Moving on to case 11. Positive for morphine, 5,000 nanograms per mil plus chromium 6 adulterated at 90 micrograms per mil. Laboratory and CCDF reports are in order. The laboratory tested 6-acetylmorphine and found it to be negative in spite of that. During the interview, the donor states that he does not know why his specimen was positive for morphine or why it was adulterated. You have a really non-productive indicator. How do you report this result? Wish we had Jeopardy music in the background. Well, the morphine quant is less than 15,000. We don't have any history for the morphine. By the opiate rule, we can't report the morphine as positive. However, we have an adulterated confirmed report from the laboratory, chromium 6 adulterated. We're going to ignore the morphine and the MRO report is going to be refusal to test because specimen adulterated with chromium 6. Questions can be put in the chat function. Case 12, positive for marijuana and cocaine. Laboratory sent the electronic report, all looks good on the CCF and the report. Now during the interview, the donor claims positive for marijuana because he was at a party, had brownies to contain marijuana, and he's positive for cocaine because the dentist used lidocaine prior to a dental procedure. Okay, the CCF documents the donor specimens collected three days after the brownies and the dental procedure. What is your MRO report? Okay, this was an easy one. I'm pretty sure you know it's going to be positive for marijuana and cocaine. Why? Because, you know, unnamed, unknowing ingestion of brownies has been claimed ever since I started in this business. Okay, and as we all know, the amount of THC, the purity of THC is way higher than it used to be, and the availability of edibles is much, much more readily obtainable than it used to be. So yeah, he can pop positive for eating a marijuana brownie. No question. Can you as an MRO accept that in the DOT testing program? And the answer is no, it's not. And I don't have to tell you again, you've heard it during the lectures, lidocaine doesn't contain cocaine even though it ends in the same set of six letters. They're different chemicals and it does not metabolize to cocaine. It does not confirm positive for cocaine. So in this case, the MRO verified report is positive marijuana, positive cocaine. Case number 13 is substituted. Laboratory report and CCF in order. During the interview, the donor claims to have been performing strenuous activity and drinking large amounts of fluid for several days prior to the collection procedure. When this reason is given, you may request to have the donor provide another specimen using a directly observed collection procedure. Now remember this, you can do this for both HHS and DOT, but what happens in that recollection? Okay, what happens? The donor has to reproduce the original findings. In other words, creatinine has to be 1.5, specific gravity has to be 1.0005. So we went through this five-day process, we had the observed recollection, but the lab reports the second specimen had a creatinine of 5.5 and a higher specific gravity. Okay, you've done that test. What is your MRO verification report? Okay, the creatinine specific gravity values are not the same, so your MRO verification is refusal to test because specimen substituted. Case 14, negative and dilute, creatinine 4, specific gravity 1.0019. Remember the values? You do not do this interview, right? You don't do the interview, and what do we do if this is an HHS specimen? We don't do anything, we report it as a negative dilute. What do we do if this is a DOT specimen? This is a DOT hyper dilute, so you don't do an interview. The donor goes back for an immediate observed recollection. Keep in mind, it's very important, especially for the test, the differences in HHS protocol for this type of result and DOT protocol for this type of result. Only DOT has a hyper dilute requirement. 15, specimens rejected for testing, fatal fatal flaw, tamper, evidence sealed, broken. Okay, electronic report's in order, the CCF is in order. What is your report? What would you do if the employer said he really had to have this result? Can't you please go ahead and test it? I don't think I have to tell you, the answer is uh-uh, no way, a fatal flaw is fatal, that's why it's called that, fatal. This is the end of this process. Okay, do we do an observed recollection? This is not a donor issue, so there is no reason for an observed recollection. If you need a negative, obviously you have to have another collection, but that second collection is not observed. Donor didn't, as far as we know, donor didn't break that seal, we hope. If you want to check with a collector, by the way, and find out if anything had happened to the specimen collection site, you're certainly able to do that. It may not be a bad idea because this is going to go down in the annals of reports as a collector paused error, when it probably shouldn't, really, because the specimen could have left the collection site intact, it could have been handled roughly during transit, and the seal could have been broken. We really don't know, we really can't blame the collector for a broken seal, although it certainly may have been the collector's issue. It does not hurt to call the collector, have one of your team members call the collector and find out if anything unusual happened at that collection. The bottom line, test canceled, and if you need a negative, you do an unobserved recollection. Okay, split specimen test result failed to reconfirm benzylicanine, and the reason is benzylicanine is not collected. Okay, laboratories required to perform drug reconfirmation at LOD, we know that. Validity testing worked, so this is a failure to reconfirm Bottle B, and we have two possible reasons for this. The first is that the specimen just wasn't there, the BE was gone in this specimen, and validity testing was done, and the validity test and specimen passed validity testing. This is the due process that played out, the specimen failed to reconfirm, both tests are canceled, and recollection, if necessary, if a negative is needed, is conducted, not observed. If validity testing showed there to be something in the specimen that caused an invalid report to be sent, that failure to reconfirm benzylicanine, and the specimen was invalid because of inability to confirm, or oxidant activity, or whatever, the specimen was invalid, that's a whole different ballgame. Your MRO verified result is still both tests canceled, but immediate observed recollection is required in this case. In the last case, failure to reconfirm an adulterant, chromium, reason did not satisfy the criteria. We're putting these cases in here to emphasize for you the reconfirmation requirements. So we've just done a validity test, this is an adulterant, and remember, adulterant reconfirmation testing is done at the same level that specimen A confirmation testing is done, not at the laboratory's lower limit of detection. So when you get a failure to reconfirm result from the laboratory for a drug, it will simply say, as we did before, benzylicanine not present. When you get a failure to reconfirm for an adulterant, which in reality, like I said, you hardly ever will, the language from the laboratory will say did not satisfy criteria for confirmation, reconfirmation for that adulterant. Okay, questions in the chat function, and that is the end of our case studies, and I hope you all have enjoyed the course.

MRO

drug testing

adulterated specimen

refusal to test

HHS and DOT protocols