Medical Review Office – Page 3 – Nationwide Testing Association, Inc.

The Opioid Crisis: It’s Real & It’s Dangerous

Posted by Nationwide Testing Association, Inc.on September 12, 2019October 21, 2019in Medical Review Office

Experts say the United States is in the throes of an Opioid epidemic as more than two million Americans have become either dependent on or abused prescription pain pills and street drugs such as Heroin. People who become dependent on prescription painkillers, but cannot obtain them legally, often switch to heroin. They are seeking both the euphoric high associated with Opiates and pain relief.

Opioids are drugs formulated to replicate the pain-reducing properties of opium. They include both legal painkillers like Morphine, Oxycodone, or Hydrocodone prescribed by doctors for acute or chronic pain, as well as illegal drugs like Heroin or illicitly made Fentanyl. The word “Opioid” is derived from the word Opium. These drugs are potent respiratory depressants and can stop respiratory function when used with higher than normal dosages.

US history takes us back as far as the Civil War when medics used Morphine on the battlefield leaving many soldiers dependent when returning home. After that, Heroin emerged in 1898, being first produced commercially by Bayer for Morphine addiction. In 1914, Congress first addressed Opiate addiction by passing legislation requiring written prescriptions for all forms of Opiates.

Fast forward to 1980 when the New England Journal of Medicine published a letter purporting that narcotics were a safe treatment for chronic pain with a low risk of addiction if monitored closely. For 15 years, obtaining a prescription for painkillers was relatively easy. Refills weren’t normally a problem either. Then came 1995, when Oxycontin was produced and marketed aggressively as a safe, long-acting Opioid slowly released over 12 hours. This was advertised as a “break-through” for those suffering from chronic pain.

Almost 12 years later, in 2007, criminal charges were filed against Pharma, the manufacturer of Oxycontin, for false and misleading information on this powerful and addictive painkiller. Since then, a steady increase in Opiate addiction has resulted in new legislation and restrictions on prescription Opioids.

In 2015, there were 52,404 overdose deaths in the United States, including 33,091 (63.1%) that involved an Opioid. That’s an average of 91 Opioid overdose deaths each day. The number of Opioid prescriptions dispensed by doctors steadily increased from 112 million prescriptions in 1992 to a peak of 282 million in 2012, according to the market research firm, IMS Health. The number of prescriptions dispensed has since declined, falling to 236 million in 2016. On October 26, 2017, President Trump declared Opioid/Opiate Abuse a National Public Health Emergency. Across the country, many local law enforcement and EMTs carry Naloxone, which temporarily blocks or reverses the effects of an Opioid/Opiate overdose.

Where do we go from here? Education on the dangers of these powerful painkillers and careful monitoring by prescribing physicians is vital. Employers and families must recognize this is a real problem that cannot be ignored.

Marijuana In The Workplace

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!

Did A “Vicks Inhaler” Cause My Positive Test?

Posted by Nationwide Testing Association, Inc.on September 10, 2019October 21, 2019in Medical Review Office

When a drug screen comes back positive for methamphetamines, and you think it could be due to a “Vicks Inhaler,” it is essential to request a D & L isomers test. Methamphetamines have two isomers, D Methamphetamine, and L Methamphetamine. D Methamphetamine is a scheduled two controlled substance commonly known as “meth” or “speed.” Desoxyn, a prescription drug also contains D Methamphetamine.

The L methamphetamine is not a controlled substance. It is found in an over the counter medicine called a “Vicks Inhaler” or in the prescription drug, Selegiline. L Methamphetamine can be produced in the illegal production of street Methamphetamine. When a D & L Isomers test is completed, the medical review office will review the results. Urine containing 20% or more D Methamphetamine is consistent with exposure to the schedule 2 substance. If the sample contains less than 20% D Methamphetamine, then the positive could have been caused by the “Vicks Inhaler.”

Make sure you always have a medical review officer to review your results. Contact our office today if you have questions or would like to talk to us about MRO services! 1.800.452.0030

What is an adulterant and why is it important to test for them?

Posted by Nationwide Testing Association, Inc.on September 3, 2019October 21, 2019in Medical Review OfficeLeave a comment

Adulteration is the tampering of a urine specimen during collection in which the donor attempts to alter the final test result or outcome. Techniques for specimen tampering or altering are always evolving as individuals develop new and innovative ways to try and ‘cheat’ an impending drug test.

Examples of popular adulterants are:

•Classic or household adulterants such as bleach, salt, eye drops, lemon juice, vinegar, & peroxide.

•Commercial or store-bought adulterants which are frequently sold for purchase online and in certain specialty stores. Creators of adulterants being sold in the current market have created special additives consisting of formulas that will allegedly alter the outcome of the test result by generating a completely negative test result (false negative). The most frequent instructions and corresponding practices, although highly unethical, include the donor discretely transporting the additive product into the collection room and covertly pouring it into the specimen.

Adulterants act by either interfering with the composition of the specimen properties tested in the immunoassay portion of testing or by converting the target drugs to other compounds. Adulterant laboratory analysis measures the urinary characteristics such as creatinine, pH, and specific gravity for existing levels while the presence of nitrate and oxidant activity is also traced.

Adulterants work to change the properties of the specimen so that during the immunoassay portion of the analysis, a reaction will transpire and as a result, a false negative will be produced. Adulterant testing must be requested specifically as adulterants will not be detected unless this particular testing is implemented. When the specimen properties are out of normal range or when significant levels of nitrates or the presence of oxidant activity is found, the test may be canceled and reported to the Medical Review Office for thorough medical review. NTA, Inc. has a highly qualified Medical Review team that is highly experienced in handling this type of testing outcome and we are proud to offer this level of quality to our clients.

Due to scientific and technological advances, adulterated specimens are detected more often than not thanks to the more sophisticated and complex laboratory analysis’ that are being carried out. A 1999-2000 Audit by SAMHSA found 6,440 adulterated specimens went to 66 certified laboratories – Wong, R, 2002 American Clinical Laboratory. It is also important to include that the Department of Transportation now requires adulteration testing on all specimens tested within the federal guidelines.

When a company implements a drug-testing program, it is recommended that they include adulterant testing in their lab panel as well as their instant drug screening devices. Adulteration is a consistent issue in the world of drug testing and it is imperative that corporations and agencies remain vigilant while working to combat and circumvent the alarming trend that is adulteration.