2025 Medical Review Officer Online Course with Live Discussion (Includes Digital Syllabus)-Tab 7

Video Transcription

Video Summary

The speaker outlines the comprehensive laboratory process for drug testing workplace specimens, emphasizing chain of custody, sample validity, testing methods, and quality controls. Specimens arrive with documentation, are checked for adequate volume and seal integrity, then initially screened using FDA-approved immunoassays that are high-throughput and cost-effective. Negative results are reported quickly while positives trigger confirmatory testing via more sensitive mass spectrometry techniques. Cutoffs for drug detection balance sensitivity and specificity, are regulated, and vary for different drugs; e.g., marijuana metabolite cutoffs have evolved over time for accuracy. Laboratories rigorously validate assays, conduct internal and external quality controls, and maintain extensive documentation for every specimen and aliquot. Specimen validity testing includes creatinine and specific gravity measurements to identify dilute, substituted, or adulterated samples, as well as pH and oxidant testing to detect interference or chemical tampering. Labs also analyze for unexpected substances and utilize strict criteria for reporting dilute or invalid samples. New regulations include changes like removing the requirement for amphetamine presence when reporting methamphetamine positives and adding fentanyl metabolites to drug panels. The speaker notes challenges from synthetic and designer drugs, and the evolving sophistication of adulterants and substitution attempts, emphasizing the complexity and rigor necessary to ensure accurate, reliable workplace drug testing.

Keywords

workplace drug testing

chain of custody

sample validity

immunoassay screening

mass spectrometry confirmation

drug detection cutoffs

quality control in laboratories

specimen adulteration detection

regulatory changes in drug testing