Recent News & Updates

What is the difference between Screen Threshold and Confirm Threshold on the NTA, Inc. test results?

Posted by on in Medical Review Office

The Screen Threshold and Confirm Threshold are the standard cutoff levels that the laboratory uses when testing a specimen.

When the laboratory first receives the specimen, they run the Immunoassay test or Screen test. Immunoassays use antibodies to detect the presence of a drug or metabolite in the urine. Antibodies are proteins that chemically bind with specific substances called antigens; in this case, a drug or drug metabolite. The first column of numbers on the NTA test results under Screen Threshold are the quantitative cutoff levels for this test.
The primary disadvantage of immunoassays is that the antibodies are seldom specific to a single drug or drug metabolite; therefore, the antibodies may bind with other substances. This is called cross-reactivity and can result in false positives. Because of this, if a substance shows positive (or above the screen threshold), the specimen is sent on for the GC/MS (Gas Chromatography/Mass Spectrometry) test, or Confirmation Test. The second column of numbers on the NTA, Inc. test under Confirm Threshold are the quantitative cutoff levels for this test.

The GC/MS test is a very sensitive and specific test, and the procedures for performing this test are very complex. In short, however, this test separates and very specifically identifies the components of the specimen, making it a highly reliable test for confirmations.

The Screen and Confirm Thresholds on the NTA, Inc. results are simply the cutoff levels for each substance on each particular test. They have nothing to do with one another, and do not reflect levels that are found in a specimen.

Understanding The Epidemic

Posted by on in Workplace Drug Testing

According to the Center for Disease Control and Prevention, nearly 200 people died from drug overdoses each day in 2017, A 68% increase from 2016. On average, 130 Americans die every day from an opioid overdose. Roughly $26 billion is spent annually on treatment services, lost productivity, and criminal justice involvement. The dramatic escalation of illicit drug overdoses has been linked to synthetic narcotics such as fentanyl; the issue of drug misuse is a problem for everyone.

While substance abuse does not discriminate, certain factors may make an individual more susceptible. Genetics, psychological makeup, and environment can all play a role. 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.

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.

Call our office today for more information! 1(800) 452-0030 ext. 0

Drug Overdose Deaths Hit Record High

Posted by on in Medical Review Office

The Centers for Disease Control and Prevention (CDC) reported that 70,237 people in the United States died of drug overdoses in 2017. The age-adjusted rate of drug overdose deaths increased from 6.1 per 100,000 standard population in 1999 to 21.7 in 2017. Drug overdose ranks as the leading cause of death for adults under age 55.

The CDC also reports that Fentanyl replaced Heroin as the deadliest drug. Fatalities involving Fentanyl increased by more than 45% in 2017.

Other key findings from the CDC Data include:

  • The drug overdose death rate in 2017 was 9.6% higher than in 2016.
  • Heroin overdose death rates were seven times higher in 2017 than in 1999.
  • Almost 14,000 Americans died from a cocaine-related overdose in 2017.
  • Overdose rates were significantly higher for males than for females.
  • West Virginia, Ohio, Pennsylvania, and Washington, DC recorded the highest drug overdose death rates in 2017.
  • Texas, North Dakota, South Dakota, and Nebraska experienced the lowest drug overdose death rates in 2017.

Is it time to review your workplace drug and alcohol testing program?  Give us a call today at 1(800) 452-0030!

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

Posted by on in 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.

Contact us today for more information! 1(800) 452-0030 ext. 0

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!

Entry-Level Driver Training, What’s new?

Posted by on in Regulatory Update

The Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA) announced a final rule streamlining the process and reducing the cost to upgrade from a Class B to Class A Commercial Driver’s License (CDL). By adopting a new curriculum, this rule is predicted to save eligible driver trainees and motor carriers $18 million annually.

Elaine L. Choa, Transportation Secretary, said: “Today’s action demonstrates the Department’s commitment to reducing regulatory burdens and addressing our nation’s shortage of commercial drivers.”

The amendment to Entry-Level Driver Training (ELDT) regulations will require the same level of theory training for individuals obtaining a CDL for the first time. FMCSA recognizes that Class B CDL holders have prior training or experience; they should not be required to receive the same level of theory training as individuals who have never held a CDL.

Click here to see the final rule. Contact our office today if you have any questions! 1(800) 452-0030 ext. 0!