1. DOT Drug Testing What’s New? What’s the Same?
Dr. Donna Smith
Regulatory Compliance Consultant

2. What’s New--Expanded Drug Testing Panel
Beginning Jan 2018 DOT drug testing includes testing for opioid drugs—hydrocodone, hydromorphone, oxycodone, and oxymorphone
Heroin, morphine and codeine continue to be included in the Opiates/opioids category
Some common names for these semi-synthetic opioids include OxyContin®, Percodan®, Percocet®, Vicodin®, Lortab®, Norco®, Dilaudid®, Exalgo®.
These medications are generally prescribed as medications for acute or chronic moderate to severe pain. They are often written as PRN—or use when needed

3. Expanded Drug Panel
Opioid positive tests will be handled like any other non-negative laboratory result. If acceptable prescription documentation is presented by the employee, the MRO will report the test as Negative
The MRO will evaluate the potential for adverse impact on safety as part of the verification interview with the employee.
If the MRO believes there is a significant safety risk with the employee’s continued use of the opioid drug(s), the MRO will instruct the employee to have his/her prescribing HCP contact the MRO to discuss possible change to or discontinuance of the medication(s).
If the prescribing HCP does not contact the MRO within 5 days, the MRO will report a safety concern to the employer
If the prescribing HCP discontinues the medication or changes the medication to one that does not present a significant safety risk, the MRO will not report a safety concern
If the prescribing HCP contacts the MRO and states that the medication is not being changed or discontinued, the MRO will report a safety-concern and recommend a fitness-for-duty evaluation of the employee
As with any urine drug testing, the opioid result does not have a relationship to the dose used, the timing of the use, or frequency of use.
The test result does not establish if an employee was “under the influence” or impaired by the drug at the time the specimen was collected.

4. Expanded Panel-- DOT Notice to Employees
DOT published a notice to all safety-sensitive employees on December 11, concerning the expanded drug panel
Explains the testing for the semi-synthetic opioids
Discusses employees’ obligations to inform employers and/or medical qualification examiners of medications they are taking
Reminds employees of their obligation to have a conversation with their prescribing physician(s) to discuss their safety-sensitive work. 
Explains reporting of medication safety-concerns to the employer or other third party by the MRO.
Employee will have up to five days to have his/her prescribing physician contact the MRO. 
Employee is responsible for facilitating the contact between the MRO and the prescribing physician. 
Employee’s prescribing physician should be willing to state to the MRO that employee can safely perform his/her safety-sensitive functions while taking the medication(s), or consider changing the medication to one that does not make the employee medically unqualified or does not pose a significant safety risk.
Notice posted at:

5. Expanded Panel—Employer Policy Requirements
No need for employers to make any changes if their current DOT policies refer to adhering to “... Part 40.” However, there are exceptions when an employer’s DOT policy lists the following optional information:
If sub-categories of drugs tested under the 5-panel are listed – for example, if a policy lists "Opiates (codeine, heroin, & morphine)" then “Opiates“ needs to change to “Opioids (codeine, heroin, morphine, oxycodone, oxymorphone, hydrocodone, hydromorphone.  If however, employers would like to delete the sub-categories of drugs, doing so will also be acceptable.
Likewise, if cut-off levels are listed in current policies, employers must update those cut-off levels. Again, employers may simply delete the cut-off levels completely and be in compliance if the DOT policy refers to adhering to “... Part 40.”

6. MRO Safety Concern on DOT Verified Negative Test
Will be reported up to 5 days after Negative has been reported to employer
DOT states that MRO cannot indicate to employer that safety-concern determination is pending; nor can the MRO delay reporting the verified negative until medication safety concerns have been determined by the MR
Employer must decide what action(s) to take when safety-concern notice is given by MRO
Remove employee from performing safety-sensitive functions until medication safety concern is resolved/addressed.
Options for resolving/addressing MRO safety-concerns
If employee is subject to DOT or State medical qualification standards (e.g. school bus driver), require employee to return to an examiner, provide all medication information to examiner and undergo re-examination.
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 (recommended--Occupational Medicine physician)
Important for employer to have medication policy and procedures in place

7. Medications and Drug Testing
Urine drug testing cannot identify medication abuse/misuse
Amount of drug detected in urine cannot be correlated to dosage, frequency of use, impairment or date/time of last use.
If employee has a legitimate prescription (in his/her name, legally dispensed, etc.), that explains the drug test result, the MRO, under federal rules is expected to report the test as negative.
There is no “expiration date” for controlled substance medications.
The MRO cannot question the prescribing physician’s “appropriateness” in prescribing the medication
MRO process will not necessarily identify multiple prescriptions obtained from more than one HCP
There is no way for an MRO to interpret a UDS in terms of normal therapeutic range for medications prescribed

8. New Federal Custody & Control Form (CCF)
The government issued a revised CCF for federal drug testing in August,
This CCF replaces the current 2013 version of the federal CCF & is very similar.
The 2017 CCF added hydrocodone, hydromorphone, oxycodone,& oxymorphone to Section 5A (primary specimen report) on CCF copy 1 and changed Section 1D to have only one block checked for a DOT agency test
Effective July 1, 2018 the 2017 CCF must be used for all DOT drug tests. For any test conducted July 1, 2018 or later using the previous version of the CCF, a statement of correction detailing why an expired CCF was used will be requested by the laboratory.
If the laboratory does not receive the statement of correction from the collector, the laboratory cannot report the test result and the MRO must cancel the test
Employers need to ensure that their collectors are using the current 2017 federal CCF for all DOT drug tests

10. FMCSA Clearinghouse Overview
Dec 5, 2016 Final Rule established requirements for the CDL Drug and Alcohol Clearinghouse
Compliance date January 6, 2020
Purpose is to maintain records of all drug and alcohol program violations in a central repository and require that employers query the system to determine whether current and prospective employees have incurred a drug or alcohol violation that would prohibit them from preforming safety-sensitive functions covered by the FMCSA and DOT drug and alcohol testing regulations
Records maintained in the Clearinghouse will follow the driver regardless of how many times he/she changes employers, seeks employment or applies for a CDL in a different state

11. Clearinghouse
Must provide CDL # and State issued for every diver being tested for CCF and ATF
Pre-employment query of Clearinghouse required before hiring a driver
Driver must provide electronic consent through the Clearinghouse granting employer access to his/her records
The query will replace the requirement for a prior employer violations check beginning in 2023
Annual query required for all drivers
Limited query simply tells employer if there is info on the driver in the database
If limited query says there is data on the driver, employer must immediately (within 24 hrs.) obtain driver’s consent for full query and obtain information
Driver consent required for limited query—can be good for more than one year.
Employers will have to pay a “reasonable” fee for queries of the Clearinghouse—specific amounts are not set by rulemaking

12. Clearinghouse
MROs must report all verified positive, adulterated, and substituted specimen (refusal to test) determinations to the Clearinghouse within 2 days
Other refusals determined by the MRO must also be reported (e.g. shy bladder refusal, refusal to undergo medical examination)
Employers must report all other Part 382 violations to Clearinghouse within 3 days
Employers must also report negative return to duty tests, completion of all required follow- up tests, and actual knowledge of Part 382 violations
Employers may designate a C/TPA to make the employer required reports to the Clearinghouse
SAPs must report for each driver who has completed the return to duty process within 1 business day
Driver must designate a SAP before a SAP can enter any information concerning the driver’s return to duty process in the Clearinghouse

13. Clearinghouse
Each employer shall notify drivers that effective Jan 6, drug/alcohol testing information will be reported to the clearinghouse
FMCSA must notify a driver when his/her information has been added, revised or removed from the database
FMCSA must notify a driver when info from clearinghouse has been released to an employer and specify the reason for the release
There will not be a fee for drivers to access their records in the database. Drivers must register with the clearinghouse in order to access their records
The FMCSA will notify by USPS unless driver provides an alternative means (e.g. )

14. What’s the Same?
Medical marijuana is still not accepted as an explanation for a positive THC drug test
Regardless of state or local laws, or a physician’s “prescription” for marijuana, “medical marijuana” or “legal marijuana” use is not acceptable as an explanation for a positive THC test
Use of CBD oils or other “hemp oil” products cannot be considered a legitimate medical explanation for a positive THC test.
Even though CBD is no longer a controlled substance, and DOT drug tests do not detect it, CBD products are NOT always THC-free
Only urine specimens can be used for DOT drug testing—no oral fluids or hair specimens permitted
DOT also does not permit “instant” or “rapid result” Point of Collection Testing (POCT). All specimens must be tested at a DHHS certified laboratory
No DNA testing permitted on DOT urine specimens
MRO cannot order testing for drugs not on the DOT panel (e.g. fentanyl, methadone, etc.)
MROs can order further testing on methamphetamine positives to determine the chiral isomers (d & l) and on THC positives to determine if THC-V metabolite is present to distinguish pharmaceutical THC (e.g. Marinol) use from smoking marijuana

15. Best Practices For Policy:
Ensure Drivers have current FMCSA publications about medications and substance abuse
Ensure drivers have DOT Notice on Expanded Opioids Testing
Clearly identify medication safety processes when MRO reports a safety concern
Reiterate prohibition on marijuana use for drivers—whether for medical or “recreational” purposes
Emphasize refusal to test criteria to drivers, especially leaving collection site before specimen collection process is complete
If driver leaves collection site before 2nd specimen is collected when 1st specimen collection was suspect
If driver leaves collection site before sufficient specimen is collected or 3 hours elapse in “shy bladder” circumstance

16. Best Practices For Random Testing:
Do not announce random testing dates/selections in advance
Once driver is notified of selection for testing ensure driver commences testing immediately (always within 2 hours)
Conduct testing on each selected driver by the end of the testing period
Cannot excuse driver from testing because he/she is absent on day random testing is conducted
Update random pool within week prior to random selections being made
Spread random testing of selected employees throughout the testing period
Do not schedule all testing within the first week of the testing period
Make sure that pattern of testing is unpredictable

17. Best Practices Reasonable suspicion testing
Ensure that all supervisors of drivers have completed 2 hour R/S testing training
Strongly recommend refresher training on signs and symptoms with particular emphasis on indicators of opioid use/abuse and marijuana use.
Distribute and review Best Practices for DOT Reasonable Suspicion Testing document and ensure that your procedures conform