Are You Smarter Than a 5th Grader? – DOT Urine Specimen
Some of the DOT drug and alcohol testing regulations are logical and intuitive, and you have a good chance at guessing the right answer to a question to which you might not know the answer. But not all DOT regulations are intuitive. For example, here are some questions about a dilute specimen that we received recently from a collection site.
The employee was not able to produce a sufficient specimen for a DOT drug test. The collector initiated the shy bladder procedure and offered fluids to the employee. The employee was then able to provide an adequate specimen within the three hour time period. The MRO returned a report of a negative dilute specimen.
Question #1: Could the dilute specimen be caused by drinking excessive fluids?
Answer: Most likely, yes, even though this does not seem to fit the shy bladder scenario described above. However, a very small number of people are able to legitimately produce specimens with unusually low creatinine that fall into the criteria of “dilute” (5 – 20 mg/dL).
Question #2: After receiving the report of a negative dilute specimen the employer sent the same employee to the collection site to be retested. Was the employer correct in retesting the employee?
Answer: Yes. The regulations give the employer the option, but do not require, retesting the employee after a report of a negative dilute specimen with creatinine in the range of 5 – 20 mg/dL. The employer must be consistent with their policy – i.e., if they choose to retest an employee after a negative dilute specimen, they must retest all employees who have negative dilute specimen.
Question #3: Furthermore, the employer instructed the collection site to perform the retest using direct observation. Was the employer correct to ask for direct observation on the retest?
Answer #3: Yes – if the MRO confirms a negative dilute specimen with creatinine between 2 and 5 mg/dL, the MRO instructs the employer to retest using direct observation. In this case of lower creatinine levels the retest is required, not optional. The reasoning is that there is a high probability that a negative dilute specimen with creatinine levels between 2 and 5 mg/dL is a substituted specimen; only rarely do these specimens have legitimate medical explanations. Therefore, DOT regulations give higher scrutiny to these specimens, and direct observation on a retest acts as a safeguard against tampering and/or substituting the specimen.
However, if the creatinine level in the negative dilute specimen is in the rage of 5 – 20 mg/dL the retest may not be performed under direct observation.
Note that a negative dilute specimen with creatinine between 2 and 5 mg/dL and a negative dilute specimen with creatinine between 5 and 20 mg/dL are both called “negative dilute specimens.” If a collection site questions the employer about whether a retest for a negative dilute specimen should be done using direct observation, they must ask if the MRO ordered the direct observation or for the creatinine level – it’s not enough just to know that the specimen was “negative dilute.”
Here’s a link to the CFR Part 40.197 regulation in AlcoPro’s Knowledge Base that addresses how employers are to handle dilute specimens. Also note that DOT revised this regulation in 2003 and 2008. If you refer to an out of date copy of the Part 40 regulations you will not get the correct guidance.