49 CFR 40.139 sets out how the MRO handles a laboratory confirmed positive opiate result. If the laboratory confirms 6-acetylmorphine (6-AM) in the specimen, the MRO must verify the result as positive. Under 49 CFR 40.151(g), the MRO must not accept an assertion of a legitimate medical explanation for 6-AM.
Without 6-AM, a morphine or codeine result at or above 15,000 ng/mL in urine is verified positive unless the employee presents a legitimate medical explanation, as with other drugs under 49 CFR 40.137. The rule states that consumption of food products, such as poppy seeds, must not be considered a legitimate medical explanation for morphine or codeine at these concentrations.
For all other codeine and morphine positive results, the MRO verifies a positive only when there is clinical evidence, in addition to the test, of unauthorized use of an opium, opiate or opium derivative. Examples in the rule include recent needle tracks, behavioral and psychological signs of acute opiate intoxication or withdrawal, a clinical history of unauthorized use recent enough to have produced the result, and use of a medication from a foreign country. Evidence of needle tracks or signs of intoxication or withdrawal requires a face-to-face examination by the MRO or another physician.
The clinical evidence must concern a drug the laboratory found. The rule's example is a test that confirmed codeine for an employee who admits unauthorized use of hydrocodone, which does not support a codeine positive. The MRO has the burden of establishing clinical evidence of unauthorized use, and when it cannot be established, the MRO verifies the test as negative.
Prescription explanations are covered in Can a Prescription Explain a Positive DOT Drug Test?, and other explanations an MRO cannot accept in What Explanations Can an MRO Not Accept for a DOT Drug Test Result?.
Employers and service agents can use the category filter in the MyDrugTesting.com directory to find MROs by location.
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