Standard Test Panel Expanded: Four Semi-Synthetic Opioids Added

According to the final rule published by the Department of Transportation (DOT) on November 13, 2017, hydrocodone, hydromorphone, oxymorphone and oxycodone will be added to the DOT Drug Testing Program Regulation and appear as part of its drug testing panel effective January 1, 2018. The decision was based on the need to maintain consistency with the U.S. Department of Health and Human Service Agency’s (HHS) mandatory guidelines. Such consistency is mandated by Federal statute.

Some of the more commonly known names for the newly added semi-synthetic opioids include:

• Vicodin
• Lortab
• Norco
• Dilaudid
• OxyContin
• Percocet
• Numorphan
• Opana

Semi-synthetic opioids are listed as Schedule II drugs under the United States Controlled Substances Act, meaning they have an accepted medical use, but have a high potential for abuse and require a prescription from a physician. Although legal to obtain, these drugs have a potential to lead to severe psychological and/or physical dependence. 

What does this mean for companies who employ workers mandated to complete drug testing under the DOT Drug Testing Program Regulation?

1. A possible increase in drug testing fees due to the additional laboratory fees levied to run the newly expanded test panel.
2. An increase in initial positive tests because of the expanded testing panel.
3. A delay in receiving test results due to the increase in positive test rates, requiring additional Medical Review Officer (MRO) involvement.

What does this mean for employees required to complete drug testing under the DOT Drug Testing Program Regulation?

1. The Medical Review Officer (MRO) is not focused on questioning the validity of a legally prescribed medication, nor on the reason for the prescription. The MRO is focused on safety. Mainly, does the prescribed medication pose a significant safety risk to the employee and others while he/she is actively taking the medication? On the other hand, if an MRO has a concern about standard of care, he/she is directed to contact the appropriate state licensing board and/or other agency who oversees the prescribing physician.
2. The MRO has a duty to verify the prescription given by the employee. Do not be surprised if a snapshot of your prescription will no longer suffice. Photo manipulation is advanced. The verification process may be concluded with the MRO having a conversation with the pharmacy who filled the prescription.  The pharmacy may also assist the MRO with determining if there is a significant safety risk present given the details of the prescription.
3. If the employee has a valid, legally prescribed medication, which explains the initial non-negative laboratory test result, the test result is downgraded and reported as negative due to the existence of a prescription. Of note, the test result will contain a statement that a MRO review was conducted with the employee, which is standard.
4. Regardless of the negative test reporting, the MRO may still determine that the prescribed medication taken by the employee poses a significant safety risk. The MRO is required to report safety concerns to third parties such as the employer, the DOT agency, or a Substance Abuse Professional (SAP) as defined under DOT. However, the final rule allows an accommodation in the timeline for the MRO to report such safety concerns. The modified timeframe for reporting significant safety risks now allots for up to five business days so the employee can arrange to have his/her prescribing physician contact the MRO with an alternative medication/treatment to address the health issue while removing the safety risk.
5. If an alternative is found by the physician to effectively treat the employee’s medical condition without risk, the MRO will not be required to make a safety concern or medically disqualifying report. 

The DOT is focused on safety. As a result of the increase in opioid misuse and abuse, the Department has taken additional steps to protect transportation safety.

The opioid epidemic in the United States has become a public health crisis. According to a July 2017 Drug Enforcement Agency (DEA) intelligence brief, Fentanyl was referred to as a “global threat.” Fentanyl is a synthetic opioid and not currently among the four opioids added to the DOT drug testing panel. Nonetheless, the drug epidemic clearly played a role in the decision to expand the DOT testing panel to include the semi-synthetic opioids listed above. The mandatory guidelines of HHS are continually evolving and may likely include additional opioids for which to be tested if the opioid epidemic is not harnessed.

 about other key components of the final rule and how the rules may affect non-mandated drug testing.

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