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DOT Testing Panel Expanded: Four Synthetic Opioids Added

According to the final rule published by the Department of Transportation (DOT) on November 13, 2017, hydrocodone, hydromorphone, oxymorphone and oxycodone were added to the DOT Drug Testing Program Regulation and appeared 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 per Federal statute.

Some of the more commonly known names for the new additions include:

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

Semi-synthetic opioids such as those listed above are a Schedule II drug 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 Regulations?

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 Regulations?

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/or others while he/she is actively taking the script? On the other hand, if a MRO has a concern about the standard of care provided by the prescribing physician, the MRO is directed to contact the appropriate state licensing board and/or other agency overseeing the physician in question.
2. The MRO has a duty to verify the prescription provided by the employee. Do not be surprised if a snapshot of your prescription bottle 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 script. The pharmacist may also assist the MRO with determining if a significant safety risk exists given the details of the particular medication.
3. If the employee has a valid, legally prescribed medication, which supports the initial non-negative laboratory test result, the result is downgraded and reported as negative due to the existence of the prescription. Of note, the test result will contain a statement that a MRO review was conducted with the employee. This is standard practice.
4. If an alternative is found by the treating 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.

Like the MRO, the DOT is focused on safety. As a result of the increase in opioid misuse and abuse, the Department has taken steps to further 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, certain opioids have become a “global threat.” 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 misuse and abuse is not curtailed.

To learn more about protecting your workplace, take a peek at what services are available: Education, Training & Testing