In some cases. Under 49 CFR 40.137, the MRO considers whether an employee's legally valid prescription, consistent with the Controlled Substances Act, is a legitimate medical explanation for a confirmed positive result for drugs such as amphetamines or semi-synthetic opioids (hydrocodone, hydromorphone, oxycodone and oxymorphone). In making that decision, the MRO must not question whether the prescribing physician should have prescribed the substance.
Section 40.137 states that the MRO offers the employee an opportunity to present a legitimate medical explanation in all cases, and the employee has the burden of proof. The information is presented at the verification interview, and the MRO may extend the time by up to five days when there is a reasonable basis to believe the employee can produce relevant evidence. If a legitimate medical explanation exists, the MRO verifies the result as negative. Otherwise, the MRO verifies it as positive.
The rule allows a medication from a foreign country to be considered only if it was obtained legally there, has a legitimate medical use and was used for its intended medical purpose. Under 49 CFR 40.151(g), an MRO must not accept a legitimate medical explanation for PCP, 6-AM, MDMA or MDA. Section 40.137 also notes that when an MRO accepts a foreign medication explanation and verifies a test negative, the MRO may have a responsibility to raise fitness-for-duty considerations with the employer.
Related topics are covered in Why Does an MRO Contact an Employee after a DOT Drug Test? and Does a State Medical Marijuana Card Excuse a Positive DOT Drug Test?.
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