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State of the US Dot Urine Drug Screen in 2018

   October/November Vol 8 Issue 7

State of the US Dot Urine Drug Screen in 2018
By: Ray Keller Jr, DO, CEO, Spread Med, Inc.

Introduction to DOT Urine Drug Screening (UDS)
US Department of Transportation (DOT) drug testing was established by Executive Order No. 12564, Section 503 of Public Law 100-71, and 5 U.S.C. section 7301. These actions were initially taken in response to a January 4, 1987 Amtrak crash in which the engineer tested positive for marijuana. 14 people perished in addition to the Amtrak engineer and a lounge car attendant.

Since that time, there have been many additions and revisions to the DOT drug screening regulations. The most recent changes went into effect January 1, 2018. The changes were in response to the rising prescription use and illegal abuse of semi-synthetic opioids.

Recent Changes
In January 2018 the DOT issued new changes to its UDS. The addition of four semi-synthetic opioids including oxycodone, oxymorphone, hydromorphone, and hydrocodone. Trade names for these drugs include OxyContin, Vicodin, Percocet, Percodan, Tylox, and Demerol. Testing is no longer required for methylenedioxyamphetatmine (MDA). Screening testing has been added for methylenedioxyethylamphetamine (MDEA) since it is a metabolite of MDA.
The new regulations also include three new “fatal flaws. ” The new flaws include:
1. There is no Custody and Control Form (CCF);
2. Two separate collections were performed using the same CCF; and
3. There was no specimen submitted to the laboratory with the CCF.

DOT also updated the screening and confirmatory cutoff levels for various substances, as outlined in Table 1.

Selected Potential Testing Outcomes

Negative – The result reported by an HHS-certified laboratory to an MRO when a specimen contains no drug or the concentration of the drug is less than the cutoff concentration for the drug or drug class and the specimen is a valid specimen.

Positive – The result reported by an HHS-certified laboratory when a specimen contains a drug or drug metabolite equal to or greater than the cutoff concentrations.

Invalid drug test – The result reported by an HHS-certified laboratory in accordance with the criteria established by HHS Mandatory Guidelines when a positive, negative, adulterated, or substituted result cannot be established for a specific drug or specimen validity test.

Cancelled test – A drug or alcohol test that has a problem identified that cannot be or has not been corrected. A cancelled test is neither a positive nor a negative result. However, if a result is cancelled, the next collection must take place under direct observation.

What if I test positive?

If the drug screen is positive, it is imperative that you talk to the medical review officer (MRO). It is their responsibility to call you, but you should also be proactive in contacting them. Any verbal communication you have with the MRO should be private. These conversations should not be conducted if a representative of your employer can overhear the conversation. It is your employer’s responsibility to provide a private environment for you to talk with the MRO.

If you have a legitimate prescription and test positive for a drug or metabolite the MRO may contact the prescriber to verify the prescription. If the MRO has a safety concern based on the prescription and your job description (s)he may report a safety concern to your employer. If you test positive, have a valid prescription, and the MRO determines that the prescription presents a safety concern you have 5 days to contact your prescriber and get a new prescription for a medication that does not present a safety concern. It is your responsibility, not the MRO’s, to have your prescription changed. If you do not have a valid prescription and test positive, your drug test will be reported positive, and you will not be allowed to work until you satisfy the return to work requirements.

Perhaps the most controversial drug tested for is marijuana. In some states marijuana is a legal prescription medication. However, because marijuana is considered a schedule 1 drug meaning that it is illegal because it has the high potential for abuse and dependence, no medical use, and severe safety concerns. Therefore, if you test positive for marijuana, even with a valid prescription, you will not be able to work unless the prescription is changed.


There have been major changes effective this year for the DOT urine drug screen. There is no doubt that the change is here to stay. Employers and employees subject to DOT UDS procedures should be sure that they understand the new requirements. If you have any questions about the new requirements do not hesitate to contact your employer or another resource that can help you navigate this new regulation.

Raymond Keller Jr., DO
CEO, Spread Med, Inc.
(O) 302-703-7245
(C) 207-929-0576