West Virginia University Hospitals East

A. A Negative Dilute result indicates that although no drugs were detected, the level of creatinine found in the urine was less than the normal levels of at least 20 mg/dl and the specific gravity was ≤1.0010 or ≥1.0200. Some individuals may have legitimate medical reasons for lower levels of creatinine. Other individuals may be trying to flush their system by drinking large amounts of water, using a cleansing agent, or may be substituting another substance for their urine specimen.

Creatinine levels between 5mg/dl and 20mg/dl are reported as Dilute. If the creatinine level is between 2 mg/dl and 5 mg/dl, it is reported as Super Dilute. We recommend that each company address the issue of dilute and super dilute specimens in your drug testing policy.

For Dilute specimens, we recommend an unannounced repeat of the urine drug test. Escort the employee directly to Business Health for a second urine drug screen. (This prevents the employee from obtaining a "clean" specimen on the way to our office.) Frequently these retests come back positive.

If the result is Super Dilute, we recommend an unannounced observed repeat of the urine drug test. As with a dilute result, escort the employee directly to Business Health for another drug screen. These usually come back positive.

A. According to DOT regulations:

• The drug test must be performed within 32 hours of the accident
• The breath alcohol test must be performed within 8 hours of the accident.

A. According to the guidelines, the following conditions may require medical clearance from the driver's personal physician, may result in less than two-year certification, or may cause disqualification:

• High blood pressure
• Diabetes currently requiring insulin for control
• Mobility or strength problems in arms, legs, or feet
• Recent heart attack or heart surgery or internal defibrillator
• Respiratory conditions such as emphysema, chronic asthma, chronic bronchitis, tuberculosis or sleep apnea
• Vision difficulty or loss of vision in one eye
• Color blindness
• Psychiatric problems
• Seizure disorder or epilepsy

A. A driver with a diagnosis of hypertension on treatment should have at least an annual certification. A CMV driver with a blood pressure (BP) 140/90 may be certified for two (2) years.
First time BP elevated:

• Stage 1 - BP 140-159/90-99 Certification Period 1 year
• Stage 2 - BP 160-179/100-109 Certification Period 3 months as one time certification. Within 3 months, if the blood pressures is below 140/90, the driver may receive 1 year certification
• Stage 3 - BP Reading >180/110 Disqualified. When the blood pressure is less than 140/90, the driver can be certified at 6-month intervals
  

A. A driver cannot take a controlled substance or prescription medication without a prescription from a licensed practitioner. If a driver uses a drug identified in 21 CFR 1308.11 (391.42(b)(12) or any other substance such as amphetamine, a narcotic, or any other habit forming drug, the driver is medically unqualified.

There is an exception: the prescribing doctor can write that the driver is safe to be a commercial vehicle driver while taking the medication. In this case, the Medical Examiner may, but does not have to certify the driver. Any anti-seizure medication used for the prevention of seizures is disqualifying. Methadone use is disqualifying. The Medical Examiner has two ways to determine if any medication a driver uses will adversely affect safe operation of a CMV:

1. Review each medication: prescription, non-prescription and supplement
2. Request a letter from the prescribing doctor
   

A. The following is a Statement from John H. Hill, the Administrator of the Federal Motor Carrier Safety Administration, dated May 23, 2008:

The Federal Motor Carrier Safety Administration's (FMSCA) regulations for the medical qualifications of interstate truck and bus drivers prohibit the use of prescribed substances or drugs that adversely affect the driver's ability to safely operate a commercial motor vehicle.

The U.S. Food and Drug Administration (FDA) approves medications for use, and has recently issued a public health advisory on Chantix (Varenicline). FMCSA's rules defer to the physicians and health care professionals to determine driver medical fitness for duty, which includes when a medication has actual and potential side effects that could impact safe driving.

While we do not name any medications, such as Chantix, in FMCSA regulations, it appears that medical examiners should not certify a driver taking Chantix because the medication may adversely affect the driver's ability to safely operate a commercial motor vehicle.

We are committed to ensuring safety on America's highways and we will continue our ongoing effort to review all FMCSA medical standards, including prescription drugs.