Thursday 28 April 2011

Pre-employment Drug Screen for Residents

Letter for testing
You will receive a letter which will tell you the location of the laboratory where you will have to submit the urine sample. Please make sure you note down the exact date and time frame before which you have present yourself. This is a time sensitive matter and delay will be construed as 'foul play'. If you have begun your employment, then they may page you for a spot check in the hospital. 

The Lab
Report to the laboratory, you will be made to sign a few forms. Then the attendant will make sure that you don't have any liquids, fluids or other specimens.  Then they will lead you to a very small bathroom which has no windows and give you a cup to void in. The cup will usually have a special sensor which detects the temperature of the sample. This has to be 37 degrees +/- 2 degrees. Once you are done voiding in a cup - do not flush the rest of the sample. The attendants make sure everything checks out okay before they will flush. The container will be then split into two, packaged in a tamper proof bag and sent via express delivery service to a testing laboratory to be screened for drugs (typically SAMHSA 5 panel). 

Sample Processing
Next step (from wikipedia), One aliquot is first screened for drugs using an analyzer that performs immunoassay as the initial screen. If the urine screen is positive then another aliquot of the sample is used to confirm the findings by gas chromatography - mass spectrometry (GC-MS) methodology. All test results are relayed to an MRO (Medical Review Office) where a medical physician reviews the results. If the result of the screen is negative, the MRO informs the employer that the employee has no detectable drug in the urine. However, if the test result of the immunoassay and GC-MS are non-negative and show a concentration level of parent drug or metabolite above the established limit, the MRO contacts the employee and to determine if there is any legitimate reason - such as a medical treatment or prescription.

Things to keep in mind
1. Not showing up before the time limit is big red flag
2. Follow all directions given by the lab tech
3. Void in the cup provided, at least 60 cc. if the cup gets full, void in the toilet bowl but do not flush
4. Do not add water to the sample if you don't have 60 cc in the cup. ask the tech for further directions.
5. Temp probe checks for pilfering, dilution or tampering with urine sample.
6. Avoid candy, pastry or preparations which are rich in poppy seeds (Khus Khus, Khaskhas, hashas, purim pastries, Kalacs, hamantash, beigli, posto dishes, doda tea etc), remember OTC meds can test as false positive - ranitidine often shows up as methamphetamine, OTC decongestants can do so too.
7. Standard panel does not test for Cotinine which is the breakdown product of nicotine, so Tobacco smokers may not have problems.

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