Proposed Rule2022-06884
Mandatory Guidelines for Federal Workplace Drug Testing Programs
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
April 7, 2022
Issuing agencies
Health and Human Services Department
Abstract
The Department of Health and Human Services ("HHS" or "Department") is proposing to revise the Mandatory Guidelines for Federal Workplace Drug Testing Programs using Oral Fluid (OFMG) which published in the Federal Register of October 25, 2019.
Full Text
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[Federal Register Volume 87, Number 67 (Thursday, April 7, 2022)]
[Proposed Rules]
[Pages 20522-20557]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-06884]
[[Page 20521]]
Vol. 87
Thursday,
No. 67
April 7, 2022
Part II
Department of Health and Human Services
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42 CFR Chapter I
Mandatory Guidelines for Federal Workplace Drug Testing Programs;
Proposed Rule
Federal Register / Vol. 87 , No. 67 / Thursday, April 7, 2022 /
Proposed Rules
[[Page 20522]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
42 CFR Chapter 1
Mandatory Guidelines for Federal Workplace Drug Testing Programs
AGENCY: Substance Abuse and Mental Health Services Administration
(SAMHSA), Department of Health and Human Services, (HHS).
ACTION: Notification of mandatory guidelines.
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SUMMARY: The Department of Health and Human Services (``HHS'' or
``Department'') is proposing to revise the Mandatory Guidelines for
Federal Workplace Drug Testing Programs using Oral Fluid (OFMG) which
published in the Federal Register of October 25, 2019.
DATES: Submit comments on or before June 6, 2022.
ADDRESSES: In commenting, please refer to file code SAMHSA 2022-001.
Because of staff and resource limitations, SAMHSA cannot accept
comments by facsimile (fax) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
<bullet> Electronically. You may submit electronic comments on this
document to <a href="https://www.regulations.gov">https://www.regulations.gov</a>. Follow ``Submit a comment''
instructions.
<bullet> By regular mail. You may mail written comments to the
following address: SAMHSA, Center for Substance Abuse Prevention
(CSAP), Division of Workplace Programs (DWP), 5600 Fishers Lane, Room
16N02, Rockville, MD 20857. Please allow sufficient time for mailed
comments to be received before the close of the comment period.
<bullet> By express or overnight mail. You may send written
comments to the following address: SAMHSA, CSAP, DWP, 5600 Fishers
Lane, Room 16N02, Rockville, MD 20857.
<bullet> By hand or courier. You may deliver your written comments
by hand or courier to the following address prior to the close of the
comment period: SAMHSA, CSAP, DWP, 5600 Fishers Lane, Room 16N02,
Rockville, MD 20857. If you intend to deliver your comments to the
Rockville address, please call (240) 276-2600 in advance to schedule
your arrival with one of our staff members. Because access to the
SAMHSA building is secure, persons without Federal Government
identification are encouraged to schedule their delivery or to leave
comments with the security guard at the front desk located in the main
lobby of the building.
All comments received before the close of the comment period will
be available for viewing by the public. Please note that all comments
are posted in their entirety, including personal or confidential
business information that is included in the comment. SAMHSA will post
all comments before the close of the comment period on the following
website: <a href="https://www.regulations.gov">https://www.regulations.gov</a>. Use the website's search function
to view the associated comments.
Comments received before the close of the comment period will also
be available for public inspection as they are received, generally
beginning approximately three weeks after publication of a document, at
SAMHSA, CSAP, DWP, 5600 Fishers Lane, Rockville, MD 20857, Monday
through Friday of each week, excluding Federal holidays, from 8:30 a.m.
to 4:00 p.m. To schedule an appointment to view public comments, please
call (240) 276-2600.
FOR FURTHER INFORMATION CONTACT: Eugene D. Hayes, Ph.D., MBA, SAMHSA,
CSAP, DWP; 5600 Fishers Lane, Room 16N02, Rockville, MD 20857, by
telephone (240) 276-1459 or by email at <a href="/cdn-cgi/l/email-protection#4f0a3a282a212a61072e362a3c0f3c2e22273c2e6127273c61282039"><span class="__cf_email__" data-cfemail="d194a4b6b4bfb4ff99b0a8b4a291a2b0bcb9a2b0ffb9b9a2ffb6bea7">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
Executive Summary
This notification of proposed revisions to the Mandatory Guidelines
for Federal Workplace Drug Testing Programs using Oral Fluid (OFMG)
includes revisions that will: Establish a process whereby the
Department annually publishes the authorized drug testing panel (i.e.,
drugs, analytes, or cutoffs) to be used for Federal workplace drug
testing programs; revise the definition of a substituted specimen to
include specimens with a biomarker concentration inconsistent with that
established for a human specimen, establish a process whereby the
Department publishes an authorized biomarker testing panel (i.e.,
biomarker analytes and cutoffs) for Federal workplace drug testing
programs; update and clarify the oral fluid collection procedures;
revise the Medical Review Officer (MRO) verification process for
positive codeine and morphine specimens; and require MROs to submit
semiannual reports to the Secretary or designated HHS representative on
Federal agency specimens that were reported as positive for a drug or
drug metabolite by a laboratory and verified as negative by the MRO. In
addition, some wording changes have been made for clarity and for
consistency with the Mandatory Guidelines for Federal Workplace Drug
Testing Programs using Urine (UrMG), 82 FR 7920 (January 23, 2017), or
to apply to any authorized specimen type.
The Department is publishing a separate Federal Register
Notification (FRN) elsewhere in this issue of the Federal Register
proposing revisions to the OFMG, including the same or similar
revisions proposed for the UrMG, where appropriate.
Background
The Department of Health and Human Services, pursuant to the
Department's authority under Section 503 of Public Law 100-71, 5 U.S.C.
Section 7301, and Executive Order 12564, establishes the scientific and
technical guidelines for Federal workplace drug testing programs and
establishes standards for certification of laboratories engaged in drug
testing for Federal agencies. Using data obtained from the Federal
Workplace Drug Testing Programs and HHS-certified laboratories, the
Department estimates that 275,000 urine specimens are tested annually
by Federal agencies. No Federal agencies are testing oral fluid
specimens at this time.
As required, HHS originally published the Mandatory Guidelines for
Federal Workplace Drug Testing Programs (Guidelines) in the Federal
Register (FR) on April 11, 1988 (53 FR 11979). The Substance Abuse and
Mental Health Services Administration (SAMHSA) subsequently revised the
Guidelines on June 9, 1994 (59 FR 29908), September 30, 1997 (62 FR
51118), November 13, 1998 (63 FR 63483), April 13, 2004 (69 FR 19644),
and November 25, 2008 (73 FR 71858). SAMHSA published the current
Mandatory Guidelines for Federal Workplace Drug Testing Programs using
Urine (UrMG) on January 23, 2017 (82 FR 7920), and HHS published the
current Mandatory Guidelines for Federal Workplace Drug Testing
Programs using Oral Fluid (OFMG) on October 25, 2019 (84 FR 57554).
Proposed Revisions to the HHS Mandatory Guidelines for Federal
Workplace Drug Testing Programs
Authorized Drug Testing Panel
The Guidelines pertain to a matter of Federal agency personnel and,
therefore, are not subject to the notification and comment procedures
under the Administrative Procedures Act. In light of the potential
impact on entities outside of the Federal Government, the Department
has chosen to submit the Guidelines to notification and comment,
[[Page 20523]]
and will continue to do so. In this revision, the Department is
proposing to change the way a specific part of the Guidelines (i.e.,
the drug testing panel) is published and the frequency with which it is
published.
Since the original Guidelines were published in 1988, several
recommendations have been made for drugs to be added to or removed from
Federal workplace drug testing programs. The Department has revised the
Guidelines in the past to add or remove drugs from the authorized drug
testing panel and to revise test cutoffs (i.e., Section 3.4 of the
UrMG). The time required to revise the Guidelines through the Federal
review process has impeded the Department's ability to respond to drug
use trends. Individuals may change their drug use, and illicit drug
manufacturers may change their manufacturing methods, to avoid testing
positive for drugs included in proposed Guidelines, especially as the
number of new drugs and drug analogues increases. A less flexible drug
testing panel may delay needed drug analyte or cutoff changes based on
the state of the science (e.g., new technologies, research including
dosing studies). Therefore, the Department proposes to publish the drug
testing panel in the Federal Register on an annual basis, including any
revisions to the panel, without the need (perceived or otherwise) to
undergo notification and comment. Should the Department remove a drug
from the drug testing panel, a Federal agency may test specimens for
that drug in accordance with Section 3.2 (i.e., on a case-by-case basis
for reasonable suspicion or post accident testing, or routinely with a
waiver from the Secretary). This process is expected to improve the
effectiveness of Federal agency drug testing programs in support of the
Federal Drug-Free Workplace Program. The drug testing panel in Section
3.4 of the final OFMG will remain in effect until the effective date of
a newly published drug testing panel.
The Department will continue to monitor drug use trends and review
information on new drugs of abuse from sources such as Federal
regulators, researchers, the drug testing industry (including HHS-
certified laboratories), and public and private sector employers, to
determine whether drugs should be added or removed from the panel. Any
changes to analytes and cutoffs made in accordance with the newly
established drug testing panel publishing process will be based on a
thorough review of relevant information, including the current state of
the science, laboratory capabilities, cost associated with the change,
and benefits of the change to Federal agencies. The Department will set
a date for the panel changes to take effect and include the effective
date in the annual drug testing panel FRN, in order to allow time for
drug testing service providers (e.g., immunoassay kit manufacturers,
oral fluid collection device manufacturers) to develop or revise their
products, and for HHS-certified laboratories to develop or revise
assays, complete validation studies, and revise procedures. The prior
version of the panel will remain in effect until the effective date of
the panel changes.
For consistency and to avoid misinterpretation of drug test
results, the Department is requiring HHS-certified laboratories and
HHS-certified instrumented initial test facilities (collectively
referred to hereafter as ``HHS-certified test facilities'') and Medical
Review Officers (MROs) to report results using the nomenclature (i.e.,
analyte names and abbreviations) published with the drug testing panel.
Authorized Biomarker Testing Panel
A biomarker is an endogenous substance used to validate a
biological specimen. The purpose of a biomarker test is to determine
whether a submitted specimen is a human specimen. The current OFMG
(effective January 1, 2020) allow additional specimen validity testing
using biomarkers upon MRO request, to provide information to assist the
MRO in the verification process. The current OFMG also require HHS-
certified laboratories to report a specimen as invalid when the
biomarker is not present or when its concentration is not consistent
with that established for human oral fluid but does not allow these
specimens to be reported as substituted. The Department proposes to
revise the OFMG to define such specimens as substituted, and to allow
only biomarker tests that have been authorized by SAMHSA for use in
Federal agency workplace drug testing programs.
To ensure that scientifically valid biomarker tests, analytes, and
cutoffs are standardized for Federal workplace drug testing, the
Department will institute an approval process for biomarker tests,
based on review of data from the scientific and/or medical literature,
before authorizing the use of the biomarker test. The Department will
accept scientific information submitted for review from various sources
(e.g., HHS-certified test facilities, drug testing industry
stakeholders, researchers). The Department will include the authorized
biomarker testing panel (i.e., a table of authorized biomarkers, with
test analytes and cutoffs), in the FRN to be published each January (as
described earlier in this preamble). Federal agencies may choose to
test some or all of their workplace specimens for one or more
authorized biomarkers.
An HHS-certified laboratory or (for urine only) an HHS-certified
instrumented initial test facility (IITF) may request authorization
from SAMHSA to conduct a biomarker test that has not been included on
the list of authorized biomarkers. The test facility must submit
supporting documentation and assay validation records to the National
Laboratory Certification Program (NLCP) for SAMHSA review and approval.
When an oral fluid biomarker test is approved through this process,
SAMHSA will authorize the individual HHS-certified laboratory to
perform the biomarker test for federally regulated specimens only upon
MRO request (i.e., a blanket request for all specimens or a case-by-
case request for a specific specimen). A certified laboratory may
choose to begin the process by submitting supporting documentation for
review prior to assay validation, or may send supporting documentation
with completed validation records. The Department will include
measurands and decision points for other specimen validity tests in the
OFMG (e.g., Section 11.17).
Once a biomarker test has been added to the authorized biomarker
panel published in the FRN, HHS-certified laboratories may routinely
conduct the test without requiring an MRO request, and only require a
signed MRO request for case-by-case biomarker testing (in accordance
with OFMG section 3.5). The Department will continue to require NLCP
review of biomarker assay validation records before allowing a
laboratory to use the test for federally regulated workplace specimens.
This process will facilitate the identification of donors who
attempt to subvert their drug test, and ensure that biomarker tests
used for federally regulated workplace programs are scientifically
supportable and properly validated, and that all HHS-certified test
facilities use the same analytes and cutoffs.
For consistency and to avoid misinterpretation of biomarker test
results, the Department is requiring HHS-certified test facilities and
Medical Review Officers (MROs) to report results using the nomenclature
(i.e., analyte names and abbreviations) published with the biomarker
testing panel.
[[Page 20524]]
Medical Review Officer (MRO) Verification of Codeine and Morphine Test
Results
The MRO has an essential role in federally regulated workplace drug
testing programs, which includes performing the review of laboratory
results and supporting documentation, interviewing the donor when
necessary, and making a final determination regarding the result.
As described in Section 13.5(c)(2) of the current OFMG, when a
donor has no legitimate medical explanation for a positive codeine or
morphine result equal to or greater than 150 ng/mL, the MRO reports the
specimen as positive to the agency. When a donor has no legitimate
medical explanation for a positive codeine or morphine result less than
150 ng/mL, the MRO must determine that there is clinical evidence of
illegal opioid use (in addition to the test results) to report such
specimens as positive. If the MRO finds no clinical evidence of illegal
opioid use, the MRO verifies the opiate results as negative. The
Department is maintaining 150 ng/mL as a conservative decision point to
rule out results that may have been due to poppy seed ingestion rather
than illicit drug use. Because MROs routinely conduct donor interviews
by telephone, rather than in-person, some MROs have expressed concern
to the Department over the feasibility of the current requirement to
make a clinical assessment (i.e., physical examination) of the donor.
In light of this information, the Department reviewed the verification
procedures and determined that the additional requirement for clinical
evidence of illegal opioid use is no longer practical or effective. The
Department proposes to revise the procedures, now in renumbered Section
13.5(c)(3), to remove the requirement for the MRO to report specimens
with morphine and/or codeine between the cutoff and 150 ng/mL as
positive based on clinical evidence of illicit drug use. The MRO will
verify such specimens as negative unless the donor admits to illegal
opioid use that could have caused the positive result. The revised
procedures will provide a reliable and objective basis for identifying
illicit drug use, based on current scientific information and industry
practice. Retaining the decision point may provide useful information
on opioids, as the Department can use the semi-annual MRO reports
(described below) to compare results of specimens with morphine and
codeine concentrations between the cutoff and 150 ng/mL to results of
other opioids, including 6-acetylmorphine.
Medical Review Officer (MRO) Semiannual Reports
The Department, through the NLCP, obtains information from HHS-
certified laboratories that is reviewed to verify accurate reports and
compliance with Guidelines requirements. The NLCP conducts statistical
analysis and provides reports to the Department on federally regulated
workplace testing, although the data are limited to laboratory-reported
results and not the final, MRO-verified results. To obtain additional
information needed to assess compliance with the Mandatory Guidelines,
the Department proposes to require each MRO performing medical review
services for Federal agencies to submit semiannual reports, in January
and July of each year, of Federal agency specimens that were reported
as positive for a drug or drug metabolite by the laboratory, and
verified as negative by the MRO, along with the reason for the negative
verification (e.g., a valid prescription for a drug). The reports will
not contain any personally identifiable information of the donors.
This revision to the Guidelines will enable Department oversight of
MRO reporting practices and will enhance the Department's ability to
verify the accuracy of MRO reports and address areas of confusion about
Guidelines requirements. The information in the MRO reports will be
matched to information submitted to the NLCP by HHS-certified
laboratories for the same specimens. This additional information will
improve statistical analyses and provide a clearer picture of illicit
drug use by Federal job applicants and employees.
MROs may also experience some savings because the removal of the
clinical evaluation requirement for some codeine and morphine positive
results will simplify the MRO verification process.
Proposed Revisions to the Guidelines
This preamble describes the proposed revisions to the Mandatory
Guidelines for Federal Workplace Drug Testing Programs using Oral Fluid
(OFMG), and the rationale for the changes.
Subpart A--Applicability
Section 1.5 defines terms used in the OFMG. The Department has
added terms and revised definitions in this section in accordance with
proposed changes to these Guidelines, and to standardize terms and
definitions, where possible, to apply to all authorized specimen types.
The Department proposes to revise the Substituted Specimen
definition to include specimens tested for a biomarker, when the
biomarker is absent or is present at a concentration inconsistent with
that established for a human specimen. For clarity, the Department also
added a reference to the oral fluid specimen reporting criteria for
substitution in Section 3.7 of the UrMG. For clarity and for
consistency with the revised Substituted Specimen definition, the
Department proposes to edit the Adulterated Specimen definition to
apply to specimens with ``an abnormal concentration of a normal
constituent (e.g., nitrite in urine''), rather than ``an abnormal
concentration of an endogenous substance''; revise definitions for
Cutoff and Initial Specimen Validity Test to remove the ``(for urine)''
specification for identifying a substituted specimen; and revise the
Invalid Result definition to mention both ``adulterated'' and
``substituted'' as results that may be determined for an oral fluid
specimen. The Department proposes to revise the Collection Container
definition to apply to all authorized specimen types, by changing ``a
urine specimen'' to ``a donor's drug test specimen.'' The Department
has also added definitions for ``Biomarker Testing Panel'' and ``Drug
Testing Panel'' consistent with the proposed publication of these
testing panels in a separate FRN each year.
Section 1.7 describes what constitutes a donor's refusal to take a
federally regulated drug test. Section 1.7(a) includes exceptions for a
donor who fails to appear in a reasonable time for a pre-employment
test and a donor who leaves the collection site before the collection
process begins for a pre-employment test. The Department finds that
there is no justification for altering a refusal to test based on
whether the test is being conducted in the employment or pre-employment
context and, therefore, proposes to remove these exceptions. The
collector will report a refusal to test for any donor who fails to
appear in a reasonable time or who leaves the collection site before
the collection is complete, regardless of the reason for the test.
The Department also revised Section 1.7(a)(7) to include a donor's
refusal to wash their hands when directed to do so by the collector as
an example of a refusal to test by failing to cooperate with the
testing process. See also Section 8.4(a).
Section 1.8(a) describes the potential consequences for a refusal
to test. The Department has reworded this section to clarify potential
actions for a Federal employee who refuses to take a drug
[[Page 20525]]
test, and the potential action for an applicant who refuses to take a
pre-employment test.
Subpart C--Oral Fluid Specimen Tests
The Department proposes to edit Section 3.1 to reflect the proposed
process for publishing drug and biomarker testing panels in an FRN each
year containing a list of authorized drug analytes and biomarkers that
can be tested. As described under Authorized drug testing panel and
Authorized biomarker testing panel above, the time required to revise
the Guidelines through the Federal review process has impeded the
Department's ability to respond to drug use trends, and to make drug
analyte or cutoff changes based on the state of the science (e.g., new
technologies, research including dosing studies). This new process is
expected to improve the effectiveness of Federal agency drug testing
programs in support of the Federal Drug-Free Workplace Program. See
also Section 3.4.
The Department also revised item 3.1(c) to remove albumin or
immunoglobulin G (IgG) tests as examples of biomarker tests, and to
allow specimen validity tests that could be used to identify specimens
that are not valid for testing. See also Sections 3.8 and 11.17(g).
For clarity, the Department also revised the header for Section 3.2
to refer to ``drugs other than those in the drug testing panel'' (see
above) rather than ``additional drugs''.
The Department has revised Section 3.4 of the OFMG to describe the
proposed publication of a final notification in the Federal Register
each year that will include the authorized drugs, test analytes, and
cutoffs; the authorized biomarkers, test analytes, and cutoffs; and the
nomenclature required for laboratory and MRO reports. The annual
notification will be posted on the SAMHSA website, <a href="https://www.samhsa.gov/workplace">https://www.samhsa.gov/workplace</a>. The table in Section 3.4 of the final OFMG
will remain in effect until the effective date of the new panels
published in the separate FRN.
The Department proposes to add a new Section 3.7 and revise Section
3.8 to require specimens to be reported as substituted based on a
biomarker concentration outside the range established for that
biomarker in human oral fluid, rather than reporting such results as
invalid. See also Section 1.5. Section 3.8 also addresses specimen
validity tests that could be used to identify invalid specimens. See
also Sections 3.1 and 11.17(g).
Subpart G--Oral Fluid Specimen Collection Devices
The Department proposes to revise Section 7.2(b) to clarify that,
depending on the device type, a collection device may include one or
two specimen tubes for a split specimen collection. The Department also
proposes to add two new requirements for collection devices in this
section.
In Section 7.2(b)(2), the Department added a requirement for oral
fluid specimen tubes to be sufficiently transparent to enable a visual
assessment of the contents without opening the tube. This will enable
the collector to identify oral fluid specimens with abnormal physical
characteristics and take action (e.g., recollection) to obtain an
acceptable specimen. See also Section 8.5(a)(3).
In Section 7.2(b)(3), the Department added a requirement for the
collection device manufacturer to include the device lot expiration
date on each specimen tube. The collector will check the expiration
date of each device prior to use and document this action on the
Federal Custody and Control Form (CCF), and the laboratory accessioner
will check and document the expiration date on both A and B specimen
tubes upon receipt. As described below regarding Section 15.1,
laboratories must reject oral fluid specimens collected using an
expired device.
Subpart H--Oral Fluid Specimen Collection Procedure
The Department is proposing revisions to the oral fluid collection
procedures as described below, for clarity and for consistency with the
2020 Federal CCF and with the Oral Fluid Specimen Collection Handbook,
which were both finalized following OFMG publication in 2019.
Proposed revisions to Section 8.3 include reordering collection
steps (e.g., item d, item h.4) and rewording for clarity (e.g., items g
and h). The Department also added steps similar to those for urine
collections, to deter donor attempts to adulterate or substitute the
specimen. The added requirement for the collector to inspect the
contents of the donor's pockets applies only when the collector does
not keep the donor under direct observation until the end of the
collection, including the 10-minute wait period described in section
8.3(h). Unlike a urine collection, if the donor refuses to display the
contents of their pockets, the collector will continue with the oral
fluid collection, but will keep the donor under their direct
observation. This is not a refusal to test. In Section 8.3(h)(4), the
Department clarified that the collector must inform the donor that the
donor's failure to remain at the collection site until the collection
is complete will be reported as a refusal to test. This is consistent
with Section 1.7.
The Department revised wording in Section 8.3(f) regarding how
instructions for completing the Federal CCF are provided to the donor.
This is consistent with changes made to the Federal CCF to enable its
use with both urine and oral fluid specimens.
The Department also proposes to add steps in Section 8.4 to deter
donor attempts to tamper with the specimen. Proposed revisions include
a new item requiring the donor to wash their hands under the
collector's observation, and to keep their hands within view and avoid
touching items or surfaces after handwashing. A donor's refusal to wash
their hands when instructed by the collector constitutes a refusal to
test. In Section 8.4(b), the Department added a new item 1 specifying
that the collector opens the package containing the specimen collection
device, in the presence of the donor. In Section 8.4(d), the Department
added ``an attempt to prevent the device from collecting sufficient
oral fluid'' to the examples of donor attempts to tamper with a
specimen. The Oral Fluid Specimen Collection Handbook includes
additional examples of tampering attempts.
In Section 8.5, the Department added a new item a.3 requiring the
collector to check each collected specimen for abnormal physical
characteristics. See also Section 7.2.
The Department also revised the wording in Section 8.9(a)(3) for
clarity.
Subpart I--HHS Certification of Laboratories
Section 9.5 describes the qualitative and quantitative
specifications for oral fluid performance test (PT) samples. In item
a.2, the Department added that a PT sample may contain an adulterant or
may satisfy the criteria for a substituted specimen or invalid result.
Section 9.6 describes PT requirements for an applicant laboratory
and Section 9.7 describes PT requirements for an HHS-certified
laboratory. The Department has added requirements for specimen validity
testing challenges in new items (a)(7) through (a)(10) in both
sections. In addition, the Department is proposing to edit Section
9.7(a)(5) to state clearly that quantitative values reported for drug
tests are evaluated based on reported results for each PT cycle, not on
cumulative results reported over two consecutive PT cycles. An HHS-
certified laboratory
[[Page 20526]]
must not obtain a quantitative value outside the specified range for a
drug, based on the appropriate reference or peer group mean.
Subpart K--Laboratory
Section 11.17 describes the requirements for an HHS-certified
laboratory to report primary (A) specimen test results to an MRO. The
Department proposes to add the requirements for reporting an oral fluid
specimen as adulterated in item 11.17(d) and as substituted in item
11.17(e). See also Section 1.5.
Section 11.17(g) addresses laboratory and MRO discussions to
determine whether additional testing may be useful for specimens with
certain invalid results. Because biomarker testing could be used to
identify substitution, the Department has revised this section to
indicate that additional testing may be useful in being able to report
a substituted result, as well as positive or adulterated results. The
Department has also reworded item 11.17(g) to allow laboratories to
report specimens as invalid based on specimen validity tests. See also
Sections 3.1 and 3.8.
Section 11.17(i) and 11.17(p) includes requirements for the
laboratory to report ``non-negative'' results for a specimen to the
MRO. The Department is adding ``substituted'' to the list of non-
negative results in these sections.
The Department also proposes to add a new item 11.17(l) stating
that the laboratory must use the HHS-specified nomenclature published
with the drug and biomarker testing panels on reports. This change is
to ensure consistency in reporting and interpretation of test results,
by requiring the results of each test performed to be reported using
clear and correct nomenclature for test analytes, with the same
terminology and units of measurement. See also Section 3.4.
Section 11.18 addresses how long specimens must be retained by the
laboratory. The Department proposes to edit item a to require HHS-
certified laboratories to retain specimens reported as substituted for
at least one year (i.e., the same as specimens reported as positive,
adulterated, or invalid). The Department is also revising item b of
this section to require laboratories to maintain oral fluid specimens
in accordance with the collection device manufacturer's instructions
(i.e., frozen at -20 [deg]C or less, or refrigerated).
Section 11.20 describes information that must be included on HHS-
certified laboratories statistical summary reports for oral fluid
testing. The Department proposes to require laboratories to include the
number of substituted specimens.
Section 11.21 describes HHS-certified laboratory information that
is available to a Federal agency. The Department proposes to add that
an agency may request records of specimens reported as substituted.
Subpart M--Medical Review Officer (MRO)
Section 13.5(b)(2) describes MRO actions when a laboratory reports
an invalid result in conjunction with a positive, adulterated, or
substituted result. The Department has revised this section to include
substituted as well as positive or adulterated results. The Department
has added an item to this section to clarify that the MRO takes the
required action for the invalid result (specified in item e of this
section) only when the MRO has verified the other result(s) for the
specimen (i.e., positive, adulterated, or substituted) as negative or
when the split (B) specimen was tested and reported as a failure to
reconfirm.
Section 13.5(c) describes MRO actions to determine whether the
donor has a legitimate medical explanation for a positive specimen test
result. The Department added a new item Section 13.5(c)(1) to clarify
that the MRO reports a positive result when the donor admits
unauthorized use of the drug(s) that caused the positive test result,
and documents the admission of unauthorized drug use in the MRO records
and in the MRO's report to the Federal agency. A donor's admission of
unauthorized drug use corroborates the positive test.
Currently, Section 13.5(c)(1) includes the policy of the Department
that ingestion of food products containing marijuana is not an
acceptable medical explanation for a positive drug test result. The
Department proposes to reword this policy, now in item ii of Section
13.5(c)(2), to clarify that the policy applies to any positive oral
fluid drug test results, not just marijuana, with the exception of
positive codeine and morphine results less than 150 ng/mL as described
in Section 13.5(d). The section now states that ingestion of food
products containing a drug is not an acceptable medical explanation for
a positive drug test, with ``products containing marijuana'' as an
example. The Department also proposes to add a new item iii to this
section stating that a physician's authorization or medical
recommendation for a Schedule I substance is not an acceptable medical
explanation for a positive drug test. Under the Controlled Substances
Act CSA, a Schedule I substance is defined as a drug, chemical, or
other substance with no currently accepted medical use in the United
States, a lack of accepted safety for use under medical supervision,
and a high potential for abuse. (Ref. 1) The Drug Enforcement
Administration (DEA) maintains the current listing of controlled
substances on their website.
Section 13.5.(c)(3) describes MRO actions when the donor has no
legitimate medical explanation for a positive drug test result, and
includes exceptions for codeine and morphine results. As described
above under Medical Review Officer (MRO) verification of codeine and
morphine test results, the Department proposes to maintain the 150 ng/
mL decision point used to rule out codeine and morphine results that
may have been due to poppy seed ingestion rather than illicit drug use,
and remove the additional requirement for clinical evidence of illegal
opioid use. MROs will verify positive codeine and morphine results less
than 150 ng/mL as negative, and will include the specimen in the
required report of verified negative specimens described under Section
13.11 below. If the donor admits unauthorized drug use during their
interview with the MRO that could have caused the positive result, the
MRO verifies the result as positive.
The Department also proposes to revise Section 13.5(c)(3) to
address substituted oral fluid specimens where appropriate.
Section 13.9 describes how an MRO reports primary (A) drug test
results to an agency. The Department proposes to add a new item 13.9(e)
stating that the MRO must use the HHS-specified nomenclature published
with the drug and biomarker testing panels on reports. See also Section
3.4.
The Department has included a new Section 13.11 describing the
proposed requirement for an MRO to send semiannual reports to the
Secretary or designated HHS representative for Federal agency specimens
that were reported as positive by a laboratory and verified as negative
by the MRO. As described under Medical Review Officer (MRO) semiannual
reports above, this change will enable Department oversight of MRO
practices and will enhance the Department's ability to verify the
accuracy of MRO reports and address areas of confusion about Guidelines
requirements. In addition, the information in the MRO reports will be
matched to information submitted to the NLCP by HHS-certified
laboratories for the same specimens, thereby improving statistical
analyses and
[[Page 20527]]
providing a clearer picture of illicit drug use by Federal job
applicants and employees. The reports must not include any personally
identifiable information for the donor, and must be submitted within 14
working days after the end of the semiannual period (i.e., in July and
January). Section 13.11 lists the information that must be included on
the reports. To facilitate report preparation and review, the
Department will include a template for these MRO reports in the MRO
Guidance Manual and will arrange a secure method for MROs to submit
reports electronically.
The Department has included a new Section 13.12 describing the
Federal agency's responsibilities for designating an MRO. These
responsibilities include verifying and documenting that individuals
meet the MRO requirements in these Guidelines before allowing them to
serve as an MRO for the agency's drug testing program and on an ongoing
basis, and ensuring that each MRO reports drug test results in
accordance with the Guidelines. Further, the Federal agency must obtain
documentation from the MRO to confirm that the MRO and any external
service provider ensures the confidentiality integrity and availability
of the data and limits the access to any data transmission, storage,
and retrieval system.
Subpart N--Split Specimen Tests
The Department proposes to add a new Section 14.4 describing how an
HHS-certified laboratory reports a split (B) oral fluid specimen when
the primary (A) specimen was reported substituted. The Department
proposes to revise this section to address primary (A) specimens
reported as substituted based on biomarker test results. See also
Section 1.5.
Section 14.5 states that the HHS-certified laboratory that tested a
split (B) specimen must report the results to the MRO. The Department
proposes to reword this section to require the laboratory to use the
HHS-specified nomenclature published with the drug and biomarker
testing panels on reports for split (B) specimens. See also Section
3.4.
Section 14.6 describes the actions an MRO takes after receiving a
split (B) oral fluid specimen result from an HHS-certified laboratory.
The Department proposes to revise this section to address MRO
verification of split (B) specimen results when the primary (A)
specimen was reported as substituted, and when a B specimen was
reported as substituted based on biomarker See also Section 1.5. The
Department also proposes to add a new item 14.6(k) to address MRO
verification of split (B) specimen results when the B specimen fails to
reconfirm adulteration or substitution and is invalid.
Section 14.7 describes how an MRO reports split (B) specimen test
results to an agency. The Department proposes to add a new item 14.7(e)
stating that the MRO must use the HHS-specified nomenclature published
with the drug and biomarker testing panels on reports. See also Section
3.4.
Subpart O--Criteria for Rejecting a Specimen for Testing
The Department is proposing to add a new item c to Section 15.1,
requiring the laboratory to reject oral fluid specimens collected using
an expired device (i.e., when the expiration date on the specimen tube
precedes the collection date), unless the split (B) specimen can be
redesignated as the primary (A) specimen. See also Section 7.2.
General Revisions
In addition to the proposed changes described by subpart and
section above, the Department has edited the OFMG to address proposed
changes (e.g., removing ``for urine'' when referring to substituted
specimens; referencing the proposed annual FRN with drug and biomarker
testing panels) and has reworded some items for clarity and/or for
consistency with the UrMG.
Impact of These Guidelines on Government Regulated Industries
The Department is aware that these proposed new Guidelines may
impact the Department of Transportation (DOT) and Nuclear Regulatory
Commission (NRC) regulated industries depending on these agencies'
decisions to incorporate the final OFMG revisions into their programs
under their own authority.
Costs and Benefits
Costs
The proposed OFMG revision to publish the drug testing panel in a
separate FRN each January (e.g., Section 3.4) may result in a cost
increase for HHS-certified laboratories and MROs (e.g., costs for test
supplies, assay validation, administrative changes) when a new drug is
added to the panel or when analytes or cutoffs are changed for current
drugs. The added costs will depend on the change. For example,
implementation costs would be lower for laboratories that already offer
the drug test or use the different analyte or cutoff for their non-
regulated clients. MROs may experience increased costs when an agency
chooses to test their Federal job applicants and employees for a new
authorized drug with a high positivity rate or a Schedule II drug
requiring the MRO to review medical explanations. Additional costs for
testing and MRO review will be incorporated into the overall cost for
the Federal agency submitting the specimen to the laboratory. Added
costs to MROs would be expected to shift to Federal agencies over time,
as existing contracts expire and new contract terms are negotiated. As
noted earlier in this preamble, the Department will consider costs when
deciding whether to make a change to the authorized drug tests. At this
time, the Department will not require HHS-certified laboratories to
implement authorized biomarker tests. Each laboratory should conduct
their own cost analysis when deciding whether to offer biomarker
testing to federally regulated clients. The Department will consider
costs when deciding whether to require all certified laboratories to
test for a specific biomarker.
There will be some administrative costs for MROs associated with
the generation and submission of the semiannual reports of verified-
negative results (see Section 13.11). The Department encourages the use
of electronic recordkeeping to facilitate information retrieval and
report generation, and will enable secure submission of electronic
information to reduce MRO costs to provide these reports.
Benefits
The potential benefits of more timely changes to the drug testing
panel will result in a healthier and more productive workforce, as well
as avoid the issues associated with addiction and rehabilitation. Since
the personnel tested under this program are in positions that are
safety sensitive, potential benefits include decreased risk of
transportation and workplace accidents, decreased risk of low-
probability high consequence events, a more responsible workforce in
positions of public trust, and potentially reducing individuals'
dependence or addiction and the personal benefits associated with those
conditions. Considering the potential health and performance costs of
drug misuse, the benefits to the Federal workplace and the individuals
within that workplace justify the more agile method of changing the
drug testing panel for the Federal workplace drug testing programs.
The number of commercial substitution and adulteration products
aimed at defeating a drug test continues to proliferate for both urine
and oral fluid. Manufacturers alter their existing
[[Page 20528]]
products or develop new products to subvert drug and specimen validity
tests in federally regulated workplace programs. (Ref. 2 and 3) When
the Department added provisions for biomarker testing in the current
OFMG, the intent was to identify non-human oral fluid samples that were
submitted for testing in place of the donor's oral fluid. The proposed
revision to report a specimen as substituted (not invalid) based on
biomarker testing is consistent with this intention. This revision, as
well as the Department review and approval of biomarker tests and the
added flexibility for making changes to the drug and biomarker testing
panels, will strengthen the Federal Government's ability to identify
illicit drug use and donor attempts to subvert drug tests.
The proposed requirement for semiannual MRO reports on laboratory-
positive/MRO- negative results will enable the Department to ensure
accurate reports and MRO compliance with Guidelines requirements. The
information in the MRO reports will be matched to information for the
same specimens that was submitted to the NLCP by the HHS-certified
laboratory, thereby improving statistical analyses and providing a
clearer picture of illicit drug use by Federal job applicants and
employees.
MROs may also experience some savings, as the removal of the
clinical evaluation requirement for some codeine and morphine positive
results will simplify the MRO verification process.
Information Collection/Record Keeping Requirements
The information collection requirements (i.e., reporting and
recordkeeping) in the current Guidelines, which establish the
scientific and technical guidelines for Federal workplace drug testing
programs and establish standards for certification of laboratories
engaged in oral fluid drug testing for Federal agencies under authority
of 5 U.S.C. 7301 and Executive Order 12564, are approved by the Office
of Management and Budget (OMB) under control number 0930-0158. The
Federal Drug Testing Custody and Control Form (Federal CCF) used to
document the collection and chain of custody of urine and oral fluid
specimens at the collection site, for laboratories to report results,
and for Medical Review Officers to make a determination; the National
Laboratory Certification Program (NLCP) application; the NLCP
Laboratory Information Checklist; and recordkeeping requirements in the
current Guidelines, as approved under control number 0930-0158, will
remain in effect.
In support of the Government Paperwork Reduction Act (PRA), the
Department revised the Federal CCF to enable its use as an electronic
form (78 FR 42091, July 15, 2013) and developed requirements and
oversight procedures to ensure that HHS-certified test facilities and
other service providers (e.g., collection sites, MROs) using an
electronic Federal CCF (ECCF) maintain the accuracy, security, and
confidentiality of electronic drug test information. Before a Federal
ECCF can be used for Federal agency specimens, HHS-certified test
facilities must submit detailed information and proposed standard
operating procedures (SOPs) to the NLCP for SAMHSA review and approval,
and undergo an NLCP inspection focused on the proposed ECCF.
Since 2013, SAMHSA has encouraged the use of Federal ECCFs and
other electronic processes in HHS-certified test facilities, when
practicable, for federally regulated testing operations. In accordance
with Section 8108(a) of the SUPPORT for Patients and Communities Act,
SAMHSA has set a deadline of August 31, 2023, for all HHS-certified
laboratories to submit a request for approval of an electronic
(paperless) Federal CCF.
The title and description of the information collected and
respondent description are shown in the following paragraphs with an
estimate of the annual reporting, disclosure, and recordkeeping burden.
Included in the estimate is the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
Title: The Mandatory Guidelines for Federal Workplace Drug Testing
Programs using Oral Fluid.
Description: The Mandatory Guidelines establish the scientific and
technical guidelines for Federal drug testing programs and establish
standards for certification of laboratories engaged in drug testing for
Federal agencies under authority of Public Law 100-71, 5 U.S.C. 7301
note, and Executive Order 12564. Federal drug testing programs test
applicants to sensitive positions, individuals involved in accidents,
individuals for cause, and random testing of persons in sensitive
positions.
Description of Respondents: Individuals or households, businesses,
or other-for-profit and not-for-profit institutions.
The burden estimates in the tables below are based on the following
number of respondents: 10,500 donors who apply for employment or are
employed in testing designated positions, 100 collectors, 10 oral fluid
specimen testing laboratories, and 100 MROs.
Estimate of Annual Reporting Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of Responses/ Hours/
Section Purpose respondents respondent response Total hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
9.2(a)(1)...................................... Laboratory or IITF required to submit 10 1 3 30
application for certification.
9.10(a)(3)..................................... Materials to submit to become an HHS 10 1 2 20
inspector.
11.3........................................... Laboratory submits qualifications of 10 1 2 20
responsible person (RP) to HHS.
11.4(c)........................................ Laboratory submits information to HHS 10 1 2 20
on new RP or alternate RP.
11.20.......................................... Specifications for laboratory 10 5 0.5 25
semiannual statistical report of test
results to each Federal agency.
13.9 and 14.7.................................. Specifies that MRO must report all 100 14 0.05 (3 min) 70
verified primary and split specimen
test results to the Federal agency.
[[Page 20529]]
13.11.......................................... Specifications for MRO semiannual 100 2 0.5 100
report to the Secretary or designated
representative for Federal agency
specimen results that were laboratory-
positive and MRO-verified negative.
16.1(b) & 16.5(a).............................. Specifies content of request for 1 1 3 3
informal review of suspension/proposed
revocation of certification.
16.4........................................... Specifies information appellant 1 1 0.5 0.5
provides in first written submission
when laboratory suspension/revocation
is proposed.
16.6........................................... Requires appellant to notify reviewing 1 1 0.5 0.5
official of resolution status at end
of abeyance period.
16.7(a)........................................ Specifies contents of appellant 1 1 50 50
submission for review.
16.9(a)........................................ Specifies content of appellant request 1 1 3 3
for expedited review of suspension or
proposed revocation.
16.9(c)........................................ Specifies contents of review file and 1 1 50 50
briefs.
---------------------------------------------------------------
Total...................................... ....................................... 256 .............. .............. 392
--------------------------------------------------------------------------------------------------------------------------------------------------------
The following reporting requirements are also in the proposed
Guidelines, but have not been addressed in the above reporting burden
table: Collector must report any unusual donor behavior or refusal to
participate in the collection process on the Federal CCF (Sections 1.8,
8.9); collector annotates the Federal CCF when a sample is a blind
sample (Section 10.3(a)); MRO notifies the Federal agency and HHS when
an error occurs on a blind sample (Section 10.4(d)); and Sections 13.6
and 13.7 describe the actions an MRO takes for the medical evaluation
of a donor who cannot provide an oral fluid specimen. SAMHSA has not
calculated a separate reporting burden for these requirements because
they are included in the burden hours estimated for collectors to
complete Federal CCFs and for MROs to report results to Federal
agencies.
Estimate of Annual Disclosure Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of Responses/ Hours/
Section Purpose respondents respondent response Total hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
8.3(a), 8.6(b)(2).............................. Collector must contact Federal agency 100 1 0.05 (3 min) 5
point of contact.
11.21, 11.22................................... Information on drug test that 25 10 3 750
laboratory must provide to Federal
agency upon request or to donor
through MRO.
13.8(b)........................................ MRO must inform donor of right to 100 14 3 4,200
request split specimen test when a
positive, adulterated, or substituted
result is reported.
---------------------------------------------------------------
Total...................................... ....................................... 225 .............. .............. 4,955
--------------------------------------------------------------------------------------------------------------------------------------------------------
The following disclosure requirements are also included in the
proposed Guidelines, but have not been addressed in the above
disclosure burden table: the collector must explain the basic
collection procedure to the donor and answer any questions (Section
8.3(h)). SAMHSA believes having the collector explain the collection
procedure to the donor and answer any questions is a standard business
practice and not a disclosure burden.
Estimate of Annual Recordkeeping Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of Responses/ Hours/
Section Purpose respondents respondent response Total hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
8.3, 8.4, 8.5, 8.8............................. Collector completes Federal CCF for 100 380 0.07 (4 min) 2,660
specimen collected.
8.8(d) & (f)................................... Donor initials specimen labels/seals 38,000 1 0.08 (5 min) 3,040
and signs statement on the Federal CCF.
11.8(a) & 11.17................................ Laboratory completes Federal CCF upon 25 1,520 0.05 (3 min) 1,900
receipt of specimen and before
reporting result.
13.4(d)(4),13.9(c),14.7(c)..................... MRO completes Federal CCF before 100 380 0.05 (3 min) 1,900
reporting the primary or split
specimen result.
[[Page 20530]]
14.1(b)........................................ MRO documents donor's request to have 100 2 0.05 (3 min) 10
split specimen tested.
---------------------------------------------------------------
Total...................................... ....................................... 38,325 .............. .............. 9,510
--------------------------------------------------------------------------------------------------------------------------------------------------------
The proposed Guidelines contain several recordkeeping requirements
that SAMHSA considers not to be an additional recordkeeping burden. In
subpart D, a trainer is required to document the training of an
individual to be a collector (Section 4.3(a)(3)) and the documentation
must be maintained in the collector's training file (Section 4.3(c)).
SAMHSA believes this training documentation is common practice and is
not considered an additional burden. In subpart F, if a collector uses
an incorrect form to collect a Federal agency specimen, the collector
is required to provide a statement (Section 6.2(b)) explaining why an
incorrect form was used to document collecting the specimen. SAMHSA
believes this is an extremely infrequent occurrence and does not create
a significant additional recordkeeping burden. Subpart H (Section
8.4(d)) requires collectors to enter any information on the Federal CCF
of any unusual findings during the oral fluid specimen collection
procedure. These recordkeeping requirements are an integral part of the
collection procedure and are essential to documenting the chain of
custody for the specimens collected. The burden for these entries is
included in the recordkeeping burden estimated to complete the Federal
CCF and is, therefore, not considered an additional recordkeeping
burden. Subpart K describes a number of recordkeeping requirements for
laboratories associated with their testing procedures, maintaining
chain of custody, and keeping records (i.e., Sections 11.1(a) and (d);
11.2(b), (c), and (d); 11.6(b); 11.7(c); 11.8; 11.10(a); 11.13(a);
11.16; 11.19(a), (b), and (c); 11.20; 11.21(a); and 11.22). These
recordkeeping requirements are necessary for any laboratory to conduct
forensic drug testing and to ensure the scientific supportability of
the test results. Therefore, they are considered to be standard
business practice and are not considered a burden for this analysis.
Thus, the total annual response burden associated with the testing
of oral fluid specimens by the laboratories and IITFs is estimated to
be 14,857 hours (that is, the sum of the total hours from the above
tables). This is in addition to the 1,788,809 hours currently approved
by OMB under control number 0930-0158 for oral fluid testing under the
current Guidelines.
As required by section 3507(d) of the PRA, the Secretary has
submitted a copy of these proposed Guidelines to OMB for its review.
Comments on the information collection requirements are specifically
solicited in order to: (1) Evaluate whether the proposed collection of
information is necessary for the proper performance of HHS's functions,
including whether the information will have practical utility; (2)
evaluate the accuracy of HHS's estimate of the burden of the proposed
collection of information, including the validity of the methodology
and assumptions used; (3) enhance the quality, utility, and clarity of
the information to be collected; and (4) minimize the burden of the
collection of information on those who are to respond, including
through the use of appropriate automated, electronic, mechanical, or
other technological collection techniques or other forms of information
technology.
OMB is required to make a decision concerning the collection of
information contained in these proposed Guidelines between 30 and 60
days after publication of this document in the Federal Register.
Therefore, a comment to OMB is best assured of having its full effect
if OMB receives it within 30 days of publication. This does not affect
the deadline for the public to comment to HHS on the proposed
Guidelines.
Organizations and individuals desiring to submit comments on the
information collection requirements should direct them to the Office of
Information and Regulatory Affairs, OMB, New Executive Office Building,
725 17th Street NW, Washington, DC 20502, Attn: Desk Officer for
SAMHSA. Because of delays in receipt of mail, comments may also be sent
to 202-395-6974 (fax).
References
1. U.S. Department of Justice (DOJ), Drug Enforcement Agency (DEA),
Diversion Control Division. Controlled Substance Schedules. <a href="https://www.deadiversion.usdoj.gov">https://www.deadiversion.usdoj.gov</a>. Accessed June 9, 2021.
2. Kim, V.J., Okano, C.K., Osborne, C.R., Frank, D.M., Meana, C.T.,
Castaneto, M.S, 2018. Can synthetic urine replace authentic urine to
``beat'' workplace drug testing? Drug Test. Anal., 11(2), 331-335.
3. Quest Diagnostics, 2018. Workforce drug positivity at highest
rate in a decade, finds analysis of more than 10 million drug test
results. <a href="https://www.questdiagnostics.com/dms/Documents/Employer-Solutions/DTI-2018/2018-quest-diagnostics-drug-testing-index-2018-report/2018QuestDiagnosticsDrugTestingIndex.pdf">https://www.questdiagnostics.com/dms/Documents/Employer-Solutions/DTI-2018/2018-quest-diagnostics-drug-testing-index-2018-report/2018QuestDiagnosticsDrugTestingIndex.pdf</a>. Accessed October
19, 2018.
Summary
These proposed revisions are intended to simplify changes to the
authorized drug testing panel for Federal workplace drug testing
programs, facilitate the identification of substituted specimens using
biomarker testing, improve detection of illicit codeine and/or morphine
use, and provide the Department with information on Federal agency drug
test specimens that were reported as positive for a drug or drug
metabolite by a laboratory and verified negative by the Medical Review
Officer (MRO). There is no requirement for Federal agencies to use oral
fluid as part of their drug testing program. A Federal agency may
choose to use urine or oral fluid, or any combination of specimen types
in accordance with the Mandatory Guidelines for each matrix in their
program based on the agency's mission, its employees' duties, and the
danger to the public health and safety or to national security that
could result from an employee's failure to carry out the duties of his
or her position. The Department believes that the proposed revisions to
the Mandatory Guidelines save costs and improve the effectiveness of
Federal workplace drug testing programs.
[[Page 20531]]
Dated: March 22, 2022
Miriam E. Delphin-Rittmon,
Assistant Secretary for Mental Health and Substance Use, Substance
Abuse and Mental Health Services Administration.
Approved: March 22, 2022.
Xavier Becerra,
Secretary, Department of Health and Human Services.
MANDATORY GUIDELINES FOR FEDERAL WORKPLACE DRUG TESTING PROGRAMS USING
ORAL FLUID SPECIMENS
Subpart A--Applicability
1.1 To whom do these Guidelines apply?
1.2 Who is responsible for developing and implementing these
Guidelines?
1.3 How does a federal agency request a change from these
Guidelines?
1.4 How are these Guidelines revised?
1.5 What do the terms used in these Guidelines mean?
1.6 What is an agency required to do to protect employee records?
1.7 What is a refusal to take a federally regulated drug test?
1.8 What are the potential consequences for refusing to take a
federally regulated drug test?
Subpart B--Oral Fluid Specimens
2.1 What type of specimen may be collected?
2.2 Under what circumstances may an oral fluid specimen be
collected?
2.3 How is each oral fluid specimen collected?
2.4 What volume of oral fluid is collected?
2.5 How is the split oral fluid specimen collected?
2.6 When may an entity or individual release an oral fluid specimen?
Subpart C--Oral Fluid Specimen Tests
3.1 Which tests are conducted on an oral fluid specimen?
3.2 May a specimen be tested for drugs other than those in the drug
testing panel?
3.3 May any of the specimens be used for other purposes?
3.4 What are the drug and biomarker test analytes and cutoffs for
undiluted (neat) oral fluid?
3.5 May an HHS-certified laboratory perform additional drug and/or
specimen validity tests on a specimen at the request of the Medical
Review Officer (MRO)?
3.6 What criteria are used to report an oral fluid specimen as
adulterated?
3.7 What criteria are used to report an oral fluid specimen as
substituted?
3.8 What criteria are used to report an invalid result for an oral
fluid specimen?
Subpart D--Collectors
4.1 Who may collect a specimen?
4.2 Who may not collect a specimen?
4.3 What are the requirements to be a collector?
4.4 What are the requirements to be a trainer for collectors?
4.5 What must a federal agency do before a collector is permitted to
collect a specimen?
Subpart E--Collection Sites
5.1 Where can a collection for a drug test take place?
5.2 What are the requirements for a collection site?
5.3 Where must collection site records be stored?
5.4 How long must collection site records be stored?
5.5 How does the collector ensure the security and integrity of a
specimen at the collection site?
5.6 What are the privacy requirements when collecting an oral fluid
specimen?
Subpart F--Federal Drug Testing Custody and Control Form
6.1 What federal form is used to document custody and control?
6.2 What happens if the correct OMB-approved Federal CCF is not
available or is not used?
Subpart G--Oral Fluid Specimen Collection Devices
7.1 What is used to collect an oral fluid specimen?
7.2 What are the requirements for an oral fluid collection device?
7.3 What are the minimum performance requirements for a collection
device?
Subpart H--Oral Fluid Specimen Collection Procedure
8.1 What privacy must the donor be given when providing an oral
fluid specimen?
8.2 What must the collector ensure at the collection site before
starting an oral fluid specimen collection?
8.3 What are the preliminary steps in the oral fluid specimen
collection procedure?
8.4 What steps does the collector take in the collection procedure
before the donor provides an oral fluid specimen?
8.5 What steps does the collector take during and after the oral
fluid specimen collection procedure?
8.6 What procedure is used when the donor states that they are
unable to provide an oral fluid specimen?
8.7 If the donor is unable to provide an oral fluid specimen, may
another specimen type be collected for testing?
8.8 How does the collector prepare the oral fluid specimens?
8.9 How does the collector report a donor's refusal to test?
8.10 What are a federal agency's responsibilities for a collection
site?
Subpart I--HHS Certification of Laboratories
9.1 Who has the authority to certify laboratories to test oral fluid
specimens for federal agencies?
9.2 What is the process for a laboratory to become HHS-certified?
9.3 What is the process for a laboratory to maintain HHS
certification?
9.4 What is the process when a laboratory does not maintain its HHS
certification?
9.5 What are the qualitative and quantitative specifications of
performance testing (PT) samples?
9.6 What are the PT requirements for an applicant laboratory?
9.7 What are the PT requirements for an HHS-certified oral fluid
laboratory?
9.8 What are the inspection requirements for an applicant
laboratory?
9.9 What are the maintenance inspection requirements for an HHS-
certified laboratory?
9.10 Who can inspect an HHS-certified laboratory and when may the
inspection be conducted?
9.11 What happens if an applicant laboratory does not satisfy the
minimum requirements for either the PT program or the inspection
program?
9.12 What happens if an HHS-certified laboratory does not satisfy
the minimum requirements for either the PT program or the inspection
program?
9.13 What factors are considered in determining whether revocation
of a laboratory's HHS certification is necessary?
9.14 What factors are considered in determining whether to suspend a
laboratory's HHS certification?
9.15 How does the Secretary notify an HHS-certified laboratory that
action is being taken against the laboratory?
9.16 May a laboratory that had its HHS certification revoked be
recertified to test federal agency specimens?
9.17 Where is the list of HHS-certified laboratories published?
Subpart J--Blind Samples Submitted by an Agency
10.1 What are the requirements for federal agencies to submit blind
samples to HHS-certified laboratories?
10.2 What are the requirements for blind samples?
10.3 How is a blind sample submitted to an HHS-certified laboratory?
10.4 What happens if an inconsistent result is reported for a blind
sample?
Subpart K--Laboratory
11.1 What must be included in the HHS-certified laboratory's
standard operating procedure manual?
11.2 What are the responsibilities of the responsible person (RP)?
11.3 What scientific qualifications must the RP have?
11.4 What happens when the RP is absent or leaves an HHS-certified
laboratory?
11.5 What qualifications must an individual have to certify a result
reported by an HHS-certified laboratory?
11.6 What qualifications and training must other personnel of an
HHS-certified laboratory have?
11.7 What security measures must an HHS-certified laboratory
maintain?
11.8 What are the laboratory chain of custody requirements for
specimens and aliquots?
11.9 What are the requirements for an initial drug test?
11.10 What must an HHS-certified laboratory do to validate an
initial drug test?
[[Page 20532]]
11.11 What are the batch quality control requirements when
conducting an initial drug test?
11.12 What are the requirements for a confirmatory drug test?
11.13 What must an HHS-certified laboratory do to validate a
confirmatory drug test?
11.14 What are the batch quality control requirements when
conducting a confirmatory drug test?
11.15 What are the analytical and quality control requirements for
conducting specimen validity tests?
11.16 What must an HHS-certified laboratory do to validate a
specimen validity test?
11.17 What are the requirements for an HHS-certified laboratory to
report a test result?
11.18 How long must an HHS-certified laboratory retain specimens?
11.19 How long must an HHS-certified laboratory retain records?
11.20 What statistical summary reports must an HHS-certified
laboratory provide for oral fluid testing?
11.21 What HHS-certified laboratory information is available to a
federal agency?
11.22 What HHS-certified laboratory information is available to a
federal employee?
11.23 What types of relationships are prohibited between an HHS-
certified laboratory and an MRO?
Subpart L--Instrumented Initial Test Facility (IITF)
12.1 May an IITF test oral fluid specimens for a federal agency's
workplace drug testing program?
Subpart M--Medical Review Officer (MRO)
13.1 Who may serve as an MRO?
13.2 How are nationally recognized entities or subspecialty boards
that certify MROs approved?
13.3 What training is required before a physician may serve as an
MRO?
13.4 What are the responsibilities of an MRO?
13.5 What must an MRO do when reviewing an oral fluid specimen's
test results?
13.6 What action does the MRO take when the collector reports that
the donor did not provide a sufficient amount of oral fluid for a
drug test?
13.7 What happens when an individual is unable to provide a
sufficient amount of oral fluid for a federal agency applicant/pre-
employment test, a follow-up test, or a return-to-duty test because
of a permanent or long-term medical condition?
13.8 Who may request a test of a split (B) specimen?
13.9 How does an MRO report a primary (A) specimen test result to an
agency?
13.10 What types of relationships are prohibited between an MRO and
an HHS-certified laboratory?
13.11 What reports must an MRO provide to the Secretary for oral
fluid testing?
13.12 What are a federal agency's responsibilities for designating
an MRO?
Subpart N--Split Specimen Tests
14.1 When may a split (B) specimen be tested?
14.2 How does an HHS-certified laboratory test a split (B) specimen
when the primary (A) specimen was reported positive?
14.3 How does an HHS-certified laboratory test a split (B) oral
fluid specimen when the primary (A) specimen was reported
adulterated?
14.4 How does an HHS-certified laboratory test a split (B) oral
fluid specimen when the primary (A) specimen was reported
substituted?
14.5 Who receives the split (B) specimen result?
14.6 What action(s) does an MRO take after receiving the split (B)
oral fluid specimen result from the second HHS-certified laboratory?
14.7 How does an MRO report a split (B) specimen test result to an
agency?
14.8 How long must an HHS-certified laboratory retain a split (B)
specimen?
Subpart O--Criteria for Rejecting a Specimen for Testing
15.1 What discrepancies require an HHS-certified laboratory to
report an oral fluid specimen as rejected for testing?
15.2 What discrepancies require an HHS-certified laboratory to
report a specimen as rejected for testing unless the discrepancy is
corrected?
15.3 What discrepancies are not sufficient to require an HHS-
certified laboratory to reject an oral fluid specimen for testing or
an MRO to cancel a test?
15.4 What discrepancies may require an MRO to cancel a test?
Subpart P--Laboratory Suspension/Revocation Procedures
16.1 When may the HHS certification of a laboratory be suspended?
16.2 What definitions are used for this subpart?
16.3 Are there any limitations on issues subject to review?
16.4 Who represents the parties?
16.5 When must a request for informal review be submitted?
16.6 What is an abeyance agreement?
16.7 What procedures are used to prepare the review file and written
argument?
16.8 When is there an opportunity for oral presentation?
16.9 Are there expedited procedures for review of immediate
suspension?
16.10 Are any types of communications prohibited?
16.11 How are communications transmitted by the reviewing official?
16.12 What are the authority and responsibilities of the reviewing
official?
16.13 What administrative records are maintained?
16.14 What are the requirements for a written decision?
16.15 Is there a review of the final administrative action?
Subpart A--Applicability
Section 1.1 To whom do these Guidelines apply?
(a) These Guidelines apply to:
(1) Executive Agencies as defined in 5 U.S.C. 105;
(2) The Uniformed Services, as defined in 5 U.S.C. 2101(3), but
excluding the Armed Forces as defined in 5 U.S.C. 2101(2);
(3) Any other employing unit or authority of the federal government
except the United States Postal Service, the Postal Rate Commission,
and employing units or authorities in the Judicial and Legislative
Branches; and
(4) The Intelligence Community, as defined by Executive Order
12333, is subject to these Guidelines only to the extent agreed to by
the head of the affected agency;
(5) Laboratories that provide drug testing services to the federal
agencies;
(6) Collectors who provide specimen collection services to the
federal agencies; and
(7) Medical Review Officers (MROs) who provide drug testing review
and interpretation of results services to the federal agencies.
(b) These Guidelines do not apply to drug testing under authority
other than Executive Order 12564, including testing of persons in the
criminal justice system, such as arrestees, detainees, probationers,
incarcerated persons, or parolees.
Section 1.2 Who is responsible for developing and implementing these
Guidelines?
(a) Executive Order 12564 and Public Law 100-71 require the
Department of Health and Human Services (HHS) to establish scientific
and technical guidelines for federal workplace drug testing programs.
(b) The Secretary has the responsibility to implement these
Guidelines.
Section 1.3 How does a federal agency request a change from these
Guidelines?
(a) Each federal agency must ensure that its workplace drug testing
program complies with the provisions of these Guidelines unless a
waiver has been obtained from the Secretary.
(b) To obtain a waiver, a federal agency must submit a written
request to the Secretary that describes the specific change for which a
waiver is sought and a detailed justification for the change.
Section 1.4 How are these Guidelines revised?
(a) To ensure the full reliability and accuracy of specimen tests,
the accurate
[[Page 20533]]
reporting of test results, and the integrity and efficacy of federal
drug testing programs, the Secretary may make changes to these
Guidelines to reflect improvements in the available science and
technology.
(b) Revisions to these Guidelines will be published in final as a
notice in the Federal Register.
Section 1.5 What do the terms used in these Guidelines mean?
The following definitions are adopted:
Accessioner. The individual who signs the Federal Drug Testing
Custody and Control Form at the time of specimen receipt at the HHS-
certified laboratory or (for urine) the HHS-certified IITF.
Adulterated Specimen. A specimen that has been altered, as
evidenced by test results showing either a substance that is not a
normal constituent for that type of specimen or showing an abnormal
concentration of a normal constituent (e.g., nitrite in urine).
Aliquot. A portion of a specimen used for testing.
Alternate Responsible Person. The person who assumes professional,
organizational, educational, and administrative responsibility for the
day-to-day management of the HHS-certified laboratory when the
responsible person is unable to fulfill these obligations.
Alternate Technology Initial Drug Test. An initial drug test using
technology other than immunoassay to differentiate negative specimens
from those requiring further testing.
Batch. A number of specimens or aliquots handled concurrently as a
group.
Biomarker. An endogenous substance used to validate a biological
specimen.
Biomarker Testing Panel. The panel published in the Federal
Register that includes the biomarkers authorized for testing, with
analytes and cutoffs for initial and confirmatory biomarker tests, as
described under Section 3.4.
Blind Sample. A sample submitted to an HHS-certified test facility
for quality assurance purposes, with a fictitious identifier, so that
the test facility cannot distinguish it from a donor specimen.
Calibrator. A sample of known content and analyte concentration
prepared in the appropriate matrix used to define expected outcomes of
a testing procedure. The test result of the calibrator is verified to
be within established limits prior to use.
Cancelled Test. The result reported by the MRO to the federal
agency when a specimen has been reported to the MRO as an invalid
result (and the donor has no legitimate explanation) or rejected for
testing, when a split specimen fails to reconfirm, or when the MRO
determines that a fatal flaw or unrecovered correctable flaw exists in
the forensic records (as described in Sections 15.1 and 15.2).
Carryover. The effect that occurs when a sample result (e.g., drug
concentration) is affected by a preceding sample during the preparation
or analysis of a sample.
Certifying Scientist (CS). The individual responsible for verifying
the chain of custody and scientific reliability of a test result
reported by an HHS-certified laboratory.
Certifying Technician (CT). The individual responsible for
verifying the chain of custody and scientific reliability of negative,
rejected for testing, and (for urine) negative/dilute results reported
by an HHS-certified laboratory or (for urine) an HHS-certified IITF.
Chain of Custody (COC) Procedures. Procedures that document the
integrity of each specimen or aliquot from the point of collection to
final disposition.
Chain of Custody Documents. Forms used to document the control and
security of the specimen and all aliquots. The document may account for
an individual specimen, aliquot, or batch of specimens/aliquots and
must include the name and signature of each individual who handled the
specimen(s) or aliquot(s) and the date and purpose of the handling.
Collection Device. A product that is used to collect an oral fluid
specimen and may include a buffer or diluent.
Collection Site. The location where specimens are collected.
Collector. A person trained to instruct and assist a donor in
providing a specimen.
Confirmatory Drug Test. A second analytical procedure performed on
a separate aliquot of a specimen to identify and quantify a specific
drug or drug metabolite.
Confirmatory Specimen Validity Test. A second test performed on a
separate aliquot of a specimen to further support a specimen validity
test result.
Control. A sample used to evaluate whether an analytical procedure
or test is operating within predefined tolerance limits.
Cutoff. The analytical value (e.g., drug, drug metabolite, or
biomarker concentration) used as the decision point to determine a
result (e.g., negative, positive, adulterated, invalid, or substituted)
or the need for further testing.
Donor. The individual from whom a specimen is collected.
Drug Testing Panel. The panel published in the Federal Register
that includes the drugs authorized for testing, with analytes and
cutoffs for initial and confirmatory drug tests, as described under
Section 3.4.
External Service Provider. An independent entity that performs
services related to federal workplace drug testing on behalf of a
federal agency, a collector/collection site, an HHS[hyphen]certified
laboratory, a Medical Review Officer (MRO), or (for urine) an
HHS[hyphen]certified Instrumented Initial Test Facility (IITF).
Failed to Reconfirm. The result reported for a split (B) specimen
when a second HHS-certified laboratory is unable to corroborate the
result reported for the primary (A) specimen.
Federal Drug Testing Custody and Control Form (Federal CCF). The
Office of Management and Budget (OMB) approved form that is used to
document the collection and chain of custody of a specimen from the
time the specimen is collected until it is received by the test
facility (i.e., HHS-certified laboratory or, for urine, HHS-certified
IITF). It may be a paper (hardcopy), electronic, or combination
electronic and paper format (hybrid). The form may also be used to
report the test result to the Medical Review Officer.
HHS. The Department of Health and Human Services.
Initial Drug Test. An analysis used to differentiate negative
specimens from those requiring further testing.
Initial Specimen Validity Test. The first analysis used to
determine if a specimen is adulterated, invalid, substituted, or (for
urine) dilute.
Instrumented Initial Test Facility (IITF). A permanent location
where (for urine) initial testing, reporting of results, and
recordkeeping are performed under the supervision of a responsible
technician.
Invalid Result. The result reported by an HHS-certified laboratory
in accordance with the criteria established in Section 3.8 when a
positive, negative, adulterated, or substituted result cannot be
established for a specific drug or specimen validity test.
Laboratory. A permanent location where initial and confirmatory
drug testing, reporting of results, and recordkeeping are performed
under the supervision of a responsible person.
Limit of Detection. The lowest concentration at which the analyte
(e.g., drug or drug metabolite) can be identified.
Limit of Quantification (LOQ). For quantitative assays, the lowest
concentration at which the identity and concentration of the analyte
(e.g., drug
[[Page 20534]]
or drug metabolite) can be accurately established.
Lot. A number of units of an item (e.g., reagents, quality control
material, oral fluid collection device) manufactured from the same
starting materials within a specified period of time for which the
manufacturer ensures that the items have essentially the same
performance characteristics and expiration date.
Medical Review Officer (MRO). A licensed physician who reviews,
verifies, and reports a specimen test result to the federal agency.
Negative Result. The result reported by an HHS-certified laboratory
or (for urine) an HHS-certified IITF to an MRO when a specimen contains
no drug and/or drug metabolite; or the concentration of the drug or
drug metabolite is less than the cutoff for that drug or drug class.
Oral Fluid Specimen. An oral fluid specimen is collected from the
donor's oral cavity and is a combination of physiological fluids
produced primarily by the salivary glands.
Oxidizing Adulterant. A substance that acts alone or in combination
with other substances to oxidize drug or drug metabolites to prevent
the detection of the drugs or drug metabolites, or affects the reagents
in either the initial or confirmatory drug test.
Performance Testing (PT) Sample. A program-generated sample sent to
a laboratory or (for urine) to an IITF to evaluate performance.
Positive Result. The result reported by an HHS-certified laboratory
when a specimen contains a drug or drug metabolite equal to or greater
than the confirmatory test cutoff.
Reconfirmed. The result reported for a split (B) specimen when the
second HHS-certified laboratory corroborates the original result
reported for the primary (A) specimen.
Rejected for Testing. The result reported by an HHS-certified
laboratory or (for urine) HHS-certified IITF when no tests are
performed on a specimen because of a fatal flaw or an unrecovered
correctable error (see Sections 15.1 and 15.2).
Responsible Person (RP). The person who assumes professional,
organizational, educational, and administrative responsibility for the
day-to-day management of an HHS-certified laboratory.
Sample. A performance testing sample, calibrator or control used
during testing, or a representative portion of a donor's specimen.
Secretary. The Secretary of the U.S. Department of Health and Human
Services.
Specimen. Fluid or material collected from a donor at the
collection site for the purpose of a drug test.
Split Specimen Collection (for Oral Fluid). A collection in which
two specimens (primary [A] and split [B]) are collected, concurrently
or serially, and independently sealed in the presence of the donor; or
a collection in which a single specimen is collected using a single
collection device and is subdivided into a primary (A) specimen and a
split (B) specimen, which are independently sealed in the presence of
the donor.
Standard. Reference material of known purity or a solution
containing a reference material at a known concentration.
Substituted Specimen. A specimen that has been submitted in place
of the donor's specimen, as evidenced by the absence of a biomarker or
a biomarker concentration inconsistent with that established for a
human specimen, as indicated in the biomarker testing panel, or (for
urine) creatinine and specific gravity values that are outside the
physiologically producible ranges of human urine, in accordance with
the criteria to report a urine specimen as substituted in UrMG Section
3.7.
Undiluted (neat) oral fluid. An oral fluid specimen to which no
other solid or liquid has been added. For example, see Section 2.4: a
collection device that uses a diluent (or other component, process, or
method that modifies the volume of the testable specimen) must collect
at least 1 mL of undiluted (neat) oral fluid.
Section 1.6 What is an agency required to do to protect employee
records?
Consistent with 5 U.S.C. 552a and 48 CFR 24.101-24.104, all agency
contracts with laboratories, collectors, and MROs must require that
they comply with the Privacy Act, 5 U.S.C. 552a. In addition, the
contracts must require compliance with employee access and
confidentiality provisions of Section 503 of Public Law 100-71. Each
federal agency must establish a Privacy Act System of Records or modify
an existing system or use any applicable Government-wide system of
records to cover the records of employee drug test results. All
contracts and the Privacy Act System of Records must specifically
require that employee records be maintained and used with the highest
regard for employee privacy.
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) Privacy Rule (Rule), 45 CFR parts 160 and 164, subparts A and
E, may be applicable to certain health care providers with whom a
federal agency may contract. If a health care provider is a HIPAA
covered entity, the provider must protect the individually identifiable
health information it maintains in accordance with the requirements of
the Rule, which includes not using or disclosing the information except
as permitted by the Rule and ensuring there are reasonable safeguards
in place to protect the privacy of the information. For more
information regarding the HIPAA Privacy Rule, please visit <a href="https://www.hhs.gov/hipaa/index.html">https://www.hhs.gov/hipaa/index.html</a>.
Section 1.7 What is a refusal to take a federally regulated drug test?
(a) As a donor for a federally regulated drug test, you have
refused to take a federally regulated drug test if you:
(1) Fail to appear for any test within a reasonable time, as
determined by the federal agency, consistent with applicable agency
regulations, after being directed to do so by the federal agency;
(2) Fail to remain at the collection site until the collection
process is complete;
(3) Fail to provide a specimen (e.g., oral fluid or another
authorized specimen type) for any drug test required by these
Guidelines or federal agency regulations;
(4) Fail to provide a sufficient amount of oral fluid when
directed, and it has been determined, through a required medical
evaluation, that there was no legitimate medical explanation for the
failure as determined by the process described in Section 13.6;
(5) Fail or decline to participate in an alternate specimen
collection (e.g., urine) as directed by the federal agency or collector
(i.e., as described in Section 8.6);
(6) Fail to undergo a medical examination or evaluation, as
directed by the MRO as part of the verification process (i.e., Section
13.6) or as directed by the federal agency. In the case of a federal
agency applicant/pre-employment drug test, the donor is deemed to have
refused to test on this basis only if the federal agency applicant/pre-
employment test is conducted following a contingent offer of
employment. If there was no contingent offer of employment, the MRO
will cancel the test;
(7) Fail to cooperate with any part of the testing process (e.g.,
disrupt the collection process, fail to rinse the mouth or wash hands
after being directed to do so by the collector, refuse to provide a
split specimen);
(8) Bring materials to the collection site for the purpose of
adulterating, substituting, or diluting the specimen;
[[Page 20535]]
(9) Attempt to adulterate, substitute, or dilute the specimen; or
(10) Admit to the collector or MRO that you have adulterated or
substituted the specimen.
Section 1.8 What are the potential consequences for refusing to take a
federally regulated drug test?
(a) A refusal to take a test may result in the initiation of
disciplinary or adverse action for a federal employee, up to and
including removal from federal employment. An applicant's refusal to
take a pre-employment test may result in non-selection for federal
employment.
(b) When a donor has refused to participate in a part of the
collection process, including failing to appear in a reasonable time
for any test, the collector must terminate the collection process and
take action as described in Section 8.9. Required action includes
immediately notifying the federal agency's designated representative by
any means (e.g., telephone or secure facsimile [fax] machine) that
ensures that the refusal notification is immediately received and, if a
Federal CCF has been initiated, documenting the refusal on the Federal
CCF, signing and dating the Federal CCF, and sending all copies of the
Federal CCF to the federal agency's designated representative.
(c) When documenting a refusal to test during the verification
process as described in Sections 13.4, 13.5, and 13.6, the MRO must
complete the MRO copy of the Federal CCF to include:
(1) Checking the refusal to test box;
(2) Providing a reason for the refusal in the remarks line; and
(3) Signing and dating the MRO copy of the Federal CCF.
Subpart B--Oral Fluid Specimens
Section 2.1 What type of specimen may be collected?
A federal agency may collect oral fluid and/or an alternate
specimen type for its workplace drug testing program. Only specimen
types authorized by Mandatory Guidelines for Federal Workplace Drug
Testing Programs may be collected. An agency using oral fluid must
follow these Guidelines.
Section 2.2 Under what circumstances may an oral fluid specimen be
collected?
A federal agency may collect an oral fluid specimen for the
following reasons:
(a) Federal agency applicant/Pre-employment test;
(b) Random test;
(c) Reasonable suspicion/cause test;
(d) Post accident test;
(e) Return to duty test; or
(f) Follow-up test.
Section 2.3 How is each oral fluid specimen collected?
Each oral fluid specimen is collected as a split specimen (i.e.,
collected either simultaneously or serially) as described in Sections
2.5 and 8.8.
Section 2.4 What volume of oral fluid is collected?
A volume of at least 1 mL of undiluted (neat) oral fluid for each
oral fluid specimen (designated ``Tube A'' and ``Tube B'') is collected
using a collection device. If the device does not include a diluent (or
other component, process, or method that modifies the volume of the
testable specimen), the A and B tubes must have a volume marking
clearly noting a level of 1 mL.
Section 2.5 How is the split oral fluid specimen collected?
The collector collects at least 1 mL of undiluted (neat) oral fluid
in a collection device designated as ``A'' (primary) and at least 1 mL
of undiluted (neat) oral fluid in a collection device designated as
``B'' (split) either simultaneously or serially (i.e., using two
devices or using one device and subdividing the specimen), as described
in Section 8.8.
Section 2.6 When may an entity or individual release an oral fluid
specimen?
Entities and individuals subject to these Guidelines under Section
1.1 may not release specimens collected pursuant to Executive Order
12564, Public Law 100-71, and these Guidelines to donors or their
designees. Specimens also may not be released to any other entity or
individual unless expressly authorized by these Guidelines or by
applicable federal law. This section does not prohibit a donor's
request to have a split (B) specimen tested in accordance with Section
13.8.
Subpart C--Oral Fluid Specimen Tests
Section 3.1 Which tests are conducted on an oral fluid specimen?
A federal agency:
(a) Must ensure that each specimen is tested for marijuana and
cocaine as provided in the drug testing panel described under Section
3.4;
(b) Is authorized to test each specimen for other Schedule I or II
drugs as provided in the drug testing panel;
(c) Is authorized upon a Medical Review Officer's request to test
an oral fluid specimen to determine specimen validity using, for
example, a test for a specific adulterant;
(d) Is authorized to test each specimen for one or more biomarkers
as provided in the biomarker testing panel described under Section 3.4;
and
(e) If a specimen exhibits abnormal characteristics (e.g., unusual
odor or color, semi-solid characteristics), causes reactions or
responses characteristic of an adulterant during initial or
confirmatory drug tests (e.g., non-recovery of internal standard,
unusual response), or contains an unidentified substance that
interferes with the confirmatory analysis, then additional testing may
be performed.
Section 3.2 May a specimen be tested for drugs other than those in the
drug testing panel?
(a) On a case-by-case basis, a specimen may be tested for
additional drugs, if a federal agency is conducting the collection for
reasonable suspicion or post accident testing. A specimen collected
from a federal agency employee may be tested by the federal agency for
any drugs listed in Schedule I or II of the Controlled Substances Act.
The federal agency must request the HHS-certified laboratory to test
for the additional drug, include a justification to test a specific
specimen for the drug, and ensure that the HHS-certified laboratory has
the capability to test for the drug and has established properly
validated initial and confirmatory analytical methods. If an initial
test procedure is not available upon request for a suspected Schedule I
or Schedule II drug, the federal agency can request an HHS-certified
laboratory to test for the drug by analyzing two separate aliquots of
the specimen in two separate testing batches using the confirmatory
analytical method. Additionally, the split (B) specimen will be
available for testing if the donor requests a retest at another HHS-
certified laboratory.
(b) A federal agency covered by these Guidelines must petition the
Secretary in writing for approval to routinely test for any drug class
not listed in the drug testing panel described under Section 3.4. Such
approval must be limited to the use of the appropriate science and
technology and must not otherwise limit agency discretion to test for
any drug tested under paragraph (a) of this section.
Section 3.3 May any of the specimens be used for other purposes?
(a) Specimens collected pursuant to Executive Order 12564, Public
Law 100-71, and these Guidelines must only be tested for drugs and to
determine
[[Page 20536]]
their validity in accordance with Subpart C of these Guidelines. Use of
specimens by donors, their designees, or any other entity, for other
purposes (e.g., deoxyribonucleic acid, DNA, testing) is prohibited
unless authorized in accordance with applicable federal law.
(b) These Guidelines are not intended to prohibit federal agencies
specifically authorized by law to test a specimen for additional
classes of drugs in its workplace drug testing program.
Section 3.4 What are the drug and biomarker test analytes and cutoffs
for undiluted (neat) oral fluid?
The Secretary will publish the drug and biomarker test analytes and
cutoffs (i.e., the ``drug testing panel'' and ``biomarker testing
panel'') for initial and confirmatory drug and biomarker tests in the
Federal Register each year. The drug and biomarker testing panels will
also be available on the internet at <a href="https://www.samhsa.gov/workplace/drug-testing">https://www.samhsa.gov/workplace/drug-testing</a>.
This drug testing panel will remain in effect until the effective
date of a new drug testing panel published in the Federal Register:
----------------------------------------------------------------------------------------------------------------
Confirmatory test Confirmatory test cutoff
Initial test analyte Initial test cutoff \1\ analyte concentration
----------------------------------------------------------------------------------------------------------------
Marijuana (THC) \2\............. 4 ng/mL \3\ THC................ 2 ng/mL
Cocaine/Benzoylecgonine......... 15 ng/mL Cocaine............ 8 ng/mL
Benzoylecgonine.... 8 ng/mL
Codeine/Morphine................ 30 ng/mL Codeine............ 15 ng/mL
Morphine........... 15 ng/mL
Hydrocodone/Hydromorphone....... 30 ng/mL Hydrocodone........ 15 ng/mL
Hydromorphone...... 15 ng/mL
Oxycodone/Oxymorphone........... 30 ng/mL Oxycodone.......... 15 ng/mL
Oxymorphone........ 15 ng/mL
6-Acetylmorphine................ 4 ng/mL \3\ 6-Acetylmorphine... 2 ng/mL
Phencyclidine................... 10 ng/mL Phencyclidine...... 10 ng/mL
Amphetamine/Methamphetamine..... 50 ng/mL Amphetamine........ 25 ng/mL
Methamphetamine.... 25 ng/mL
MDMA \4\/MDA \5\................ 50 ng/mL MDMA............... 25 ng/mL
MDA................ 25 ng/mL
----------------------------------------------------------------------------------------------------------------
\1\ For grouped analytes (i.e., two or more analytes that are in the same drug class and have the same initial
test cutoff):
Immunoassay: The test must be calibrated with one analyte from the group identified as the target analyte. The
cross reactivity of the immunoassay to the other analyte(s) within the group must be 80 percent or greater; if
not, separate immunoassays must be used for the analytes within the group.
Alternate technology: Either one analyte or all analytes from the group must be used for calibration, depending
on the technology. At least one analyte within the group must have a concentration equal to or greater than
the initial test cutoff or, alternatively, the sum of the analytes present (i.e., equal to or greater than the
laboratory's validated limit of quantification) must be equal to or greater than the initial test cutoff.
\2\ An immunoassay must be calibrated with the target analyte, [Delta]-9-tetrahydrocannabinol (THC).
\3\ Alternate technology (THC and 6-AM): The confirmatory test cutoff must be used for an alternate technology
initial test that is specific for the target analyte (i.e., 2 ng/mL for THC, 2 ng/mL for 6-AM).
\4\ Methylenedioxymethamphetamine (MDMA).
\5\ Methylenedioxyamphetamine (MDA).
(a) The drug testing panel will include drugs authorized for
testing in federal workplace drug testing programs, with the required
test analytes and cutoffs;
(b) The biomarker testing panel will include biomarkers authorized
for testing in federal workplace drug testing programs, with the
required test analytes and cutoffs; and
(c) HHS-certified laboratories and Medical Review Officers must use
the nomenclature (i.e., analyte names and abbreviations) published in
the Federal Register with the drug and biomarker testing panels to
report federal workplace drug test results.
Section 3.5 May an HHS-certified laboratory perform additional drug
and/or specimen validity tests on a specimen at the request of the
Medical Review Officer (MRO)?
An HHS-certified laboratory is authorized to perform additional
drug and/or specimen validity tests on a case-by-case basis as
necessary to provide information that the MRO would use to report a
verified drug test result (e.g., specimen validity tests). An HHS-
certified laboratory is not authorized to routinely perform additional
drug and/or specimen validity tests at the request of an MRO without
prior authorization from the Secretary or designated HHS
representative, with the exception of the determination of D,L
stereoisomers of amphetamine and methamphetamine. All tests must meet
appropriate validation and quality control requirements in accordance
with these Guidelines.
Section 3.6 What criteria are used to report an oral fluid specimen as
adulterated?
An HHS-certified laboratory reports a primary (A) specimen as
adulterated when the presence of an adulterant is verified using an
initial test on the first aliquot and a different confirmatory test on
the second aliquot.
Section 3.7 What criteria are used to report an oral fluid specimen as
substituted?
An HHS-certified laboratory reports a primary (A) specimen as
substituted when a biomarker is not detected or is present at a
concentration inconsistent with that established for human oral fluid
for both the initial (first) test and the confirmatory (second) test on
two separate aliquots (i.e., using the test analytes and cutoffs listed
in the biomarker testing panel).
Section 3.8 What criteria are used to report an invalid result for an
oral fluid specimen?
An HHS-certified laboratory reports a primary (A) oral fluid
specimen as an invalid result when:
(a) Interference occurs on the initial drug tests on two separate
aliquots (i.e., valid immunoassay or alternate technology initial drug
test results cannot be obtained);
(b) Interference with the drug confirmatory assay occurs on two
separate aliquots of the specimen and
[[Page 20537]]
the laboratory is unable to identify the interfering substance;
(c) The physical appearance of the specimen (e.g., viscosity) is
such that testing the specimen may damage the laboratory's instruments;
(d) The specimen has been tested and the appearances of the primary
(A) and the split (B) specimens (e.g., color) are clearly different; or
(e) A specimen validity test on two separate aliquots of the
specimen indicates that the specimen is not valid for testing.
Subpart D--Collectors
Section 4.1 Who may collect a specimen?
(a) A collector who has been trained to collect oral fluid
specimens in accordance with these Guidelines and the manufacturer's
procedures for the collection device.
(b) The immediate supervisor of a federal employee donor may only
collect that donor's specimen when no other collector is available. The
supervisor must be a trained collector.
(c) The hiring official of a federal agency applicant may only
collect that federal agency applicant's specimen when no other
collector is available. The hiring official must be a trained
collector.
Section 4.2 Who may not collect a specimen?
(a) A federal agency employee who is in a testing designated
position and subject to the federal agency drug testing rules must not
be a collector for co-workers in the same testing pool or who work with
that employee on a daily basis.
(b) A federal agency applicant or employee must not collect their
own drug testing specimen.
(c) An employee working for an HHS-certified laboratory must not
act as a collector if the employee could link the identity of the donor
to the donor's drug test result.
(d) To avoid a potential conflict of interest, a collector must not
be related to the employee (e.g., spouse, ex-spouse, relative) or
personal friend (e.g., fianc[eacute]e).
Section 4.3 What are the requirements to be a collector?
(a) An individual may serve as a collector if they fulfill the
following conditions:
(1) Is knowledgeable about the collection procedure described in
these Guidelines;
(2) Is knowledgeable about any guidance provided by the federal
agency's Drug-Free Workplace Program and additional information
provided by the Secretary relating to the collection procedure
described in these Guidelines;
(3) Is trained and qualified to use the specific oral fluid
collection device. Training must include the following:
(i) All steps necessary to complete an oral fluid collection;
(ii) Completion and distribution of the Federal CCF;
(iii) Problem collections;
(iv) Fatal flaws, correctable flaws, and how to correct problems in
collections; and
(v) The collector's responsibility for maintaining the integrity of
the collection process, ensuring the privacy of the donor, ensuring the
security of the specimen, and avoiding conduct or statements that could
be viewed as offensive or inappropriate.
(4) Has demonstrated proficiency in collections by completing five
consecutive error-free mock collections.
(i) The five mock collections must include two uneventful
collection scenarios, one insufficient specimen quantity scenario, one
scenario in which the donor refuses to sign the Federal CCF, and one
scenario in which the donor refuses to initial the specimen tube
tamper-evident seal.
(ii) A qualified trainer for collectors must monitor and evaluate
the individual being trained, in person or by a means that provides
real-time observation and interaction between the trainer and the
trainee, and the trainer must attest in writing that the mock
collections are error-free.
(b) A trained collector must complete refresher training at least
every five years that includes the requirements in paragraph (a) of
this section.
(c) The collector must maintain the documentation of their training
and provide that documentation to a federal agency when requested.
(d) An individual may not collect specimens for a federal agency
until the individual's training as a collector has been properly
documented.
Section 4.4 What are the requirements to be a trainer for collectors?
(a) Individuals are considered qualified trainers for collectors
for a specific oral fluid collection device and may train others to
collect oral fluid specimens using that collection device when they
have completed the following:
(1) Qualified as a trained collector and regularly conducted oral
fluid drug test collections using that collection device for a period
of at least one year or
(2) Completed a ``train the trainer'' course given by an
organization (e.g., manufacturer, private entity, contractor, federal
agency).
(b) A qualified trainer for collectors must complete refresher
training at least every five years in accordance with the collector
requirements in Section 4.3(a).
(c) A qualified trainer for collectors must maintain the
documentation of the trainer's training and provide that documentation
to a federal agency when requested.
Section 4.5 What must a federal agency do before a collector is
permitted to collect a specimen?
A federal agency must ensure the following:
(a) The collector has satisfied the requirements described in
Section 4.3;
(b) The collector, who may be self-employed, or an organization
(e.g., third party administrator that provides a collection service,
collector training company, federal agency that employs its own
collectors) maintains a copy of the training record(s); and
(c) The collector has been provided the name and telephone number
of the federal agency representative.
Subpart E--Collection Sites
Section 5.1 Where can a collection for a drug test take place?
(a) A collection site may be a permanent or temporary facility
located either at the work site or at a remote site.
(b) In the event that an agency-designated collection site is not
accessible and there is an immediate requirement to collect an oral
fluid specimen (e.g., an accident investigation), another site may be
used for the collection, providing the collection is performed by a
collector who has been trained to collect oral fluid specimens in
accordance with these Guidelines and the manufacturer's procedures for
the collection device.
Section 5.2 What are the requirements for a collection site?
The facility used as a collection site must have the following:
(a) Provisions to ensure donor privacy during the collection (as
described in Section 8.1);
(b) A suitable and clean surface area that is not accessible to the
donor for handling the specimens and completing the required paperwork;
(c) A secure temporary storage area to maintain specimens until the
specimen is transferred to an HHS-certified laboratory;
(d) A restricted access area where only authorized personnel may be
present during the collection;
[[Page 20538]]
(e) A restricted access area for the storage of collection
supplies; and
(f) The ability to store records securely.
Section 5.3 Where must collection site records be stored?
Collection site records must be stored at a secure site designated
by the collector or the collector's employer.
Section 5.4 How long must collection site records be stored?
Collection site records (e.g., collector copies of the OMB-approved
Federal CCF) must be stored securely for a minimum of 2 years. The
collection site may convert hardcopy records to electronic records for
storage and discard the hardcopy records after 6 months.
Section 5.5 How does the collector ensure the security and integrity of
a specimen at the collection site?
(a) A collector must do the following to maintain the security and
integrity of a specimen:
(1) Not allow unauthorized personnel to enter the collection area
during the collection procedure;
(2) Perform only one donor collection at a time;
(3) Restrict access to collection supplies before, during, and
after collection;
(4) Ensure that only the collector and the donor are allowed to
handle the unsealed specimen;
(5) Ensure the chain of custody process is maintained and
documented throughout the entire collection, storage, and transport
procedures;
(6) Ensure that the Federal CCF is completed and distributed as
required; and
(7) Ensure that specimens transported to an HHS-certified
laboratory are sealed and placed in transport containers designed to
minimize the possibility of damage during shipment (e.g., specimen
boxes, padded mailers, or other suitable shipping container), and those
containers are securely sealed to eliminate the possibility of
undetected tampering;
(b) Couriers, express carriers, and postal service personnel are
not required to document chain of custody since specimens are sealed in
packages that would indicate tampering during transit to the HHS-
certified laboratory.
Section 5.6 What are the privacy requirements when collecting an oral
fluid specimen?
Collections must be performed at a site that provides reasonable
privacy (as described in Section 8.1).
Subpart F--Federal Drug Testing Custody and Control Form
Section 6.1 What federal form is used to document custody and control?
The OMB-approved Federal CCF must be used to document custody and
control of each specimen at the collection site.
Section 6.2 What happens if the correct OMB-approved Federal CCF is not
available or is not used?
(a) The use of a non-federal CCF or an expired Federal CCF is not,
by itself, a reason for the HHS-certified laboratory to automatically
reject the specimen for testing or for the MRO to cancel the test.
(b) If the collector does not use the correct OMB-approved Federal
CCF, the collector must document that it is a federal agency specimen
collection and provide the reason that the incorrect form was used.
Based on the information provided by the collector, the HHS-certified
laboratory must handle and test the specimen as a federal agency
specimen.
(c) If the HHS-certified laboratory or MRO discovers that the
collector used an incorrect form, the laboratory or MRO must obtain a
memorandum for the record from the collector describing the reason the
incorrect form was used. If a memorandum for the record cannot be
obtained, the laboratory reports a rejected for testing result to the
MRO and the MRO cancels the test. The HHS-certified laboratory must
wait at least 5 business days while attempting to obtain the memorandum
before reporting a rejected for testing result to the MRO.
Subpart G--Oral Fluid Specimen Collection Devices
Section 7.1 What is used to collect an oral fluid specimen?
An FDA-cleared single-use collection device intended to collect an
oral fluid specimen must be used. This collection device must maintain
the integrity of such specimens during storage and transport so that
the specimen contained therein can be tested in an HHS-certified
laboratory for the presence of drugs or their metabolites.
Section 7.2 What are the requirements for an oral fluid collection
device?
An oral fluid specimen collection device must provide:
(a) An indicator that demonstrates the adequacy of the volume of
oral fluid specimen collected;
(b) One or two sealable, non-leaking tubes [depending on the device
type, as described in Section 8.8(a)] that:
(1) Maintain the integrity of the specimen during storage and
transport so that the specimen contained therein can be tested in an
HHS-certified laboratory for the presence of drugs or their
metabolites,
(2) are sufficiently transparent to enable a visual assessment of
the contents (i.e., oral fluid, buffer/diluent, collection pad) for
identification of abnormal physical characteristics without opening the
tube, and
(3) include the device lot expiration date on each specimen tube
(i.e., the expiration date of the buffer/diluent or, for devices
without a buffer/diluent, the earliest expiration date of any device
component);
(c) Components that ensure pre-analytical drug and drug metabolite
stability; and
(d) Components that do not substantially affect the composition of
drugs and/or drug metabolites in the oral fluid specimen.
Section 7.3 What are the minimum performance requirements for a
collection device?
An oral fluid collection device must meet the following minimum
performance requirements.
(a) Reliable collection of a minimum of 1 mL of undiluted (neat)
oral fluid;
(b) If the collection device contains a diluent (or other
component, process, or method that modifies the volume of the testable
specimen):
(1) The volume of oral fluid collected should be at least 1.0 mL
<plus-minus>10 percent, and
(2) The volume of diluent in the device should be within <plus-
minus>2.5 percent of the diluent target volume;
(c) Stability (recoverable concentrations >=80 percent of the
concentration at the time of collection) of the drugs and/or drug
metabolites for five days at room temperature (64- 77 [deg]F/18-25
[deg]C) and under the manufacturer's intended shipping and storage
conditions; and
(d) Recover >=80 percent (but no more than 120 percent) of drug
and/or drug metabolite in the undiluted (neat) oral fluid at (or near)
the initial test cutoff listed in the drug testing panel.
Subpart H--Oral Fluid Specimen Collection Procedure
Section 8.1 What privacy must the donor be given when providing an oral
fluid specimen?
The following privacy requirements apply when a donor is providing
an oral fluid specimen:
(a) Only authorized personnel and the donor may be present in the
restricted
[[Page 20539]]
access area where the collection takes place.
(b) The collector is not required to be the same gender as the
donor.
Section 8.2 What must the collector ensure at the collection site
before starting an oral fluid specimen collection?
The collector must deter the adulteration or substitution of an
oral fluid specimen at the collection site.
Section 8.3 What are the preliminary steps in the oral fluid specimen
collection procedure?
The collector must take the following steps before beginning an
oral fluid specimen collection:
(a) If a donor fails to arrive at the collection site at the
assigned time, the collector must follow the federal agency policy or
contact the federal agency representative to obtain guidance on action
to be taken.
(b) When the donor arrives at the collection site, the collector
should begin the collection procedure without undue delay. For example,
the collection should not be delayed because an authorized employer or
employer representative is late in arriving.
(c) The collector requests the donor to present photo
identification (e.g., driver's license; employee badge issued by the
employer; an alternative photo identification issued by a federal,
state, or local government agency). If the donor does not have proper
photo identification, the collector shall contact the supervisor of the
donor or the federal agency representative who can positively identify
the donor. If the donor's identity cannot be established, the collector
must not proceed with the collection.
(d) The collector must provide identification (e.g., employee
badge, employee list) if requested by the donor.
(e) The collector asks the donor to remove any unnecessary outer
garments (e.g., coat, jacket) that might conceal items or substances
that could be used to adulterate or substitute the oral fluid specimen.
The collector must ensure that all personal belongings (e.g., purse or
briefcase) remain with the outer garments. The donor may retain the
donor's wallet.
(f) If the donor will remain under the collector's direct
observation until the end of the collection, including the 10-minute
wait period described in Section 8.3(h), the collector proceeds to
Section 8.3(g). If the collector will not keep the donor under direct
observation from this point until the end of the collection, the
collector asks the donor to empty the donor's pockets and display the
contents to ensure no items are present that could be used to
adulterate or substitute the specimen.
(1) If no items are present that can be used to adulterate or
substitute the specimen, the collector instructs the donor to return
the items to their pockets and continues the collection procedure.
(2) If an item is present whose purpose is to adulterate or
substitute the specimen (e.g., a commercial drug culture product or
other substance for which the donor has no reasonable explanation),
this is considered a refusal to test. The collector must stop the
collection and report the refusal to test as described in Section 8.9.
(3) If an item that could be used to adulterate or substitute the
specimen (e.g., common personal care products such as mouthwash,
lozenges, capsules) appears to have been inadvertently brought to the
collection site, the collector must secure the item and continue with
the normal collection procedure.
(4) If the donor refuses to show the collector the items in their
pockets, the collector must keep the donor under direct observation
until the end of the oral fluid collection.
(g) The collector requests that the donor open the donor's mouth,
and the collector inspects the oral cavity to ensure that it is free of
any items (e.g., candy, gum, food, tobacco) that could impede or
interfere with the collection of an oral fluid specimen or items that
could be used to adulterate, substitute, or dilute the specimen.
(1) If an item is present that whose purpose is to adulterate or
substitute the specimen (e.g., a commercial drug culture product or
other item for which the donor has no reasonable explanation), this is
considered a refusal to test. The collector must stop the collection
and report the refusal to test as described in Section 8.9.
(2) If an item is present that could impede or interfere with the
collection of an oral fluid specimen (including abnormally colored
saliva), or the donor claims to have ``dry mouth,'' the collector gives
the donor water (e.g., up to 4 oz.) to rinse their mouth. The donor may
drink the water. If the donor refuses to remove the item or refuses to
rinse, this is a refusal to test.
(3) If the donor claims that they have a medical condition that
prevents opening their mouth for inspection, the collector follows the
procedure in Section 8.6(b)(2).
(h) The collector must initiate a 10-minute wait period prior to
collecting the specimen. During these 10 minutes, the collector must:
(1) Explain the basic collection procedure to the donor;
(2) Provide the instructions for completing the Federal CCF for the
donor's review, and informs the donor that these instructions and the
collection device-specific instructions are available upon request.
(3) Answer any reasonable and appropriate questions the donor may
have regarding the collection procedure; and
(4) Inform the donor that they must remain at the collection site
(i.e., in the area designated by the collector) during the wait period,
and that failure to follow these instructions will be reported as a
refusal to test.
Section 8.4 What steps does the collector take in the collection
procedure before the donor provides an oral fluid specimen?
(a) The collector shall instruct the donor to wash and dry the
donor's hands under the collector's observation, and to keep their
hands within view and avoid touching items or surfaces after
handwashing. If the donor refuses to wash their hands when instructed
by the collector, this is a refusal to test.
(b) The collector will provide or the donor may select the specimen
collection device(s) to be used for the collection. The device(s) must
be clean, unused, and wrapped/sealed in original packaging. See Section
8.8(a) for types of specimen collection devices used for oral fluid
split specimen collections.
(1) The collector will open the package in view of the donor.
(2) Both the collector and the donor must keep the unwrapped
collection devices in view at all times until each collection device
containing the donor's oral fluid specimen has been sealed and labeled.
(c) The collector reviews with the donor the procedures required
for a successful oral fluid specimen collection as stated in the
manufacturer's instructions for the specimen collection device.
(d) The collector notes any unusual behavior or appearance of the
donor on the Federal CCF. If the collector detects any conduct that
clearly indicates an attempt to tamper with a specimen (e.g., an
attempt to prevent the device from collecting sufficient oral fluid; an
attempt to bring into the collection site an adulterant or oral fluid
substitute), the collector must report a refusal to test in accordance
with Section 8.9.
[[Page 20540]]
Section 8.5 What steps does the collector take during and after the
oral fluid specimen collection procedure?
Integrity and Identity of the Specimen. The collector must take the
following steps during and after the donor provides the oral fluid
specimen:
(a) The collector shall be present and maintain visual contact with
the donor during the procedures outlined in this section.
(1) Under the observation of the collector, the donor is
responsible for positioning the specimen collection device for
collection. The collector must ensure the collection is performed
correctly and that the collection device is working properly. If there
is a failure to collect the specimen, the collector must begin the
process again, beginning with Step 8.4(b), using a new specimen
collection device (for both A and B specimens) and notes the failed
collection attempt on the Federal CCF. If the donor states that they
are unable to provide an oral fluid specimen during the collection
process or after multiple failures to collect the specimen, the
collector follows the procedure in Section 8.6.
(2) The donor and the collector must complete the collection in
accordance with the manufacturer instructions for the collection
device.
(3) The collector must inspect the specimen to determine if there
is any sign indicating that the specimen may not be a valid oral fluid
specimen (e.g., unusual color, presence of foreign objects or
material), documents any unusual findings on the Federal CCF, and takes
action (e.g., recollection) to obtain an acceptable specimen.
(b) If the donor fails to remain present through the completion of
the collection, fails to follow the instructions for the collection
device, refuses to begin the collection process after a failure to
collect the specimen as required in step (a)(1) above, refuses to
provide a split specimen as instructed by the collector, or refuses to
provide an alternate specimen as authorized in Section 8.6, the
collector stops the collection and reports the refusal to test in
accordance with Section 8.9.
Section 8.6 What procedure is used when the donor states that they are
unable to provide an oral fluid specimen?
(a) If the donor states that they are unable to provide an oral
fluid specimen during the collection process, the collector requests
that the donor follow the collector instructions and attempt to provide
an oral fluid specimen.
(b) The donor demonstrates their inability to provide a specimen
when, after 15 minutes of using the collection device, there is
insufficient volume or no oral fluid collected using the device.
(1) If the donor states that they could provide a specimen after
drinking some fluids, the collector gives the donor a drink (up to 8
ounces) and waits an additional 10 minutes before beginning the
specimen collection (a period of 1 hour must be provided or until the
donor has provided a sufficient oral fluid specimen). If the donor
simply needs more time before attempting to provide an oral fluid
specimen, the donor may choose not to drink any fluids during the 1
hour wait time. The collector must inform the donor that the donor must
remain at the collection site (i.e., in an area designated by the
collector) during the wait period.
(2) If the donor states that they are unable to provide an oral
fluid specimen, the collector records the reason for not collecting an
oral fluid specimen on the Federal CCF, notifies the federal agency's
designated representative for authorization of an alternate specimen to
be collected, and sends the appropriate copies of the Federal CCF to
the MRO and to the federal agency's designated representative. The
federal agency may choose to provide the collection site with a
standard protocol to follow in lieu of requiring the collector to
notify the agency's designated representative for authorization in each
case. If an alternate specimen is authorized, the collector may begin
the collection procedure for the alternate specimen (see Section 8.7)
in accordance with the Mandatory Guidelines for Federal Workplace Drug
Testing Programs using the alternative specimen.
Section 8.7 If the donor is unable to provide an oral fluid specimen,
may another specimen type be collected for testing?
Yes, if the alternate specimen type is authorized by Mandatory
Guidelines for Federal Workplace Drug Testing Programs and specifically
authorized by the federal agency.
Section 8.8 How does the collector prepare the oral fluid specimens?
(a) All federal agency collections are to be split specimen
collections. An oral fluid split specimen collection may be:
(1) Two specimens collected simultaneously with two separate
collection devices;
(2) Two specimens collected serially with two separate collection
devices. The donor is not allowed to drink or rinse their mouth between
the two collections. Collection of the second specimen must begin
within two minutes after the completion of the first collection and
recorded on the Federal CCF;
(3) Two specimens collected simultaneously using a single
collection device that directs the oral fluid into two separate
collection tubes; or
(4) A single specimen collected using a single collection device,
that is subsequently subdivided into two specimens.
(b) A volume of at least 1 mL of undiluted (neat) oral fluid is
collected for the specimen designated as ``Tube A'' and a volume of at
least 1 mL of undiluted (neat) oral fluid is collected for the specimen
designated as ``Tube B''.
(c) In the presence of the donor, the collector places a tamper-
evident label/seal from the Federal CCF over the cap of each specimen
tube. The collector records the date of the collection on the tamper-
evident labels/seals.
(d) The collector instructs the donor to initial the tamper-evident
labels/seals on each specimen tube. If the donor refuses to initial the
labels/seals, the collector notes the refusal on the Federal CCF and
continues with the collection process.
(e) The collector must ensure that all the information required on
the Federal CCF is provided.
(f) The collector asks the donor to read and sign a statement on
the Federal CCF certifying that the specimens identified were collected
from the donor. If the donor refuses to sign the certification
statement, the collector notes the refusal on the Federal CCF and
continues with the collection process.
(g) The collector signs and prints their name on the Federal CCF,
completes the Federal CCF, and distributes the copies of the Federal
CCF as required.
(h) The collector seals the specimens (Tube A and Tube B) in a
package and, within 24 hours or during the next business day, sends
them to the HHS-certified laboratory that will be testing the Tube A
oral fluid specimen.
(i) If the specimen and Federal CCF are not immediately transported
to an HHS-certified laboratory, they must remain under direct control
of the collector or be appropriately secured under proper specimen
storage conditions until transported.
Section 8.9 How does the collector report a donor's refusal to test?
If there is a refusal to test as defined in Section 1.7, the
collector stops the collection, discards any oral fluid specimen
collected and reports the refusal to test by:
[[Page 20541]]
(a) Notifying the federal agency by means (e.g., telephone, email,
or secure fax) that ensures that the notification is immediately
received,
(b) Documenting the refusal to test on the Federal CCF, and
(c) Sending all copies of the Federal CCF to the federal agency's
designated representative.
Section 8.10 What are a federal agency's responsibilities for a
collection site?
(a) A federal agency must ensure that collectors and collection
sites satisfy all requirements in subparts D, E, F, G, and H.
(b) A federal agency (or only one federal agency when several
agencies are using the same collection site) must inspect 5 percent or
up to a maximum of 50 collection sites each year, selected randomly
from those sites used to collect agency specimens (e.g., virtual,
onsite, or self-evaluation).
(c) A federal agency must investigate reported collection site
deficiencies (e.g., specimens reported ``rejected for testing'' by an
HHS-certified laboratory) and take appropriate action which may include
a collection site self-assessment (i.e., using the Collection Site
Checklist for the Collection of Oral Fluid Specimens for Federal Agency
Workplace Drug Testing Programs) or an inspection of the collection
site. The inspections of these additional collection sites may be
included in the 5 percent or maximum of 50 collection sites inspected
annually.
Subpart I--HHS Certification of Laboratories
Section 9.1 Who has the authority to certify laboratories to test oral
fluid specimens for federal agencies?
(a) The Secretary has broad discretion to take appropriate action
to ensure the full reliability and accuracy of drug testing and
reporting, to resolve problems related to drug testing, and to enforce
all standards set forth in these Guidelines. The Secretary has the
authority to issue directives to any HHS-certified laboratory,
including suspending the use of certain analytical procedures when
necessary to protect the integrity of the testing process; ordering any
HHS-certified laboratory to undertake corrective actions to respond to
material deficiencies identified by an inspection or through
performance testing; ordering any HHS-certified laboratory to send
specimens or specimen aliquots to another HHS-certified laboratory for
retesting when necessary to ensure the accuracy of testing under these
Guidelines; ordering the review of results for specimens tested under
the Guidelines for private sector clients to the extent necessary to
ensure the full reliability of drug testing for federal agencies; and
ordering any other action necessary to address deficiencies in drug
testing, analysis, specimen collection, chain of custody, reporting of
results, or any other aspect of the certification program.
(b) A laboratory is prohibited from stating or implying that it is
certified by HHS under these Guidelines to test oral fluid specimens
for federal agencies unless it holds such certification.
Section 9.2 What is the process for a laboratory to become HHS-
certified?
(a) A laboratory seeking HHS certification must:
(1) Submit a completed OMB-approved application form (i.e., the
applicant laboratory provides detailed information on both the
administrative and analytical procedures to be used for federally
regulated specimens);
(2) Have its application reviewed as complete and accepted by HHS;
(3) Successfully complete the PT challenges in 3 consecutive sets
of initial PT samples;
(4) Satisfy all the requirements for an initial inspection; and
(5) Receive notification of certification from the Secretary before
testing specimens for federal agencies.
Section 9.3 What is the process for a laboratory to maintain HHS
certification?
(a) To maintain HHS certification, a laboratory must:
(1) Successfully participate in both the maintenance PT and
inspection programs (i.e., successfully test the required quarterly
sets of maintenance PT samples, undergo an inspection 3 months after
being certified, and undergo maintenance inspections at a minimum of
every 6 months thereafter);
(2) Respond in an appropriate, timely, and complete manner to
required corrective action requests if deficiencies are identified in
the maintenance PT performance, during the inspections, operations, or
reporting; and
(3) Satisfactorily complete corrective remedial actions, and
undergo special inspection and special PT sets to maintain or restore
certification when material deficiencies occur in either the PT
program, inspection program, or in operations and reporting.
Section 9.4 What is the process when a laboratory does not maintain its
HHS certification?
(a) A laboratory that does not maintain its HHS certification must:
(1) Stop testing federally regulated specimens;
(2) Ensure the security of federally regulated specimens and
records throughout the required storage period described in Sections
11.18, 11.19, and 14.8;
(3) Ensure access to federally regulated specimens and records in
accordance with Sections 11.21 and 11.22 and Subpart P; and
(4) Follow the HHS suspension and revocation procedures when
imposed by the Secretary, follow the HHS procedures in Subpart P that
will be used for all actions associated with the suspension and/or
revocation of HHS-certification.
Section 9.5 What are the qualitative and quantitative specifications of
performance testing (PT) samples?
(a) PT samples used to evaluate drug tests will be prepared using
the following specifications:
(1) PT samples may contain one or more of the drugs and drug
metabolites in the drug classes listed in the drug testing panel and
may be sent to the laboratory as undiluted (neat) oral fluid. The PT
samples must satisfy one of the following parameters:
(i) The concentration of a drug or metabolite will be at least 20
percent above the initial test cutoff for the drug or drug metabolite;
(ii) The concentration of a drug or metabolite may be as low as 40
percent of the confirmatory test cutoff when the PT sample is
designated as a retest sample; or
(iii) The concentration of drug or metabolite may differ from
9.5(a)(1)(i) and 9.5(a)(1)(ii) for a special purpose.
(2) A PT sample may contain an interfering substance, an
adulterant, or other substances for special purposes, or may satisfy
the criteria for a substituted specimen or invalid result.
(3) A negative PT sample will not contain a measurable amount of a
target analyte.
(b) The laboratory must (to the greatest extent possible) handle,
test, and report a PT sample in a manner identical to that used for a
donor specimen, unless otherwise specified.
Section 9.6 What are the PT requirements for an applicant laboratory?
(a) An applicant laboratory that seeks certification under these
Guidelines must satisfy the following criteria on three consecutive
sets of PT samples:
(1) Have no false positive results;
(2) Correctly identify, confirm, and report at least 90 percent of
the total drug challenges over the three sets of PT samples;
[[Page 20542]]
(3) Correctly identify at least 80 percent of the drug challenges
for each initial drug test over the three sets of PT samples;
(4) For the confirmatory drug tests, correctly determine the
concentrations (i.e., no more than <plus-minus>20 percent or <plus-
minus>2 standard deviations [whichever is larger] from the appropriate
reference or peer group means) for at least 80 percent of the total
drug challenges over the three sets of PT samples;
(5) For the confirmatory drug tests, must not obtain any drug
concentration that differs by more than <plus-minus>50 percent from the
appropriate reference or peer group mean;
(6) For each confirmatory drug test, correctly identify and
determine the concentrations (i.e., no more than <plus-minus>20 percent
or <plus-minus>2 standard deviations [whichever is larger] from the
appropriate reference or peer group means) for at least 50 percent of
the drug challenges for an individual drug over the three sets of PT
samples;
(7) Correctly identify at least 80 percent of the total specimen
validity testing challenges over the three sets of PT samples;
(8) Correctly identify at least 80 percent of the challenges for
each individual specimen validity test over the three sets of PT
samples;
(9) For quantitative specimen validity tests, obtain quantitative
values for at least 80 percent of the total challenges over the three
sets of PT samples that satisfy the specified criteria; and
(10) Do not report any PT sample as adulterated with a compound
that is not present in the sample or substituted when the appropriate
reference or peer group mean for a biomarker is within the acceptable
range.
(b) Failure to satisfy these requirements will result in
disqualification.
Section 9.7 What are the PT requirements for an HHS-certified oral
fluid laboratory?
(a) A laboratory certified under these Guidelines must satisfy the
following criteria on the maintenance PT samples:
(1) Have no false positive results;
(2) Correctly identify, confirm, and report at least 90 percent of
the total drug challenges over two consecutive PT cycles;
(3) Correctly identify at least 80 percent of the drug challenges
for each initial drug test over two consecutive PT cycles;
(4) For the confirmatory drug tests, correctly determine that the
concentrations for at least 80 percent of the total drug challenges are
no more than <plus-minus>20 percent or <plus-minus>2 standard
deviations (whichever is larger) from the appropriate reference or peer
group means over two consecutive PT cycles;
(5) For the confirmatory drug tests, do not obtain any drug
concentration that differs by more than <plus-minus>50 percent from the
appropriate reference or peer group mean;
(6) For each confirmatory drug test, correctly identify and
determine that the concentrations for at least 50 percent of the drug
challenges for an individual drug are no more than <plus-minus>20
percent or <plus-minus>2 standard deviations (whichever is larger) from
the appropriate reference or peer group means over two consecutive PT
cycles;
(7) Correctly identify at least 80 percent of the total specimen
validity testing challenges over two consecutive PT cycles;
(8) Correctly identify at least 80 percent of the challenges for
each individual specimen validity test over two consecutive PT cycles;
(9) For quantitative specimen validity tests, obtain quantitative
values for at least 80 percent of the total challenges over two
consecutive PT cycles that satisfy the specified criteria; and
(10) Do not report any PT sample as adulterated with a compound
that is not present in the sample or substituted when the appropriate
reference or peer group mean for a biomarker is within the acceptable
range.
(b) Failure to participate in all PT cycles or to satisfy these
requirements may result in suspension or revocation of an HHS-certified
laboratory's certification.
Section 9.8 What are the inspection requirements for an applicant
laboratory?
(a) An applicant laboratory is inspected by a team of two
inspectors.
(b) Each inspector conducts an independent review and evaluation of
all aspects of the laboratory's testing procedures and facilities using
an inspection checklist.
Section 9.9 What are the maintenance inspection requirements for an
HHS-certified laboratory?
(a) An HHS-certified laboratory must undergo an inspection 3 months
after becoming certified and at least every 6 months thereafter.
(b) An HHS-certified laboratory is inspected by one or more
inspectors. The number of inspectors is determined according to the
number of specimens reviewed. Additional information regarding
inspections is available from SAMHSA.
(c) Each inspector conducts an independent evaluation and review of
the HHS-certified laboratory's procedures, records, and facilities
using guidance provided by the Secretary.
(d) To remain certified, an HHS-certified laboratory must continue
to satisfy the minimum requirements as stated in these Guidelines.
Section 9.10 Who can inspect an HHS-certified laboratory and when may
the inspection be conducted?
(a) An individual may be selected as an inspector for the Secretary
if they satisfy the following criteria:
(1) Has experience and an educational background similar to that
required for either a responsible person or a certifying scientist for
an HHS-certified laboratory as described in Subpart K;
(2) Has read and thoroughly understands the policies and
requirements contained in these Guidelines and in other guidance
consistent with these Guidelines provided by the Secretary;
(3) Submits a resume and documentation of qualifications to HHS;
(4) Attends approved training; and
(5) Performs acceptably as an inspector on an inspection of an HHS-
certified laboratory.
(b) The Secretary or a federal agency may conduct an inspection at
any time.
Section 9.11 What happens if an applicant laboratory does not satisfy
the minimum requirements for either the PT program or the inspection
program?
If an applicant laboratory fails to satisfy the requirements
established for the initial certification process, the laboratory must
start the certification process from the beginning.
Section 9.12 What happens if an HHS-certified laboratory does not
satisfy the minimum requirements for either the PT program or the
inspection program?
(a) If an HHS-certified laboratory fails to satisfy the minimum
requirements for certification, the laboratory is given a period of
time (e.g., 5 or 30 working days depending on the nature of the
deficiency) to provide any explanation for its performance and evidence
that all deficiencies have been corrected.
(b) A laboratory's HHS certification may be revoked, suspended, or
no further action taken depending on the seriousness of the
deficiencies and whether there is evidence that the deficiencies have
been corrected and that current performance meets the requirements for
certification.
(c) An HHS-certified laboratory may be required to undergo a
special inspection or to test additional PT samples to address
deficiencies.
(d) If an HHS-certified laboratory's certification is revoked or
suspended in
[[Page 20543]]
accordance with the process described in Subpart P, the laboratory is
not permitted to test federally regulated specimens until the
suspension is lifted or the laboratory has successfully completed the
certification requirements as a new applicant laboratory.
Section 9.13 What factors are considered in determining whether
revocation of a laboratory's HHS certification is necessary?
(a) The Secretary shall revoke certification of an HHS-certified
laboratory in accordance with these Guidelines if the Secretary
determines that revocation is necessary to ensure fully reliable and
accurate drug test results and reports.
(b) The Secretary shall consider the following factors in
determining whether revocation is necessary:
(1) Unsatisfactory performance in analyzing and reporting the
results of drug tests (e.g., an HHS-certified laboratory reporting a
false positive result for an employee's drug test);
(2) Unsatisfactory participation in performance testing or
inspections;
(3) A material violation of a certification standard, contract
term, or other condition imposed on the HHS-certified laboratory by a
federal agency using the laboratory's services;
(4) Conviction for any criminal offense committed as an incident to
operation of the HHS-certified laboratory; or
(5) Any other cause that materially affects the ability of the HHS-
certified laboratory to ensure fully reliable and accurate drug test
results and reports.
(c) The period and terms of revocation shall be determined by the
Secretary and shall depend upon the facts and circumstances of the
revocation and the need to ensure accurate and reliable drug testing.
Section 9.14 What factors are considered in determining whether to
suspend a laboratory's HHS certification?
(a) The Secretary may immediately suspend (either partially or
fully) a laboratory's HHS certification to conduct drug testing for
federal agencies if the Secretary has reason to believe that revocation
may be required and that immediate action is necessary to protect the
interests of the United States and its employees.
(b) The Secretary shall determine the period and terms of
suspension based upon the facts and circumstances of the suspension and
the need to ensure accurate and reliable drug testing.
Section 9.15 How does the Secretary notify an HHS-certified laboratory
that action is being taken against the laboratory?
(a) When a laboratory's HHS certification is suspended or the
Secretary seeks to revoke HHS certification, the Secretary shall
immediately serve the HHS-certified laboratory with written notice of
the suspension or proposed revocation by fax, mail, personal service,
or registered or certified mail, return receipt requested. This
notification shall state the following:
(1) The reasons for the suspension or proposed revocation;
(2) The terms of the suspension or proposed revocation; and
(3) The period of suspension or proposed revocation.
(b) The written notification shall state that the laboratory will
be afforded an opportunity for an informal review of the suspension or
proposed revocation if it so requests in writing within 30 days of the
date the laboratory received the notification, or if expedited review
is requested, within 3 days of the date the laboratory received the
notification. Subpart P contains detailed procedures to be followed for
an informal review of the suspension or proposed revocation.
(c) A suspension must be effective immediately. A proposed
revocation must be effective 30 days after written notification is
given or, if review is requested, upon the reviewing official's
decision to uphold the proposed revocation. If the reviewing official
decides not to uphold the suspension or proposed revocation, the
suspension must terminate immediately and any proposed revocation shall
not take effect.
(d) The Secretary will publish in the Federal Register the name,
address, and telephone number of any HHS-certified laboratory that has
its certification revoked or suspended under Section 9.13 or Section
9.14, respectively, and the name of any HHS-certified laboratory that
has its suspension lifted. The Secretary shall provide to any member of
the public upon request the written notification provided to a
laboratory that has its HHS certification suspended or revoked, as well
as the reviewing official's written decision which upholds or denies
the suspension or proposed revocation under the procedures of Subpart
P.
Section 9.16 May a laboratory that had its HHS certification revoked be
recertified to test federal agency specimens?
Following revocation, a laboratory may apply for recertification.
Unless otherwise provided by the Secretary in the notification of
revocation under Section 9.15 or the reviewing official's decision
under Section 16.9(e) or 16.14(a), a laboratory which has had its
certification revoked may reapply for HHS certification as an applicant
laboratory.
Section 9.17 Where is the list of HHS-certified laboratories published?
(a) The list of HHS-certified laboratories is published monthly in
the Federal Register. This notification is also available on the
internet at <a href="https://www.samhsa.gov/workplace">https://www.samhsa.gov/workplace</a>.
(b) An applicant laboratory is not included on the list.
Subpart J--Blind Samples Submitted by an Agency
Section 10.1 What are the requirements for federal agencies to submit
blind samples to HHS-certified laboratories?
(a) Each federal agency is required to submit blind samples for its
workplace drug testing program. The collector must send the blind
samples to the HHS-certified laboratory that the collector sends
employee specimens.
(b) Each federal agency must submit at least 3 percent blind
samples along with its donor specimens based on the projected total
number of donor specimens collected per year (up to a maximum of 400
blind samples). Every effort should be made to ensure that blind
samples are submitted quarterly.
(c) Approximately 75 percent of the blind samples submitted each
year by an agency must be negative and 25 percent must be positive for
one or more drugs.
Section 10.2 What are the requirements for blind samples?
(a) Drug positive blind samples must be validated by the supplier
in the selected manufacturer's collection device as to their content
using appropriate initial and confirmatory tests.
(1) Drug positive blind samples must be fortified with one or more
of the drugs or metabolites listed in the drug testing panel.
(2) Drug positive blind samples must contain concentrations of
drugs between 1.5 and 2 times the initial drug test cutoff.
(b) Drug negative blind samples (i.e., certified to contain no
drugs) must be validated by the supplier in the selected manufacturer's
collection device as negative using appropriate initial and
confirmatory tests.
[[Page 20544]]
(c) The supplier must provide information on the blind samples'
content, validation, expected results, and stability to the collection
site/collector sending the blind samples to the laboratory, and must
provide the information upon request to the MRO, the federal agency for
which the blind sample was submitted, or the Secretary.
Section 10.3 How is a blind sample submitted to an HHS-certified
laboratory?
(a) A blind sample must be submitted as a split specimen (specimens
A and B) with the current Federal CCF that the HHS-certified laboratory
uses for donor specimens. The collector provides the required
information to ensure that the Federal CCF has been properly completed
and provides fictitious initials on the specimen label/seal. The
collector must indicate that the specimen is a blind sample on the MRO
copy where a donor would normally provide a signature.
(b) A collector should attempt to distribute the required number of
blind samples randomly with donor specimens rather than submitting the
full complement of blind samples as a single group.
Section 10.4 What happens if an inconsistent result is reported for a
blind sample?
If an HHS-certified laboratory reports a result for a blind sample
that is inconsistent with the expected result (e.g., a laboratory
reports a negative result for a blind sample that was supposed to be
positive, a laboratory reports a positive result for a blind sample
that was supposed to be negative):
(a) The MRO must contact the laboratory and attempt to determine if
the laboratory made an error during the testing or reporting of the
sample;
(b) The MRO must contact the blind sample supplier and attempt to
determine if the supplier made an error during the preparation or
transfer of the sample;
(c) The MRO must contact the collector and determine if the
collector made an error when preparing the blind sample for transfer to
the HHS-certified laboratory;
(d) If there is no obvious reason for the inconsistent result, the
MRO must notify both the federal agency for which the blind sample was
submitted and the Secretary; and
(e) The Secretary shall investigate the blind sample error. A
report of the Secretary's investigative findings and the corrective
action taken in response to identified deficiencies must be sent to the
federal agency. The Secretary shall ensure notification of the finding
as appropriate to other federal agencies and coordinate any necessary
actions to prevent the recurrence of the error.
Subpart K--Laboratory
Section 11.1 What must be included in the HHS-certified laboratory's
standard operating procedure manual?
(a) An HHS-certified laboratory must have a standard operating
procedure (SOP) manual that describes, in detail, all HHS-certified
laboratory operations. When followed, the SOP manual ensures that all
specimens are tested using the same procedures.
(b) The SOP manual must include at a minimum, but is not limited
to, a detailed description of the following:
(1) Chain of custody procedures;
(2) Accessioning;
(3) Security;
(4) Quality control/quality assurance programs;
(5) Analytical methods and procedures;
(6) Equipment and maintenance programs;
(7) Personnel training;
(8) Reporting procedures; and
(9) Computers, software, and laboratory information management
systems.
(c) All procedures in the SOP manual must be compliant with these
Guidelines and all guidance provided by the Secretary.
(d) A copy of all procedures that have been replaced or revised and
the dates on which the procedures were in effect must be maintained for
at least 2 years.
Section 11.2 What are the responsibilities of the responsible person
(RP)?
(a) Manage the day-to-day operations of the HHS-certified
laboratory even if another individual has overall responsibility for
alternate areas of a multi-specialty laboratory.
(b) Ensure that there are sufficient personnel with adequate
training and experience to supervise and conduct the work of the HHS-
certified laboratory. The RP must ensure the continued competency of
laboratory staff by documenting their in-service training, reviewing
their work performance, and verifying their skills.
(c) Maintain a complete and current SOP manual that is available to
all personnel of the HHS-certified laboratory and ensure that it is
followed. The SOP manual must be reviewed, signed, and dated by the
RP(s) when procedures are first placed into use and when changed or
when a new individual assumes responsibility for the management of the
HHS-certified laboratory. The SOP must be reviewed and documented by
the RP annually.
(d) Maintain a quality assurance program that ensures the proper
performance and reporting of all test results; verify and monitor
acceptable analytical performance for all controls and calibrators;
monitor quality control testing; and document the validity,
reliability, accuracy, precision, and performance characteristics of
each test and test system.
(e) Initiate and implement all remedial actions necessary to
maintain satisfactory operation and performance of the HHS-certified
laboratory in response to the following: Quality control systems not
within performance specifications; errors in result reporting or in
analysis of performance testing samples; and inspection deficiencies.
The RP must ensure that specimen results are not reported until all
corrective actions have been taken and that the results provided are
accurate and reliable.
Section 11.3 What scientific qualifications must the RP have?
The RP must have documented scientific qualifications in analytical
toxicology. Minimum qualifications are:
(a) Certification or licensure as a laboratory director by the
state in forensic or clinical laboratory toxicology, a Ph.D. in one of
the natural sciences, or training and experience comparable to a Ph.D.
in one of the natural sciences with training and laboratory/research
experience in biology, chemistry, and pharmacology or toxicology;
(b) Experience in forensic toxicology with emphasis on the
collection and analysis of biological specimens for drugs of abuse;
(c) Experience in forensic applications of analytical toxicology
(e.g., publications, court testimony, conducting research on the
pharmacology and toxicology of drugs of abuse) or qualify as an expert
witness in forensic toxicology;
(d) Fulfillment of the RP responsibilities and qualifications, as
demonstrated by the HHS-certified laboratory's performance and verified
upon interview by HHS-trained inspectors during each on-site
inspection; and
(e) Qualify as a certifying scientist.
Section 11.4 What happens when the RP is absent or leaves an HHS-
certified laboratory?
(a) HHS-certified laboratories must have multiple RPs or one RP and
an
[[Page 20545]]
alternate RP. If the RP(s) are concurrently absent, an alternate RP
must be present and qualified to fulfill the responsibilities of the
RP.
(1) If an HHS-certified laboratory is without the RP and alternate
RP for 14 calendar days or less (e.g., temporary absence due to
vacation, illness, or business trip), the HHS-certified laboratory may
continue operations and testing of federal agency specimens under the
direction of a certifying scientist.
(2) The Secretary, in accordance with these Guidelines, will
suspend a laboratory's HHS certification for all specimens if the
laboratory does not have an RP or alternate RP for a period of more
than 14 calendar days. The suspension will be lifted upon the
Secretary's approval of a new permanent RP or alternate RP.
(b) If the RP leaves an HHS-certified laboratory:
(1) The HHS-certified laboratory may maintain certification and
continue testing federally regulated specimens under the direction of
an alternate RP for a period of up to 180 days while seeking to hire
and receive the Secretary's approval of the RP's replacement.
(2) The Secretary, in accordance with these Guidelines, will
suspend a laboratory's HHS certification for all federally regulated
specimens if the laboratory does not have a permanent RP within 180
days. The suspension will be lifted upon the Secretary's approval of
the new permanent RP.
(c) To nominate an individual as an RP or alternate RP, the HHS-
certified laboratory must submit the following documents to the
Secretary: The candidate's current resume or curriculum vitae, copies
of diplomas and licensures, a training plan (not to exceed 90 days) to
transition the candidate into the position, an itemized comparison of
the candidate's qualifications to the minimum RP qualifications
described in the Guidelines, and have official academic transcript(s)
submitted from the candidate's institution(s) of higher learning. The
candidate must be found qualified during an on-site inspection of the
HHS-certified laboratory.
(d) The HHS-certified laboratory must fulfill additional inspection
and PT criteria as required prior to conducting federally regulated
testing under a new RP.
Section 11.5 What qualifications must an individual have to certify a
result reported by an HHS-certified laboratory?
(a) A certifying scientist must have:
(1) At least a bachelor's degree in the chemical or biological
sciences or medical technology, or equivalent;
(2) Training and experience in the analytical methods and forensic
procedures used by the HHS-certified laboratory relevant to the results
that the individual certifies; and
(3) Training and experience in reviewing and reporting forensic
test results and maintaining chain of custody, and an understanding of
appropriate remedial actions in response to problems that may arise.
(b) A certifying technician must have:
(1) Training and experience in the analytical methods and forensic
procedures used by the HHS-certified laboratory relevant to the results
that the individual certifies; and
(2) Training and experience in reviewing and reporting forensic
test results and maintaining chain of custody, and an understanding of
appropriate remedial actions in response to problems that may arise.
Section 11.6 What qualifications and training must other personnel of
an HHS-certified laboratory have?
(a) All HHS-certified laboratory staff (e.g., technicians,
administrative staff) must have the appropriate training and skills for
the tasks they perform.
(b) Each individual working in an HHS-certified laboratory must be
properly trained (i.e., receive training in each area of work that the
individual will be performing, including training in forensic
procedures related to their job duties) before they are permitted to
work independently with federally regulated specimens. All training
must be documented.
Section 11.7 What security measures must an HHS-certified laboratory
maintain?
(a) An HHS-certified laboratory must control access to the drug
testing facility, specimens, aliquots, and records.
(b) Authorized visitors must be escorted at all times, except for
individuals conducting inspections (i.e., for the Department, a federal
agency, a state, or other accrediting agency) or emergency personnel
(e.g., firefighters and medical rescue teams).
(c) An HHS-certified laboratory must maintain records documenting
the identity of the visitor and escort, date, time of entry and exit,
and purpose for access to the secured area.
Section 11.8 What are the laboratory chain of custody requirements for
specimens and aliquots?
(a) HHS-certified laboratories must use chain of custody procedures
(internal and external) to maintain control and accountability of
specimens from the time of receipt at the laboratory through completion
of testing, reporting of results, during storage, and continuing until
final disposition of the specimens.
(b) HHS-certified laboratories must use chain of custody procedures
to document the handling and transfer of aliquots throughout the
testing process until final disposal.
(c) The chain of custody must be documented using either paper copy
or electronic procedures.
(d) Each individual who handles a specimen or aliquot must sign and
complete the appropriate entries on the chain of custody form when the
specimen or aliquot is handled or transferred, and every individual in
the chain must be identified.
(e) The date and purpose must be recorded on an appropriate chain
of custody form each time a specimen or aliquot is handled or
transferred.
Section 11.9 What are the requirements for an initial drug test?
(a) An initial drug test may be:
(1) An immunoassay or
(2) An alternate technology (e.g., spectrometry, spectroscopy).
(b) An HHS-certified laboratory must validate an initial drug test
before testing specimens.
(c) Initial drug tests must be accurate and reliable for the
testing of specimens when identifying drugs or their metabolites.
(d) An HHS-certified laboratory may conduct a second initial drug
test using a method with different specificity, to rule out cross-
reacting compounds. This second initial drug test must satisfy the
batch quality control requirements specified in Section 11.11.
Section 11.10 What must an HHS-certified laboratory do to validate an
initial drug test?
(a) An HHS-certified laboratory must demonstrate and document the
following for each initial drug test:
(1) The ability to differentiate negative specimens from those
requiring further testing;
(2) The performance of the test around the cutoff, using samples at
several concentrations between 0 and 150 percent of the cutoff;
(3) The effective concentration range of the test (linearity);
[[Page 20546]]
(4) The potential for carryover;
(5) The potential for interfering substances; and
(6) The potential matrix effects if using an alternate technology.
(b) Each new lot of reagent must be verified prior to being placed
into service.
(c) Each initial drug test using an alternate technology must be
re-verified periodically or at least annually.
Section 11.11 What are the batch quality control requirements when
conducting an initial drug test?
(a) Each batch of specimens must contain the following controls:
(1) At least one control certified to contain no drug or drug
metabolite;
(2) At least one positive control with the drug or drug metabolite
targeted at a concentration 25 percent above the cutoff;
(3) At least one control with the drug or drug metabolite targeted
at a concentration 75 percent of the cutoff; and
(4) At least one control that appears as a donor specimen to the
analysts.
(b) Calibrators and controls must total at least 10 percent of the
aliquots analyzed in each batch.
Section 11.12 What are the requirements for a confirmatory drug test?
(a) The analytical method must use mass spectrometric
identification (e.g., gas chromatography-mass spectrometry [GC-MS],
liquid chromatography-mass spectrometry [LC-MS], GC-MS/MS, LC-MS/MS) or
equivalent.
(b) A confirmatory drug test must be validated before it can be
used to test federally regulated specimens.
(c) Confirmatory drug tests must be accurate and reliable for the
testing of an oral fluid specimen when identifying and quantifying
drugs or their metabolites.
Section 11.13 What must an HHS-certified laboratory do to validate a
confirmatory drug test?
(a) An HHS-certified laboratory must demonstrate and document the
following for each confirmatory drug test:
(1) The linear range of the analysis;
(2) The limit of detection;
(3) The limit of quantification;
(4) The accuracy and precision at the cutoff;
(5) The accuracy (bias) and precision at 40 percent of the cutoff;
(6) The potential for interfering substances;
(7) The potential for carryover; and
(8) The potential matrix effects if using liquid chromatography
coupled with mass spectrometry.
(b) Each new lot of reagent must be verified prior to being placed
into service.
(c) HHS-certified laboratories must re-verify each confirmatory
drug test method periodically or at least annually.
Section 11.14 What are the batch quality control requirements when
conducting a confirmatory drug test?
(a) At a minimum, each batch of specimens must contain the
following calibrators and controls:
(1) A calibrator at the cutoff;
(2) At least one control certified to contain no drug or drug
metabolite;
(3) At least one positive control with the drug or drug metabolite
targeted at 25 percent above the cutoff; and
(4) At least one control targeted at or less than 40 percent of the
cutoff.
(b) Calibrators and controls must total at least 10 percent of the
aliquots analyzed in each batch.
Section 11.15 What are the analytical and quality control requirements
for conducting specimen validity tests?
(a) Each invalid, adulterated, or substituted specimen validity
test result must be based on an initial specimen validity test on one
aliquot and a confirmatory specimen validity test on a second aliquot;
(b) The HHS-certified laboratory must establish acceptance criteria
and analyze calibrators and controls as appropriate to verify and
document the validity of the test results; and
(c) Controls must be analyzed concurrently with specimens.
Section 11.16 What must an HHS-certified laboratory do to validate a
specimen validity test?
An HHS-certified laboratory must demonstrate and document for each
specimen validity test the appropriate performance characteristics of
the test, and must re-verify the test periodically, or at least
annually. Each new lot of reagent must be verified prior to being
placed into service.
Section 11.17 What are the requirements for an HHS-certified laboratory
to report a test result?
(a) Laboratories must report a test result to the agency's MRO
within an average of 5 working days after receipt of the specimen.
Reports must use the Federal CCF and/or an electronic report. Before
any test result can be reported, it must be certified by a certifying
scientist or a certifying technician (as appropriate).
(b) A primary (A) specimen is reported negative when each initial
drug test is negative or if the specimen is negative upon confirmatory
drug testing, and the specimen does not meet invalid criteria as
described in items (g)(1) through (g)(5) below.
(c) A primary (A) specimen is reported positive for a specific drug
or drug metabolite when both the initial drug test is positive and the
confirmatory drug test is positive in accordance with the cutoffs
listed in the drug testing panel.
(d) A primary (A) oral fluid specimen is reported adulterated when
the presence of an adulterant is verified using an initial test on the
first aliquot and a different confirmatory test on the second aliquot.
(e) A primary (A) oral fluid specimen is reported substituted when
a biomarker is not present or is present at a concentration
inconsistent with that established for human oral fluid.
(f) For a specimen that has an invalid result for one of the
reasons stated in items (g)(1) through (g)(5) below, the HHS-certified
laboratory shall contact the MRO and both will decide if testing by
another HHS-certified laboratory would be useful in being able to
report a positive, adulterated, or substituted result. If no further
testing is necessary, the HHS-certified laboratory then reports the
invalid result to the MRO.
(g) A primary (A) oral fluid specimen is reported as an invalid
result when:
(1) Interference occurs on the initial drug tests on two separate
aliquots (i.e., valid initial drug test results cannot be obtained);
(2) Interference with the confirmatory drug test occurs on at least
two separate aliquots of the specimen and the HHS-certified laboratory
is unable to identify the interfering substance;
(3) The physical appearance of the specimen is such that testing
the specimen may damage the laboratory's instruments;
(4) The physical appearances of the A and B specimens are clearly
different (note: A is tested); or
(5) A specimen validity test on two separate aliquots of the
specimen indicates that the specimen is not valid for testing.
(h) An HHS-certified laboratory shall reject a primary (A) specimen
for testing when a fatal flaw occurs as described in Section 15.1 or
when a correctable flaw as described in Section 15.2 is not recovered.
The HHS-certified laboratory will indicate on the Federal CCF that the
specimen was rejected for testing and provide the reason for reporting
the rejected for testing result.
[[Page 20547]]
(i) An HHS-certified laboratory must report all positive,
adulterated, substituted, and invalid test results for an oral fluid
specimen. For example, a specimen can be positive for a specific drug
and adulterated.
(j) An HHS-certified laboratory must report the confirmatory
concentration of each drug or drug metabolite reported for a positive
result.
(k) An HHS-certified laboratory must report numerical values of the
specimen validity test results that support a specimen that is reported
adulterated, substituted, or invalid (as appropriate).
(l) An HHS-certified laboratory must report results using the HHS-
specified nomenclature published with the drug and biomarker testing
panels.
(m) When the concentration of a drug or drug metabolite exceeds the
validated linear range of the confirmatory test, HHS-certified
laboratories may report to the MRO that the quantitative value exceeds
the linear range of the test or that the quantitative value is greater
than ``insert the actual value for the upper limit of the linear
range,'' or laboratories may report a quantitative value above the
upper limit of the linear range that was obtained by diluting an
aliquot of the specimen to achieve a result within the method's linear
range and multiplying the result by the appropriate dilution factor.
(n) HHS-certified laboratories may transmit test results to the MRO
by various electronic means (e.g., teleprinter, fax, or computer).
Transmissions of the reports must ensure confidentiality and the
results may not be reported verbally by telephone. Laboratories and
external service providers must ensure the confidentiality, integrity,
and availability of the data and limit access to any data transmission,
storage, and retrieval system.
(o) HHS-certified laboratories must fax, courier, mail, or
electronically transmit a legible image or copy of the completed
Federal CCF and/or forward a computer-generated electronic report. The
computer-generated report must contain sufficient information to ensure
that the test results can accurately represent the content of the
custody and control form that the MRO received from the collector.
(p) For positive, adulterated, substituted, invalid, and rejected
specimens, laboratories must fax, courier, mail, or electronically
transmit a legible image or copy of the completed Federal CCF.
Section 11.18 How long must an HHS-certified laboratory retain
specimens?
(a) An HHS-certified laboratory must retain specimens that were
reported as positive, adulterated, substituted, or as an invalid result
for a minimum of 1 year.
(b) Retained specimens must be kept in secured storage in
accordance with the collection device manufacturer's specifications
(i.e., frozen at -20 [deg]C or less, or refrigerated), to ensure their
availability for retesting during an administrative or judicial
proceeding.
(c) Federal agencies may request that the HHS-certified laboratory
retain a specimen for an additional specified period of time and must
make that request within the 1-year period.
Section 11.19 How long must an HHS-certified laboratory retain records?
(a) An HHS-certified laboratory must retain all records generated
to support test results for at least 2 years. The laboratory may
convert hardcopy records to electronic records for storage and then
discard the hardcopy records after 6 months.
(b) A federal agency may request the HHS-certified laboratory to
maintain a documentation package (as described in Section 11.21) that
supports the chain of custody, testing, and reporting of a donor's
specimen that is under legal challenge by a donor. The federal agency's
request to the laboratory must be in writing and must specify the
period of time to maintain the documentation package.
(c) An HHS-certified laboratory may retain records other than those
included in the documentation package beyond the normal 2-year period
of time.
Section 11.20 What statistical summary reports must an HHS-certified
laboratory provide for oral fluid testing?
(a) HHS-certified laboratories must provide to each federal agency
for which they perform testing a semiannual statistical summary report
that must be submitted by mail, fax, or email within 14 working days
after the end of the semiannual period. The summary report must not
include any personally identifiable information. A copy of the
semiannual statistical summary report will also be sent to the
Secretary or designated HHS representative. The semiannual statistical
report contains the following information:
(1) Reporting period (inclusive dates);
(2) HHS-certified laboratory name and address;
(3) Federal agency name;
(4) Number of specimen results reported;
(5) Number of specimens collected by reason for test;
(6) Number of specimens reported negative;
(7) Number of specimens rejected for testing because of a fatal
flaw;
(8) Number of specimens rejected for testing because of an
uncorrected flaw;
(9) Number of specimens tested positive by each initial drug test;
(10) Number of specimens reported positive;
(11) Number of specimens reported positive for each drug and drug
metabolite;
(12) Number of specimens reported adulterated;
(13) Number of specimens reported substituted; and
(14) Number of specimens reported as invalid result.
(b) An HHS-certified laboratory must make copies of an agency's
test results available when requested to do so by the Secretary or by
the federal agency for which the laboratory is performing drug-testing
services.
(c) An HHS-certified laboratory must ensure that a qualified
individual is available to testify in a proceeding against a federal
employee when the proceeding is based on a test result reported by the
laboratory.
Section 11.21 What HHS-certified laboratory information is available to
a federal agency?
(a) Following a federal agency's receipt of a positive,
adulterated, or substituted drug test report, the federal agency may
submit a written request for copies of the records relating to the drug
test results or a documentation package or any relevant certification,
review, or revocation of certification records.
(b) Standard documentation packages provided by an HHS-certified
laboratory must contain the following items:
(1) A cover sheet providing a brief description of the procedures
and tests performed on the donor's specimen;
(2) A table of contents that lists all documents and materials in
the package by page number;
(3) A copy of the Federal CCF with any attachments, internal chain
of custody records for the specimen, memoranda (if any) generated by
the HHS-certified laboratory, and a copy of the electronic report (if
any) generated by the HHS-certified laboratory;
(4) A brief description of the HHS-certified laboratory's initial
drug (and specimen validity, if applicable) testing procedures,
instrumentation, and batch quality control requirements;
(5) Copies of the initial test data for the donor's specimen with
all calibrators and controls and copies of all
[[Page 20548]]
internal chain of custody documents related to the initial tests;
(6) A brief description of the HHS-certified laboratory's
confirmatory drug (and specimen validity, if applicable) testing
procedures, instrumentation, and batch quality control requirements;
(7) Copies of the confirmatory test data for the donor's specimen
with all calibrators and controls and copies of all internal chain of
custody documents related to the confirmatory tests; and
(8) Copies of the r[eacute]sum[eacute] or curriculum vitae for the
RP(s) and the certifying technician or certifying scientist of record.
Section 11.22 What HHS-certified laboratory information is available to
a federal employee?
A federal employee who is the subject of a workplace drug test may
submit a written request through the MRO and/or the federal agency
requesting copies of any records relating to the employee's drug test
results or a documentation package as described in Section 11.21(b) and
any relevant certification, review, or revocation of certification
records. Federal employees, or their designees, are not permitted
access to their specimens collected pursuant to Executive Order 12564,
Public Law 100-71, and these Guidelines.
Section 11.23 What types of relationships are prohibited between an
HHS-certified laboratory and an MRO?
An HHS-certified laboratory must not enter into any relationship
with a federal agency's MRO that may be construed as a potential
conflict of interest or derive any financial benefit by having a
federal agency use a specific MRO.
This means an MRO may be an employee of the agency or a contractor
for the agency; however, an MRO shall not be an employee or agent of or
have any financial interest in the HHS-certified laboratory for which
the MRO is reviewing drug testing results. Additionally, an MRO shall
not derive any financial benefit by having an agency use a specific
HHS-certified laboratory or have any agreement with an HHS-certified
laboratory that may be construed as a potential conflict of interest.
Subpart L--Instrumented Initial Test Facility (IITF)
Section 12.1 May an IITF test oral fluid specimens for a federal
agency's workplace drug testing program?
No, only HHS-certified laboratories are authorized to test oral
fluid specimens for federal agency workplace drug testing programs in
accordance with these Guidelines.
Subpart M--Medical Review Officer (MRO)
Section 13.1 Who may serve as an MRO?
(a) A currently licensed physician who has:
(1) A Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.)
degree;
(2) Knowledge regarding the pharmacology and toxicology of illicit
drugs;
(3) The training necessary to serve as an MRO as set out in Section
13.3;
(4) Satisfactorily passed an initial examination administered by a
nationally recognized entity or a subspecialty board that has been
approved by the Secretary to certify MROs; and
(5) At least every five years from initial certification, completed
requalification training on the topics in Section 13.3 and
satisfactorily passed a requalification examination administered by a
nationally recognized entity or a subspecialty board that has been
approved by the Secretary to certify MROs.
Section 13.2 How are nationally recognized entities or subspecialty
boards that certify MROs approved?
All nationally recognized entities or subspecialty boards which
seek approval by the Secretary to certify physicians as MROs for
federal workplace drug testing programs must submit their
qualifications, a sample examination, and other necessary supporting
examination materials (e.g., answers, previous examination statistics
or other background examination information, if requested). Approval
will be based on an objective review of qualifications that include a
copy of the MRO applicant application form, documentation that the
continuing education courses are accredited by a professional
organization, and the delivery method and content of the examination.
Each approved MRO certification entity must resubmit their
qualifications for approval every two years. The Secretary shall
publish at least every two years a notification in the Federal Register
listing those entities and subspecialty boards that have been approved.
This notification is also available on the internet at <a href="https://www.samhsa.gov/workplace/drug-testing">https://www.samhsa.gov/workplace/drug-testing</a>.
Section 13.3 What training is required before a physician may serve as
an MRO?
(a) A physician must receive training that includes a thorough
review of the following:
(1) The collection procedures used to collect federal agency
specimens;
(2) How to interpret test results reported by HHS-certified IITFs
and laboratories (e.g., negative, negative/dilute, positive,
adulterated, substituted, rejected for testing, and invalid);
(3) Chain of custody, reporting, and recordkeeping requirements for
federal agency specimens;
(4) The HHS Mandatory Guidelines for Federal Workplace Drug Testing
Programs for all authorized specimen types; and
(5) Procedures for interpretation, review (e.g., donor interview
for legitimate medical explanations, review of documentation provided
by the donor to support a legitimate medical explanation), and
reporting of results specified by any federal agency for which the
individual may serve as an MRO;
(b) Certified MROs must complete training on any revisions to these
Guidelines prior to their effective date, to continue serving as an MRO
for federal agency specimens.
Section 13.4 What are the responsibilities of an MRO?
(a) The MRO must review all positive, adulterated, rejected for
testing, invalid, and substituted test results.
(b) Staff under the direct, personal supervision of the MRO may
review and report negative and (for urine) negative/dilute test results
to the agency's designated representative. The MRO must review at least
5 percent of all negative results reported by the MRO staff to ensure
that the MRO staff are properly performing the review process.
(c) The MRO must discuss potential invalid results with the HHS-
certified laboratory, as addressed in Section 11.17(f) to determine
whether testing at another HHS-certified laboratory may be warranted.
(d) After receiving a report from an HHS-certified laboratory or
(for urine) HHS-certified IITF, the MRO must:
(1) Review the information on the MRO copy of the Federal CCF that
was received from the collector and the report received from the HHS-
certified laboratory or HHS-certified IITF;
(2) Interview the donor when required;
(3) Make a determination regarding the test result; and
(4) Report the verified result to the federal agency.
[[Page 20549]]
(e) The MRO must maintain records for a minimum of two years while
maintaining the confidentiality of the information. The MRO may convert
hardcopy records to electronic records for storage and discard the
hardcopy records after six months.
(f) The MRO must conduct a medical examination or a review of the
examining physician's findings and make a determination of refusal to
test or cancelled test when a collector reports that the donor was
unable to provide a specimen and an alternate specimen was not
collected, as addressed in Sections 8.6 and 13.6.
Section 13.5 What must an MRO do when reviewing an oral fluid
specimen's test results?
(a) When the HHS-certified laboratory reports a negative result for
the primary (A) specimen, the MRO reports a negative result to the
agency.
(b) When the HHS-certified laboratory reports multiple results for
the primary (A) specimen, as the MRO, you must follow the verification
procedures described in 13.5(c) through (f) and:
(1) Report all verified positive and/or refusal to test results to
the federal agency.
(2) If an invalid result was reported in conjunction with a
positive, adulterated, or substituted result, do not report the
verified invalid result to the federal agency at this time. The MRO
takes the action described in Section 13.5(e) for the verified invalid
result(s) for the primary (A) specimen only when:
(i) The MRO verifies the laboratory-reported positive, adulterated,
or substituted result as negative based on a legitimate medical
explanation as described in 13.5(c)(2) and 13.5(d)(1), or based on
codeine and/or morphine concentrations less than 150 ng/mL as described
in 13.5(c)(3)(i); or
(ii) The split (B) specimen is tested and reported as a failure to
reconfirm as described in Section 14.6(m).
(c) When the HHS-certified laboratory reports a positive result for
the primary (A) specimen, the MRO must contact the donor to determine
if there is any legitimate medical explanation for the positive result.
(1) If the donor admits unauthorized use of the drug(s) that caused
the positive result, the MRO reports the test result as positive to the
agency. The MRO must document the donor's admission of unauthorized
drug use in the MRO records and in the MRO's report to the agency.
(2) If the donor provides documentation (e.g., a valid
prescription) to support a legitimate medical explanation for the
positive result, the MRO reports the test result as negative to the
agency.
(i) Passive exposure to a drug (e.g., exposure to secondhand
marijuana smoke) is not a legitimate medical explanation for a positive
drug test result.
(ii) Ingestion of food products containing a drug (e.g., products
containing marijuana) is not a legitimate medical explanation for a
positive drug test result. See exceptions for positive codeine and
morphine results in item 3 below.
(iii) A physician's authorization or medical recommendation for a
Schedule 1 controlled substance is not a legitimate medical explanation
for a positive drug test result.
(3) If the donor is unable to provide a legitimate medical
explanation for the positive result, the MRO reports the positive
result to the agency, for all drugs except codeine and/or morphine as
follows:
(i) For codeine and/or morphine less than 150 ng/mL, the MRO must
report the result as negative to the agency, unless the donor admits
unauthorized use of the drug(s) that caused the positive result as
described in item (c)(1) above.
(ii) For codeine and/or morphine equal to or greater than 150 ng/mL
and no legitimate medical explanation, the MRO shall report a positive
result to the agency. Consumption of food products must not be
considered a legitimate medical explanation for the donor having
morphine or codeine at or above this concentration.
(d) When the HHS-certified laboratory reports an adulterated or
substituted result for the primary (A) oral fluid specimen, the MRO
contacts the donor to determine if the donor has a legitimate medical
explanation for the adulterated or substituted result.
(1) If the donor provides a legitimate medical explanation, the MRO
reports a negative result to the federal agency.
(2) If the donor is unable to provide a legitimate medical
explanation, the MRO reports a refusal to test to the federal agency
because the oral fluid specimen was adulterated or substituted.
(e) When the HHS-certified laboratory reports an invalid result for
the primary (A) oral fluid specimen, the MRO must contact the donor to
determine if there is a legitimate explanation for the invalid result.
(1) If the donor provides a legitimate explanation (e.g., a
prescription medication), the MRO reports a
[…truncated; see source link]Indexed from Federal Register on April 7, 2022.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.