Omnibus Transportation Employee Testing Act (OTETA) A Basic Course in DOT Drug & Alcohol Testing Programs Dr. Donna Smith FirstLab, Inc.

History & Rationale 1991 Omnibus Transportation Employee Testing Act mandated drug and alcohol testing for all Commercial Driver’s Licensed (CDL) employees Requirements for testing are detailed in FMCSA regulation 49 CFR Part 382 and the procedures for conducting the testing are found in 49 CFR Part 40 OTETA was aimed at preventing illicit drug use and alcohol misuse by employees in public transportation occupations to promote and protect public safety

Program Basics Each employer must: −Have a written substance abuse policy −Appoint a Designated Employer Representative (DER) −Conduct required drug and alcohol testing in accordance with Part 40 procedures −Conduct Reasonable Suspicion Training for supervisors −Provide drug and alcohol education materials or training for all CDL employees −Maintain records and documents as required by DOT regulations −Conduct a check for previous drug and alcohol violations with prior employers for all CDL applicants

Substance Abuse Policy - Identify prohibited drug and alcohol-related conduct - Explain drug and alcohol testing requirements and testing procedures - Define safety-sensitive duty and positions - State consequences and disciplinary actions for violation of policy - Provide a copy of the policy to each employee and maintain documentation that employee has received and understands the policy

Designated Employer Representative (DER) - Serves as point of contact for the testing program - Receives test results from the Medical Review Officer and Breath Alcohol Technician (BAT) - Ensures that drivers who violate the policy are removed from driving duties and meet return to duty requirements, if they return to work - Ensures that drivers are in a random testing pool

DOT Testing Procedures 49 CFR Part 40 Applies to Employers. Employees, Service Agents Specimen Collection, Laboratory analysis, MRO, Alcohol Testing SAP and Return to Duty Process TPA functions Confidentiality and Release of Information

Reasonable Suspicion Training Required for all supervisors of CDL employees Minimum of 2 hours −Signs and symptoms of drug/alcohol misuse −Criteria for reasonable suspicion testing −Procedures for documenting R/S testing and getting employee tested Training can be classroom, video, computer-based

Employee Drug and Alcohol Awareness Information Educational materials or training classes must be provided to all CDL employees Information must include: − Prohibited conduct −Testing requirements and procedures −Consequences and disciplinary actions −Employee rights and responsibilities in testing program −Alcohol and drug abuse awareness information −Information on getting help with a substance abuse problem Employee must sign acknowledgment of receipt of information/materials

DOT Employee Booklet Available at

Record Keeping Employers or their TPA must keep extensive records −Test results, including CCFs −Random testing documents −P/A and R/S testing documentation −Prior Employer checks −Supervisor and employee training records −SAP & RTD documents

Check for Previous Drug & Alcohol Violations Required at time of application or transfer to a CDL position Applicant must sign release, identifying employers in past 2 years Prospective employers must contact prior employers, provide signed release and request info on D & A violations If previous employers report a DOT violation and applicant is hired, new employer must ensure SAP process is complete and FU testing is conducted

FMCSA 49 CFR Part 382 Safety-sensitive positions: CDL drivers Pre-employment, reasonable suspicion, post- accident, random, return to duty and Follow-up testing −For pre-employment only a drug test is required 24 out-of-service for 0.02—0.039 BrAC

Pre-employment Test Negative result on a PE drug test required −Applies to employees transferring into a CDL position, as well as new-hires −PE test exception allowed if applicant has been in a DOT testing program with a prior employer for past 12 mos. Applicants who are positive or refuse to test cannot be hired and must be provided SAP referral information −If reapplication is allowed, completion of SAP process must be documented

Reasonable Suspicion Testing Based on the observations of a supervisor who has completed R/S training Supervisor’s observations must be documented on a form or written report R/S tests must be completed ASAP after decision to test is made −If both alcohol and drug tests are indicated, the alcohol test should be conducted first Employee should be escorted to testing site Employee should not be permitted to return to work after testing; transportation home should be offered −RTW only after test results are received

Post-Accident Testing Post-Accident testing required if: −Fatality −Driver citied for violation and - Injuries requiring medical treatment away from scene, or - Disabling damage to vehicle requiring towing Law enforcement P/A tests can be used in lieu of employer’s test Post-accident tests must be conducted ASAP −Alcohol—within 2 hrs, if longer must document and complete by 8 hrs −Drug—ASAP—but within 32 hrs.

Random Testing Selection for random testing must use a scientifically valid random number selection process Selections must be made at least 4 times per year and spread reasonable throughout the year All CDL drivers must be in the random pool from which selections are made Once notified of selection for random test, the driver must proceed immediately to complete the test Number of random drug tests conducted must be at least 50% of CDL population; random alcohol tests must be at least 10% If a selected driver is not available for testing during the selection period (month, quarter, etc.), the reason for not testing must be documented −If alternates were selected, they may be tested instead of unavailable drivers If drivers are removed from the random pool for more than 30 days, they must have a pre-employment drug test when they return to driving duties If a test result is cancelled, the test does not count toward the annual percentage.

Best Practices for DOT Random Drug & Alcohol Testing

Return to Duty and Follow-up Testing Occur only when there has been a DOT violation (positive, refusal to test, etc.) RTD test conducted after SAP has provided follow-up evaluation report stating that employee has complied with treatment requirements Follow-up testing determined by SAP −Begins when employee returns to safety-sensitive duties −Minimum of 6 FU tests in first 12 months after return to duty −FU testing may extend for up to 60 months as ordered by SAP −Number of tests and duration of testing determined by SAP −Employer sets schedule for “no notice” FU tests −Employee is also in CDL random pool

Urine Specimen Collection All DOT tests require: −Use of Federal custody and control form (CCF) −Split specimen collection −Shy bladder procedure for inability to provide specimen Direct observation collections required in specific circumstances −Specimen temperature out-of range −Specimen suspected of adulteration −Previous test canceled because specimen invalid −Previous test canceled because split not available −Previous test “very” dilute—creatinine 2-5

Urine Specimen Collection II Collectors must complete training and proficiency demonstration Supervisors of employees should not act as collectors Most collections conducted at laboratory patient service centers (PSC) or medical clinics (3 rd Party sites) Specimens packaged in specimen bottles, sealed, and placed in plastic bag with CCF Collector must distribute CCF copies to MRO, employer, and donor

Laboratory Analysis DOT testing must be conducted at a DHHS/SAMHSA certified laboratory Screening test conducted using immunoassay Confirmation required for all positive screens using GC/MS Cut-off levels establish positive result (ng/mL) Laboratories authorized to conduct specimen validity testing Laboratories must review CCF for flaws prior to testing specimen

Specimen Validity Testing Creatinine & Specific Gravity −Dilute--creatinine <20; SG < “Ultra-dilute”—2-5 creatinine −Substituted—creatinine Adulterated −Ph: Acid or base added ( 11) −Nitrites >500 mcg −Specific substance added (soap. bleach, etc) Invalid −Interfering substance but cannot identify it −Medication interference

Drugs Detected THC −Metabolite of marijuana and cannabis products Cocaine −Benzaegoline is metabolite of cocaine, including crack Amphetamines −Amphetamine and methamphetamine (MDMA—Ecstasy) Opiates −Morphine, codeine, and heroin (6AM) PCP −Phencyclidine (Angel Dust)

Urine Testing Facts Positive does not establish impairment or intoxication All drugs except THC are only detected in urine 2-3 days after use THC can be detected in urine up to 20 days after use for chronic, regular user Over half of all positives are for THC Cut-off levels rule out passive inhalation or “incidental exposure” causes Laboratories must report results to MRO, not employer or TPA

Medical Review Officer MROs must be physicians who have special MRO certification All results must be verified by MRO prior to release to employer or TPA Must have CCF copy from collection site prior to reporting results Non-negative results must have donor interview with MRO prior to verification MRO cannot give employer (or TPA) any information prior to final verification of result

MRO Results Negative—No drugs present above cut-off level Negative Dilute—No drugs present above cut-off level and low specific gravity & creatinine Positive—Drugs present and no medical explanation Refusal to Test—Adulterated (contains exogenous substance or excessive level of endogenous substances) or Substituted (SG & creatinine not consistent with human urine) Canceled Test—Invalid specimen, flawed collection/specimen, Shy bladder with medical explanation

MRO Safety Concern Issued by MRO when laboratory positive drug test is due to use of a prescribed or medically administered drug and MRO believes: −Use of prescribed medication poses a significant safety risk, or −Medical condition for which medication is prescribed may pose a significant safety risk Test result will be reported as “Negative” with MRO comment of a safety concern Employee is informed by MRO that safety concern is being reported to employer

MRO Notice to Donor MRO notifies donor that he/she can submit (within 5 days) documentation from prescribing physician that demonstrates: −Medication has been discontinued, or −changed to one that does not cause concern If MRO receives such documentation, employer will be notified that safety concern is removed

Employer Actions on MRO Safety Concern Options for resolving safety-concerns −Have prescribing physician provide statement that employee is able to perform safety-sensitive duties while taking medications −Have employee undergo “fitness for duty” evaluation by employer designated physician Important for employer to have medication policy and procedures in place MRO cannot make “fitness for duty” recommendation based on donor interview and urine drug test result

Split Specimens MRO must offer split specimen analysis to any donor with a positive, adulterated or substituted result Employee cannot be required to pre-pay for split analysis Employee has 72 hrs to decide if he/she wants split analyzed MRO processes split request in writing to laboratory Split musty be tested at a different SAMHSA certified laboratory Split results reported to MRO Employee must be removed from duty based on primary specimen result; cannot delay removal pending split outcome

Split Specimen Outcomes Result reconfirmed −Drugs present at limit of detection −Adulteration & substitution criteria met Failed to Reconfirm −Drugs not detected −Adulteration or substitution criteria not met −Split specimen not available or not suitable for testing

Alcohol Testing Pre-employment alcohol testing not required 0.04 or greater BrAC is a rule violation (positive test) 0.02—0.039 BrAC requires temporary removal from safety- sensitive duty Screening test uses breath or saliva specimen Confirmation test required within 30 minutes of >0.02 screening result −Confirmation must be an evidential breath test (EBT)

Alcohol Testing II Tests must be conducted by trained technicians (STTs or BATs) DOT Alcohol Test Form (ATF) must be used for all DOT tests BAT notifies employer or TPA of result (no MRO review of alcohol test results) EBT detects only ethanol Waiting period (15—30 min) between screen and confirmation test eliminates “mouth alcohol” Procedures for “shy lung” or inability to complete test

Third Party Administrator (TPA) Service agent for employers in implementing testing programs Can maintain all records for employer Can perform all tasks except DER, medical review and laboratory functions TPA must conform to Part 40 and DOT agency rules

SAP & Return To Duty Employers must provide SAP information to all individuals who violate DOT rules, even if they terminate employment Employees cannot return to duty unless they have: −Been evaluated by a SAP −Complied with recommended treatment/rehab −Undergone a follow-up evaluation by the SAP −Passed a return to duty test −Been prescribed a follow-up testing program (at least 6 tests in first 12 months)

Significant Compliance Issues Random testing −Must do random selections at least quarterly −Must document reasons for not testing selected employees −Must complete tests within testing period −Cancelled and “late” tests do not count toward percentage −Cannot “discontinue” random testing once the required percentage is achieved −Must update random pool to include all safety-sensitive employees

Significant Compliance Issues MIS reports −Must provide annual statistical data as required by DOT rule −Jan-Dec calendar year Pre-employment tests on all s-s employees before they are hired or perform s-s duties Prior Violations check ( 2yrs) on all new hires Post-accident testing documentation on all qualifying accidents −Including missed and delayed alcohol and drug tests

Commonly Asked Questions What does a “pending” test result mean? What do I do about a negative-dilute? Can I change a non-DOT test to a DOT test? I need a DOT MIS report? What do I do about employees who are laid off or are on WC leave and are on my random list? One of my employees got a DUI. Do I have to remove him from duty? Do I need to do a drug test with my driver’s physical exam?

Commonly Asked Questions My random list is wrong. How do I get a new one? What do I do about an employee who couldn’t provide a urine specimen at the collection site? How do I get a laboratory statistical report? My driver’s random test was reported as canceled. Do I send him in for another test? It’s been five days and I don’t have a test result. Is it pending for the MRO review?

Employer Guide to DOT Testing Available at

Stop By FirstLab’s Table and Meet FirstLab’s Florida Account Manager Lisa Busse 1364 Welsh Road North Wales, PA Ext