Tempted to run to your doctor for some drugs for that little sniffle? The US Centers for Disease Control is observing Antibiotic Awareness Week from November 18-24, 2021.  While antibiotics have revolutionized medicine and have saved countless lives, they are also now one of the most misused and dangerous classes of medications. For example, most of our upper respiratory symptoms are viruses (yep, COVID), allergies, or minor infections for which antibiotics aren’t appropriate. The danger comes both in the short term (dangerous side effects or allergic reactions) and in the long term (allowing antibiotic resistance to flourish – superbugs!). Be sure to keep yourself as healthy as possible, discuss your situation thoroughly with your healthcare provider, and take your prescriptions exactly as written (no saving up the last few pills for future self-treatment!). For more information, visit https://www.cdc.gov/antibiotic-use/week/get-involved.html.

Vick’s VapoRub and Heisenberg? What’s the connection? Drug testing usually looks for amphetamines, a group of stimulants. Of course, these can be used legitimately (in medications, for example Adderall, for attention deficit disorder (ADD) or narcolepsy) or illegally (as “meth” (methamphetamines) also known by countless street names). Amphetamines exist in two distinct forms with very different effects – you can think of these as right hand (“d”) and left hand (“l”) versions, also know as isomers.  The “l” form is a mild stimulant (and in Vick’s Inhaler a mild decongestant), but the “d” form is much more potent and addictive. Only a small amount of the “l” form is converted by the body to the “d” form, but not so much in the other direction.  When a drug screen is performed the amounts of each of the forms are measured.; this tells the physician analyzing the result which substance is responsible for the result, the “d”rug form or the “l”egit form. People who have used Vick’s or ADD medication should not worry about passing a drug screen if the drug screen is analyzed properly – just ask Walter White … or us! If you have any questions about this type of testing, we’d be happy to help sort it out.

Worried your applicants are trying to beat a drug test? One maneuver is to dilute (water down) one’s urine by drinking excessive fluids or using diuretics. Since testing is based on concentration of drugs in the urine, this makes it more likely that the measured amount will fall below the “cut-off” and, thus,  be deemed “negative” (it’s like making 10 gallons of tea using only one teabag). But, not so fast! We’re on to them. Lab testing also includes two key biologic measurements: specific gravity and creatinine. Specific gravity is urine density compared to plain water; creatinine is a bodily by-product that serves as an indicator of dilution. Measuring these two gives an excellent picture of the “quality” of the specimen. They determine if the urine submitted is substituted (not really urine), invalid (too much like water for testing), or dilute (more watery than normal). This might trigger recollection (and someone might have to watch them pee next time) or might be considered a refusal to test. We have a certified Medical Review Officer (MRO) that can held sort this out.  If you have any drug screening questions, call us!

Immigration Update! As of 11/3/21 the U.S. Citizenship & Immigration Service (USCIS) has added a vaccination requirement for child immigrants and refugees. All children age 5 and older who are applying for “adjustment of status” must now COMPLETE a COVID-19 vaccination series (with rare exceptions).  For now, this is TWO shots of the Pfizer-BioNTech (the only approved vaccine for children at present) vaccine. The Civil Surgeon cannot sign and date the Form I-693 (Report of Medical Examination and Vaccination Record) for immigrants or “modified’ Form I-693 for refugees until this vaccination requirement has been met.  Call us with any questions about this new requirement.

Workplace drug testing has long included marijuana as one of the main substances of interest, specifically testing for THC, the psychoactive compound in marijuana. In years past, marijuana was only available “illegally”, but, over the last 25 years, some states have legalized, decriminalized, or allowed for medical use of marijuana. The popularity of another cannabis plant-derived substance, cannabidiol (a.k.a. CBD) has also exploded. Unfortunately, CBD is poorly regulated and the Food and Drug Administration (FDA) does not certify THC levels in any product, including CBD goods. Makers of CBD products may inaccurately represent, poorly monitor, or omit information on THC content. In any event, drug testing for marijuana is directed solely toward detecting THC, and any amount over the predetermined cutoff level will be considered a positive result in virtually all circumstances.  CBD products are not currently considered a legitimate medical explanation for a laboratory-confirmed marijuana result. Employees are cautioned in their decision to use CBD products if they are subjected to any workplace drug testing.

The Department of Transportation (DOT) requires a negative urine drug test before allowing a Commercial Driver’s License (CDL) holders to begin work and in various other scenarios.  Although this is termed a “5-panel” test, it actually screens for fourteen (14) different drugs. Marijuana is detected specifically through THC (and not CBD). Cocaine (a narcotic) and PCP (a hallucinogenic drug) remain on the standard test panel. Amphetamine testing includes not only amphetamines and methamphetamines (“meth”), but also MDMA (a.k.a. “ecstasy” or “Molly”) and MDA (a.k.a “Sally”, an amphetamine-related drug considered a hallucinogen). in response to opioid crisis, in 2018 testing was expanded to include not only the “traditional” morphine, codeine, and heroin, but also the so-called semi-synthetic opioids hydrocodone (Lortab, Norco), oxycodone (Percocet and others), hydromorphone (Dilaudid, Exalgo), and oxymorphone (Opana). Call us for any questions about DOT mandated drug testing.

Immigration Update! As of 9/1/21 the U.S. Citizenship & Immigration Service (USCIS) has revised the laboratory screening test requirements for immigrants. Individuals who are applying for “adjustment of status” are subject to new screening criteria for syphilis (usually Rapid Plasma Reagin a.k.a. “RPR” test by blood) and gonorrhea (usually Nucleic Acid Amplification Test a.k.a. “NAAT” by urine) with some exceptions.  Under the new guidelines, applicants UNDER the age of 18 years (0-17) or over the age of 44 years (45 and older) do NOT require screening for EITHER disease. Applicants from age 18-24 years require testing for BOTH syphilis and gonorrhea. Applicants from age 25-44 years require screening ONLY for syphilis. The requirement for screening for tuberculosis (Interferon-Gamma Release Assay a.k.a. IGRA – QuantiFERON or T-SPOT.TB test by blood) remains UNCHANGED and is required of all applicants over the age of two (2) years. The Civil Surgeon cannot sign and date the Form I-693 (Report of Medical Examination and Vaccination Record) for immigrants until these screening requirements and any potential treatment requirements have been met.  Call us with any questions about this new screening schedule.

The Department of Transportation (DOT) requires a medical examination for all drivers to receive and maintain a CDL (commercial driver’s license). Part of that assessment is a determination of whether the driver has, or requires testing for, sleep apnea (a.k.a. “obstructive sleep apnea” or “OSA”).  If the driver is diagnosed with OSA they must show compliance with use of a CPAP (continuous positive airway pressure) machine. This information must be presented to a certified medical examiner at the time of initial exam or recertification. Typically, a report can be downloaded from the CPAP device or app. This must show use of the CPAP machine at least four (4) hours per night AND at least 70 percent of the time before the driver can be certified; non-compliance is not an option.  Drivers should plan ahead, especially for recertification, and bring the report to the examination to avoid any delays.  Call us to schedule your DOT exam or with any questions about OSA/CPAP requirements.

Immigration Update! As of 10/1/21 the U.S. Citizenship & Immigration Service (USCIS) has added a vaccination requirement for immigrants and refugees. All individuals who are applying for “adjustment of status” must now COMPLETE a COVID-19 vaccination series (with rare exceptions).  This may include the SINGLE shot Johnson & Johnson vaccine or TWO shots of the Pfizer-BioNTech or Moderna vaccines. Essentially, anyone of any age who meets the requirements for any COVID-19 vaccine must be vaccinated. The Civil Surgeon cannot sign and date the Form I-693 (Report of Medical Examination and Vaccination Record) for immigrants or “modified’ Form I-693 for refugees until this vaccination requirement has been met.  Call us with any questions about this new requirement.