THE MROCC MONOGRAPH SERIES
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#2  ALTERNATIVE  SPECIMENS  FOR  WORKPLACE  DRUG  TESTING
 

At the conclusion of this activity, participants should be able to:

§          Advise employers and others about the pros and cons of different specimens for drug testing

§          Select appropriate specimens for different types of drug tests

§          Interpret workplace drug test results from alternative specimens

§         Integrate point of collection test (POCT) devices into workplace testing programs

When workplace drug testing became widespread in the 1980s, urine was favored because of large-scale experience in military and drug treatment programs.  Urine was also favored over the apparent alternative of blood because urine was less invasive, less infectious, identified use over a longer period of time, and contained drugs and metabolites in higher concentrations.  Today, urine remains the most common choice for workplace drug testing, even as tests of hair, oral fluid, and sweat have become affordable and reliable.

But drug users sometimes exploit weaknesses in urine testing, and some employers now test hair or oral fluid because these specimens are collected under direct observation, thereby reducing opportunities for tampering with the specimen.

Rather than trying to decide if one specimen is better than another, one can consider the different specimens in the same manner parents consider their children:  Each is good, in its own way, and some are better than others in certain situations.  This monograph and CME activity addresses laboratory-based tests of hair and oral fluid, and point-of-collection (“on-site”) tests of urine and oral fluid.  Although used less often in workplace programs, this monograph includes limited material on sweat, nail (finger and toe), and blood tests.

The procedures in this monograph are a blend of those presented by the Department of Health and Human Services in its 2004 proposed rule, and those typically used in mid-2008 when this monograph was written

MROCC’s CME program based on this monograph provides MROs with the most up-to-date and practical information associated with alternative specimens for workplace drug testing.  The CMEs from this monograph will fulfill a portion of both DOT and MROCC certification requirements This activity has been developed for physicians who serve as Certified Medical Review Officers (MROs) within Regulated (DOT Regulation 49 CFR Part 40) and Non-Regulated drug testing programs. Up to 4 Category 1 CME credit hours may be obtained through this activity.