fluid drug testing can only be used by Non-DOT workplaces. However, it is being reviewed as a potentially viable alternative to urine for employees regulated by the Department of Transportation. If you are interested in looking into oral fluid testing, give our office a call! 1.800.452.0030